A Possible Alternative Exercise Test for Youths with Cystic Fibrosis: The Steep Ramp Test

Abstract

Purpose: The steep ramp test (SRT) can be used to provide an indication of exercise capacity when gas exchange measurements are not possible. This study evaluated the clinical usefulness of the SRT in adolescents with cystic fibrosis (CF) and compared the physiological responses of the SRT with the standard cardiopulmonary exercise test (CPET). Methods: Forty patients with CF (17 boys and 23 girls; mean +/- SD age, 14.7 +/- 1.7 years; forced expiratory volume in 1 s, 86% +/- 18% of predicted) performed an SRT and a CPET with respiratory gas analysis in a randomized balanced design. Peak work rate (WRpeak), HRpeak, peak minute ventilation ((v) over dot(Epeak)), and peak oxygen uptake ((v) over dotO(2peak)) were the main outcome measures. Results: Patients with CF attained values for absolute and relative WRpeak during the SRT of 82% T 14% and 92% +/- 14% of predicted. Nutritional status and degree of airway obstruction did not influence SRT performance. Significantly higher values were attained for WRpeak during the SRT compared with those during the CPET (252 +/- 60 vs 174 +/- 46 W; P <0.001), whereas significantly lower values were achieved for HRpeak (168 +/- 14 vs 182 +/- 12 bpm; P <0.001), (v) over dot(Epeak) (59.2 +/- 19.5 vs 72.0 +/- 20.2 LImin(-1); P = 0.006), and (v) over dotO(2peak) (36.9 +/- 7.5 vs 41.5 +/- 7.6 mLIkg(-1) Imin(-1); P = 0.008). A strong correlation between WRpeak attained at the SRT and the (v) over dotO(2peak) achieved during the CPET was found (r = 0.822, P <0.001). Conclusions: The SRT seems to be a quick, convenient, and low-cost exercise test that is well-tolerated in patients with CF with mild-to-moderate airway obstruction. It provides an indication of exercise capacity and can potentially be used when exercise testing using gas exchange measurements is not possible.