This consists of a short, selfadministered progressive series of questions pertaining to activities of daily living. Some example questions are presented in Table 5. Figure 4 illustrates the relationship between MET values achieved on the treadmill and those estimated from the questionnaire. Although the mean MET values did not differ between those achieved on the treadmill and those estimated by the questionnaire (8.4 ±3.5 vs 8.8 ±2.6, respectively), a significant degree of variation was present. Moreover, while patients with low MET levels tended to overestimate their exercise capacity, patients who achieved high MET levels tended to underestimate their exercise capacity. Nevertheless, the significant correlation (r=0.69, p<0.001) and 95% confidence limits suggest that a reasonable estimate of a patient s exercise capacity can be obtained quickly for the purposes of individualizing the ramp rate.
In recent years, a call for “optimizing” exercise testing, including customizing the test given the specific conditions, patient, or test purpose has been made. The ramp test has several features that allow it to meet these recommendations. Herein we have described a method of performing the test. Naturally, the approach was empirical and relied greatly on intuition. The protocol must be validated in different patient populations. Moreover, to our knowledge, this test has never been used to evaluate a clinical intervention. More data are necessary to confirm its usefulness in clinical trials.
Table 5—Sample Questions from Specific Activity Questionnaire
|Draw one line below the activities you are able to do routinely with minimal or no symptoms, such as shortness of breath, chest discomfort, fatigue:|
|2 METs: Taking a shower|
|Walking down 8 steps|
|4 METs: Light yard work, ie, raking leaves, weeding, or pushing a power mower|
|7 METs: Perform heavy outdoor work, ie, digging, spading soil, etc.|
|Play tennis (singles)|
|Carry 60 lb (27 kg)|