Can Bi-levels Stairs and Two-Step Stool Climbing be Efficient Tools of Breathing Retraining in Overweight Dyspneic patients? (Effects on Hypertension, Dyspnea, breathing pattern, exercises and weight loss)

Background: Improvements in exercise tolerance diminish with time upon cessation of the exercise program. Incremental Bi-levels “Two-stepstool test” (TSST) and Bi-level Stairs Climbing (BiSC) 30-45 minute session have routinely been used in pulmonary rehabilitation since 1968. Introduction: Structured exercise rehabilitation programs of six to eight weeks duration have been reported to improve quality of life, increase exercise tolerance, and boost maximal oxygen consumption (VO2 max) and endurance by 20 to 40%. Objective: The purpose of this study was: (1) to analyze and assess subjective, physical, and some physiological responses to TSST; (2) to join the TSST (speed x20 times) with BiSC of 30 min, designed for endurance training at home; (3) to compare both tests at the maximal responses with those of incremental cycle-ergometry (30 W/3 min); (4) to analyze subjective, psychological and functional parameters of Dyspnea. Design: This is a longitudinal study on 15 consecutive subjects with Dyspnea and overweight (39-66 yrs, BMI = 32.46 ± 6.77 kg/m2). Each subject performed the TSST at increasing speeds (10, 20, 30, times/min), on two 15 cm steps and, and 3 times the BiSC in 1 floor, up and down (20 steps 15 cm high each) under breathing education: Exertional dyspnea (ED), leg pain (LP), oxygen uptake (VO2), Ventilation (VE), respiratory rate (RR), tidal volume (VT), heart rate (HR), and peripheral oxyhemoglobin saturation (SpO2), were measured during TSST. Multivariate analysis for each parameter was analyzed according to a mixed model. Results: All subjects increased significantly (p ≤ 0.01) the speed in the TSST (x60 times), and the BiSC (from 3 floors to 8 floors) and could maintain the speed (20/min) on the TSST and more than 15 min on the BiSC. After training, HR reached 80 to 96% of values at VO2 max, thus high intensity. All parameters ED, LP, VE, RR, VO2 (p ≤ 0.01) and the weight (-16%). decreased to the same level of exercises, while VT and diaphragmatic mobility increased (p ≤ 0.01); Subjects found it simple, practical, and easy to perform the TSST and BiSC at home. There were no complications. Conclusions: 1) The incremental TSST and BiSC are cost-effective exercise to assess subjective, physical, and physiological responses if used separately; 2) When combined (TSST with BiSC endurance of 30-40 minute session), they provide an efficient tool for endurance training at home (with HR and SpO2 controls).