Comparison of Different Exercise Training on Exercise Capacity and Fatigue in Patients With Sarcoidosis

The distance covered in meters in a straight corridor of 30 meters will be recorded as fast as possible but without running for 6 minutes. The distance that normal individuals should take in this period is 400-700 meters. In addition, oxygen saturation and heart rate, resting fatigue and dyspnea levels will be evaluated with pulse oximetry before and after testing. Modified Borg Dyspnea and Fatigue Scales will be used to determine resting dyspnea and fatigue levels.

Endurance Shuttle Walk test: This is a standardized field test for the assessment of endurance capacity. In the Endurance Shuttle Walk Test, the participant walks at a constant speed between cones spaced 10 m apart. The selected speed is 85% of the participant's maximum capacity measured in the shuttle walk test at increasing speed. Therefore, before this test, the patient should be given an increasing speed ıncremental shuttle walk test.

The incremental shuttle walk test (ISWT) is a field-based assessment of cardiorespiratory fitness and physical function. The ISWT is a performance-based assessment of exercise and functional capacity that measures walking distance in meters. It is a relatively brief and easy test to perform. The ISWT simulates a maximal cardiopulmonary test in a field setting and requires minimal equipment. Longer walking distances signify better performance.

Fatigue Assessment Scale: It includes five-point Likert type options (1=Always-5=Never). Higher scores indicate greater levels of fatigue.

The assessment includes 20 questions that encompass different dimensions of fatigue. These questions are divided into five subscales: general fatigue, physical fatigue, mental fatigue, reduced motivation, and reduced activity. Each subscale consists of 4 questions/statements and employs a 5-point Likert scale. Scores of 53 and above on the questionnaire indicate the presence of fatigue symptoms.

To assess fatigue, blood lactate levels, which serve as an objective outcome measure, were taken before exercise, immediately after exercise, at the 5th minute post-exercise, and at the 20th minute post-exercise. A lactate measurement device was used for the blood lactate level measurements. For lactate analysis, a 0.2 μl capillary blood sample was required. Blood samples were taken from the patients' fingertips, placed on the device's strips, and inserted into the designated area of the device. The result was displayed on the device screen in mmol/L within 10 seconds, and the recorded value was noted.

The Medical Research Council Scale (MRC) was used to assess dyspnea. The MRC is a five-item scale based on different physical activities that can cause dyspnea. Patients are asked to indicate the level of activity that leads to their dyspnea. The scale rates breathlessness starting from "1," where "1" indicates no dyspnea.

A hand-held dynamometer was used to assess the strength of the quadriceps femoris, tibialis anterior, and gastrosoleus muscles. It has been reported that the hand-held dynamometer is a reliable method for measuring muscle strength.

Health-related quality of life was assessed using the St. George's Respiratory Questionnaire (SGRQ). The scale has three subdomains: Symptoms (8 items), Activities (16 items), and Impacts of the disease (26 items). The scale score ranges from 0 to 100, with higher scores indicating lower quality of life.

The Leicester Cough Questionnaire (LCQ) is an assessment tool used to measure the impact of cough on quality of life and consists of 19 questions. It includes psychological, social, and physical subdomains. Lower scores indicate individuals who are more affected by cough, reflecting a lower quality of life.

In the current study, the respiratory function test results of patients with sarcoidosis from the past 6 months were recorded. Respiratory function tests (RFT) or pulmonary function tests reflect the physiological characteristics of the lungs (e.g., airflow mechanics, volumes, and gas transfer). RFT measurements are primarily conducted using spirometry. In this study, the participants' RFT measurements were performed using spirometry. Additionally, a diffusion test was conducted for DLCO measurement, an important parameter in interstitial lung diseases. The FEV1, FVC, FEV1/FVC, and DLCO values of the patients were recorded as a result of both measurements. The respiratory function test was conducted in accordance with the ATS/ERS spirometry guidelines.