The Exercise Vital Sign as a Potential Alternative to Determining Cardiorespiratory Fitness

Abstract

Ross1Ross R. Knowing that cardiorespiratory fitness should be a vital sign is not enough.Mayo Clin Proc. 2019; 94: 1395-1397Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar makes a powerful argument for the measurement of cardiorespiratory fitness (CRF) in clinical care and challenges us to take action. Cardiorespiratory fitness is potentially a stronger predictor of mortality than are established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, and its routine measurement would certainly improve patient care.2Ross R. Blair S.N. Arena R. et al.American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic HealthCouncil on Clinical CardiologyCouncil on Epidemiology and PreventionCouncil on Cardiovascular and Stroke NursingCouncil on Functional Genomics and Translational BiologyStroke CouncilImportance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association.Circulation. 2016; 134: e653-e699Crossref PubMed Scopus (804) Google Scholar The routine measurement of CRF, however, is not feasible in most clinical settings because of logistics, cost, and time. The use of nonexercise estimates of CRF has been advocated as an alternative to CRF measurement. These CRF estimates are based on complex sex-specific formulas that are negatively affected by age, body mass index, and resting heart rate and positively affected by a physical activity score/index obtained from self-reported exercise intensity, duration, and frequency.3Nes B.M. Vatten L.J. Nauman J. Janszky I. Wisloff U. A simple nonexercise model of cardiorespiratory fitness predicts long-term mortality.Med Sci Sports Exerc. 2014; 46: 1159-1165Crossref PubMed Scopus (85) Google Scholar,4Wang Y. Chen S. Zhang J. et al.Nonexercise estimated cardiorespiratory fitness and all-cancer mortality: the NHANES III study.Mayo Clin Proc. 2018; 93: 848-856Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The exercise vital sign (EVS) has been proposed to help health care systems and providers prioritize physical activity assessment, advice, and promotion during clinical encounters. The EVS is the product of the answer to 2 questions: “On average, how many days per week do you engage in moderate to strenuous exercise like a brisk walk?” and “On average how many minutes do you engage in exercise at this level?”5Coleman K.J. Ngor E. Reynolds K. et al.Initial validation of an exercise “vital sign” in electronic medical records.Med Sci Sports Exerc. 2012; 44: 2071-2076Crossref PubMed Scopus (179) Google Scholar The result can determine whether an individual is meeting current physical activity guidelines.6Piercy K.L. Troiano R.P. Ballard R.M. et al.The physical activity guidelines for Americans.JAMA. 2018; 320: 2020-2028Crossref PubMed Scopus (1455) Google Scholar The EVS includes 2 of the self-reported physical activity components (frequency and duration) that formulas use to estimate CRF. The EVS is easily obtained and calculated and is already included in many electronic medical records. Until CRF can be more easily measured or estimated in clinical practice, health care providers should focus on promoting physical activity and CRF by routinely obtaining the EVS. Knowing That Cardiorespiratory Fitness Should Be a Vital Sign Is Not EnoughMayo Clinic ProceedingsVol. 94Issue 8Preview“Knowing is not enough; we must apply. Willing is not enough; we must do.”1 Full-Text PDF In reply—The Exercise Vital Sign as a Potential Alternative to Determining Cardiorespiratory FitnessMayo Clinic ProceedingsVol. 95Issue 3PreviewIn his letter, Langland1 acknowledges the importance of including cardiorespiratory fitness (CRF) as a routine measure in clinical practice, as CRF is a stronger predictor of mortality than are established risk factors, and consequently its routine measure would improve patient care.2,3 Langland agrees that direct measures of CRF in most clinical settings is not feasible because of logistics and cost. However, he posits that the alternative recommendation—to use nonexercise estimates of CRF—presents a challenge, as they are based on complex sex-specific formulas that incorporate age, body mass index, resting heart rate, and self-reported measures of physical activity to derive the CRF estimate. Full-Text PDF