Borg CR-10 Scale Research Articles

Silent Hypoxia in COVID-19: A Case Series

Background: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global crisis challenging the worldwide healthcare systems. Many patients present with a mismatch of profound hypoxemia and few signs of respiratory distress (i.e., silent hypoxemia). This particular clinical presentation is often cited, but data are limited. Main Body: We describe dyspnea sensation as assessed by using the BORG scale in pulmonary patients admitted to the emergency room during a 4-week period and transferred to the respiratory department of Siloah Hospital, Hannover, Germany. From October 1 to November 1, 2020, 82 patients with hypoxemia defined as oxygen demand to achieve an oxygen saturation (SpO₂) ≥92% were included. In 45/82 (55%) patients, SARS-CoV-2 was detected by PCR on admission. Among non-COVID patients, exacerbation of COPD was the main diagnosis (15/37, 41%). All subjects rated their perceived dyspnea using the modified Borg CR10 scale. Patients in the non-COVID group suffered from more dyspnea on the modified Borg CR10 scale (median 1, IQR: 0–2 vs. median 5, IQR: 3–6, p < 0.001). In multivariate analysis, “silent hypoxemia” as defined by the dyspnea Borg CR10 scale ≥5 was independently associated with COVID-19 and presence of severe hypocapnia with an odds ratio of 0.221 (95% confidence interval 0.054, 0.907, p 0.036). Conclusion: Among pulmonary patients with acute hypoxemia defined as oxygen demand, patients suffering from COVID-19 experience less dyspnea compared to non-COVID patients. “Silent” hypoxemia was more common in COVID-19 patients.

Short-distance versus long-distance deep-seaport container truck drivers’ prevalence and perceived discomfort of musculoskeletal symptoms in the Thailand Eastern Economic Corridor

Objectives. This research aimed to study the prevalence and perceived discomfort of musculoskeletal (MSK) symptoms among short-distance and long-distance deep-seaport truck drivers. Methods. Cross-sectional analysis using a standardized modified version of the Nordic musculoskeletal questionnaire (NMQ) was carried out using direct interviews with 25 male participants: 15 short-distance and 10 long-distance truck drivers. Results. As much as 88% was reported for the existence of MSK symptoms in the past 12 months. Considering all truck groups, regardless of short or long distance, the lower back was found with the highest prevalence (72%) followed by the neck (32%). The χ2 test showed long-distance truck drivers had statistically significantly more prevalence in the neck (p = 0.028) than short-distance drivers. Perceived discomfort by the Borg CR10 scale confirmed the lower back had the highest score (2.4) followed by the neck (1.44). The Kruskal–Wallis test revealed that long-distance truck drivers had significantly higher scores on the lower back and neck (p = 0.039 and p = 0.009, respectively). Conclusion. Longer exposure to prolonged non-natural working postures, vibration, traffic conditions and working stress could be the judicial causes. To minimize this problem, integrated interventions need to be implemented with particular measures among short-distance and long-distance truck drivers.

Safety, Fear and Neuromuscular Responses after a Resisted Knee Extension Performed to Failure in Patients with Severe Haemophilia.

Background: low–moderate intensity strength training to failure increases strength and muscle hypertrophy in healthy people. However, no study assessed the safety and neuromuscular response of training to failure in people with severe haemophilia (PWH). The purpose of the study was to analyse neuromuscular responses, fear of movement, and possible adverse effects in PWH, after knee extensions to failure. Methods: twelve severe PWH in prophylactic treatment performed knee extensions until failure at an intensity of five on the Borg CR10 scale. Normalised values of amplitude (nRMS) and neuromuscular fatigue were determined using surface electromyography for the rectus femoris, vastus medialis, and vastus lateralis. After the exercise, participants were asked about their perceived change in fear of movement, and to report any possible adverse effects. Results: Patients reported no adverse effects or increased fear. The nRMS was maximal for all the muscles before failure, the median frequency decreased, and wavelet index increased during the repetitions. The vastus lateralis demonstrated a higher maximum nRMS threshold and earlier fatigue, albeit with a lower and more progressive overall fatigue. Conclusions: severe PWH with adequate prophylactic treatment can perform knee extensions to task failure using a moderate intensity, without increasing fear of movement, or adverse effects.

Relationship Between Tasked Vocal Effort Levels and Measures of Vocal Intensity.

Purpose Patients with voice problems commonly report increased vocal effort, regardless of the underlying pathophysiology. Previous studies investigating vocal effort and voice production have used a range of methods to quantify vocal effort. The goals of the current study were to use the Borg CR100 effort scale to (a) demonstrate the relation between vocal intensity or vocal level (dB) and tasked vocal effort goals and (b) investigate the repeated measure reliability of vocal level at tasked effort level goals. Method Three types of speech (automatic, read, and structured spontaneous) were elicited at four vocal effort level goals on the Borg CR100 scale (2, 13, 25, and 50) from 20 participants (10 females and 10 males). Results Participants' vocal level reliably changed approximately 5 dB between the elicited effort level goals; this difference was statistically significant and repeatable. Biological females produced a voice with consistently less intensity for a vocal effort level goal compared to biological males. Conclusions The results indicate the utility of the Borg CR100 in tracking effort in voice production that is repeatable with respect to vocal level (dB). Future research will investigate other metrics of voice production with the goal of understanding the mechanisms underlying vocal effort and the external environmental influences on the perception of vocal effort.

Changes in muscle activation, oxygenation, and morphology following a fatiguing repetitive forward reaching task in young adult males and females

We sought to evaluate sex-specific 1) muscle activation patterns, hemodynamics, and swelling responses to short-cycle repetitive fatigue; 2) relationships between muscular responses and perceived fatigability. Asymptomatic participants (N = 26, 13 females) completed a repetitive pointing task until 8/10 on the Borg CR10 scale. Upper trapezius (UT), supraspinatus (SUPRA), and biceps brachii (BIC) muscle activation, activation variability (CV), median power frequency (MdPF) and thickness, and UT oxygenation were recorded. Males had higher BIC CV, UT and SUPRA MdPF, and UT and BIC thickness. Longer time to fatigue-terminal was correlated to greater SUPRA activation increase (ρ = 0.624) and BIC MdPF decrease (ρ = -0.674) in males, while in females it was correlated to greater (ρ = -0.657) and lower (ρ = 0.683) decrease of SUPRA and BIC CV, respectively. Male’s greater increase in SUPRA thickness correlated to greater increase in UT thickness and tissue oxygenation index, and to lower increase of UT deoxyhemoglobin. Females’ greater decrease of SUPRA MdPF correlated to greater decrease of UT MdPF, while greater UT activation increase was related to lower UT thickness increase. Results suggest that despite comparable time to fatigue-terminal, males have greater force-generating capacity and neuromuscular reliance on recruitment and excitation rates, while females have greater reliance on activation variability. Further, there are relationships between hemodynamic and swelling patterns in males, while there are relationships between activation and swelling patterns in females. Although there were no differences in experimental task-induced changes, there are sex-specific relationships between muscular patterns and perceived fatigability, which may help explain sex-specific mechanisms of musculoskeletal disorders.

Exercise Duration Affects Session Ratings of Perceived Exertion as a Function of Exercise Intensity.

Session ratings of perceived exertion (sRPE) are considered a practical marker of whole session exercise intensity, but its relationship to exercise volume has remained unclear. We analyzed the effects of exercise duration at different intensities on overall and differentiated sRPE. Sixteen males (Mage = 22.6, SD = 2.2 years; Mheight = 176.4, SD = 5.8 cm; Mweight = 74.0, SD = 5.9 kg; and Mbody fat = 9.4, SD = 2.2%) performed 15 and 30 minute runs at speeds associated with RPE levels of two (weak), three (moderate) and five (strong) on Borg's CR-10 scale during a previous graded exercise test. We used Foster's scale to access sRPE 30 minutes after each trial. Significant increases in sRPE were found with increases in running speed (p < 0.01, ηG2 = 0.48) and duration (p < 0.01, ηG2 = 0.16), with a significant speed X duration interaction (p < 0.01, ηG2 = 0.10). In addition, there was a significant effect for sRPE type (p = 0.01, ηG2 = 0.05) in that overall sRPE was slightly lower than sRPE differentiated to legs and higher than sRPE differentiated to breathing through the trials. Changes in sRPE from 15 to 30-minute trials were minimal for the slow speed and weak sRPE (Cohen´s dz = 0.04 - 0.25) but got higher at the moderate (Cohen´s dz = 0.88 - 1.06) and strong (Cohen´s dz = 1.94 - 2.50) speeds and sRPEs. Thus, exercise duration affects sRPE in an intensity dependent manner. This finding has practical relevance for prescribing exercise, suggesting a need to target specific training loads or aims to optimize trainees' retrospective perceptions of the exercise experience.

Obesity impacts on task performance and perceived discomfort during seated foot target reaches

This study examined obesity impacts on task performance and perceived discomfort during seated foot target reaches. Three independent variables, participant group, movement distance, and, movement direction, were considered. The task performance measures employed were reaction time, movement time and task performance time. Perceived discomfort was measured using a modified Borg CR-10 scale. Statistical analyses revealed that: obesity was associated with increases in movement time, reaction time and performance time; movement distance significantly affected the three task performance measures and discomfort rating; and, movement direction significantly affected movement time, performance time and discomfort rating. The obesity impacts observed are thought to reflect the decelerating effects of the extra fat mass in the obese body during foot reaches and possibly obesity-related physiological and cognitive changes. Design improvements of foot-operated systems, such as reducing distances to targets, increasing target sizes and avoiding forward foot reaches, may help counteract the observed obesity impacts. Practitioner summary: This study empirically investigated the obesity impacts on task performance and perceived discomfort during seated foot target reaches. Obesity was found to be associated with increases in movement time, reaction time and performance time. The observed obesity impacts seem attributable to the anthropometric, motor and cognitive characteristics of the obese.

Variations of Training Workload in Micro- and Meso-Cycles Based on Position in Elite Young Soccer Players: A Competition Season Study.

The objectives of this study were to quantify the matches and training workload in micro-cycles of an elite young soccer team considering field position and to explain meso-cycles based on change of weekly acute (wAWL), chronic load (wCWL), acute-to-chronic workload ratio, training monotony (wTM), and training strain (wTS) between early-, mid-, and end-season periods considering playing position and whole team. Twenty-six under-16 elite young soccer players participated in this study, including six wide defenders and wide midfielders (WM), five central defenders (CD) and central midfielders, and four strikers (ST). Daily monitoring was performed by players for 20 weeks with the rating of perceived exertion using the Borg CR-10 scale. In comparison with early-season, results showed that there was a significant increase, in all playing positions, in wAWL and wCWL (except ST) and in wTM (except CD and ST) compared with end-season. On the other hand, there were significant reductions in wTS in CD, WM, and ST at the end-season. According to the results, coaches should consider the field position in different situations. Differences between training workload and matches can be a good guide for coaches, who have a special understanding of what causes the most load in training programs. Excessive training workload can potentially cause injury to adolescent athletes and controlling wTM can prevent this.

Relationship Between External Load and Self-Reported Wellness Measures Across a Men's Collegiate Soccer Preseason.

Fields, JB, Lameira, DM, Short, JL, Merrigan, JM, Gallo, S, White, JB, and Jones, MT. Relationship between external load and self-reported wellness measures across a collegiate men's soccer preseason. J Strength Cond Res 35(5): 1182-1186, 2021-Monitoring athlete training load is important to training programming and can help balance training and recovery periods. Furthermore, psychological factors can affect athlete's performance. Therefore, the purpose was to examine the relationship between external load and self-reported wellness measures during soccer preseason. Collegiate men soccer athletes (n = 20; mean ± SD age: 20.3 ± 0.9 years; body mass: 77.9 ± 6.8 kg; body height: 178.87 ± 7.18cm; body fat: 10.0 ± 5.0%; V̇o2max: 65.39 ± 7.61ml·kg-1·min-1) participated. Likert scale self-assessments of fatigue, soreness, sleep, stress, and energy were collected daily in conjunction with the Brief Assessment of Mood (vigor, depression, anger, fatigue, and confusion). Total distance (TD), player load (PL), high-speed distance (HSD, >13 mph [5.8 m·s-1]), high inertial movement analysis (IMA, >3.5 m·s-2), and repeated high-intensity efforts (RHIEs) were collected in each training session using positional monitoring (global positioning system/global navigation satellite system [GPS/GNSS]) technology. Session rate of perceived exertion (sRPE) was determined from athlete's post-training rating (Borg CR-10 Scale) and time of training session. Multilevel models revealed the bidirectional prediction of load markers on fatigue, soreness, sleep, energy, and sRPE (p < 0.05). Morning ratings of soreness and fatigue were predicted by previous afternoon's practice measures of TD, PL, HSD, IMA, RHIE, and sRPE. Morning soreness and fatigue negatively predicted that day's afternoon practice TD, PL, HSD, IMA, RHIE, and sRPE. Morning ratings of negative mood were positively predicted by previous day's afternoon practice HSD. In addition, negative morning mood states inversely predicted HSD (p = 0.011), TD (p = 0.002), and PL (p < 0.001) for that day's afternoon practice. Using self-reported wellness measures with GPS/GNSS technology may enhance the understanding of training responses and inform program development.

Recreational beach tennis reduces 24-h blood pressure in adults with hypertension: a randomized crossover trial

To evaluate the effect of a beach tennis session on 24-h ambulatory blood pressure in adults with hypertension. In this randomized crossover trial, 24 participants (12 men and 12 women) randomly performed two experimental sessions: a beach tennis session and a non-exercise control session. The beach tennis session started with a standardized 5-min warm-up consisting of basic techniques, followed by three 12-min beach tennis matches with 2-min intervals between them. Heart rate was continuously recorded and rating of perceived exertion was assessed in the middle and at the end of each set during the beach tennis session. Enjoyment was also assessed after the beach tennis session. The control session was performed in seated rest. Both experimental sessions lasted 45min. Ambulatory blood pressure was measured continuously for 24 h after sessions. Systolic blood pressure (24-h: 6mmHg, P = 0.008; daytime: 6mmHg, P = 0.031; nighttime: 6mmHg, P = 0.042) and diastolic blood pressure (24-h: 3mmHg, P = 0.021; daytime: 3mmHg, P = 0.036; nighttime: 4mmHg, P = 0.076) decreased after beach tennis when compared with control. The participants presented a reserve heart rate of 59-68%, and a rating of perceived exertion score of 3.4-4.7 using Borg's CR10 Scale. The enjoyment scores after beach tennis session were higher than 90%. A single session of recreational beach tennis reduces 24-h ambulatory blood pressure in adults with hypertension. Additionally, the participants can achieve a high physiological stress but perceive less effort during the practice. Date: April 10, 2019; identifier number NCT03909308 (Clinicaltrials.gov).

The Feasibility of High-Intensity Interval Training in Patients with Intensive Care Unit-Acquired Weakness Syndrome Following Long-Term Invasive Ventilation

BackgroundIntensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation. Despite recommendations of early patient mobilisation, little is known about the feasibility, safety and benefit of interval training in early rehabilitation facilities (ERF) after long-term invasive ventilation.Methods and ResultsWe retrospectively analysed two established training protocols of bicycle ergometry in ERF patients after long-term (> 7 days) invasive ventilation (n = 46). Patients conducted moderate continuous (MCT, n = 24, mean age 70.3 ± 10.1 years) or high-intensity interval training (HIIT, n = 22, mean age 63.6 ± 12.6 years). The intensity of training was monitored with the BORG CR10 scale (intense phases ≥ 7/10 and moderate phases ≤ 4/10 points). The primary outcome was improvement (∆-values) of six-minute-walk-test (6 MWT), while the secondary outcomes were improvement of vital capacity (VCmax), forced expiratory volume in 1 s (FEV1), maximal inspiratory pressure (PImax) and functional capabilities (functional independence assessment measure, FIM/FAM and Barthel scores) after 3 weeks of training. No adverse events were observed. There was a trend towards a greater improvement of 6 MWT in HIIT than MCT (159.5 ± 64.9 m vs. 120.4 ± 60.4 m; p = .057), despite more days of invasive ventilation (39.6 ± 16.8 days vs. 26.8 ± 16.2 days; p = .009). VCmax (∆0.5l ± 0.6 vs. ∆0.5l ± 0.3; p = .462), FEV1 (∆0.2l ± 0.3 vs. ∆0.3l ± 0.2; p = .218) PImax (∆0.8 ± 1.1 kPa vs. ∆0.7 ± 1.3pts; p = .918) and functional status (FIM/FAM: ∆29.0 ± 14.8pts vs. ∆30.9 ± 16.0pts; p = .707; Barthel: ∆28.9 ± 16.0 pts vs. ∆25.0 ± 10.5pts; p = .341) improved in HIIT and MCT.ConclusionsWe demonstrate the feasibility and safety of HIIT in the early rehabilitation of ICUAWS patients. Larger trials are necessary to find adequate dosage of HIIT in ICUAWS patients.

Variations of workload and well-being measures across a professional basketball season

Abstract The aims of this study were: (i) to describe weekly variations of acute load (AL), acute:chronic workload ratio, delayed onset muscle soreness (DOMS), and fatigue; (ii) to analyze variations of weekly workload and well-being in three periods of the season (P1, P2, and P3); and (iii) to analyze the relationships between workload and well-being measures. Fifteen professional basketball players from a first-league European club were monitored throughout the season using the CR-10 Borg scale and the Hooper questionnaire. Weekly AL and acute:chronic workload ratio (ACWR) were weekly calculated for monitoring of the internal load. In addition, DOMS and fatigue values were weekly calculated. Greater AL, DOMS, and fatigue values were found during the early season, and the highest ACWR value was found during the second period. Overall, AL presented large correlations with DOMS (r=0.60) and fatigue (r=0.62). The results of this study indicate that load is higher in the first period and then decreases throughout the season. The results also showed that AL is more closely related to well-being parameters than ACWR.

Implications of Walking Aid Selection for Nonweightbearing Ambulation on Stance Limb Plantar Force, Walking Speed, Perceived Exertion, and Device Preference in Healthy Adults 50 Years of Age and Older.

Background:Young adults often tolerate the increased energy expenditure, coordination, and stance limb discomfort associated with walking aids for nonweightbearing ambulation. Adults aged ≥50 years may not have the same tolerance. Therefore, the objective of this study was to determine how walking aid selection affects stance limb plantar force, walking speed, perceived exertion, and device preference in adults aged ≥50 years.Methods:A prospective randomized crossover study was performed using healthy adults, aged ≥50 years, with no use of walking aids within 5 years. Participants walked 200 m in 4 randomized conditions: single nonweightbearing ambulation using crutches, a walker, a wheeled knee walker, and unaided walking. An in-shoe sensor measured stance limb plantar force, a stopwatch timed each walk, perceived exertion was reported using the BORG CR-10 scale, and device preference was identified.Results:Twenty-one participants (7 male; age: 56 ± 5 years; BMI: 26.6 ±1.9) showed stance limb plantar force was lowest when using a wheeled knee walker (P < .001). Walking speed was similar in unaided and wheeled knee walker conditions (1.41 and 1.31 m/s), but slower with crutches or a walker (42%-68%, P < .001). Perceived exertion was similar in unaided and wheeled knee walker conditions (1.6 and 2.8), but higher with crutches or a walker (5.7 and 6.1, P < .001). Most (20/21) participants preferred the wheeled knee walker.Conclusions:Using a wheeled knee walker for nonweightbearing ambulation reduced stance limb plantar force, maintained unaided walking speed and perceived exertion, and was preferred to crutches or a walker.Level of Evidence:Level II, comparative study.

Variety of verbal and amplitude-frequency characteristics of wheezing in patients with bronchial asthma, depending on the severity of bronchial obstruction and shortness of breath

Objective. To study the “language” of whistling wheezing in patients with asthma, the relationship between verbal and amplitude-frequency characteristics (AFC) of wheezing and the severity of bronchial obstruction and dyspnea. Methods. 72 patients with partially controlled asthma were examined. The patients described whistling breathing by comparison and evaluated the degree of intensity of wheezing and dyspnea (Borg CR-10 scale). Spirometry was carried out with Vitalograph ALPHA spirometer (England) according to the rules of ATS/ERS with a bronchodilator test and simultaneous recording of pulmonary sounds with the Littmann 3,200 electronic stethoscope. Results. 2 groups of patients were formed based on verbal characteristics of the whistling wheezing. The 1 st group (38 patients) had wheezes of high-tone AFC (576 ± 33 Hz), 6.5 ± 0.7 points of wheezing intensity, and the degree of dyspnea intensity 4.8 ± 1.2 points on the Borg scale. The 2 nd group (34 patients) had wheezes of medium and low-tone AFC (368 ± 40.2 Hz), 3.8 ± 0.6 points of wheezing intensity, and degree of dyspnea intensity 3.7 ± 0.5 points according to Borg scale. Various “language” characteristics of whistling wheezing are obtained. The direct correlation between the degree of obstruction and subjective sensations of whistling breathing was found. The 1 st group had marked moderate and severe bronchial obstruction (FEV1 &lt; 50%). The 2 nd group had mild and medium degree bronchial obstruction (50 &gt; FEV1 &lt; 80%). A positive bronchodilatator test was recorded in 100% patients in the 1 st group and 37% patients in the 2nd group. Postbronchodilator AFC of the wheezes were comparable between the groups. The decrease in the intensity of wheezing led to a reduced severity of shortness of breath. Dyspnea did not affect the subjective intensity of wheezing. Conclusion . Verbal characteristics of whistling breathing in asthma patients are given. There was a direct strong correlation between the perception of wheezing with the severity of bronchial obstruction and a weak feedback between the intensity of perception of wheezing and shortness of breath before the use of bronchodilator. A direct moderate correlation was found after the bronchodilatator test. The severity of bronchial obstruction in patients with asthma plays a major role in the occurrence of wheezing high-tone AFC. A good response to beta2-agonist inhalation therapy should be expected in these patients.

PARALISIA BULBAR PROGRESSIVA (PBP): relato de caso

Motor neuron disease is a term used in several clinical syndromes, among them Progressive Bulbar Paralysis, a rare degenerative and progressive disease of rapid evolution and loss of early respiratory muscle strength. The characteristics are dysphonia, dysphagia, dysarthria, inability in bronchial hygiene, wheezing breaths and atrophy of the tongue musculature, affecting chewing, the grinding of food is increasingly difficult, affecting chewing, causing a potentially disabling and debilitating disease. This study aimed to describe a clinical case of an individual with a clinical diagnosis of Progressive Bulbar Paralysis in Propaedeutics at the Clinical School of the Faculty of the Alto Paranaíba-MG region. The object of study was a 57-year-old male, who underwent an initial physical therapy evaluation and was collected with maximum physiological pressure: maximum inspiratory pressure, maximum expiratory pressure, Borg CR-10 scale, heart rate (HR), respiratory pressure (RF), systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral oxygen saturation (SPO2). Then, follow a course of action in accordance with the provisions of the literature on the performance of the disease. The results found in this study are satisfactory, for all eight variables analyzed, with the possibility of highlighting the variable Borg CR-10 as the most satisfactory variable compared.

Wearability Testing of Ambulatory Vital Sign Monitoring Devices: Prospective Observational Cohort Study

BackgroundTimely recognition of patient deterioration remains challenging. Ambulatory monitoring systems (AMSs) may provide support to current monitoring practices; however, they need to be thoroughly tested before implementation in the clinical environment for early detection of deterioration.ObjectiveThe objective of this study was to assess the wearability of a selection of commercially available AMSs to inform a future prospective study of ambulatory vital sign monitors in an acute hospital ward.MethodsFive pulse oximeters (4 with finger probes and 1 wrist-worn only, collecting pulse rates and oxygen saturation) and 2 chest patches (collecting heart rates and respiratory rates) were selected to be part of this study: The 2 chest-worn patches were VitalPatch (VitalConnect) and Peerbridge Cor (Peerbridge); the 4 wrist-worn devices with finger probe were Nonin WristOx2 3150 (Nonin), Checkme O2+ (Viatom Technology), PC-68B, and AP-20 (both from Creative Medical); and the 1 solely wrist-worn device was Wavelet (Wavelet Health). Adult participants wore each device for up to 72 hours while performing usual “activities of daily living” and were asked to score the perceived exertion and perception of pain or discomfort by using the Borg CR-10 scale; thoughts and feelings caused by the AMS using the Comfort Rating Scale (CRS); and to provide general free text feedback. Median and IQRs were reported and nonparametric tests were used to assess differences between the devices’ CRS scores.ResultsQuantitative scores and feedback were collected in 70 completed questionnaires from 20 healthy volunteers, with each device tested approximately 10 times. The Wavelet seemed to be the most wearable device (P<.001) with an overall median (IQR) CRS score of 1.00 (0.88). There were no statistically significant differences in wearability between the chest patches in the CRS total score; however, the VitalPatch was superior in the Attachment section (P=.04) with a median (IQR) score of 3.00 (1.00). General pain and discomfort scores and total percentage of time worn are also reflective of this.ConclusionsOur results suggest that adult participants prefer to wear wrist-worn pulse oximeters without a probe compressing the fingertip and they prefer to wear a smaller chest patch. A compromise between wearability, reliability, and accuracy should be made for successful and practical integration of AMSs within the hospital environment.

Standardization of the 6-min walk test in clinical trials of idiopathic pulmonary fibrosis

The 6-min walk test (6MWT) is an important measure of functional capacity in idiopathic pulmonary fibrosis (IPF) and has been an endpoint of several IPF clinical trials. However, current guidance for the 6MWT offers insufficient advice on standardization, particularly oxygen supplementation, for clinical trials. Three physicians experienced with the 6MWT and IPF developed a standardized protocol for the 6MWT based on existing clinical guidelines and published literature. The protocol comprises guidance on test conditions, pre-defined parameters to measure at specified timepoints, and step-by-step instructions on conducting the test. The standardized test will be evaluated in the large-scale phase 3 ISABELA trials (NCT03711162; NCT03733444). The test is conducted indoors, using standardized equipment, along a flat, straight, 30-m unobstructed corridor; tests for each individual are performed by the same administrators at the same time of day; warm-up prior to testing is prohibited; supplemental oxygen tanks are permitted and moved by the patient in the same manner for each test; precise wording is used to instruct and encourage patients. Contraindications and stopping criteria are specified. Key assessments include: 6-min walk distance, distance walked at 1 and 3 min, the Borg CR10 scale, heart rate, blood pressure, and oxygen desaturation levels. A standardized 6MWT for IPF will enable more reliable comparisons between clinical trials and limit variability, optimizing use as an endpoint. Application of the standardized 6MWT in the ISABELA program will allow its correlation with other clinically important endpoints and may lead to novel composite endpoints for use in future trials.Submission category: Study Design, Statistical Design, Study Protocols.Submission classifications: Clinical study methodology; Clinical trial design; Clinical trials; Pulmonary disease; Pulmonary disease clinical trial; Respiratory medicine.

Is sex a proxy for mechanical variables during an upper limb repetitive movement task? An investigation of the effects of sex and of anthropometric load on muscle fatigue

BackgroundWomen report more work-related pain and neck/shoulder musculoskeletal disorders than men. For the same absolute workload, due to lower strength, females generally work at a higher relative intensity, which could induce more fatigue. However, the arm’s anthropometric load (AL) of men is higher. Therefore, simply lifting their arm could be more fatiguing. Sex as a variable is formed of many constructs, and analyses can become muddied by their differing responses to fatigue. No studies have considered AL, when comparing how fatigue affects men and women. The purpose was to determine if including the arm’s AL in the statistical analysis would impact findings of sex-specific effects of shoulder fatigue on muscle EMG.MethodsFifty-five (29m/26f) participants completed a repetitive pointing task (RPT) at shoulder height until they reported fatigue of 8+ on the BORG CR-10 scale. Muscle activities were measured using surface electrodes placed over the anterior deltoid (AD) and upper trapezius (UT) muscles. Muscle activity amplitude was quantified using root mean square (RMS). First- and last-minute data were used to assess change from no-fatigue (NF) to fatigue-terminal (FT) conditions. AL was calculated using sex-specific body parameter equations. General estimating equations (GEE) were used to determine the effects of sex and fatigue on RMS values, while including AL in the GEE.ResultsThere was no sex difference in time to reach fatigue. A significant main effect of sex on RMS was observed (χ2(1) = 4.17, p = 0.04) when including AL as a covariate. Females displayed a significantly higher percentage change in AD RMS from NF to FT, compared to males (p = 0.03), when AL was included in the GEE. No sex differences in UT were observed.ConclusionsThis sex difference emerged when AL was included as a covariate, suggesting that sex-associated anthropometric differences may contribute to sex differences in the fatigue response. Differences in the impact of AL on AD compared to UT could be explained by differences in their respective mechanical roles or muscle fiber content. Anthropometrics may be useful to include as covariates in future research to separate individual anthropometric differences from sex differences.

A Wearable Sensor System for Physical Ergonomics Interventions Using Haptic Feedback.

Work-related musculoskeletal disorders are a major concern globally affecting societies, companies, and individuals. To address this, a new sensor-based system is presented: the Smart Workwear System, aimed at facilitating preventive measures by supporting risk assessments, work design, and work technique training. The system has a module-based platform that enables flexibility of sensor-type utilization, depending on the specific application. A module of the Smart Workwear System that utilizes haptic feedback for work technique training is further presented and evaluated in simulated mail sorting on sixteen novice participants for its potential to reduce adverse arm movements and postures in repetitive manual handling. Upper-arm postures were recorded, using an inertial measurement unit (IMU), perceived pain/discomfort with the Borg CR10-scale, and user experience with a semi-structured interview. This study shows that the use of haptic feedback for work technique training has the potential to significantly reduce the time in adverse upper-arm postures after short periods of training. The haptic feedback was experienced positive and usable by the participants and was effective in supporting learning of how to improve postures and movements. It is concluded that this type of sensorized system, using haptic feedback training, is promising for the future, especially when organizations are introducing newly employed staff, when teaching ergonomics to employees in physically demanding jobs, and when performing ergonomics interventions.

Feasibility, safety and muscle activity during flywheel vs traditional strength training in adult patients with severe haemophilia.

Eccentric training has been associated with several specific physiological adaptations. The flywheel machine is one of the easiest ways of performing eccentric overload training. However, no studies evaluated its feasibility, safety and muscle activity in patients with haemophilia (PWH). To evaluate feasibility and safety and compare muscle activity during flywheel vs weight machine knee extension exercise in severe PWH. Eleven severe PWH [mean age of 33.5 (8.1) years] participated in this cross-sectional study after receiving prophylactic treatment. Surface electromyography (EMG) signals were recorded for the rectus femoris during the knee extension exercise performed with 2 different conditions (flywheel and weight machine) with matched intensity (6 on the Borg CR10 scale). Kinesiophobia was assessed before and after the experimental session. Participants were asked to rate tolerability of each condition. Adverse effects were evaluated 24 and 48hours after the session. Kinesophobia did not increase after the experimental session, and no adverse effects were reported. At 60%-70% of the contraction cycle, the flywheel exercise showed higher (P=.024) eccentric rectus femoris muscle activity than the weight machine. In contrast, during the last 90%-100% of the contraction cycle, the traditional weight machine showed higher (P=.004) rectus femoris activity than the flywheel. The knee extension exercise performed with the flywheel at moderate intensity is safe and well tolerated among severe PWH under adequate factor coverage. Importantly, the flywheel variation provides higher eccentric rectus femoris activity at the breaking force moment, while it provides lower eccentric muscle activity at the end of the cycle.