Exercise Vital Sign Research Articles

Chronotropic Incompetence During Exercise Testing as a Marker of Autonomic Dysfunction in Individuals with Early Parkinson's Disease.

An attenuated heart rate response to exercise, termed chronotropic incompetence, has been reported in Parkinson's disease (PD). Chronotropic incompetence may be a marker of autonomic dysfunction and a cause of exercise intolerance in early stages of PD. To investigate the relationship between chronotropic incompetence, orthostatic blood pressure change (supine - standing), and exercise performance (maximal oxygen consumption, VO2peak) in individuals with early PD within 5 years of diagnosis not on dopaminergic medications. We performed secondary analyses of heart rate and blood pressure data from the Study in Parkinson's Disease of Exercise (SPARX). 128 individuals were enrolled into SPARX (63.7±9.3 years; 57.0% male, 0.4 years since diagnosis [median]). 103 individuals were not taking chronotropic medications, of which 90 had a normal maximal heart rate response to exercise testing (155.3±14.0 bpm; PDnon-chrono) and 13 showed evidence of chronotropic incompetence (121.3±11.3 bpm; PDchrono, p < 0.05). PDchrono had decreased VO2peak compared to PDnon-chrono (19.7±4.5 mL/kg/min and 24.3±5.8 mL/kg/min, respectively, p = 0.027). There was a positive correlation between peak heart rate during exercise and the change in systolic blood pressure from supine to standing (r = 0.365, p < 0.001). A subgroup of individuals with early PD not on dopaminergic medication had chronotropic incompetence and decreased VO2peak, which may be related to autonomic dysfunction. Evaluation of both heart rate responses to incremental exercise and orthostatic vital signs may serve as biomarkers of early autonomic impairment and guide treatment. Further studies should investigate whether cardiovascular autonomic dysfunction affects the ability to exercise and whether exercise training improves autonomic dysfunction.

Criterion Validity and Reliability of 2 Brief Physical Activity Questionnaires in Ethnically Diverse Adults.

The study compares moderate- to vigorous-intensity physical activity (MVPA) as evaluated by the Exercise Vital Signs (EVS) and Physical Activity Vital Signs (PAVS) questionnaires to accelerometry, and evaluates the reliability of the questionnaires in ethnically diverse adults. Ninety-nine participants (mean age 38.1y; 49.5% women; Hispanics 43.8%; European American 18.8%; African American 14.6%) were included in the analyses. Participants wore an accelerometer at the hip for at least 7days and completed the EVS and PAVS questionnaires at the beginning (T1) and at the end (T2) of the 7days. Associations between the questionnaires and accelerometry were examined using Spearman rho. The reliability of the questionnaires was evaluated using intraclass correlation coefficient. Sensitivity and specificity were also calculated. Weak positive correlations were observed between the accelerometer MVPA and the EVS MVPA at T2 (ρ = .263, P = .013), and the PAVS MVPA at T2 (ρ = .327, P = .003). The sensitivity of the EVS and PAVS was 73.2% and 82.6%, respectively. The specificity for each questionnaire was 35.3%. The reliability for the EVS questionnaire (intraclass correlation coefficient = .855; 95% CI, .791-.901; P < .001) was good, while the reliability of the PAVS questionnaire (intraclass correlation coefficient = .652; 95% CI, .511-.758; P < .001) was moderate. Caution should be used when utilizing the EVS and PAVS questionnaires in ethnically diverse adults.

A Christmas themed physical activity intervention to increase participation in physical activity during Advent: pilot randomised controlled trial

ObjectivesTo examine the recruitment, retention, and preliminary effects of a Christmas themed physical activity intervention designed to increase participation in physical activity and decrease sedentary behaviour in inactive adults.DesignPilot randomised...

Half Of Adolescents Never Met Physical Activity Guidelines Over A Nine Week Period

PURPOSE: Consistency in physical activity is crucial to acquire maximum health benefits. The current physical activity (PA) recommendation for adolescents is to accrue 420 minutes of PA a week. The purpose of this study was to examine proximal changes in adolescent physical activity. METHODS: Adolescents in a freshman high school health class answered Exercise Vital Sign (EVS) questions over the course of nine weeks. Minutes of PA per week was calculated by multiplying days of PA by minutes of PA. Participants were then categorized as meeting (≥420 minutes/week) or not meeting (<420 minutes per week) current PA guidelines. An alluvial diagram was created to perform exploratory visual analysis of the magnitude and variability in meeting and not meeting PA trajectories across the four time points. RESULTS: Of the twenty-five who participated, 21 had EVS data at four points in time. The average PA across all time points was 312 ± 272 minutes per week. PA between the time points ranged from 245-355 minutes per week. 14% of adolescents always met PA recommendations and 48% never met PA recommendations. 10% of adolescents missed the recommended PA only once, 24% missed twice, and 5% missed PA recommendations three times. From Time Point 1 to Time Point 4 the percentage of adolescents who did not meet PA recommendations were 57%, 71%, 71%, and 62%, respectfully. DISCUSSION: The benefits of regular, consistent exercise include improved mood, physical fitness and sleep quality as well as a decreased risk of chronic diseases. Adolescence is a key developmental stage because developed health behaviors often translate into adulthood. A large majority (86%) did not meet PA guidelines at least once during the study. There may be differences between those who never meet and those who sometimes meet the recommended PA levels. Individual Trajectories of Meeting and Not Meeting PA Guidelines over Four points in Time

Clinical Utility and Validity of Exercise Vital Sign in Children.

We reviewed charts of 14,446 sports medicine patients, children aged 5 to 18 years, over a 3-year period to determine the discriminant validity of Exercise Vital Sign (EVS) questions. A logistic regression analyzed factors related to any moderate to vigorous physical activity (MVPA). A linear regression analyzed factors related to amount of MVPA for those who participated in any weekly MVPA. Overall, 48% of children reported meeting physical activity guidelines for 420 min·wk-1. Overall, children reported 400.36 ± 280.04 min·wk-1 of MVPA. Those with depression had significantly less MVPA than those without (95% confidence interval [CI], -96.65 to -26.31). Girls had significantly less MVPA than boys (95% CI, -59.15 to -40.31). Overweight and obese children reported less MVPA compared with normal weight children (95% CIs, -42.65 to -17.29 and -91.61 to -65.50, respectively). EVS demonstrates strong discriminant validity to detect differences between groups as a function of sex, body mass index, and depression.

Self-Reported Physical Activity and Asthma Risk in Children

Increased physical activity (PA) may protect against asthma but PA can trigger asthma symptoms. To investigate relationships between moderate-to-vigorous PA (MVPA) assessed during routine care visits and incident asthma. For this retrospective cohort, 542,486 children between 2 and 17 years from 2010 to 2017 were included who had an MVPA assessment (exercise vital sign) during routine care visits. The association of MVPA and asthma was analyzed using Cox proportional hazards regression models as a function of age, with MVPA and body mass index (BMI) being time-varying factors, adjusted for race and ethnicity, socioeconomic status, and air pollution. The mean MVPA was 5.4 (standard deviation: 4.4) hours/week. Crude asthma incidence density rate (IDR) was highest in children with <1 hour/week of MVPA (IDR: 9.07, 95% confidence interval [CI]: 8.79, 9.36) and lowest in children engaging in 4 to 7 hours/week of MVPA (IDR: 6.55, 95% CI: 6.33, 6.77). In adjusted models, an increase in MVPA wasassociated with lower asthma risk in children reporting 0 hour/week of MVPA (hazard ratio: 0.981, 95% CI: 0.973, 0.990). In children with ≥8 hours/week of MVPA, an increase in MVPA was associated with higher asthma risk (1.005, 95% CI: 1.002, 1.009). There was no significant BMI by MVPA interaction. Increasing MVPA in children with low activity levels is associated with lower asthma risk; children reporting high levels of activity may experience greater asthma risk as their activity levels increase further. Understanding the role of PA in the development of asthma and assessing MVPA during routine care visits in children may help to develop targeted interventions and guide asthma management.

Physical activity, post-traumatic stress disorder, and exposure to torture among asylum seekers in Sweden: a cross-sectional study

BackgroundForced migrant populations have high rates of trauma-related ill health, including post-traumatic stress disorder (PTSD). Physical activity (PA) is well-established as an effective stress reliever, while insufficient PA is associated with adverse effects on both mental and physical health. The aim of this study was to examine the prevalence of different levels of PA and its association with PTSD symptom severity, controlled for exposure to torture, among asylum seekers in Sweden.MethodsA cross-sectional survey study, with data from 455 asylum seekers, originating from Afghanistan, Eritrea, Iraq, Somalia, and Syria, residing at large housing facilities across Sweden. Level of PA was assessed by the Exercise Vital Sign and categorized as; Inactive, Insufficient PA, and Sufficient PA. Prevalence estimates for proportions of different levels of PA were calculated. Analysis of variance were conducted to determine the association between levels of PA and PTSD symptom severity, measured by the Harvard Trauma Questionnaire. Multivariable logistic regression analysis was performed to determine the contribution of PA on PTSD beyond sex, age, and exposure to torture.ResultsAbout half of the participants (53.3, 95% CI: 48.6–58.1) met the recommendations for Sufficient PA. One third of the participants (33.3, 95% CI: 28.7–37.8) were insufficiently engaged in PA, and 13.4% (95% CI: 10.1–16.7) were inactive. There was a significant difference in PTSD symptom severity between groups of asylum seekers with different levels of PA (F(2, 316) = 23.15, p < .001). When controlling for sex, age, and exposure to torture, Sufficient PA was found to be associated with less PTSD symptom severity compared to both Insufficient PA (B = 0.297, SE = 0.086, p < .001) and Inactive (B = 0.789, SE = 0.104, p < .001).ConclusionsInsufficient PA was common among the asylum seekers and our findings suggest that more PA is highly associated with lower PTSD symptom severity. An increased focus on assessment and promotion of PA is justified and discussed as particularly pertinent considering the much extended time of asylum-seeking processes. The results support previous evidence of PA as a potentially important factor in the context of PTSD and forced migrants’ health.

Physical Activity And Mental Health In Injured Adolescents

PURPOSE: Approximately 20% of adolescents meet the minimal standards of moderate to vigorous physical activity (PA) national guidelines. Adolescents that accrue lower PA have greater depression and anxiety symptoms when compared to adolescents that engage in higher amounts of PA. Musculoskeletal injuries are common in adolescents and may exacerbate depression or anxiety symptoms that were decreased due to the ability to partake in PA. In addition, injuries may cause new anxiety and depression symptoms. While PA has generally been shown to help decrease and protect against both depression and anxiety symptoms in adolescents, some recent work has questioned the impact of PA on adolescent mental health. The purpose of this study was to determine if adequate levels of PA in adolescents that have experienced an injury had less anxiety and depression symptoms. METHODS: A total of 63 adolescents (59% female; mean age = 14.57 ± 1.52 years) between the ages of 12-18 that were being treated by a tertiary sports medicine clinic were enrolled. Participants filled out the Patient Health Questionairre-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) to measure depression and anxiety symptoms, respectively. Scores greater than 5 were considered elevated for each scale and prompted further evaluation by the attending physician. PA was self-reported by asking exercise vital sign questions to obtain days per week and minutes per day of moderate to vigorous physical activity from the past week. RESULTS: Average PHQ-9 score was 3.63 ± 4.11, average GAD-7 score was 3.33 ± 3.60 and average weekly PA was 319.37 ± 261.12 minutes. There were 22% with elevated PHQ-9 scores, nearly 24% with elevated GAD-7 scores and 35% reported meeting the PA guidelines in the last week. There were no differences between those who met or did not meet PA guidelines on the proportion of those with elevated depression or anxiety scores (p = .47, p = .93, respectively). CONCLUSIONS: While there were no differences between the prevalence of elevated depression or anxiety scores between those who met or did not meet PA guidelines, injured adolescents had high rates of elevated scores for anxiety and depression. Clinicians should consider screening injured adolescents for anxiety and depression to aid in early intervention.

Do assessments of cardiorespiratory and muscular fitness influence subsequent reported physical activity? A randomized controlled trial

BackgroundRegular physical activity and exercise provide many health benefits. These health benefits are mediated in large part through cardiorespiratory fitness and muscular strength. As most individuals have not had an assessment of their personal cardiorespiratory fitness or muscular strength we investigated if measurements of cardiorespiratory fitness and muscular strength would influence an individual’s subsequent self-reported exercise and physical activity.MethodsVolunteer subjects at a State Fair were randomized in 1:1 parallel fashion to control and intervention groups. The baseline Exercise Vital Sign (EVS) and type of physical activity were obtained from all subjects. The intervention group received estimated maximum oxygen uptake (VO2max) using a step test and muscular strength using a hand grip dynamometer along with age-specific norms for both measurements. All subjects were provided exercise recommendations. Follow up surveys were conducted at 3, 6 and 12 months regarding their EVS and physical activity.ResultsOne thousand three hundred fifteen individuals (656 intervention, 659 control) were randomized with 1 year follow up data obtained from 823 subjects (62.5%). Baseline mean EVS was 213 min/week. No change in EVS was found in either group at follow-up (p = 0.99). Subjects who were less active at baseline (EVS < 150) did show an increase in EVS (86 to 146) at 6 months (p < 0.05). At 3 months the intervention group increased resistance training (29.1 to 42.8%) compared to controls (26.3 to 31.4%) (p < 0.05). Lifestyle physical activity increased in the intervention group at 3 months (27.7 to 29.1%) and 6 months (25%) whereas it declined in the control group at 3 months (24.4 to 20.1%) and 6 months (18.7%) (p < 0.05).ConclusionProviding VO2max estimates and grip strength did not produce an increase in overall physical activity. The EVS and exercise recommendations did however produce an increase in physical activity in less active individuals. In a very active population the VO2max estimate and measured grip strength did increase lifestyle activity and resistance training. Wider adoption of these measures could be effective in promoting physical activity and resistance training.Trial registrationclinicaltrials.gov NCT03518931 Registered 05/08/2018 -retrospectively registered.

Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients

ObjectivesTo compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines.MethodsWe identified 48...

Validity of the Exercise Vital Sign Tool to Assess Physical Activity

Assessment and counseling by healthcare providers can successfully increase physical activity; however, a valid instrument to effectively measure physical activity is needed. This study examines the validity of the Exercise Vital Sign tool by comparing Exercise Vital Sign data collected at Kaiser Permanente Northwest with accelerometry data. Participants (n=521) completed accelerometer monitoring and had ≥1 Exercise Vital Sign measurement in their electronic medical record. Using accelerometry as the gold standard, the association between moderate-to-vigorous physical activity minutes per week estimated through Exercise Vital Sign and that estimated through accelerometry was examined using the Spearman correlation coefficient. Comparability of moderate-to-vigorous physical activity categories (inactive, lowly active, moderately active, sufficiently active) was assessed using simple and weighted κ statistics. Sensitivity, specificity, and positive and negative predictive values were calculated. The study was conducted in 2012-2015, with analysis in 2019-2020. Average accelerometry-based moderate-to-vigorous physical activity was 212 minutes per week, and 57% of the participants were considered sufficiently active. Exercise Vital Sign‒based moderate-to-vigorous physical activity averaged 170 minutes per week, and 53% of the participants were active. There was a positive correlation between the moderate-to-vigorous physical activity minutes per week reported through Exercise Vital Sign and that reported through accelerometry (r =0.38, p<0.0001). A fair agreement was observed between Exercise Vital Sign‒ and accelerometry-based moderate-to-vigorous physical activity categories (weighted κ=0.29), with the highest agreement occurring for those with physical activity level ≥150 minutes per week. The positive correlation increased when moderate-to-vigorous physical activity was examined dichotomously (<150 or ≥150 minutes per week, κ=0.34). The sensitivity, specificity, positive predictive value, and negative predictive value for Exercise Vital Sign (when compared with those of accelerometry) were 67%, 68%, 61%, and 73%, respectively. The Exercise Vital Sign is a useful physical activity assessment tool that correctly identifies the majority of adults who do and do not meet physical activity guidelines.

Lack of Physical Activity Associated with Higher Rates of Severe COVID-19 Outcomes

Background: Of the studies examining risk factors for severe COVID-19 outcomes, none have examined inadequate physical activity (PA). We compared hospitalization rates, intensive care unit (ICU) admissions and mortality for COVID-19 patients who were inactive, inconsistently active, or regularly physically active.Methods: This retrospective observational study was done at Kaiser Permanente in Southern California. We identified 48,440 adult patients with a COVID-19 diagnosis from January 1, 2020 to October 21, 2020, with at least two Exercise Vital Sign (EVS) measurements from March 19, 2018 to March 18, 2020. We linked each patient’s self-reported PA category (consistently inactive = 0-10 min/week, inconsistently active = 11-149 min/week, consistently active = 150+ min/week) to risk of hospitalization, ICU admission and death after COVID-19 diagnosis. We conducted multivariate logistic regression controlling for known risk factors to assess whether regular PA was associated with COIVD -19 outcomes.Findings: COVID-19 patients who were consistently inactive were more likely to be hospitalized (OR 2.26; 95% CI: 1.81, 2.83), admitted to the ICU (OR= 1.73; 95% CI: 1.18, 2.55) and die (OR 2.49; 95% CI: 1.33, 4.67) than patients who were consistently active. Patients who were inconsistently active were more likely to be hospitalized (OR 1.89; 95% CI: 1.53, 2.33), admitted to the ICU (OR 1.58; 95% CI: 1.10, 2.27) and die (OR 1.88; 95% CI: 1.02, 3.47) compared to those who were consistently active. Patients who were consistently inactive had a greater risk of being hospitalized (OR= 1.20; 95% CI: 1.10, 1.32), admitted to the ICU (OR 1.10; 95% CI: 0.93, 1.29) and death (OR 1.32; 95% CI: 1.09, 1.60) than patients who were inconsistently active.Interpretations: Regular PA is a strong, modifiable independent risk factor for protecting against severe COVID-19 outcomes. Pandemic control measures should prioritize supporting regular PA to lessen COVID-19 morbidity and mortality.Funding Statement: This study was in part supported through funding from the Kaiser Permanente Community Benefits Funds.Declaration of Interests: The authors report no conflict of interest except Dr. Tartof reports grants from Roche/Genentech, Inc., during the conduct of the study.Ethics Approval Statement: The study was approved by the KPSC Institutional Review Board.

Validation Of Exercise Vital Sign (evs) Questions In A Pediatric Population

PURPOSE: The purpose of this study was to determine which factors were associated with increased weekly moderate to vigorous physical activity (MVPA) measured by Exercise Vital Sign (EVS) questions. METHODS: Patients presenting to a sports medicine clinic between the ages of 5-18 were asked “On average, how many days per week did you participate in MVPA” and “On average, how many minutes per day did you participate in MVPA”. Weekly physical activity, age, sex, BMI percentile, as well as history of asthma, attention deficit hyperactivity disorder, depression and diabetes were recorded. A linear regression analysis was utilized in those who reported any physical activity to determine which factors were associated with increased MVPA. RESULTS: Data were recorded on 14,440 subjects. Average age was 13.91±2.49 years and average BMI percentile was 65.50±27.74 percent. Females made up 54.1%. Asthma was reported by 2340 (16.2%), ADHD was reported by 818 (5.7%), depression was reported by 308 (2.1%), and diabetes was reported by 92 (.6%). Overall, 45.6% of subjects reported 420 minutes or more of weekly MVPA. Those who reported any physical activity (n=13,708) averaged 424.14±287.45 minutes per week of MVPA. Those with a history of depression had almost 60 minutes/week less MVPA when controlling for age, sex, BMI percentile, asthma, ADHD, and diabetes (p>.001). Females reported 45 minutes less MVPA than males when controlling for age, BMI percentile, asthma, ADHD, depression and diabetes (p>.001). Discussion: Physical activity is an important health determinant in childrens’ current and future health. The majority of youth do not meet current physical activity recommendations. Children suffering from depression should be screened for MVPA to encourage meeting physical activity recommendations. As females continue to obtain significantly less MVPA than males, targeted interventions need to be developed for this population. Regular screenings of MVPA levels should be implemented for children to help identifying and counsel those who are insufficiently active.

Physical Activity in Adults With an Amputation as Assessed With a Self‐Reported Exercise Vital Sign

Physical activity (PA) is important for the prevention and treatment of numerous chronic medical conditions. Individuals with a limb amputation face unique challenges for staying physically active. There are few studies evaluating PA of civilians with amputation in the United States. To evaluate self-reported PA in persons with an amputation in the outpatient setting using a standardized exercise vital sign (EVS) and correlate PA with demographic information, amputation characteristics, and disease burden. Cross-sectional observational study. Outpatient rehabilitation clinic at a tertiary care institution. N/A. Two hundred twenty-nine patients with limb amputation. EVS (self-reported weekly participation in moderate to vigorous intensity exercise), disease burden using a modified Charlson Comorbidity Index (CCI), possession of a prosthetic limb, amputation level, time from amputation, body mass index (BMI), gender, race, and age. A total of 28.8% of patients with limb amputation self-reported exercising at or above 150 min/wk as recommended by the United States Department of Health and Human Services (HHS); 31.8% of patients with transfemoral amputations, 27.8% with transtibial amputations, and 36% with upper extremity amputations reported exercising the recommended amount. Those with a prosthesis exercised 0.91 h/wk more than those without a prosthesis (95% CI 0.01, 1.8, P = .047), and female patients exercised 1.09 h/wk less than male patients (95% confidence interval [CI] 1.69-0.49, P < .001). Increasing age (P = .045), CCI (P = .006), and BMI (P = .005) all had a small but significant correlation with lower EVS. There was no statistically significant correlation between EVS and amputation level, race, or time from amputation. Less than one-third of patients with an amputation meet HHS recommendations for aerobic exercise. Male patients, those with a prosthesis, lower CCI, lower BMI, and younger age reported higher PA rates. Assessing EVS can help clinicians to identify patients with amputation that are not sufficiently active and may benefit from PA counseling and prescription.

PHYSICAL ACTIVITY LEVEL IN STABLE COPD PATIENTS FROM CENTRAL EASTERN EUROPE: RESULTS FROM A LARGE OBSERVATIONAL STUDY

SESSION TITLE: Pulmonary Rehabilitation and Muscle Dysfunction SESSION TYPE: Original Investigations PRESENTED ON: 10/22/2019 10:45 AM - 11:45 AM PURPOSE: Physical activity (PA) is an important functional outcome in chronic obstructive pulmonary disease (COPD). Low levels of PA are associated with a higher risk of exacerbations, exacerbations-related hospitalizations and mortality in COPD patients. This study aimed to describe the PA level (PAL) in a large population of stable COPD patients in Europe. The results from 5 Central Eastern European (CEE) countries are presented. METHODS: This multinational, cross-sectional study (NCT03031769) was conducted in 11 countries. In total, 2162 COPD patients were enrolled; some 1422 patients were from CEE countries: Romania (RO) 406, Poland (PL) 356, Serbia (SB) 250, Bulgaria (BG) 210 and Slovakia (SK) 200. All patients had COPD with duration of ≥1 year and no exacerbation history or changes in maintenance treatment in the last 2 months before enrolment. At each study visit, dyspnea was assessed with modified Medical Research Council (mMRC) scale. PAL was assessed through patient self-reports during clinical interview and clinical judgment of physicians (no specific guidance provided). The EVS program (exercise vital sign) and Yale Physical Activity Survey (YAPS) were used for self-reports. Active/insufficiently active/inactive were defined as performing ≥150/149-1/0 minutes/week of moderate to vigorous exercise, respectively. RESULTS: The 5 cohorts of patients presented the following mean ages (years): BG 66.7, PL 67.0, RO 65.9, SK 66.6, SB 68.0. Most patients had moderate to severe airflow obstruction: BG 84.3%, PL 87.7%, RO 83.7%, SK 90.0%, SB 80.0%. In BG 72.8%, PL 64.0%, RO 72.4%, SK 67.5% and SB 51.6% patients had mMRC≥2. The percentages of self-reported vs. clinically judged active patients were: BG 33.8% vs 44.3%, PL 38.5% vs 32.9%, RO 23.9% vs 54.4%, SK 36.0% vs 59.0%, SB 31.2% vs 38.4%. The percentages of completely inactive patients as self-reported by subjects vs. clinically judged by physicians were: BG 27.1% vs 12.4%, PL 15.2% vs 13.2%, RO 37.2% vs 9.1%, SK 37.0% vs 7.0%, SB 30.8% vs 9.6%, respectively. By YPAS, the mean time spent in mostly light activities expressed in hours/day was BG 2.8, PL 2.4, RO 3.7, SK 2.9, SB 3.4. The summary index of YPAS indicated the following values in each country: BG 41.0, PL 37.8, RO 45.3, SK 45.0 and SB 43.9, where 51 is the cut-off score used to identify COPD patients at risk of sedentarism CONCLUSIONS: This study confirms low levels of physical activity among COPD patients in CEE countries. In the absence of standardized tools, physicians tend to overestimate the physical activity of their COPD patients. CLINICAL IMPLICATIONS: Physicians and patients have a different perception of physical activity. Generally, COPD patients are less active than their physicians perceive. Clinicians should be equipped with adequate tools to assess and promote physical activity in their respiratory patients. DISCLOSURES: Employee relationship with AstraZeneca Please note: $1001 - $5000 Added 03/10/2019 by Silviu Alecu, source=Web Response, value=Salary No relevant relationships by Adam Antczak, source=Web Response Employee relationship with AstraZeneca Please note: $1001 - $5000 Added 03/14/2019 by Yunqin Chen, source=Web Response, value=Salary No relevant relationships by Florin Mihaltan, source=Web Response No relevant relationships by Vesna Radulović, source=Web Response

COMBATING PHYSICAL INACTIVITY: THE ROLE OF HEALTH CARE PROVIDERS

Apply It! • Partnering between health care providers and exercise specialists is needed to promote the successful implementation of physical activity guidelines in patients. • Using an exercise or physical activity vital sign is the first step in determining a patient’s physical activity levels. • Exercise prescriptions need to take into account patient preferences and abilities. • Exercise is Medicine® (EIM) provides resources for clinicians and patients on physical activity implementation and benefits.

Effect of high flow oxygen on exertional dyspnea in cancer patients: A double-blind randomized clinical trial.

11600 Background: High flow oxygen therapy is effective for hypoxemic respiratory failure. However, its effect on dyspnea in non-hypoxemic patients is unknown. In this 2x2 factorial, double-blind randomized clinical trial, we assessed the effect of flow rate (high vs. low) and gas (oxygen vs. air) on exertional dyspnea in cancer patients. Methods: Non-hypoxemic patients with cancer completed two structured cycle ergometer exercise tests with Low Flow Air [LFAir] at 2 L/min. They were then randomized to receive High Flow Oxygen [HFOx] with up to 60 L/min, High Flow Air [HFAir], Low Flow Oxygen [LFOx] or LFAir during a constant work rate exercise test at 80% maximum. Dyspnea intensity was assessed with the modified 0-10 Borg scale. The primary outcome was difference in the slope of dyspnea intensity vs. time during the third test. Secondary outcomes included difference in exercise time, vital signs, and adverse events. We estimated that 10 patients per arm will provide 86% power to detect a 1-standard deviation main effect and 86% power to detect a 2-SD interaction effect with an alpha of 5%. A linear mixed effects model was used to assess the impact of flow rate and gas on study outcomes. Results: 45 patients were randomized and 44 completed the study (10, 11, 12, 11 patients on HFOx, HFAir, LFOx, LFAir, respectively). The mean age was 63 (range 47-77); 18 (41%) were female; 34 (44%) had lung cancer; and 20 (46%) had metastatic disease. In mixed effects model, the association between the change in dyspnea intensity over time with flow rate differed significantly between oxygen and air (P = 0.04). Specifically, HFOx (slope difference -0.20, P &lt; 0.001) and LFOx (-0.14, P = 0.01) were significantly better than LFAir, but not HFAir (+0.09, P = 0.09). Exercise time also significantly increased with HFOx (difference +2.5 min, P = 0.009) compared to LFAir, but not HFAir (+0.63 min, P = 0.48) or LFOx (+0.39 min, P = 0.65). HFOx was well tolerated without significant adverse effects. Conclusions: The combination of high flow rate and oxygen improved dyspnea and exercise duration during constant work exercise test in non-hypoxemic cancer patients. Larger trials are needed to confirm the benefits of HFOx during exercises. Clinical trial information: NCT02357134.

Validity and Reliability of the Exercise Vital Sign Questionnaire in an Ethnically Diverse Group: A Pilot Study.

The purpose of this study was to determine the validity and reliability of the Exercise Vital Sign (EVS) questionnaire in an ethnically diverse sample. Participants (N = 39) were asked to wear an accelerometer at the hip for at least 7 days and to complete the EVS at the beginning (T1) and end (T2) of the wear period. The EVS questionnaire validity was determined against accelerometry, and bias was calculated as the mean difference between measures. The sensitivity and specificity of the EVS questionnaire were also evaluated. The reliability of the questionnaire was calculated using intraclass correlation coefficient (ICC) between EVS responses at T1 and T2. The mean difference in EVS- and accelerometer-determined time in MVPA was 24 min/wk. The reliability for the questionnaire was excellent (ICC = 0.98). The EVS specificity and sensitivity at T2 were 56% and 78%, respectively. The EVS questionnaire may be an acceptable measure of weekly MVPA time compared to accelerometry in an ethnically diverse sample; however, further research is needed to confirm these findings.

False-positive stress testing: Does endothelial vascular dysfunction contribute to ST-segment depression in women? A pilot study.

The utility of exercise-induced ST-segment depression for diagnosing ischemic heart disease (IHD) in women is unclear. Based on evidence that IHD pathophysiology in women involves coronary vascular dysfunction, we hypothesized that coronary vascular dysfunction contributes to exercise electrocardiography (Ex-ECG) ST-depression in the absence of obstructive coronary artery disease, so-called false positive results. We tested our hypothesis in a pilot study evaluating the relationship between peripheral vascular endothelial function and Ex-ECG. Twenty-nine asymptomatic women without cardiac risk factors underwent maximal Bruce protocol exercise treadmill testing and peripheral endothelial function assessment using peripheral arterial tonometry (Itamar EndoPAT 2000) to measure reactive hyperemia index (RHI). The relationship between RHI and Ex-ECG ST-segment depression was evaluated using logistic regression and differences in subgroups using 2-tailed t tests. Mean age was 54 ± 7 years, body mass index 25 ± 4 kg/m2 , and RHI 2.51 ± 0.66. Three women (10%) had RHI <1.68, consistent with abnormal peripheral endothelial function, whereas 18 women (62%) met criteria for positive Ex-ECG based on ST-segment depression in contiguous leads. Women with and without ST-segment depression had similar baseline and exercise vital signs, metabolic equivalents achieved, and RHI (all P > 0.05). RHI did not predict ST-segment depression. Our pilot study demonstrates high prevalence of exercise-induced ST-segment depression in asymptomatic, middle-aged, overweight women. Peripheral vascular endothelial dysfunction did not predict Ex-ECG ST-segment depression. Further work is needed to investigate the utility of vascular endothelial testing and Ex-ECG for IHD diagnostic and management purposes in women.

Validity and Reliability of the Exercise Vital Signs Questionnaire in a Diverse Urban Population

The Exercise Vital Signs (EVS) is a new brief (<30 seconds) physical activity (PA) questionnaire used by the Exercise is Medicine initiative within the American College of Sports Medicine. While the criterion validity of the EVS has been evaluated in a select number of ethnic groups, research on the validity and reliability of the EVS questionnaire in a diverse, urban sample is lacking. PURPOSE: To determine the validity and reliability of the EVS in a diverse, urban sample. METHODS: An ethnically-diverse sample (White 33%, Latino 31%, Asian 21%, Black 15%) of N=39 participants [age 31(10.4)] were asked to wear an accelerometer at the hip for 9 days and to complete the EVS at the beginning (T1) and end (T2) of the wear period. The criterion validity of the EVS-estimated minutes of weekly moderate-vigorous PA (MVPA) was determined against accelerometer-derived estimates of the total time spent in ≥10min bouts of MVPA using Spearman’s correlations. EVS responses were used to predict subjects who were confirmed to meet current PA guidelines of ≥150 MVPA min/week via accelerometry using logistic regression. The EVS receiver operating characteristic area under the curve (AUC), sensitivity, and specificity were calculated. The concurrent validity of the EVS MVPA estimates was tested against accelerometer- derived steps/day using Spearman’s correlations. The intraclass correlation coefficient (ICC) was calculated between the EVS responses at T1 and T2 in order to evaluate questionnaire test-retest reliability. RESULTS: Reliability for the EVS questionnaire was strong (ICC= .98). There was a moderate correlation (rho= .58 at T2, p= <.01) between the EVS-estimated PA minutes/ week and the accelerometer-derived MVPA minutes/week. There was also a moderate correlation (rho= .43 at T2, p= .006) between EVS-determined PA minutes/week and the accelerometer-derived steps/day. The T2 EVS specificity and sensitivity were 56% and 78%, respectively, and the AUC was 0.74. CONCLUSIONS: In a diverse, urban sample, the EVS questionnaire has acceptable validity and high test-retest reliability. The EVS may be a useful tool for identifying ethnically-diverse individuals not meeting current PA guidelines. Further research in larger ethnically-diverse samples is needed.