Ratings Of Perceived Breathlessness Research Articles

Respiratory symptom perception during exercise in patients with heart failure with preserved ejection fraction

We investigated whether central or peripheral limitations to oxygen uptake elicit different respiratory sensations and whether dyspnea on exertion (DOE) provokes unpleasantness and negative emotions in patients with heart failure with preserved ejection fraction (HFpEF). 48 patients were categorized based on their cardiac output (Q̇c)/oxygen uptake (V̇O2) slope and stroke volume (SV) reserve during an incremental cycling test. 15 were classified as centrally limited and 33 were classified as peripherally limited. Ratings of perceived breathlessness (RPB) and unpleasantness (RPU) were assessed (Borg 0–10 scale) during a 20 W cycling test. 15 respiratory sensations statements (1–10 scale) and 5 negative emotions statements (1−10) were subsequently rated. RPB (Central: 3.5±2.0 vs. Peripheral: 3.4±2.0, p=0.86), respiratory sensations, or negative emotions were not different between groups (p>0.05). RPB correlated (p<0.05) with RPU (r=0.925), “anxious” (r=0.610), and “afraid” (r=0.383). While DOE provokes elevated levels of negative emotions, DOE and respiratory sensations seem more related to a common mechanism rather than central and/or peripheral limitations in HFpEF.

Effects of no mask, a surgical mask and a fabric buff on peripheral oxygenation saturation during moderate intensity exercise: a randomised cross-over study.

Mask-wearing caused significant reductions in coronavirus disease 2019 (COVID-19) transmission. We aimed to determine whether face mask-wearing during exercise caused reductions in peripheral oxygen saturation (SpO2) and whether it affected secondary physiological measures [end-tidal carbon dioxide (EtCO2), respiratory rate (RR), heart rate (HR), expired breath temperature (EBT)]. Subjective measurements included ratings of perceived exertion (RPE), ratings of perceived breathlessness (RPB), and symptomology. A randomised cross-over trial examined no mask (NM), surgical mask (SM) and a buff mask (BM). Thirty participants (30-45 years) cycled at 60% power output for 30 min in three exercise sessions, 24 h apart, within 6 days. Each session recorded all measures at resting baseline (T0), 9 min (T1), 18 min (T2), and 27 min (T3). Dependent statistical tests determined significant differences between masks and time-points. SpO2 decreased for SM and BM between T0 compared to T1, T2 and T3 (all P<0.005). BM caused significant reductions at T1 and T2 compared to NM (P<0.001 and P=0.018). Significant changes in EtCO2 and EBT occurred throughout exercise and between exercise stages for all mask conditions (P<0.001). As expected for moderate intensity exercise, RR and HR were significantly higher during exercise compared to T0 (P<0.001). RPB significantly increased for each condition at each time point (P<0.001). RPE was not significant between mask conditions at any exercise stage. SM and BM caused a mild but sustained reduction in SpO2 at commencement of exercise, which did not worsen throughout short (<30 min) moderate intensity exercise. Level of perception was similar, suggesting healthy people can wear masks during moderate exercise and activities of daily living.

A lab-based comparison of differential ratings of perceived exertion between a run and jump protocol involving low or high impacts on the lower extremities

ABSTRACT The rating of perceived exertion method (RPE) allows to describe training intensity in a single value. To better understand the underlying components, the separate rating of perceived breathlessness (RPE-B) and leg-muscle exertion (RPE-L) has been proposed. Here we hypothesised that the separation between the two components may (partly) be determined by the impacts on the lower extremities. In this study, we aimed to experimentally evaluate the differential effect of high versus low impact running and jumping on RPE-B and RPE-L in team sport activities by manipulating the movement strategy (heel strike and passive landing pattern versus forefoot strike and active landing pattern). Eighteen recreational team sport players participated in two submaximal tests consisting of a sequence of running and jumping bouts, whilst ground reaction forces (GRF) were collected. RPE-B and RPE-L data were collected after each bout using the CR100 scale. Paired-samples t-tests were used to analyse between-session differences in these variables. GRF analysis showed that absorption mechanics differed considerably between the two sessions. RPE-L was on average 6.50 AU higher in the low impact session (p = 0.006). However, RPE-B was also increased by 4.96 AU with low impact (p = 0.009). We conclude that the extent to which the lower extremities are being exposed to high or low impacts does not explain a possible separation between the two RPE types. Highlights The separate rating of the different underlying components of RPE (e.g. variables related to the cardiorespiratory and the muscular system) may provide more insight in the relationship between training load and training outcomes, which likely differs between these components. The findings of this study do not support the idea that the separation in rating between perceived breathlessness (RPE-B, cardiorespiratory) and leg-muscle exertion (RPE-L, muscular) is also rooted in the extent to which musculoskeletal structures in the lower extremities are being exposed to high or low impacts.

Evaluation of Exertional Dyspnea During Recovery From SARS‐CoV‐2 Infection in Young Adults

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection can result in severe physiological impairments to cardiovascular and respiratory function. Further, a hallmark symptom of SARS‐CoV‐2 infection is shortness of breath, even at rest, which may be exaggerated during periods of exertion. However, the lasting effects of COVID‐19 on quantitative measures of exertional breathlessness in otherwise healthy individuals is unknown.PurposeThe purpose of this study was to examine the sensory and affective dimensions of exertional dyspnea (i.e., shortness of breath during exercise) in otherwise healthy, young adults who had previously tested positive for SARS‐CoV‐2 over a period of three months.MethodsOtherwise healthy, young adults (4M/3F, age: 21 ± 1 y, body mass index: 24.1±1.4 kgᐧm‐2, aerobic fitness: 35.7± 11.3 mL·kg‐1·min‐1) who tested positive for SARS‐CoV‐2 completed an incremental exercise test to voluntary exhaustion on a cycle ergometer three‐to‐four weeks after the positive SARS‐CoV‐2 test result (BL), as well as one and two months following baseline testing (1M and 2M, respectively). Subjective ratings of perceived breathlessness (RPB) and unpleasantness of breathing (RPU) were collected at rest and during each stage of exercise. Following exercise completion, subjects rated the unpleasantness and accompanying negative emotions (depression, anxiety, frustration, anger, and fear) associated with their exertional dyspnea using a visual analog scale (VAS).ResultsRPB at rest, during cycling at 60W, and at peak exercise were similar across visits (p > 0.05). RPB during cycling at 120W tended to decrease across time (BL: 2.9±0.9; 1M: 2.1±1.1; 2M: 2.0±1.4; p = 0.06). RPU at rest, during cycling at 60W, 120W, and at peak exercise were not different between visits (p > 0.05). VAS ratings of anxiety (BL: 1.8±2.1 cm; 1M: 3.1±3.2 cm; 2M: 0.8±0.7 cm; p = 0.05), but not those of depression, unpleasantness, anger, frustration, or fear differed across visits (p > 0.05).ConclusionThese data suggest that the sensory dimension of exertional dyspnea during moderate intensity exercise improves (i.e., decreases) during recovery from SARS‐CoV‐2 infection. In contrast, the affective dimension of exertional dyspnea appears to be largely maintained throughout recovery, as only anxious emotions related to exertional dyspnea fluctuated over the three‐month time period.

Elastic Taping’s Effect on Exercise Capacity in Recreational Runner with Inspiratory Muscle Training

Background: Running is a new trend of recreational sports in Indonesia. About 70% of recreational runners have difficulty in improving exercise capacity due to exercise-related transient abdominal pain (ETAP), caused by fatigue of the diaphragmatic muscles. Previous studies have shown that various training methods may increase diaphragmatic muscle strength and endurance, for example, inspiratory muscle training (IMT). Unfortunately, improvement of inspiratory muscle strength and endurance after exercise and IMT are still varies. Therefore, other methods are needed to optimize the effect of IMT. Application of the elastic taping on thoracic wall during exercise allows the inspiratory muscles to contract optimally which might improve functional capacity.Aim: To assess the effect of elastic taping on inspiratory muscle training using the pressure threshold IMT, in increasing the functional exercise capacity of recreational runners. Functional capacity was measured based on VO2max value, rating of perceived breathlessness (RPB) and rating of perceived exertion (RPE).Methods: an experimental study involved 14 nonsmoker recreational runners, ages 20-40 years, at Outpatient Clinic of Physical Medicine and Rehabilitation Department of Dr. Soetomo Hospital Surabaya. Subjects were divided into two groups (pressure threshold IMT with and without elastic taping groups), which were observed for four weeks. IMT was done five times a week, twice a day, with 30 repetitions, and 60% resistance 30 RM using Respironics®. Elastic taping Leukotape® was applied on the first until fifth day in each IMT sessions. The running exercises were done three times a week with EnMill® Treadmill ETB-03195 with a speed of 4.5 mph and 0% inclination. RBP, RPE and VO2max were measured using Borg Dyspneu scale, Borg Scale, and Bruce Treadmill Protocol test, respectively, before the first exercise and after 4 weeks of exercise.Results: There were an improvement of functional exercise capacity in both groups which were marked with a decline of RPB and RPE and increase of VO2max (p values &lt; 0.05). However, there were no significant differences in the decrease of RPB and RPE and an increase of VO2max between groups (p values of were 0.31, 0.83, and 0.13, respectively). The effect of the elastic taping (r2 = 0.99) was not reflected in the differences of RPB, RPE and increasing VO2max.Conclusion: Inspiratory muscle training using pressure threshold IMT with or without the elastic taping for four weeks can improve exercise capacity of recreational runners.

Elastic Taping’s Effect on Exercise Capacity in Recreational Runner with Inspiratory Muscle Training

Background: Running is a new trend of recreational sports in Indonesia. About 70% of recreational runners have difficulty in improving exercise capacity due to exercise-related transient abdominal pain (ETAP), caused by fatigue of the diaphragmatic muscles. Previous studies have shown that various training methods may increase diaphragmatic muscle strength and endurance, for example, inspiratory muscle training (IMT). Unfortunately, improvement of inspiratory muscle strength and endurance after exercise and IMT are still varies. Therefore, other methods are needed to optimize the effect of IMT. Application of the elastic taping on thoracic wall during exercise allows the inspiratory muscles to contract optimally which might improve functional capacity.Aim: To assess the effect of elastic taping on inspiratory muscle training using the pressure threshold IMT, in increasing the functional exercise capacity of recreational runners. Functional capacity was measured based on VO2max value, rating of perceived breathlessness (RPB) and rating of perceived exertion (RPE).Methods: an experimental study involved 14 nonsmoker recreational runners, ages 20-40 years, at Outpatient Clinic of Physical Medicine and Rehabilitation Department of Dr. Soetomo Hospital Surabaya. Subjects were divided into two groups (pressure threshold IMT with and without elastic taping groups), which were observed for four weeks. IMT was done five times a week, twice a day, with 30 repetitions, and 60% resistance 30 RM using Respironics®. Elastic taping Leukotape® was applied on the first until fifth day in each IMT sessions. The running exercises were done three times a week with EnMill® Treadmill ETB-03195 with a speed of 4.5 mph and 0% inclination. RBP, RPE and VO2max were measured using Borg Dyspneu scale, Borg Scale, and Bruce Treadmill Protocol test, respectively, before the first exercise and after 4 weeks of exercise.Results: There were an improvement of functional exercise capacity in both groups which were marked with a decline of RPB and RPE and increase of VO2max (p values &lt; 0.05). However, there were no significant differences in the decrease of RPB and RPE and an increase of VO2max between groups (p values of were 0.31, 0.83, and 0.13, respectively). The effect of the elastic taping (r2 = 0.99) was not reflected in the differences of RPB, RPE and increasing VO2max.Conclusion: Inspiratory muscle training using pressure threshold IMT with or without the elastic taping for four weeks can improve exercise capacity of recreational runners.

Comparison between a facemask and mouthpiece on breathing mechanics and gas exchange variables during high-intensity exercise

Gas-collection masks are used as a comfortable alternative to the traditional mouthpiece and noseclip during exercise testing protocols in human performance laboratories. However, these masks may introduce potential problems which could affect metabolic and ventilatory parameters, including gas leaks and added dead space. Therefore, the purpose of this study was to compare breathing mechanics, gas exchange variables and ratings of perceived breathlessness (RPB) during high-intensity exercise between a mouthpiece and face mask. Fourteen men [⩒O2peak = 55.3 ± 7.3 ml·kg−1·min−1] were recruited to perform 6 min of cycle ergometry (Velotron Pro, RacerMate, Inc., Seattle, WA) at a work rate corresponding to 90% of ⩒O2peak while breathing on either (1) a mouthpiece (Hans Rudolph, KC, KS) with nose clip, or (2) a face mask (7450, Hans Rudolph, KC, KS). The difference in ⩒E between the mouthpiece (156.8 ± 23.3 L/min) and face mask (153.3 ± 21.8 L/min) was not significant (p = 0.534). Similarly, there were no significant differences in breathing mechanics, gas exchange variables or RPB. These data suggest that the facemask can continue to be used interchangeably with the mouthpiece and may even be a more comfortable alternative during high-intensity exercise.

Dyspnea on exertion provokes unpleasantness and negative emotions in women with obesity

PurposeWhile dyspnea on exertion (DOE) is a common complaint in otherwise healthy obese women, less is known about feelings of unpleasantness and/or negative emotions provoked by DOE. We examined whether ratings of perceived breathlessness (RPB) during exercise were associated with ratings of unpleasantness and negative emotions (depression, anxiety, frustration, anger, and fear) in obese women. MethodsSeventy-four women (34 ± 7 yrs, 36 ± 4 kg/m2, 46 ± 5% body fat) performed 6 min of constant-load cycling (60 W); RPB (0–10 scale), and unpleasantness and negative emotions (visual analog scales, 10 cm) were assessed at the end. ResultsRPB were significantly correlated with unpleasantness and negative emotions (p < 0.05). The strongest correlations were between RPB and unpleasantness (r = 0.61, p < 0.001), and RPB and anxiety (r = 0.50, p < 0.001). ConclusionsDOE can significantly provoke unpleasantness and negative emotions during exercise in obese women. This may affect their willingness to engage in regular physical activity.

Dyspnea Intensity, Descriptors, And Negative Symptoms During Exercise In Obese And Nonobese Children

PURPOSE: The purpose of this study was to examine dyspnea intensity, descriptors, and associated negative symptoms during exercise in 10 and 11 year old obese and nonobese children. METHODS: 12 obese (9 boys, age: 11.3 ± 0.6y, height: 149.7 ± 6.7cm, mass: 65.8 ± 14.4kg, BMI percentile: 97.5 ± 1.4, body fat: 46 ± 3%) and 11 nonobese (5 boys, age: 10.8 ± 0.5y, height: 143.3 ± 5.2cm, mass: 35.8 ± 3.8kg, BMI percentile: 50.3 ± 21.5, body fat: 27 ± 6%) underwent 3 constant load exercise tests for 6 minutes each (at 40W, 50% of VO2max, and 50% of VO2max + 20W), and a maximal exercise test. Ratings of perceived breathlessness (RPB), ratings of perceived exertion (RPE), top 3 descriptors related to dyspnea, and negative symptoms related to dyspnea (unpleasantness, depression, anxiety, frustration, fear, and anger) on a visual analog scale (VAS) were measured. Also, parents reported whether their child gets short of breath with exertion during the screening process to ascertain whether the child experienced dyspnea on exertion (DOE) outside the laboratory. RESULTS: 58% of obese children complained of DOE outside of the laboratory, compared to only 9% of nonobese children (P = 0.013). RPB and RPE were not different between obese and nonobese children during each submaximal exercise test for both absolute and relative work rates (P > 0.05). Nonobese children picked 13 out of 15 descriptors of dyspnea within their top 3 during cycling at 40W, with 30% of nonobese children expressing that their “breathing required work”. In contrast, obese children picked only 7 (i.e. they felt they were breathing more, their breathing was heavy, rapid, and shallow, required work/effort, and they had difficulty with inhalation). Unpleasantness associated with dyspnea on the VAS scale was higher in nonobese children while cycling at 40W compared with obese children (3.0 ± 1.5 vs. 0.8 ± 0.5; P = 0.001), although relative exercise intensity was similar between groups (P = 0.842). CONCLUSIONS: At both relative and absolute exercise intensities, RPB and RPE were not different between obese and nonobese 10 and 11 year old children. Surprisingly, negative symptoms related to dyspnea were actually greater in the nonobese children. This suggests that obese children are able to tolerate moderate to vigorous intensity exercise to the same extent as nonobese children.

Aerobic exercise training without weight loss reduces dyspnea on exertion in obese women

Dyspnea on exertion (DOE) is a common symptom in obesity. We investigated whether aerobic exercise training without weight loss could reduce DOE. Twenty-two otherwise healthy obese women participated in a 12-week supervised aerobic exercise training program, exercising 30min/day at 70–80% heart rate reserve, 4 days/week. Subjects were grouped based on their Ratings of Perceived Breathlessness (RPB) during constant load 60W cycling: +DOE (n=12, RPB≥4, 37±7 years, 34±4kg/m2) and –DOE (n=10, RPB≤2, 32±6 years, 33±3kg/m2). No significant differences between the groups in body composition, pulmonary function, or cardiorespiratory fitness were observed pre-training. Post-training,peak was improved significantly in both groups (+DOE: 12±7, –DOE: 14±8%). RPB was significantly decreased in the +DOE (4.7±1.0–2.5±1.0) and remained low in the –DOE group (1.2±0.6–1.3±1.0) (interaction p<0.001). The reduction in RPB was not significantly correlated with the improvement in cardiorespiratory fitness. Aerobic exercise training improved cardiorespiratory fitness and DOE and thus appears to be an effective treatment for DOE in obese women.

Weight loss reduces dyspnea on exertion in obese women

During submaximal exercise, some otherwise healthy obese women experience breathlessness, or dyspnea on exertion (+DOE), while others have mild or no DOE (−DOE). We investigated whether weight loss could reduce DOE. Twenty nine obese women were grouped based on their Ratings of Perceived Breathlessness (RPB) during constant load 60W cycling: +DOE (n=14, RPB≥4, 34±8 years, and 36±3kg/m2) and −DOE (n=15, RPB≤2, 32±8 years, and 36±4kg/m2) and then completed a 12-week weight loss program. Both groups lost a moderate amount of weight (+DOE: 6.6±2.4kg, −DOE: 8.4±3.5kg, and p<0.001). RPB decreased significantly in the +DOE group (from 4.7±1.1 to 3.1±1.6) and remained low in the −DOE (from 1.5±0.7 to 1.6±1.1) (interaction p<0.002). Most physiological variables measured (i.e. body composition, fat distribution, pulmonary function, oxygen cost of breathing, and cardiorespiratory measures) improved with weight loss; however, the decrease in RPB was not correlated with any of these variables (p>0.05). In conclusion, moderate weight loss was effective in reducing breathlessness on exertion in obese women who experienced DOE at baseline.

Respiratory Symptom Perception Differs in Obese Women With Strong or Mild Breathlessness During Constant-Load Exercise

During constant-load exercise, some otherwise healthy obese women report substantially more dyspnea on exertion (DOE) than do others. The objective of this study was to investigate whether qualitative differences exist between the sensations of dyspnea felt by these women. Seventy-eight women were categorized based on their ratings of perceived breathlessness (RPBs) (Borg 0-10 scale) after 6 min of 60-W cycling. Thirty-four women rated RPB ≥ 4 (+DOE) (34 ± 7 years, 36 ± 5 kg/m² BMI), and 22 women rated RPB ≤ 2 (-DOE) (32 ± 7 years, 37 ± 4 kg/m² BMI). Twenty-two women rated RPB as 3 (RPB = 3) (34 ± 7 years, 34 ± 4 kg/m² BMI) and were grouped separately to allow for a better delineation of the +DOE and the -DOE groups. After the exercise test, subjects were asked to pick three of 15 statements that best described their respiratory sensations. The +DOE and the -DOE groups were characterized differentially (P < .05) by the respiratory clusters "Breathing more" (82% of -DOE vs 41% of +DOE), "Shallow" (36% vs 6%), and "Heavy" (14% vs 53%). All four descriptors in the cluster "Work/Effort" were chosen more frequently by women in the +DOE group than by women in the -DOE group. Although relative exercise intensity was higher in the +DOE women (75% ± 13% vs 67% ± 10% of oxygen uptake at peak exercise, 41 ± 10 L/min vs 31 ± 8 L/min as % maximal voluntary ventilation, 83% ± 7% vs 76% ± 7% of peak heart rate), none of these variables was significantly associated with RPB. Not only is the intensity of dyspnea significantly different between the +DOE and the -DOE groups, but so are the self-reported qualitative aspects of their dyspnea. Women in the +DOE group reported an increased sensation of the work of breathing relative to women in the -DOE group, which may be associated with the elevated RPB.

Oxygen cost of breathing and breathlessness during exercise in nonobese women and men.

Although it has been reported that the work of breathing may be higher in women, inconsistencies among studies leaves this important question unresolved. Also, the association between the oxygen cost of breathing and rating of perceived breathlessness (RPB) during exercise has not been examined between women and men. This study aimed to measure oxygen cost of breathing during eucapnic voluntary hyperpnea and RPB (Borg 0-10 scale) during 6 min of constant work rate cycling at 60 and 90 W, respectively, in healthy, nonobese women and men. A total of 9 women (27 yr, body mass index = 21 kg·m(-2)) and 10 men (29 yr, body mass index = 25 kg·m(-2)) participated. All subjects underwent pulmonary function testing, exercise cycling, and determination of oxygen cost of breathing during eucapnic voluntary hyperpnea. Oxygen cost of breathing was obtained from the slope of the oxygen uptake (mL·min(-1)) and ventilation (L·min(-1)) relationship. RPB and cardiorespiratory measures were collected during minute 6 of the exercise. Data were analyzed by independent t-test and regression analysis. Age and pulmonary function were similar between the nonobese women and men. Oxygen cost of breathing was similar between the nonobese women (1.17 ± 0.26 mL·L(-1)) and men (1.21 ± 0.42 mL·(-1)L). RPB during exercise was similar between the women (2.1 ± 1.3) and men (2.6 ± 1.2) and was correlated (P < 0.05) with relative oxygen uptake (r = 0.55) but not the oxygen cost of breathing. In nonobese women and men, oxygen cost of breathing is not different over the ventilatory ranges studied and RPB is similar at the same relative exercise intensity. In addition, the oxygen cost of breathing was not associated with RPB during constant work rate exercise.

1 - Classification and Aetiology of the Aplastic Anaemias

While dyspnea on exertion (DOE) is a common complaint in otherwise healthy obese women, less is known about feelings of unpleasantness and/or negative emotions provoked by DOE. We examined whether ratings of perceived breathlessness (RPB) during exercise were associated with ratings of unpleasantness and negative emotions (depression, anxiety, frustration, anger, and fear) in obese women.Seventy-four women (34 ± 7 yrs, 36 ± 4 kg/m2, 46 ± 5% body fat) performed 6 min of constant-load cycling (60 W); RPB (0–10 scale), and unpleasantness and negative emotions (visual analog scales, 10 cm) were assessed at the end.RPB were significantly correlated with unpleasantness and negative emotions (p < 0.05). The strongest correlations were between RPB and unpleasantness (r = 0.61, p < 0.001), and RPB and anxiety (r = 0.50, p < 0.001).DOE can significantly provoke unpleasantness and negative emotions during exercise in obese women. This may affect their willingness to engage in regular physical activity.