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Hijleh AA, Wang S, Berton DC, Neder-Serafini I, Vincent S, James M, Domnik N, Phillips D, Nery LE, O'Donnell DE, Neder JA. Reference values for leg effort during incremental cycle ergometry in non-trained healthy men and women, aged 19-85. Scand J Med Sci Sports 2024; 34:e14625. [PMID: 38597357 DOI: 10.1111/sms.14625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
Heightened sensation of leg effort contributes importantly to poor exercise tolerance in patient populations. We aim to provide a sex- and age-adjusted frame of reference to judge symptom's normalcy across progressively higher exercise intensities during incremental exercise. Two-hundred and seventy-five non-trained subjects (130 men) aged 19-85 prospectively underwent incremental cycle ergometry. After establishing centiles-based norms for Borg leg effort scores (0-10 category-ratio scale) versus work rate, exponential loss function identified the centile that best quantified the symptom's severity individually. Peak O2 uptake and work rate (% predicted) were used to threshold gradually higher symptom intensity categories. Leg effort-work rate increased as a function of age; women typically reported higher scores at a given age, particularly in the younger groups (p < 0.05). For instance, "heavy" (5) scores at the 95th centile were reported at ~200 W (<40 years) and ~90 W (≥70 years) in men versus ~130 W and ~70 W in women, respectively. The following categories of leg effort severity were associated with progressively lower exercise capacity: ≤50th ("mild"), >50th to <75th ("moderate"), ≥75th to <95th ("severe"), and ≥ 95th ("very severe") (p < 0.05). Although most subjects reporting peak scores <5 were in "mild" range, higher scores were not predictive of the other categories (p > 0.05). This novel frame of reference for 0-10 Borg leg effort, which considers its cumulative burden across increasingly higher exercise intensities, might prove valuable to judging symptom's normalcy, quantifying its severity, and assessing the effects of interventions in clinical populations.
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Affiliation(s)
- Abed A Hijleh
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sophia Wang
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Danilo C Berton
- Pulmonary Function Tests Laboratory, Federal University of Rio Grande to Sul, Porto Alegre, RS, Brazil
| | - Igor Neder-Serafini
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sandra Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matthew James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicolle Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Devin Phillips
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Luiz E Nery
- Clinical Exercise Physiology Unit, Division of Pulmonology, Department o Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Satia I, Farooqi MAM, Cusack R, Matsuoka M, Yanqing X, Kurmi O, O’Byrne PM, Killian KJ. The contribution of FEV1 and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real-world cohort. Physiol Rep 2020; 8:e14415. [PMID: 32323482 PMCID: PMC7177171 DOI: 10.14814/phy2.14415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022] Open
Abstract
RATIONALE The effort required to cycle and breathe intensify as power increases during incremental exercise. It is currently unclear how changes in FEV1 in the presence or absence of airflow limitation) impacts the intensity of dyspnea and leg effort. This is clinically important as the improvement in FEV1 is often the target for improving dyspnea. OBJECTIVES To investigate the relationship between dyspnea (D), leg effort, power (P), and FEV1 with and without airflow limitation using direct psychophysical scaling performed during incremental exercise testing to symptom limited capacity. METHODS Retrospective analysis of consecutive patients over the age of 35 referred for cardio-pulmonary exercise testing at McMaster University Medical Centre from 1988-2012.The modified Borg scale was used to measure dyspnea throughout incremental exercise testing. MEASUREMENTS AND RESULTS 38,788 patients were included in the analysis [Mean Age 58.6 years (SD ±11.8), Males 61%, BMI 28.1 kg/m2 (SD ±5.1), FEV1 was 2.7 L (SD ±0.85), 95% predicted (SD ±20.4), FVC 3.4 L (SD ± 1.0), 94% predicted (SD ±17.0)], and 10.9% had airflow limitation (AL, FEV1 /FVC < 70%). In a nonlinear regression analysis, the intensity of dyspnea increased in a positively accelerating manner with power and as the FEV1 % predicted decreased: Dyspnea = 0.06 * Power1.03 * FEV1 %Pred-0.66 (r = .63). The intensity of leg effort increased with power and declining quadricep strength and FEV1% predicted: Leg Effort = 0.06 * Power1.22 * Quad-0.56 *FEV1 %Pred-0.39 (r = .73). There was no independent effect of AL on dyspnea of leg effort. CONCLUSION Power, quadriceps strength and FEV1 are the dominant factors contributing to dyspnea and leg effort, irrespective of the degree of airflow limitation.
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Affiliation(s)
- Imran Satia
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
- Firestone Institute for Respiratory HealthSt Joseph’s HealthcareHamiltonONCanada
- Division of Infection, Immunity and Respiratory MedicineManchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | - Mohammad Abdul Malik Farooqi
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
- Firestone Institute for Respiratory HealthSt Joseph’s HealthcareHamiltonONCanada
| | - Ruth Cusack
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
| | - Masanobu Matsuoka
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
| | - Xie Yanqing
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
| | - Om Kurmi
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
| | - Paul M. O’Byrne
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
- Firestone Institute for Respiratory HealthSt Joseph’s HealthcareHamiltonONCanada
| | - Kieran J. Killian
- Division of RespirologyDepartment of MedicineMcMaster UniversityHamiltonONCanada
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