FromChest Journal, 1 October 2013.
Self-Assessment Using a Validated Visual Analogue Scale Predicts Response to Submaximal Exercise Testing.
Hauser T, Holley A.
Walter Reed National Military Medical Center, Bethesda, MD
Abstract
SESSION TITLE: Physiology/PFTs/Rehabilitation Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM – 02:30 PM
PURPOSE
Cardiopulmonary exercise testing (CPET) is used to determine the etiology of unexplained exercise symptoms in otherwise healthy patients and those with well defined cardiopulmonary disease. Test results vary by baseline physical activity levels which are difficult to assess objectively.
METHODS
We performed submaximal exercise testing on 40 physically active, healthy control patients as part of a prospective trial to evaluate the exercise response in patients with chronic fatigue syndrome. All patients provided a self-assessment of fitness using a series of previously validated visual analogue scales (VAS). We evaluated the relationship between baseline fitness and physiologic response to exercise.
RESULTS
Mean age and BMI for the group were 30.7±8.8 and 27.0±3.6 respectively. There were 25 males (62.5%), 23 caucasians (57.5%) and 13 (32.5%) African Americans.
On a VAS from one to ten with ten being optimal, patients rated their current endurance, fitness and muscular strength at 7.8±1.5, 7.9±1.1 and 7.3±1.9. Self-assessment of endurance was significantly correlated with maximum respiratory rate (r=-0.34, p=0.03), fitness showed a trend toward correlation with heart rate reserve (r=0.27, p=0.09) and muscular strength was significantly correlated with peak heart rate (r=-0.43, p=0.01), heart rate reserve (r=0.33, p=0.04) and O2-pulse at VO2 max (r=0.37, p=0.02).
Female assessment of fitness and muscle strength showed good correlation with work rate achieved (0.40 and 0.53 respectively).
CONCLUSIONS
In a group of young, physically fit patients self assessment is correlated with aerobic fitness measured on symptom targeted, sub-maximal exercise testing. VAS scores for muscular strength seemed to be a better predictor of the cardiac response to exercise than were scores for endurance or fitness.
CLINICAL IMPLICATIONS
Visual analogue scales can be used to provide a baseline assessment of fitness, In conjunction with other factors
known to predict responses to exercise these scales could theoretically help better define normality for a given patient.
From Veterinary Quarterly, 28 October 2013[Epub ahead of print]
Clinical microbiology of Coxiella burnetii and relevant aspects for the diagnosis and control of the zoonotic disease Q fever.
Roest HI, Bossers A, van Zijderveld FG, Rebel JM.
Department of Bacteriology and TSEs, Central Veterinary Institute, Wageningen University and Research Centre, Lelystad, the Netherlands.
Abstract
Coxiella burnetii is the causative agent of the zoonotic disease Q fever. Since its first recognition as a disease in the 1930s, the knowledge about the agent and the disease itself has increased. This review summarizes the current knowledge on C. burnetii and Q fever, its pathogenesis, diagnosis and control.
C. burnetii is a bacterium which naturally replicates inside human or animal host cells. The clinical presentation of Q fever varies per host species. C. burnetii infection in animals is mainly asymptomatic except for pregnant ruminants in which abortions and stillbirth can occur.
In humans, the disease is also mainly asymptomatic, but clinical presentations include acute and chronic Q fever and the post-Q fever fatigue syndrome. Knowledge of the pathogenesis of Q fever in animals and excretion of C. burnetii in infected animals is crucial in understanding the transmission routes and risks of human infection.
Our studies indicated that infected pregnant animals only excrete C. burnetii during and after parturition, independent of abortion, and that C. burnetii phase specific serology can be a useful tool in the early detection of infection. Domestic ruminants are the main reservoir for human Q fever, which has a major public health impact when outbreaks occur.
In outbreaks, epidemiological source identification can only be refined by genotypic analysis of the strains involved. To control outbreaks and Q fever in domestic ruminants, vaccination with a phase 1 vaccine is effective. Future challenges are to identify factors for virulence, host susceptibility and protection.