Those with limited language comprehension or literacy face problems completing written questionnaires evaluating their health or physical status on which treatment plans are based. This brief report describes how a picture-based version of the 10 items in the limitations of activities section of the short form 36 health survey questionnaire (SF-36) was developed iteratively and then piloted. Study participants were 101 community-living volunteers (58 female and 43 male volunteers aged 18–93 yrs) educated to postsecondary level (52), high school grades 10–12 (44), and grade 9 or less (5). They first completed the picture-based SF-36 LoA and described verbally and in writing what they understood each picture to mean and then completed the English text version of the SF-36 limitations of physical activities domain for comparison assessment. Additional feedback suggested where pictures could be altered to increase information capture. Subjects rated their health as 26.7% excellent, 25.7% very good, 29.8% good, 10.9% fair, and 6.9% poor. Analysis showed strong correlation between text-based SF-36 LoA questions and the picture-based visual score—VSF-36 LoA—(intraclass correlation coefficient = 0.98) with question 10 correlating highest (intraclass correlation coefficient = 0.90) and question 2 lowest (intraclass correlation coefficient = 0.82). The VSF-36 LoA is the first picture-based version of the SF-36; good correlation with the text-based version and global need warrants further development to aid those with limited literacy or language comprehension.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Natural Sciences and Engineering Research Council of Canada and B.C. Sports & Exercise Medicine Research Foundation. Background The epidemiologic evidence suggests that the health benefits of exercise in healthy adults outweigh the adverse effects of air pollution in all but the most extreme concentrations. However, no studies have examined the acute response to exercise in air pollution in individuals with hypertension, a subgroup particularly susceptible to the cardiovascular effects of air population. Purpose The purpose of this study was to determine the impact of traffic-related air pollution on the acute cardiovascular response to exercise in patients with hypertension. We hypothesized that exposure to higher levels of traffic-related air pollution during exercise would attenuate, but not eliminate, acute post-exercise reductions in blood pressure and arterial stiffness. Methods Fourteen patients with hypertension (62.4±6.8 years; 81% male) completed a real-world, randomized, crossover study. Two 30-minute exercise bouts at 40-59% heart rate reserve were performed: once along a commercial street (high traffic) and once in an urban plaza (low traffic). Blood pressure (BP) and arterial stiffness (i.e., carotid-femoral pulse wave velocity [cfPWV]) were examined prior to, 30 minutes after, and 2 hours following exercise. 24-hour ambulatory BP monitoring was immediately completed following each visit. Black carbon, noise, relative humidity, and temperature were measured during each exercise bout (Figure 1). Results No differences were found for baseline cardiovascular measures between high and low traffic visits. At 30 minutes and 2 hours post-exercise, systolic BP was significantly reduced relative to baseline in the low-traffic condition only; diastolic BP was not significantly reduced at any timepoint. Based on linear mixed-effects analyses, exercising at the low traffic site was associated, relative to the high traffic site, with a significant (p = 0.04) reduction in systolic BP (-4.30 mm Hg [95% CI -8.09 to -0.54]) up to 2 hours following exercise after adjusting for exercise intensity, temperature, and noise; no differences were found for diastolic BP (-1.56 mm Hg [95% CI -4.87 to 1.83], p = 0.39). Each interquartile increase in black carbon (1168 ng/m³) was significantly associated with a 2.33 mm Hg (95% CI 0.37 to 4.17) increase in systolic BP up to 2 hours following exercise. No associations were observed between traffic site and BP for any ambulatory periods (i.e., 24-hour average, daytime, nighttime, or evening). The acute cfPWV response to exercise was also similar between traffic sites (p > 0.05). Conclusion Our findings suggest that exposure to traffic-related air pollution during exercise may adversely impact the beneficial short-term BP response to exercise in patients with hypertension. While the long-term implications of these changes to the acute BP response to exercise must be further explored, patients with hypertension can employ the prudent strategy of maximizing their distance from major roadways when exercising.