Dalhousie Pictorial Scales Measuring Dyspnea and Perceived Exertion during Exercise for Children and Adolescents

Pianosi, Paul; Huebner, Marianne; Zhang, Zhen; Turchetta, Attilio; McGrath, Patrick J.

doi:10.1513/annalsats.201410-477oc

Cited by 16 publications

(13 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We conclude the Dalhousie Dyspnea and Perceived Exertion Scales yield comparable results to the Borg CR-10 scale in measuring dyspnea and perceived leg exertion during bicycle exercise in healthy adults and in adults with pulmonary disease. We already demonstrated feasibility and reproducibility of using the Dalhousie scales in a population of Italian children running on a treadmill in the hope that the pictorial nature of the scales would obviate need for verbal descriptors that might limit scale comprehension in subjects with limited literacy or understanding [ 13 ]. By the same reasoning, the Dalhousie scales can now be employed in exercise testing of adults in whom a clinician might have similar concerns.…”

Section: Discussionmentioning

confidence: 99%

“…We reported that the Dalhousie scales accurately track dyspnea and perceived exertion during a maximal exercise test in a pediatric population of individuals with and without respiratory disease [ 12 ]. Most recently, we demonstrated excellent correlations between ratings of dyspnea and ventilation, or perceived exertion and work intensity, during incremental exercise in children and adolescents [ 13 ]. We now report validation studies for our Dalhousie Dyspnea and Perceived Exertion Scales in adults, both healthy and with pulmonary disease, via three steps: (1) comparison with the current “gold standard,” i.e., Borg scale (concurrent validity); (2) Dalhousie pictorial ratings of dyspnea should rise with increasing ventilation and of perceived exertion should rise with increasing work (content validity); and (3) determination that rating trajectories conformed to a power function (internal validity).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Measuring Dyspnea and Perceived Exertion in Healthy Adults and with Respiratory Disease: New Pictorial Scales

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundDyspnea or perceived exertion during exercise is most commonly measured using Borg or visual analog scales, created for use in adults. In contrast, pictorial scales have been promoted for children due to skepticism concerning applicability of the said scales in pediatrics. We sought to validate our newly created, pictorial Dalhousie Dyspnea and Perceived Exertion Scales in adult populations and compare ratings with the Borg scale.MethodsDyspnea and perceived exertion ratings obtained with both modified Borg CR-10 and Dalhousie scales during maximal cycle exercise were compared in 24 healthy adults and 17 with various pulmonary disorders. Scale ratings for perceived exertion were plotted against work while ratings for dyspnea were plotted against ventilation using previously developed alternative models to simple power law. Goodness of fit was determined by lowest root-mean-square error or by corrected Akaike information criterion.ResultsPictorial ratings of dyspnea and perceived exertion measured by both scale ratings rose as expected with increasing exercise intensity, and individual trajectories obtained by either scale were virtually superimposable in 90 % of subjects. In general, the lowest root-mean-square error or corrected Akaike information criterion was found with models which incorporated a time delay, defined as the fraction of maximum work or ventilation at which point a clear increase in ratings above resting level was reported.ConclusionsThe Dalhousie Dyspnea and Exertion Scales offer an equally good alternative to the Borg scale for measuring dyspnea and perceived exertion in adults.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Measuring Dyspnea and Perceived Exertion in Healthy Adults and with Respiratory Disease: New Pictorial Scales

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Finally, dyspnea ratings were not recorded because existing dyspnea scales had dubious validity in children when testing began in 2007. We recently published our validation studies in pediatric subjects (Pianosi et al, 2014, 2015), and found remarkable similarity in dyspnea ratings during exercise among healthy controls, subjects with asthma, or cystic fibrosis.…”

Section: Discussionmentioning

confidence: 98%

Ventilatory Limitation of Exercise in Pediatric Subjects Evaluated for Exertional Dyspnea

Pianosi

Smith

2019

Front. Physiol.

Self Cite

View full text Add to dashboard Cite

Purpose: Attribution of ventilatory limitation to exercise when the ratio of ventilation (trueV˙E) at peak work to maximum voluntary ventilation (MVV) exceeds 0.80 is problematic in pediatrics. Instead, expiratory flow limitation (EFL) measured by tidal flow-volume loop (FVL) analysis – the method of choice – was compared with directly measured MVV or proxies to determine ventilatory limitation.Methods: Subjects undergoing clinical evaluation for exertional dyspnea performed maximal exercise testing with measurement of tidal FVL. EFL was defined when exercise tidal FVL overlapped at least 5% of the maximal expiratory flow-volume envelope for > 5 breaths in any stage of exercise. We compared this method of ventilatory limitation to traditional methods based on MVV or multiples (30, 35, or 40) of FEV1. Receiver operating characteristic curves were constructed and area under curve (AUC) computed for peak trueV˙E/MVV and peak trueV˙E/x⋅FEV1.Results: Among 148 subjects aged 7–18 years (60% female), EFL was found in 87 (59%). Using EFL shown by FVL analysis as a true positive to determine ventilatory limitation, AUC for peak trueV˙E/30⋅FEV1 was 0.84 (95% CI 0.78–0.90), significantly better than AUC 0.70 (95% CI 0.61–0.79) when 12-s sprint MVV was used for peak trueV˙E/MVV. Sensitivity and specificity were 0.82 and 0.70 respectively when using a cutoff of 0.85 for peak trueV˙E/30⋅FEV1 to predict ventilatory limitation to exercise.Conclusion: Peak trueV˙E/30⋅FEV1 is superior to peak trueV˙E/MVV, as a means to identify potential ventilatory limitation in pediatric subjects when FVL analysis is not available.

show abstract

“…Although exertional dyspnea was the reason for exercise testing, dyspnea ratings were not sought due to concern for validity of Borg scales in pediatrics (Pianosi et al, 2014; Pianosi et al, 2015). Finally, level of habitual activity was not gauged nor were subjects grouped according to training status.…”

Section: Discussionmentioning

confidence: 99%

Flow limitation and dysanapsis in children and adolescents with exertional dyspnea

Pianosi

2018

Respiratory Physiology & Neurobiology

Self Cite

View full text Add to dashboard Cite

The consequence of dysanapsis, quantitated by dysanapsis ratio (DR), on expiratory flow limitation (EFL) during exercise in pediatric subjects was examined. EFL occurred in 80 (56%) subjects from an enriched sample of children and adolescents tested during investigation of exertional dyspnea. DR was lower in subjects with vs without EFL during exercise: (0.055 ± 0.015 vs 0.067 ± 0.017, p < 0.001), and lower ratio correlated with greater extent of EFL (r = -0.64, p < 0.001). EFL was seen more often in boys: 67% vs 46% (p = 0.01), as girls had higher DR (0.063 ± 0.016 vs 0.056 ± 0.018, p = 0.007). Lower FEV (95 ± 17 vs 102 ± 15%predicted, p < 0.005) and FEF (3.47 ± 1.28 vs 4.08 ± 1.20 L s, p = 0.002) distinguished those with vs without EFL. Inspiratory capacity rose (IC) steadily, as work increased among those with EFL, whereas it fell to back resting levels after an initial rise in subjects without EFL. Low DR predicts EFL in pediatric subjects. Adjusting operating lung volume during exercise can mitigate EFL but this strategy may contribute to exertional dyspnea.

show abstract

Dalhousie Pictorial Scales Measuring Dyspnea and Perceived Exertion during Exercise for Children and Adolescents

Abstract: Dalhousie Dyspnea and Perceived Exertion Scales offer an alternative to the Borg scale for use during exercise in pediatric subjects. Children and adolescents exhibit large variation in patterns of ratings of dyspnea and perceived exertion in incremental exercise.

Cited by 16 publications

References 31 publications

Measuring Dyspnea and Perceived Exertion in Healthy Adults and with Respiratory Disease: New Pictorial Scales

Measuring Dyspnea and Perceived Exertion in Healthy Adults and with Respiratory Disease: New Pictorial Scales

Ventilatory Limitation of Exercise in Pediatric Subjects Evaluated for Exertional Dyspnea

Flow limitation and dysanapsis in children and adolescents with exertional dyspnea

Contact Info

Product

Resources

About