Pneumologische Bewertung und Begutachtung im Spiegel von Beanspruchungskriterien

Abstract

Professional opinions on and assessments of physical performance must be oriented to the individual capacity of the person in question. Moreover, this performance has to be correlated with the expected physical load at work, sports activities or operative stress. This "Load to Capacity Concept" is already a part of an integrative medical assessment, based on clinical experience and common sense, rather than on diagnostic numerical values. An evaluation of work intensity in the context of socio-medical assessment ("light - moderate - severe - very severe", German Statutory Pension Insurance, based on the German REFAClassification) can now be complemented by well accessible and valid data based on measurements of real-life and professional activities. Also the ratio of continuous power in view of the maximal power output (V'O peak) and the power at the aerobic-anaerobic threshold (V'O at VT1) is well established. This information is gained by ergospirometry (CPET - Cardio Pulmonary Exercise Testing). The focus while interpreting the performance lies on Watt as a physical parameter and on O-consumption (V'O L/min) as the crucial biological correlate. V'O is presented as a direct value (L/min) or in complex values like MET (Metabolic Equivalent of Task) and calories (kcal).Recent studies can take advantage of technical progress in this field: rapid sensory measurement, convenient display in graphs and tables. In earlier literature there is ample information on working demands and energy expenditure, supplemented by V'O-data and MET (see Ainsworth et al.). These studies are helpful for orientation. However, it has to be kept in mind that these studies were done with technical possibilities available then, mostly in a laboratory setting, not under real-life conditions. Portable ergospirometry was not available at that time. Ergospirometry has already proved to be a useful tool in cases where expert opinion is required on compensation claims or questions of early retirement. Positive results of our study on "Occupational Activity of Cleaning Personnel in Clinics" are also reported here.

Physical workload and cardiopulmonary parameters in relation to individual capacity of bulk waste workers – a cross-sectional field-study

“…According to more recent publications, a maximum acceptable RAS of 33-40% . VO 2,max seems too low, since this value does not represent a physiologically reasonable limit in relation to thresholds such as the ventilatory threshold (VT1) or the lactate turning point 1 (LTP1) [3,[18][19][20]. The VT1 and LTP1 allow us to identify the individual turning point from aerobic to anaerobic metabolism and have therefore been proposed as indicators of heavy workload [20][21][22][23][24][25][26].…”