Test–Retest Reliability of a Modified Visual Analog Scale Assessment Tool for Determining Incidence and Severity of Gastrointestinal Symptoms in Response to Exercise Stress

Abstract

Considering the recent growth of exercise gastroenterology research focusing on exercise-induced gastrointestinal syndrome mechanisms, response magnitude, prevention and management strategies, the standardized assessment of gastrointestinal symptoms (GIS) is warranted. The current methodological study aimed to test the reliability of a modified visual analog scale for assessing GIS during exercise, in response to a variety of exertional-stress scenarios, with and without dietary intervention. Recreational endurance runners (n = 31) performed one of the three exercise protocols, which included: 2-hr running at 70% in temperate (24.7 °C) ambient conditions, with fluid restriction; 2-hr running at 60% in hot (35.1 °C) ambient conditions, while consuming chilled water immediately before and every 15 min during exercise; and 2-hr running at 60% in temperate (23.0 °C) ambient conditions, while consuming 30 g/20 min carbohydrate (2∶1 glucose∶fructose, 10% temperate w/v), followed by a 1-hr distance test. GIS was monitored pre-exercise, periodically during exercise, and immediately postexercise. After wash out, participants were retested in mirrored conditions. No significant differences (p > .05) were identified between test–retest using Wilcoxon signed-rank test for all GIS (specific and categorized), within each exercise protocol and the combined protocols. Strong correlations were observed for gut discomfort, total GIS, upper GIS, and nausea (rs = .566 to rs = .686; p < .001), but not for lower GIS (rs = .204; p = .232). Cohen’s magnitude of difference was minimal for all GIS (specific δ < 0.14 and categorized δ < 0.08). The modified visual analog scale for assessing GIS during exercise appears to be a reliable tool for identifying incidence and severity of GIS in cohort populations and is sensitive enough to detect exertional and intervention differences.

Is the gut microbiota bacterial abundance and composition associated with intestinal epithelial injury, systemic inflammatory profile, and gastrointestinal symptoms in response to exertional-heat stress?

“…Participants were provided with a diet low FODMAP diet that met their estimated total daily energy expenditure for the 24-h period before each experimental trial (11.3 ± 1.3 MJ, 440 ± 67 g carbohydrate, 110 ± 8 g protein, 63 ± 8 g fat) to reduce gastrointestinal symptoms arising from pre-exercise food and fluid intake. 18,19 Participants were asked to refrain from consuming additional high-FODMAP foods, alcohol, and caffeinated beverages during the diet-controlled period, and refrained from strenuous exercise during the 48-h period before the experimental trial. Compliance was determined by a dietary and exercise log.…”

Addition of pectin-alginate to a carbohydrate beverage does not maintain gastrointestinal barrier function during exercise in hot-humid conditions better than carbohydrate ingestion alone

“…Subjective ratings of perceived exertion (Borg 1982), thermal sensation (Tikuisis et al 2002) and thermal comfort (ASHRAE 2004) were collected at rest and at 10 minute intervals throughout exercise. At 30 min intervals participants were asked to fill out a short questionnaire regarding the presence of GI problems at that moment (Gaskell et al 2019).…”

Gastrointestinal Tolerance of Low, Medium and High Dose Acute Oral l-Glutamine Supplementation in Healthy Adults: A Pilot Study

“…Subjective perception of GI symptoms was measured using a modified visual analogue scale (mVAS) [ 22 ]. The mVAS is a 20-item questionnaire of common GI symptoms that range from 0 (absent), through 1–4 (mild GI symptoms that did not interfere with current activity), then 5–9 (severe GI symptoms that disrupted activity) to 10 (extremely severe GI symptoms) along a 10-point scale.…”

“…Miscellaneous symptoms (nausea, dizziness, stitch and GI discomfort) were only analysed individually. This grouping technique follows current recommendations [ 22 ]. Symptom incidence was indicative of scores rated ≥1 and severity indicative of the mean accumulated score of all reported symptoms ≥1.…”

“…Statistical significance was accepted at the alpha level of p ≤ 0.05. Symptom severity are presented as mean ± range of accumulated scores for consistency with published guidance [ 22 ].…”