Systematic Review and Meta-Analysis of the Relationship between Actual Exercise Intensity and Rating of Perceived Exertion in the Overweight and Obese Population

6-Minute Walk Test: Exploring Factors Influencing Perceived Intensity in Older Patients Undergoing Cardiac Rehabilitation-A Qualitative Study

Background/Objectives: In cardiac rehabilitation, the 6-minute walk test (6-MWT) is a standard assessment of initial evaluation. It measures walking distance as a surrogate of submaximal physical performance. Thereby, a subjective rating of perceived exertion, assessed by the Borg Scale, plays an important role. It has been observed that patients with coronary heart disease often rate themselves lower than the person supervising the test. Since this discrepancy might lead to inadequate exercise prescription, this study aims to explore reasons for low self-rating. Methods: In a qualitative study, influencing factors for low self-rating were collected from patients using interviews and questionnaires and from a focus group of physiotherapists. The evaluation was based on the grounded theory. Results: Self-image after retirement emerged as the central factor, as it shaped patients' behavior during the 6-MWT and their subsequent self-assessment. Additionally, five different categories of causal conditions were detected from ten patients and five therapists: fears, physical limitations, test instruction, testing conditions, and therapists' expectations. Conclusions: Patients with coronary heart disease had poor self-perception of exercise intensity and limited understanding of the meaning of the Borg Scale and the 6-MWT. Physiotherapists should place greater emphasis on patients' perceived exertion to be able to effectively tailor exercise prescription and, therefore, improve attainment of cardiac rehabilitation goals and long-term adherence.

Feasibility of a 12 weeks supervised exercise training intervention among people with Maturity Onset Diabetes of the Young (MODY) or type 2 diabetes in Greenland

Preventing and managing Type 2 diabetes (T2D) involves adopting healthy lifestyle habits such as balanced nutrition and regular exercise. Maturity Onset Diabetes of The Young (MODY) shares diagnostic characteristics with T2D, but exercise responses in MODY remain unclear. In Greenland, MODY is 4-5 times more common than in other countries. No established exercise regimen exists for either T2D or MODY in Greenland. This study assessed the feasibility of a 12-week supervised exercise programme for MODY and T2D in Greenland, focusing on attendance, satisfaction, and effects on cardiovascular disease (CVD) risk factors and quality of life (QoL). Conducted as an experimental, two-armed, controlled trial, nine participants (4 with MODY) engaged in prescribed training sessions twice weekly for 45-60 minutes, while another nine (4 with MODY) formed the control group. Key outcomes included adherence rates, satisfaction levels, changes in HbA1c, body composition, aerobic fitness, blood pressure, CVD risk factors, and SF-12 scores. Although training adherence was modest at 56%, participant satisfaction remained high. Notable findings included a slight decrease of -0.3 mmol/l in HDL-cholesterol and a 5.7-point increase in the mental component (MCS) of SF-12 within the intervention group. However, the study underscores the need to refine the study design before supervised exercise programmes can be widely implemented in clinical settings in Greenland.

The Rating of Perceived Exertion-Pediatric (RPE-P) Scale: Preliminary Validation

Physical activity is critical to functional rehabilitation for youth with chronic pain, which may be especially true for those with co-occurring obesity. To facilitate the development of physical activity interventions for youth with chronic pain, the newly developed "Rating of Perceived Exertion-Pediatric" scale was modeled after the widely used pain numeric rating scale-11. This study is an initial evaluation of the scale in a sample of adolescents (n = 157, 13-17 years, 51% female) with four subgroups: (1) healthy controls (healthy weight/no pain); (2) chronic pain/healthy weight; (3) obese (no pain); (4) chronic pain/obese. Participants rated perceived exertion using the new scale and the Borg 6-20 Scale of Perceived Exertion while holding a three-minute yoga pose (Warrior II). In the whole sample, the Perceived Exertion-Pediatric scale showed good concurrent (p < 0.001), convergent (all ps < 0.05), discriminant (p = 0.431), and known-groups validity (all ps < 0.05). The chronic pain subgroup also showed good concurrent (p < 0.001), mixed convergent (ps < 0.001 to 0.315), and good discriminant validity (p = 0.607). Limitations include the restricted age range, lack of diversity, and lack of test-retest reliability. The RPE-P shows promise as an assessment tool for perceived exertion in adolescents with and without chronic pain.

Changes in physical function and physical activity in patients up to 5 years after bariatric surgery

BACKGROUND

Bariatric surgery is effective for patients with severe obesity, but relatively little is known about long-term functional outcomes.

OBJECTIVE

To describe physical fitness and activity changes among bariatric surgery patients in a clinical trial of physical activity interventions through 5 years postoperatively.

SETTING

Large bariatric center in the midwestern United States.

METHODS

Preoperatively, 6 months, and 5 years after surgery, 42 bariatric surgery patients wore an accelerometer to track activity and completed strength and cardiovascular endurance testing via treadmill, where estimated metabolic equivalents (METs) and ratings of perceived exertion (RPEs) were obtained.

RESULTS

Preoperatively, 25% of patients reported exertion of <3 METs (equivalent to walking 2.5 mi/hr) as an RPE of 16 ("hard to very hard"). This decreased significantly to approximately 5% of patients 6 months and 5 years after surgery. Before surgery, 7.5% achieved ≥6 METs (vigorous activity) at an RPE of 16. This increased significantly to 36.6% at 6 months and 42.1% at 5 years after surgery. Body mass index and age, but no physical activity measure, predicted functional ability over time. The steps/d and exercise bout min/wk increased significantly from before surgery to 6 months postoperatively (4886.5 to 5948.5 steps and 23.8 to 66.6 bout min), but increases were not maintained at 5 years (5677.7 steps and 41.4 bout min). Conversely, moderate to vigorous min/ d increased progressively from before surgery (17.4) to 6 months (32.3) and 5 years (48.1) postoperatively.

CONCLUSIONS

Functional abilities of bariatric surgery patients increased postoperatively and were maintained over 5 years. However, treadmill testing suggests that most patients are still unable to perform sustained activities of 6 METs (vigorous) or greater. Research is needed on bariatric patients' long-term function- and intervention- optimizing outcomes.

Pregnancy Activity Levels and Impediments in the Era of COVID-19 Based on the Health Belief Model: A Cross-Sectional Study

Physical activity (PA) and exercise benefit both the mother and the fetus. Many pregnant women avoid or severely limit PA, leading to complications before and after delivery. This study elucidated the precise effect of each moderator variable on prenatal physical activity (PPA) by examining demographic factors, the PPA-related health belief level (HBL), and the current PPA level. The health belief model (HBM) in conjunction with the international prenatal physical activity questionnaire was used. The HBL in pregnant parous women (PPW) (3.42) was significantly higher than that in nonpregnant nulliparous women (NNW) (3.06). The PPA level in pregnant nulliparous women (PNW) (5.67 metabolic equivalent-hours per week (MET-h/week)) was lower than in the PPW (6.01 MET-h/week). All HBM dimensions (except for perceived barriers) were positively correlated with exercise expenditure in both PNW and PPW. According to the regression tree, participants in PNW aged ≤ 23 years with annual household incomes > CNY 100,001−150,000 had the highest energy expenditure (10.75 MET-h/week), whereas participants in PPW with a perceived benefit score of >4 had the highest energy expenditure (10 MET-h/week). The results demonstrated that the HBL in all groups was acceptable, whereas the PPA level was lower than the recommended PA level. In both PPW and PNW, the HBL was most strongly correlated with exercise expenditure. There is an urgent need to organize public-interest courses to alleviate household expenditure, raise the HBL about PPA in pregnant and NNW, and ensure personal health in the context of COVID-19.

A Comparison of Functional Features of Chinese and US Mobile Apps for Pregnancy and Postnatal Care: A Systematic App Store Search and Content Analysis

BACKGROUND

Pregnancy to postpartum (PtP) applications (apps) are becoming more common tools to document everything from pregnancy and delivery to nutrient allocation, life taboos, and infant medical examinations. However, the dependability, quality, and efficacy of these apps remain unclear. This study examined the features and functions of mobile PtP care apps accessible in China and the United States and to identify the major gaps that need to be addressed.

METHODS

Apps were selected by searching the Apple App Store and Android Markets (in the US and China) for the terms "pregnancy" and "postpartum" in Chinese and English. The apps' security, quality, and effectiveness were investigated, and chi-square tests and analysis of variance were performed to examine the differences in characteristics between apps available in the US and China.

RESULTS

A total of 84 mobile PtP care apps (45 from the US and 39 from China) were included. A total of 89.7% (35/39) of Chinese mobile apps did not provide safety statements or supporting evidence. The objective app quality ratings for Chinese and US apps were 3.20 ± 0.48 (mean ± standard deviation) and 3.56 ± 0.45, respectively (p > 0.05). A greater number of Chinese apps provided app-based monitoring functions, namely recording fetal size (n = 18, 46.2% in China vs. n = 3, 6.7% in the US), contractions (n = 11, 28.2% in China vs. n = 0, 0% in the US), pregnancy weight (n = 11, 28.2% in China vs. 0, 0% in the US), and pregnancy check-up reminders (n = 10, 25.6% in China vs. n = 0, 0% in the US). Meanwhile, a greater number of US apps provided exercise modules, namely pregnancy yoga (n = 2, 5.1% in China vs. n = 21, 46.7% in the US), pregnancy workouts (n = 2, 5.1% in China vs. n = 13, 28.9% in the US), and pregnancy meditation (n = 0, 0% in China vs. 10, 22.2% in the US) (p < 0.01). A medium security risk was identified for 40% (18/45) of apps in the US and 82.1% (32/39) of apps in China (p < 0.01).

CONCLUSIONS

The functionality and characteristics of in-store mobile apps for PtP care varied between China and the US. Both countries' apps, particularly Chinese apps, encountered issues related to a lack of evidence-based information, acceptable content risk, and program evaluations. Both countries' apps lacked proper mental health care functions. The findings suggest that the design of app features should be enhanced in both countries, and increased interaction between app creators and users is recommended.