Is There a Relationship Between Metabolic Equivalence and the SYNTAX Score as Strong Prognostic Markers?

OBJECTIVE: The metabolic equivalent (MET) and Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score are two parameters with known cardiovascular prognostic significance. In this study, we aimed to investigate the direct relationship between MET and SYNTAX score in patients with chronic coronary syndrome (CCS). METHOD: This retrospective study included 200 patients over 18 years of age who underwent coronary angiography and had a positive exercise electrocardiography test result. Patients were divided into two groups: Group 1 with a low SYNTAX score and Group 2 with a medium-high SYNTAX score. MET values were then compared between these groups. RESULTS: Baseline demographic characteristics and laboratory values were similar between the groups. The mean MET values in the low and medium-high SYNTAX score groups were 9.36 ± 2.38 and 8.78 ± 2.43, respectively. No statistical difference was observed (P = 0.086). Additionally, there was no statistical difference between the two groups in terms of MET values being 10 ≤ or 10 > (P = 0.172). CONCLUSION: The main conclusion of our study is that there is no correlation between the SYNTAX score and functional MET value in CCS.

Determination of moderate walking intensity using step rate and VO2 reserve in healthy men.

OBJECTIVE: This study investigated step rates (SR) during overground walking to estimate the relative aerobic capacity that corresponds to a moderate intensity. METHODS: The present study utilized a repeated measure, within-subjects design incorporating a counterbalanced order. A total of twenty-three healthy men walked on a 119-meter oval track with artificial turf at self-selected pace (FP), 100, 120, and 140 steps/min for 6 min each while oxygen uptake (VO2), speed (in km/h), distance (in m), and steps (in steps/min) were measured. RESULTS: During FP, participants walked an average cadence of 117 ± 9.3 steps/minclose to 120 steps/min, which corresponds to 4.7 metabolic equivalents (METs). The estimated VO2 reserve was 30.5% of VO2 reserve at the FP and was close to the 120 steps/min of 33.3%. At the 100 and 140 steps/min, the VO2 reserve were 24.1% and 45.2%, respectively. The regression analysis revealed that an SR of 88.2 elicited 3METs and 17.1% of VO2reserve. Additionally, an SR of 129 elicited 5.9METs and 40% of VO2 reserve. CONCLUSIONS: This study demonstrated that a moderate walking intensity for young, healthy men corresponded to 128.9 steps per minute. A range of 120 ~ 140 steps/min for walking could be recommended as a general guideline for moderate-intensity exercise. However, concerning providing public guidelines, caution should be taken regarding determining the moderate walking intensity due to the individual's fitness level.

Pre-stroke physical activity is associated with post-stroke physical activity and sedentary behavior in the acute phase.

This study investigated the link between pre-stroke and acute-stage physical activity (PA) and sedentary behavior. Forty individuals with stroke (aged 73.6 ± 8.9 years) were enrolled. Post-stroke activity, including metabolic equivalents (METs), sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA), was measured using a tri-axial accelerometer (ActiGraph wGT3X-BT) over 11 consecutive days starting from the 4th day post-stroke. Pre-stroke PA levels were assessed using the International Physical Activity Questionnaire (IPAQ). We measured skeletal muscle mass index (SMI) and phase angle using a bioelectrical impedance analyzer (Inbody S10) upon admission. Physical therapists assessed the Brunnstrom recovery stage (BRS) within 3 days post-stroke. Total daily activity averaged 1.05 ± 0.05 METs. Throughout the day, 91.2 ± 5.1, 7.6 ± 4.1, and 1.2 ± 1.3% was spent in sedentary behavior, light PA, and MVPA, respectively. Only pre-stroke PA was independently associated with METs (ß = 0.66), sedentary behavior (ß = -0.58), light PA (ß = 0.50), and MVPA (ß = 0.71) after adjusting for age, sex, stroke severity, and activities of daily living. This suggests that pre-stroke PA might play a crucial role in reducing sedentary behavior and promoting PA during the acute phase.

Assessing human internal exposure to chemicals at different physical activity levels: A physiologically based kinetic (PBK) model incorporating metabolic equivalent of task (MET).

Physical activity levels have the potential to impact human internal exposure to environmental chemicals. However, the current lack of simple modeling approaches hinders the high-throughput screening of chemical exposure at different physical activity levels. To address this gap, this study proposes a straightforward model for assessing human internal exposure to chemicals. Our approach is based on the physiologically based kinetic (PBK) model and utilizes the metabolic equivalent of task (MET) to characterize internal exposure to chemicals at varying activity levels. To facilitate the application of this model, we have developed an Excel-based operation tool, allowing users to easily modify the MET value and generate simulation results for different physical activity levels. The simulation results demonstrate that as physical activity levels increase, the biotransfer factors (BTFs) of chemicals decrease, suggesting that higher physical activity levels reduce the bioaccumulation potential of chemicals. The intensified physical activity enhances the overall elimination kinetics of chemicals from the human body. However, the simulated concentrations of chemicals in the human body increase with higher physical activity levels, due to the significantly increased external exposure to chemicals, such as through inhalation. Our proposed modeling approach, along with the operational tool, enables high-throughput simulation of human chronic internal exposure to chemicals at different physical activity levels, where the findings can assist in screening chemicals for further health risk assessment. To accomplish this, the model incorporates certain assumptions and utilizes generic model input values. However, due to the intricate nature of the interaction between external and internal exposures at different physical activity levels, validating the simulation through experimental studies becomes challenging and is not performed in this study. For future studies, we recommend incorporating more MET-related physiological input variables, improving energy balance estimates, comprehending external exposure estimates, and conducting cohort studies to enhance and validate the proposed modeling approach.

Cadence (steps/min) and relative intensity in 61 to 85-year-olds: the CADENCE-Adults study.

BACKGROUND: We previously demonstrated that a heuristic (i.e., evidence-based, rounded yet practical) cadence threshold of ≥ 100 steps/min was associated with absolutely-defined moderate intensity physical activity (i.e., ≥ 3 metabolic equivalents [METs]) in older adults 61-85 years of age. Although it was difficult to ascertain achievement of absolutely-defined vigorous (6 METs) intensity, ≥ 130 steps/min was identified as a defensible threshold for this population. However, little evidence exists regarding cadence thresholds and relatively-defined moderate intensity indicators, including ≥ 64% heart rate [HR] maximum [HRmax = 220-age], ≥ 40% HR reserve [HRR = HRmax-HRresting], and ≥ 12 Borg Scale Rating of Perceived Exertion [RPE]; or vigorous intensity indicators including ≥ 77%HRmax, ≥ 60%HRR, and ≥ 14 RPE. PURPOSE: To analyze the relationship between cadence and relatively-defined physical activity intensity and identify relatively-defined moderate and vigorous heuristic cadence thresholds for older adults 61-85 years of age. METHODS: Ninety-seven ostensibly healthy adults (72.7 ± 6.9 years; 49.5% women) completed up to nine 5-min treadmill walking bouts beginning at 0.5 mph (0.8 km/h) and progressing by 0.5 mph speed increments (with 2-min rest between bouts). Directly-observed (and video-recorded) steps were hand-counted, HR was measured using a chest-strapped monitor, and in the final minute of each bout, participants self-reported RPE. Segmented mixed model regression and Receiver Operating Characteristic (ROC) curve analyses identified optimal cadence thresholds associated with relatively-defined moderate (≥ 64%HRmax, ≥ 40%HRR, and ≥ 12 RPE) and vigorous (≥ 77%HRmax, ≥ 60%HRR, and ≥ 14 RPE) intensities. A compromise between the two analytical methods, including Youden's Index (a sum of sensitivity and specificity), positive and negative predictive values, and overall accuracy, yielded final heuristic cadences. RESULTS: Across all relatively-defined moderate intensity indicators, segmented regression models and ROC curve analyses identified optimal cadence thresholds ranging from 105.9 to 112.8 steps/min and 102.0-104.3 steps/min, respectively. Comparable values for vigorous intensity indicators ranged between126.1-132.1 steps/min and 106.7-116.0 steps/min, respectively. Regardless of the relatively-defined intensity indicator, the overall best heuristic cadence threshold aligned with moderate intensity was ≥ 105 steps/min. Vigorous intensity varied between ≥ 115 (greater sensitivity) or ≥ 120 (greater specificity) steps/min. CONCLUSIONS: Heuristic cadence thresholds align with relatively-defined intensity indicators and can be useful for studying and prescribing older adults' physiological response to, and/or perceived experience of, ambulatory physical activity. TRIAL REGISTRATION: Clinicaltrials.gov NCT02650258. Registered 24 December 2015.

Demographic variables, anthropometric indices, sleep quality, Metabolic Equivalent Task (MET), and developing diabetes in the southwest of Iran.

Propose: The present study has sought to investigate the prevalence of diabetes and its related risk factors, to examine the relationship between demographic variables, anthropometric indices, sleep quality, and Metabolic Equivalent Task (MET) with diabetes in Khuzestan province, southwest Iran. Methods: The present study has a cross-sectional design (the baseline data of the Hoveyzeh cohort study as a sub-branch of the Persian Prospective Cohort Study). Comprehensive information from 10,009 adults (aged 35-70 years) was collected from May 2016 to August 2018 through a multi-part general questionnaire containing general characteristics, marital status, education, smoking, sleep quality, MET, and anthropometric indices. Data analysis was performed by SPSS software version 19. Results: The mean age of the sample was 52.97 ± 8.99 years. 60.3% of the population were women and 67.7% were illiterate. Out of the 10,009 people surveyed, 1,733 stated that they have diabetes (17%). In 1,711 patients (17%) the amount of FBS was ≥126 mg/dl. There is a statistically significant relationship between diabetes and MET. More than 40% had BMI above 30. Anthropometric indices in diabetic and non-diabetic individuals were different. Also, there was a statistically significant difference between the mean duration of sleep and the use of sleeping pills in diabetic and non-diabetic groups (p < 0.05). Based on logistic regression, marital status [OR = 1.69 (95% CI, 1.24, 2.30)], education level [OR = 1.49 (95% CI, 1.22, 1.83)], MET [OR = 2.30 (95% CI, 2.01, 2.63)], height [OR = 0.99 (95% CI, 0.98, 0.99)], weight [OR = 1.007 (95% CI, 1.006, 1.012)], wrist circumference [OR = 1.10 (95% CI, 1.06, 1.14)], waist circumference [OR = 1.03 (95% CI, 1.02, 1.03)], waist-to-hip ratio [OR = 3.41 (95% CI, 2.70, 4.29)], and BMI [OR = 2.55 (95% CI, 1.53, 4.25)], are good predictors for diabetes. Conclusion: The results of this study showed that the prevalence of diabetes in Hoveyzeh city, Khuzestan, Iran, was almost high. and emphasize that preventive interventions should focus on risk factors, especially socioeconomic status, and anthropometric indicators along with lifestyle.

Moderate-intensity stepping in older adults: insights from treadmill walking and daily living.

BACKGROUND: A step cadence of 100 steps/minute is widely used to define moderate-intensity walking. However, the generalizability of this threshold to different populations needs further research. We investigate moderate-intensity step cadence values during treadmill walking and daily living in older adults. METHODS: Older adults (≥ 60 years) were recruited from urban community venues. Data collection included 7 days of physical activity measured by an activPAL3™ thigh worn device, followed by a laboratory visit involving a 60-min assessment of resting metabolic rate, then a treadmill assessment with expired gas measured using a breath-by-breath analyser and steps measured by an activPAL3™. Treadmill stages were undertaken in a random order and lasted 5 min each at speeds of 1, 2, 3, 4 and 5 km/h. Metabolic equivalent values were determined for each stage as standardised values (METSstandard) and as multiples of resting metabolic rate (METSrelative). A value of 3 METSstandard defined moderate-intensity stepping. Segmented generalised estimating equations modelled the association between step cadence and MET values. RESULTS: The study included 53 participants (median age = 75, years, BMI = 28.0 kg/m2, 45.3% women). At 2 km/h, the median METSstandard and METSrelative values were above 3 with a median cadence of 81.00 (IQR 72.00, 88.67) steps/minute. The predicted cadence at 3 METSstandard was 70.3 (95% CI 61.4, 75.8) steps/minute. During free-living, participants undertook median (IQR) of 6988 (5933, 9211) steps/day, of which 2554 (1297, 4456) steps/day were undertaken in continuous stepping bouts lasting ≥ 1 min. For bouted daily steps, 96.4% (90.7%, 98.9%) were undertaken at ≥ 70 steps/minute. CONCLUSION: A threshold as low as 70 steps/minute may be reflective of moderate-intensity stepping in older adults, with the vast majority of all bouted free-living stepping occurring above this threshold.

Unveiling the Relationships Between Seismocardiogram Signals, Physical Activity Types and Metabolic Equivalent of Task Scores.

OBJECTIVE: The diagnosis of metabolic syndrome and cardiovascular disorders can highly benefit from physical activity and energy expenditure assessment. In this study, we investigated the relationship between metabolic equivalent of task (MET) scores and seismocardiogram (SCG)-derived parameters. METHODS: We worked with the PAMAP2 dataset and focused on the 3-axial chest acceleration data. We first segmented the 3-axial SCG signals into respiration (0-1 Hz), cardiac vibrations (1-20 Hz) and heart sounds (20-40 Hz) components. Additionally, we investigated their combinations: 0-20 Hz, 1-40 Hz and 0-40 Hz. We then windowed each signal, and extracted time and frequency domain features from each window. Using the MET scores and activity types, we trained linear regression and random forest classification models first using 80-20% split, then with leave-one-subject-out cross-validation (LOSO-CV). Additionally, we investigated the significance of each feature and axis. RESULTS: For the 80-20% task, the best performing frequency bands were 0-1 Hz, 0-20 Hz, and 0-40 Hz, which yielded a (MET mean-squared-error, classification accuracy) pair of (0.354, 0.952), (0.367, 0.904), and (0.377, 0.914), respectively. When LOSO-CV was applied, we obtained (1.059, 0.865), (0.681, 0.868), and (0.804, 0.875) for each band, respectively. Additionally, our results revealed that the lateral axis provides the most critical information about cardiorespiratory effect of performed activities. CONCLUSION: Different SCG components can provide unique and substantial contributions to activity and energy expenditure assessment. SIGNIFICANCE: This framework can be leveraged in the design of wearable systems for monitoring the activity and energy expenditure levels, and understanding their relationship with underlying cardiorespiratory parameters.

Cadence-based classification of moderate-intensity overground walking in 41- to 85-year-old adults.

BACKGROUND: Walking cadence (steps/min) has emerged as a valid proxy of physical activity intensity, with consensus across numerous laboratory-based treadmill studies that ≥100 steps/min approximates absolutely defined moderate intensity (≥3 metabolic equivalents; METs). We recently reported that this cadence threshold had a classification accuracy of 73.3% for identifying moderate intensity during preferred pace overground walking in young adults. The purpose of this study was to evaluate and compare the performance of a cadence threshold of ≥100 steps/min for correctly classifying moderate intensity during overground walking in middle- and older-aged adults. METHODS: Participants (N = 174, 48.3% female, 41-85 years of age) completed laboratory-based cross-sectional study involving an indoor 5-min overground walking trial at their preferred pace. Steps were manually counted and converted to cadence (total steps/5 min). Intensity was measured using indirect calorimetry and expressed as METs. Classification accuracy (sensitivity, specificity, accuracy) of a cadence threshold of ≥100 steps/min to identify individuals walking at ≥3 METs was calculated. RESULTS: The ≥100 steps/min threshold demonstrated accuracy of 74.7% for classifying moderate intensity. When comparing middle- vs. older-aged adults, similar accuracy (73.4% vs. 75.8%, respectively) and specificity (33.3% vs. 34.5%) were observed. Sensitivity was high, but was lower for middle- vs. older-aged adults (85.2% vs. 93.9%, respectively). CONCLUSION: A cadence threshold of ≥100 steps/min accurately identified moderate-intensity overground walking. Furthermore, accuracy was similar when comparing middle- and older-aged adults. These findings extend our previous analysis in younger adults and confirm the appropriateness of applying this cadence threshold across the adult lifespan.

Role of metabolic equivalent between calcium intake and vertebral fractures: a cross-sectional study of NHANES 2013-2014.

BACKGROUND: This study was to analyze the association of calcium intake and metabolic equivalent (MET) with vertebral fractures, and to explore the role of MET between calcium intake and vertebral fractures. METHOD: This cross-sectional study used data from the National Health and Nutrition Examination Surveys (NHANES) 2013-2014. The study involved individuals aged ≥ 50 years old with complete information on vertebral fracture, calcium intake, and physical activity. Vertebral fracture assessment is obtained using dual-energy x-ray absorptiometry to perform a lateral scan of the thoracolumbar spine. Calcium intake included total nutrient intake and total dietary supplements. The total MET is the sum of the METs for each activity (Vigorous/ moderate work-related activities, walking or bicycling for transportation and vigorous/ moderate recreational activities). Univariate and multivariate logistic regression analyses were utilized to investigate the effect of calcium intake, MET, and their combined effect on vertebral fracture. RESULTS: A total of 766 participants were included in the analysis, and 54 participants had vertebral fractures. The median calcium intake and MET were 8.43 mcg and 280.00, respectively. Multivariate results showed that neither calcium intake nor MET as continuous or categorical variables was significantly associated with vertebral fractures. MET < 160 and calcium intake ≥ 670 mg group was associated with the decreased risks of vertebral fracture [odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.26-0.83, P = 0.032] after adjusting for age, race, energy, total femur bone mineral density (BMD), and femoral neck BMD. In the group of MET < 160, increased calcium intake was associated with a reduced risk of vertebral fracture, with a decreased OR value. In the group of MET ≥ 160, increased calcium intake was associated with an increased risk of vertebral fracture, with an increased OR value. CONCLUSION: The combination of MET < 160 and calcium intake ≥ 670 mg was associated with decreased risks of vertebral fractures. There may be an interaction between calcium intake and MET on vertebral fracture risk.

The association between metabolic equivalent and visceral adiposity index among children and adolescents: Ten-cycle cross-sectional study on NHANES (1999-2018).

Metabolic disorder is globally prevalent in children and adolescents, and physical activity may have a protective role against metabolic disorder. However, the association between metabolic equivalent (MET) and visceral adiposity index (VAI) among children and adolescents remains unclear. This study aimed to address this concern. Data were retrieved from the National Health and Nutrition Examination Survey (NHANES), which used the Global Physical Activity Questionnaire to assess the physical activity levels. VAI was calculated according to body mass index (BMI), waist circumference (WC), triglyceride (TG), and high-density lipoprotein (HDL). Linear regression was adopted to assess the association between MET and VAI. Restricted cubic spline regression was used to further explore the nonlinear relationship, Interaction effect analysis was conducted to identify whether the sample characteristic could modify the effect of MET on VAI. After data cleansing, a total of 3402 participants aged <18 years were enrolled. In the fully adjusted linear regression model, the ß for VAI was 0.01 (95% confidence interval [CI]: -0.08, 0.09) for the second tertile and -0.11 (95% CI: -0.20, -0.03) for the third tertile. A linear downward trend was found in the restricted cubic spline regression (overall P < .05). Interaction effect analysis revealed no significant effects of age, gender, race, income poverty ratio, and insurance (all P for interaction >0.05). High physical activity intensity is associated with decreased VAI scores in children and adolescents.

Association between Physical Activity and 32 Chronic Conditions among Spanish Adults.

The objective was to analyse the association between physical activity and the risk of suffering from 32 chronic conditions using a large representative sample of Spanish adults. We utilised the dataset of the last edition of the Spanish National Health Survey, which was conducted in the year 2017. This dataset included a total of 23,089 adults between the ages of 15 and 103 years. The average age was 53.4 years (standard deviation 18.9 years). Regarding sex distribution, 54.1% of the participants were females. The instrument used to measure physical activity was the short form of the international physical activity questionnaire. The question used to evaluate if the participants suffered from chronic conditions was "Have you ever been diagnosed with chronic condition?". This question was asked for 32 different chronic conditions. The association between low levels of physical activity (exposure) and chronic conditions (outcome) was assessed with multivariable logistic regression analyses. The highest prevalence of chronic conditions was found in the group doing less than 600 MET (metabolic equivalent of task)-min/week of physical activity (in 28 of the 32 conditions analyzed). The lowest prevalence was in the group doing at least 1200 MET-min/week (in 30 of the 32). Adjusted multivariable logistic regression analyses showed that less than 600 MET-min/week of physical activity was significantly associated with a higher risk of 19 chronic conditions. All these significant associations, except for hypertension, were also maintained in those doing less than 1200 MET-min/week. In conclusion, higher physical activity is a protective factor against the risk of suffering from chronic conditions, with the lowest prevalence of chronic conditions in people doing more than 1200 MET-min/week. International physical activity guidelines should recommend at least 1200 MET-min/week to prevent the risk of chronic conditions.

Los equivalentes metabólicos estimados no se relacionan con el consumo máximo de oxígeno calculado en pacientes candidatos a cirugía de resección pulmonar / Estimated metabolic equivalents of task do not correlate with the maximal oxygen consumption of patients undergoing lung resection surgery

Antecedentes y objetivo: Los equivalentes metabólicos (MET) son una medida fisiológica que representa el coste metabólico de una actividad de la vida cotidiana. Un MET equivale al consumo metabólico en reposo. Los MET se pueden estimar mediante cuestionarios o calcular a partir de la medida del máximo consumo de oxígeno (VO2máx). El objetivo de este estudio es determinar si existe concordancia entre los MET estimados en la consulta de preanestesia (METSe) con los MET calculados a partir de VO2máx (METVO2). Pacientes y métodos: Estudio observacional retrospectivo en pacientes candidatos a cirugía de resección pulmonar. La estimación de los METSe se obtuvo en la consulta de preanestesia de acuerdo a las guías europeas y americanas de valoración cardiovascular preoperatoria en cirugía no cardiaca de 2014. El VO2máx se calculó en el laboratorio de ergometría. Resultados: Se incluyeron un total de 104 pacientes en el estudio, de los que 25 (24%) eran mujeres. La edad media fue de 65,1 años (±9,8). Veintiséis pacientes (25%) presentaron una clasificación concordante de METSe con METVO2 (κ=−0,107; p=0,02). En el resto de los pacientes, los METSe sobreestimaron la capacidad funcional medida por ergometría (METSe>METVO2). Conclusiones: La valoración subjetiva sobreestima la capacidad funcional y no debe reemplazar la realización de pruebas objetivas en pacientes propuestos para cirugía de resección pulmonar.(AU)

Background and objective: Metabolic equivalent of task (MET) is a physiological measure that represents the metabolic cost of an activity of daily living. One MET is equivalent to the resting metabolic rate. METs can be estimated by questionnaires or calculated by measuring maximal oxygen uptake (VO2max). The aim of this study is to determine whether METs estimated in the pre- consultation (METse) correlates with METs calculated from VO2max (METsVO2). Patients and methods: Retrospective observational study in patients scheduled for lung resection surgery. The estimation of METs was obtained in the pre- consultation according to the 2014 European and American guidelines for preoperative cardiovascular assessment in non-cardiac surgery. VO2max was calculated in the ergometry laboratory. Results: A total of 104 patients were included in the study, of whom 25 (24%) were female. The mean age was 65.1 years (±9.8). In 26 patients (25%), the METse classification correlated with METsVO2 (κ=−0.107; P=0.02). In the remaining patients, METse overestimated functional capacity measured by ergometry (METse>METsVO2). Conclusions: Subjective assessment overestimates functional capacity and should not replace objective testing in patients scheduled for lung resection surgery.(AU)

Classification of moderate-intensity overground walking speed in 21- to 85-year-old adults.

The Compendium of Physical Activities reports that walking at 2.5 mph associates with absolutely-defined moderate intensity (i.e., ≥3 metabolic equivalents [METs]). However, it is unclear whether this speed threshold is accurate during overground walking and/or across the adult age-span. This study aimed to identify optimal and heuristic speed thresholds associated with 3 METs during overground walking across age groups. Healthy adults (n = 248, 21-85 years old, 49% women) performed a 5-minute self-paced overground walking trial. Speed was measured using an electronic gait mat, and oxygen uptake was measured using indirect calorimetry and converted to METs. Optimal and heuristic thresholds and classification accuracy metrics were determined and compared using ROC curve analyses. Speed thresholds (95% CIs) associated with 3 METs for the whole sample, young (21-40 years), middle-aged (41-60 years) and older-aged (61-85 years) groups were 1.29 (1.25, 1.33), 1.30 (1,26, 1,35), and 1.25 (1.21, 1.29) m/s, respectively. Overall, 3 mph and 5 km/h performed better than 2.5 mph and 4.5 km/h in balancing both sensitivity and specificity (higher Youden's Indices). Overground walking speeds associated with 3 METs were similar across age groups. A heuristic threshold of 3 mph or 5 km/h may better identify absolutely-defined moderate intensity overground walking.

Estimated metabolic equivalents of task do not correlate with the maximal oxygen consumption of patients undergoing lung resection surgery.

BACKGROUND AND OBJECTIVE: Metabolic equivalent of task (MET) is a physiological measure that represents the metabolic cost of an activity of daily living. One MET is equivalent to the resting metabolic rate. METs can be estimated by questionnaires or calculated by measuring maximal oxygen uptake (VO2max). The aim of this study is to determine whether METs estimated in the pre-consultation (METse) correlates with METs calculated from VO2max (METsVO2). PATIENTS AND METHODS: Retrospective observational study in patients scheduled for lung resection surgery. The estimation of METs was obtained in the pre-consultation according to the 2014 European and American guidelines for preoperative cardiovascular assessment in non-cardiac surgery. VO2max was calculated in the ergometry laboratory. RESULTS: A total of 104 patients were included in the study, of whom 25 (24%) were female. The mean age was 65.1 years (±9.8). In 26 patients (25%), the METse classification correlated with METsVO2 (κ = -0.107 P = .02). In the remaining patients, METse overestimated functional capacity measured by ergometry (METse > METsVO2). CONCLUSIONS: Subjective assessment overestimates functional capacity and should not replace objective testing in patients scheduled for lung resection surgery.

Relation of a Maximal Exercise Test to Change in Exercise Tolerance During Cardiac Rehabilitation.

The purpose of this study was to test the hypothesis that an individualized exercise training target heart rate (HR) based on a maximal graded exercise test (GXT) is associated with greater improvements in exercise tolerance during cardiac rehabilitation (CR) compared with no GXT. In this retrospective study, we identified patients who completed 9 to 36 visits of CR between 2001 and 2016, with a length of stay ≤18 weeks and a visit frequency of 1 to 3 days per week. Patients were grouped based on whether their exercise was guided by a target HR determined from a GXT. To assess the relation between GXT and change in exercise training metabolic equivalents of task (METs), we used generalized linear models adjusted for age, gender, race, referral reason, CR visits, CR frequency, METs at start, CR location, and year of participation. Out of 4,455 patients (37% female, 48% White, median age = 62 years), 53% were prescribed a target HR based on a GXT. Compared with no GXT, a GXT was associated with a significantly greater increase in covariate-adjusted METs during CR and percentage change from start (+0.44 METs [95% confidence interval [CI] 0.38 to 0.51] and +17% [95% CI 14% to 19%], respectively). In a sensitivity analysis limited to patients with 24 to 36 visits at ≥2 days per week (n = 1,319), a GXT was associated with a significantly greater increase in covariate-adjusted exercise training METs (+0.51 [95% CI 0.36 to 0.66]; +19% [95% CI 13% to 24%]). In conclusion, to maximize the potential increase in exercise capacity during CR, patients should undergo a GXT to determine an individualized exercise training target HR.

A Higher Phase Angle Is Associated with Greater Metabolic Equivalents in Women 1 Year After Bariatric Surgery.

BACKGROUND: Phase angle (PhA), proposed as an indicator of the number, integrity, and function of cells and evaluated in some clinical situations, decreases after bariatric surgery (BS). In contrast, higher values are found in physically active or exercising individuals. We therefore evaluated the influence of physical activity on PhA after BS. METHODS: The PhA and body composition (obtained by bioelectrical impedance analysis), physical activity level (obtained by International Physical Activity Questionnaire), and metabolic equivalents (METs) were evaluated in adult women submitted to BS. The PhA and body composition were evaluated at three time points: before and 6 and 12 months after surgery. Physical activity level and METs were measured at the two postoperative time points. RESULTS: A reduction in PhA was observed 6 (p < 0.01) and 12 months (p < 0.01) after BS, with no significant difference between time points. A moderate or high physical activity level was found in 81% of the volunteers after 6 months and in 65% after 12 months. METs were reduced after 12 months compared to 6 months. A positive correlation (p < 0.05) was observed between PhA and body cell mass after surgery. There was a significant positive correlation (p < 0.01) between PhA and METs after 12 months. CONCLUSIONS: Physical activity may attenuate the PhA reduction that occurs after BS, with this parameter reflecting the engagement of these patients in this type of activity.

Association between behavioral patterns and mortality among US adults: National Health and Nutrition Examination Survey, 2007-2014.

Few large-scale studies have been conducted to show the joint effects of mortality associated with physical activity and sedentarism. Therefore, we examined the relationship between all-cause mortality and behavioral patterns among adults in the United States. Data of 17,730 non-institutionalized US civilians aged ≥20 years were extracted from the 2007-2014 National Health and Nutrition Examination Survey. We set the criteria for metabolic equivalents as 600 according to the WHO guideline, and sedentary time as 300 min/day according to the median. The Cox proportional hazards model was adjusted for demographic and lifestyle characteristics. During the 58.54±28.18 months follow-up, all-cause mortality rate was 4% and heart-related and cancer mortality rate was 1%. Participants in the high metabolic equivalents and low sedentary time group had a lower risk of all-cause (hazard ratio = 0.41, 95% confidence interval = 0.34-0.50), cardiovascular (hazard ratio = 0.36; 95% confidence interval = 0.23-0.55), and cancer (hazard ratio = 0.55; 95% confidence interval = 0.37-0.83) mortality, compared to those in the low metabolic equivalents and high sedentary time group. Sufficient physical activity and less sedentary behavior reduce all-cause and cause-specific mortality in adults in the United States, especially cardiovascular mortality among the elderly. Additional nationwide policies to improve behavioral patterns among adults need to be implemented in the United States.

Leisure-Time and Transport-Related Physical Activity and the Risk of Mortality: The CRONICAS Cohort Study.

BACKGROUND: The long-term health association of the leisure-time and transport-related physical activity domains of the International Physical Activity Questionnaire have not been established in Latin American settings. The authors aimed to quantify the 7-year all-cause mortality risk associated with levels of leisure-time and transport-related physical activity. METHODS: Ongoing prospective cohort study conducted in 4 sites in Peru. People ≥35 years were randomly selected from the general population in each study site. The exposures were leisure-time and transport-related physical activity (International Physical Activity Questionnaire) at baseline. The outcome was all-cause mortality based on information retrieved from national records. Cox regression and sensitivity analyses were conducted. RESULTS: There were 3601 people (mean age 55.8 y, 51.5% women). Greater levels of physical activity were associated with lower risk of all-cause mortality, an observation confirmed in sensitivity analyses. Compared with those with low levels of physical activity, leisure-time (≥500 metabolic equivalent of task minutes per week) and transport-related (500-1499 and ≥1500 metabolic equivalent of task minutes per week) physical activity were associated with 70% (95% confidence interval, 3%-90%), 43% (95% confidence interval, 18%-61%), and 42% (95% confidence interval, 8%-63%) lower all-cause mortality, respectively. CONCLUSIONS: Greater levels of leisure-time and transport-related physical activity were associated with a strong reduction in the risk of all-cause mortality across different geographical sites.