Interobserver variability of ventilatory anaerobic threshold in asymptomatic volunteers

Abstract

Background The ventilatory anaerobic threshold (VO 2 @AT) has been used in preoperative risk assessment and rehabilitation for many years. Our aim was to determine the interobserver variability of AT using cardiopulmonary exercise (CPET) data from a large epidemiological study (SHIP, Study of Health in Pomerania). Methods VO 2 @AT was determined from CPET of 1,079 cross-sectional volunteers, according to American Heart Association guidelines. VO 2 @AT determinations were compared between two experienced physicians, between physicians and qualified medical assistants, and between physicians or medical assistants and software-based algorithms. For the first 522 data sets, the two physicians discussed discrepant readings to reach consensus; the remaining data sets were analyzed without consensus discussion. Results VO 2 @AT was detectable in 1,056 data sets. The physicians recorded identical VO 2 @AT values in 319 out of 522 cases before consensus discussion (61.1%; intraclass correlation coefficient [ICC]: 0.90; 95% confidence interval [CI]: 0.88–0.92) and in 700 out of 1,056 cases overall (66.3%; ICC: 0.95; 95% CI: 0.95–0.96), with an interobserver difference of 0 ± 8% (95% limits of agreement [LOA]: ±161 mL/min). The interobserver difference was − 2 ± 18% (95% LOA: ±418 mL/min) between a physician and medical assistants, and − 19 ± 24% to − 22 ± 26% (95% LOAs: ±719–806 mL/min) between physicians or medical assistants and software-based algorithms. Conclusions Experienced physicians show high agreement when determining AT in asymptomatic volunteers. However, agreement between physicians and qualified medical assistants is lower, and there is substantial deviation in AT determination between physicians or medical assistants and software-based algorithms. This must be considered when using AT as a decision tool.

Equipment-free, unsupervised high intensity interval training elicits significant improvements in the physiological resilience of older adults

“…Participants were encouraged to exercise to volitional exhaustion, with termination criteria as per safety guidelines [ 35 , 36 ]. VO 2 peak was defined as the highest VO 2 attained during the test with anaerobic threshold (AT) defined using a combination of the modified V-slope and ventilatory equivalents methods by two blinded experienced assessors [ 41 ].…”

Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial

“… 41 However, these parameters are determined by the operator using methods which are subject to considerable interobserver variability. The subjective decisions of the physician to terminate CPET based on symptoms, 42 , 43 further emphasizes a point in the assessment chain that is, again, vulnerable to bias with an unblinded design.…”

Periodontitis Is Related to Exercise Capacity: Two Cross-sectional Studies

“…Nevertheless, exercise duration is highly dependent on the chosen examination protocol. Inconsistent results for remaining CPET parameters might be explained by 1) high observer variabilities (Kaczmarek et al 2019); 2) the fact that they were derived from other parameters, each presenting with potentially high variability themselves; and 3) the fact that all of them are affected by multiple risk factors (Glaser et al 2010; Roman et al 2016). Scattered differences in sizes of effect estimates between SHIP-1 and SHIP-Trend-0 might also be explained by different definitions of confounders (i.e., Baecke score in SHIP-1 versus physically active in SHIP-Trend-0) or varying impacts of residual confounding on effect estimates within both studies.…”