OMNI scale perceived exertion at ventilatory breakpoint in children: response normalized.

PURPOSE: The Children's OMNI Scale of Perceived Exertion was used to identify a response normalized rating of perceived exertion (RPE)-Overall, RPE-Legs, and RPE-Chest that corresponds to the ventilatory breakpoint (Vpt) in 8- to 12-yr-old female and male children. METHODS: Subjects were a priori stratified into two fitness groups on the basis of peak oxygen uptake (VO2 peak): average (A) (41.0-49.0 mL x kg(-1) x min(-1); N = 24) and above average (AA) (50.0-58.0 mL x kg(-1) x min(-1); N = 24). Vpt was determined by a progressive cycle ergometer protocol to VO2 peak. RESULTS: A gender effect was not observed for any descriptive or dependent variable. Mean VO2peak for the A group was 1.72 L x min(-1) and for the AA group 2.04 L x min(-1). Vpt corresponded to 64.0% VO2 peak for A and 74.0% VO2peak for AA. RPE-Overall (mean A and AA, 6.1), RPE-Legs (mean A and AA, 7.2), and RPE-Chest (mean A and AA, 4.5) did not differ between the fitness groups. CONCLUSION: Findings indicated that undifferentiated and differentiated RPE-Vpt were similar between female and male children who varied in VO2peak and Vpt. A comparatively stable RPE-Vpt for 8- to 12-yr-old children that vary in VO2peak and Vpt indicates a group normalized perceptual response.

Children's OMNI scale of perceived exertion: mixed gender and race validation.

PURPOSE: The newly developed Children's OMNI Scale of Perceived Exertion (category range: 0 to 10) was validated using separate cohorts of female and male, African American and white subjects. Each of the four cohorts contained 20 clinically normal, nonobese children, 8-12 yr of age. METHODS: A cross-sectional, perceptual estimation paradigm using a single multi-stage cycle ergometer test protocol was used. Oxygen uptake (VO2; mL x min(-1)), heart rate (HR; beats x min(-1)) and ratings of perceived exertion for the overall body (RPE-Overall), legs (RPE-Legs), and chest (RPE-Chest) were determined at the end of each continuously administered 3-min power output (PO) (i.e., 25, 50, 75, and 100 W) test stage. RESULTS: The range of responses over the four POs for all cohorts was VO2: 290.8 to 1204.0 mL x min(-1); HR: 89.2 to 164.4 beats x min(-1); and RPE-Overall, RPE-Legs, and RPE-Chest: 0.85 to 9.1. First-order correlation and linear regression analyses were performed for each cohort separately and the total sample using a repeated measures paradigm over the four POs. For all correlation/regression paradigms RPE-Overall, RPE-Legs, and RPE-Chest distributed as a positive linear function of both VO2 and HR; r = 0.85 to 0.94; P < 0.01. Differences between RPE-Overall, RPE-Legs, and RPE-Chest were examined with ANOVA for the repeated measures paradigm. RPE-Legs was higher (P < 0.01) than RPE-Chest and RPE-Overall at 25, 50, 75, and 100 W. RPE-Chest did not differ from RPE-Overall at 25 and 50 W but was lower (P < 0.01) than RPE-Overall at 75 and 100 W. CONCLUSION: The psycho-physiological responses provide validity evidence for use of the Children's OMNI Scale over a wide range of dynamic exercise intensities.

Unstable angina pectoris: comparison with the National Cooperative Study.

Seventy-eight patients having prolonged pain (greater than 20 minutes) with transient S-T segment and T-wave changes and coronary artery bypass were compared to 288 patients previously reported in the National Cooperative Study on the treatment of unstable angina pectoris. Clinical characteristics observed in the present study that differed from those of the National Cooperative Study included a more chronic anginal pattern, slightly older age, greater number of women, and higher incidence of prior myocardial infarction. The severity of vessel disease was the same for both groups. Left ventricular function was slightly better in the present series. The incidence of perioperative infarction in the present series (3.8%) was significantly less than that for surgical patients reported in the National Cooperative Study (17%). Hospital mortality was also less: 1.2% versus 2.0 and 3.0% for the medical and surgical patients, respectively, in the National Cooperative Study. Late myocardial infarction was 11% and 13% at 30 months for medical and surgical patients in the National Cooperative Study, and only 3% at 43 months in the present surgical series. Actuarial survival for the entire patient population was 95% at 42 months. The reduced hospital mortality and perioperative infarction rates were attributed to immediate operation once acute myocardial infarction has been ruled out, advances in surgical and anesthetic technique, selection of patients with preserved left ventricular function, and a trend toward complete revascularization.

Coronary bypass for relief of persistent pain following acute myocardial infarction.

Between January, 1976, and April, 1980, 116 patients had urgent myocardial revascularization for clinical instability within 30 days of acute myocardial infarction (MI). Group 1 (8 patients) had coronary bypass grafting within 24 hours of acute MI; Group 2 (20 patients) had coronary bypass grafting 2 to 7 days after acute MI; and Group 3 (88 patients) had coronary bypass grafting 8 to 30 days after infarction. Indications for operation were persistent or recurrent pain (81%), pain plus ventricular arrhythmias (12%), and pain plus compelling anatomy. The incidence of single-vessel, triple-vessel, and left main coronary artery disease was 28%, 31%, and 12%, respectively. There were no hospital deaths in the series. The incidence of inotropic requirements, postoperative intraaortic balloon pumping, ventricular arrhythmias, and perioperative infarction was higher in patients operated on within 7 days of acute MI than for patients having coronary bypass grafting after this time. There have been 5 late deaths during a mean follow-up of 14 months. Actuarial survival was 97% at 18 months. Seventy-one percent of patients are presently pain free. Graft patency was 84% in 17 patients recatheterized after coronary bypass grafting and in 14 patients, grafts placed into the area of infarction were patent. This study suggests that the frequency of perioperative complications will be increased in patients operated on within one week of MI, but after this period, coronary bypass grafting can be accomplished with the same morbidity as the of elective operation.

Influence of left ventricular aneurysm on survival following the coronary bypass operation.

Patients having coronary bypass and aneurysm resection (N = 40) or aneurysm plication (N = 32) were compared with patients having coronary bypass without aneurysm (N = 2782). Unlike other series, the primary indication for surgery in the aneurysm patients was angina pectoris, with heart failure playing a secondary role. Multivessel disease was present in 83% of the patients with aneurysm. Total occlusion of the anterior descending coronary artery was more prevalent in the group of patients who had aneurysmectomy (75%) than in rhe group of patients who had plication (38%), and more grafts/patient could be performed in the plication group (2.6 vs 2.0). Location of the aneurysm was most often anteroapical (N = 55) and infrequently inferior (N = 6). Septal wall motion was akinetic or aneurysmal in 47% of the aneurysmectomy group, and 10% of the plication group. Postoperative requirements for inotropes or intra-aortic balloon assist was much higher in the aneurysm group (aneurysmectomy or plication) than in patients without aneurysm having bypass. Hospital mortality for aneurysm patients was 2.7% versus 1.4% in patients without aneurysms having coronary bypass. The actuarial survival rate at 42 months for all aneurysm patients was 90%. Improvement in anginal symptoms after plication and coronary bypass (96%) was more frequent than with aneurysmectomy and coronary bypass (76%) and this was attributed to larger viable muscle mass and greater revascularization. Although two-thirds of patients having surgery for aneurysms had improvement in heart failure symptoms after operation, 30% of those having aneurysmectomies and 35% of those having plications said they were unimproved after surgery. However, this could be explained by the finding that a significant number (35% of the aneurysmectomy and 45% of the plication group) were in heart failure Class I prior to operation. Hospital mortality has been progressively reduced and late survival increased by the surgical treatment of left ventricular aneurysm, primarily through early operation at a time when coronary bypass can be used as an adjunct to aneurysm resection or plication.