{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:16:45Z","timestamp":1788916605091,"version":"build-2803163510"},"reference-count":40,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2020,5,29]],"date-time":"2020-05-29T00:00:00Z","timestamp":1590710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2020,5,12]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>Assessment of dyspnoea severity during incremental cardiopulmonary exercise testing (CPET) has long been hampered by the lack of reference ranges as a function of work rate (WR) and ventilation (<jats:italic>V\u2032<\/jats:italic><jats:sub>E<\/jats:sub>). This is particularly relevant to cycling, a testing modality which overtaxes the leg muscles leading to a heightened sensation of leg discomfort.<\/jats:p><jats:p>Reference ranges based on dyspnoea percentiles (0\u201310 Borg scale) at standardised work rates and<jats:italic>V\u2032<\/jats:italic><jats:sub>E<\/jats:sub>were established in 275 apparently healthy subjects aged 20\u201385 years (131 men). They were compared with values recorded in a randomly selected \u201cvalidation\u201d sample (n=451; 224 men). Their usefulness in properly uncovering the severity of exertional dyspnoea were tested in 167 subjects under investigation for chronic dyspnoea (\u201ctesting sample\u201d) who terminated CPET due to leg discomfort (86 men).<\/jats:p><jats:p>Iso-work rate and, to a lesser extent, iso-<jats:italic>V\u2032<\/jats:italic><jats:sub>E<\/jats:sub>reference ranges (5th\u201325th, 25th\u201350th, 50\u201375th and 75th\u201395th percentiles) increased as a function of age, being systematically higher in women (p&lt;0.01). There were no significant differences in percentiles distribution between \u201creference\u201d and \u201cvalidation\u201d samples (p&gt;0.05). Submaximal dyspnoea-work rate scores fell within the 75th\u201395th or &gt;95th percentiles in 108 out of 118 (91.5%) subjects of the \u201ctesting\u201d sample who showed physiological abnormalities known to elicit exertional dyspnoea,<jats:italic>i.e.<\/jats:italic>ventilatory inefficiency and\/or critical inspiratory constraints. In contrast, dyspnoea scores typically fell in the 5th\u201350th range in subjects without those abnormalities (p&lt;0.001).<\/jats:p><jats:p>This frame of reference might prove useful to uncover the severity of exertional dyspnoea in subjects who otherwise would be labelled as \u201cnon-dyspnoeic\u201d while providing mechanistic insights into the genesis of this distressing symptom.<\/jats:p>","DOI":"10.1183\/13993003.00191-2020","type":"journal-article","created":{"date-parts":[[2020,5,29]],"date-time":"2020-05-29T20:17:09Z","timestamp":1590783429000},"page":"2000191","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":40,"title":["A frame of reference for assessing the intensity of exertional dyspnoea during incremental cycle ergometry"],"prefix":"10.1183","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8019-281X","authenticated-orcid":false,"given":"J. Alberto","family":"Neder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8393-3126","authenticated-orcid":false,"given":"Danilo C.","family":"Berton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz E.","family":"Nery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan C.","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8393-3126","authenticated-orcid":false,"given":"Jean","family":"Bourbeau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7593-2433","authenticated-orcid":false,"given":"Denis E.","family":"O'Donnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2020,5,29]]},"reference":[{"key":"2024102101430803000_56.4.2000191.1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0800"},{"key":"2024102101430803000_56.4.2000191.2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00092613"},{"key":"2024102101430803000_56.4.2000191.3","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201111-2042ST"},{"key":"2024102101430803000_56.4.2000191.4","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.167.2.211"},{"key":"2024102101430803000_56.4.2000191.5","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200507-1037OC"},{"key":"2024102101430803000_56.4.2000191.6","unstructured":"Borg G . A category scale with ratio properties for intermodal and interindividual comparisons. In: Geissler HG , Petzold P , eds. Psychophys. Judgm. Process Percept. Berlin, VEB Deutscher Verlag der Wissenschaften, 1982; pp. 25\u201334."},{"key":"2024102101430803000_56.4.2000191.7","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/145.6.1339"},{"key":"2024102101430803000_56.4.2000191.8","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200208-856OC"},{"key":"2024102101430803000_56.4.2000191.9","doi-asserted-by":"crossref","unstructured":"Wasserman K , Hansen J , Sue D , et al. Principles of Exercise Testing and Interpretation. Philadelphia, Lea & Ferbiger, 1987.","DOI":"10.1097\/00008483-198704000-00014"},{"key":"2024102101430803000_56.4.2000191.10","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826fb946"},{"key":"2024102101430803000_56.4.2000191.11","doi-asserted-by":"crossref","unstructured":"Ward SA , Palange P . Clinical Exercise Testing (European Respiratory Monograph). Sheffield, European Respiratory Society, 2007.","DOI":"10.1183\/1025448x.ERM4007"},{"key":"2024102101430803000_56.4.2000191.12","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2012.665520"},{"key":"2024102101430803000_56.4.2000191.13","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.99.14613049"},{"key":"2024102101430803000_56.4.2000191.14","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/S0272-5231(21)01072-8","article-title":"Clinical evaluation of exertional dyspnea","volume":"15","author":"Mahler","year":"1994","journal-title":"Clin Chest Med"},{"key":"2024102101430803000_56.4.2000191.15","first-page":"12","article-title":"Task group on surveillance for respiratory hazards in the occupational setting. Surveillance for respiratory hazards","volume":"8","year":"1982","journal-title":"ATS News"},{"key":"2024102101430803000_56.4.2000191.16","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1080\/15412555.2019.1631776","article-title":"Inspiratory constraints and ventilatory inefficiency are superior to breathing reserve in the assessment of exertional dyspnea in COPD","volume":"16","author":"Neder","year":"2019","journal-title":"COPD"},{"key":"2024102101430803000_56.4.2000191.17","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"key":"2024102101430803000_56.4.2000191.18","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01159-2017"},{"key":"2024102101430803000_56.4.2000191.19","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00080312"},{"key":"2024102101430803000_56.4.2000191.20","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1183\/09041950.005s1693","article-title":"Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society","volume":"16","author":"Quanjer","year":"1993","journal-title":"Eur Respir J Suppl"},{"key":"2024102101430803000_56.4.2000191.21","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2202033"},{"key":"2024102101430803000_56.4.2000191.22","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/95608.1"},{"key":"2024102101430803000_56.4.2000191.23","doi-asserted-by":"crossref","first-page":"412","DOI":"10.4236\/ojs.2015.55043","article-title":"Use of Pearson's Chi-square for testing equality of percentile profiles across multiple populations","volume":"5","author":"Johnson","year":"2015","journal-title":"Open J Stat"},{"key":"2024102101430803000_56.4.2000191.24","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"1","author":"Bland","year":"1986","journal-title":"Lancet Lond Engl"},{"key":"2024102101430803000_56.4.2000191.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2009.01.010"},{"key":"2024102101430803000_56.4.2000191.26","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01376-2017"},{"key":"2024102101430803000_56.4.2000191.27","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1164\/rccm.201508-1637ED","article-title":"Dyspnea: don't just look, ask!","volume":"192","author":"Banzett","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102101430803000_56.4.2000191.28","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0044-2016"},{"key":"2024102101430803000_56.4.2000191.29","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00223611"},{"key":"2024102101430803000_56.4.2000191.30","first-page":"219","article-title":"Excercise physiology in health and disease","volume":"112","author":"Wasserman","year":"1975","journal-title":"Am Rev Respir Dis"},{"key":"2024102101430803000_56.4.2000191.31","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.8.2103007"},{"key":"2024102101430803000_56.4.2000191.32","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0272-5231(21)01070-4","article-title":"Impact of the aging pulmonary system on the response to exercise","volume":"15","author":"Johnson","year":"1994","journal-title":"Clin Chest Med"},{"key":"2024102101430803000_56.4.2000191.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2014.10.017"},{"key":"2024102101430803000_56.4.2000191.34","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.ccm.2019.02.014","article-title":"Unraveling the causes of unexplained dyspnea: the value of exercise testing","volume":"40","author":"O'Donnell","year":"2019","journal-title":"Clin Chest Med"},{"key":"2024102101430803000_56.4.2000191.35","doi-asserted-by":"crossref","first-page":"567","DOI":"10.2165\/00007256-200434090-00002","article-title":"Sex differences in respiratory exercise physiology","volume":"34","author":"Sheel","year":"2004","journal-title":"Sports Med Auckl NZ"},{"key":"2024102101430803000_56.4.2000191.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2009.01.011"},{"key":"2024102101430803000_56.4.2000191.37","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1513\/AnnalsATS.201612-955FR","article-title":"Graphical data display for clinical cardiopulmonary exercise testing","volume":"14","author":"Dumitrescu","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"2024102101430803000_56.4.2000191.38","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01518-2019"},{"key":"2024102101430803000_56.4.2000191.39","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000134"},{"key":"2024102101430803000_56.4.2000191.40","doi-asserted-by":"publisher","DOI":"10.1164\/arrd.1984.129.2P2.S90"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.00191-2020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T07:34:17Z","timestamp":1740382457000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.00191-2020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,29]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,10,1]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1183\/13993003.00191-2020"],"URL":"https:\/\/doi.org\/10.1183\/13993003.00191-2020","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,29]]}}}