Measuring Dyspnea and Perceived Exertion in Healthy Adults and with Respiratory Disease: New Pictorial Scales

Abstract

Background: Dyspnea or perceived exertion during exercise is most commonly measured using Borg or visual analog scales, created for use in adults. In contrast, pictorial scales have been promoted for children due to skepticism concerning applicability of the said scales in pediatrics. We sought to validate our newly created, pictorial Dalhousie Dyspnea and Perceived Exertion Scales in adult populations and compare ratings with the Borg scale. Methods: Dyspnea and perceived exertion ratings obtained with both modified Borg CR-10 and Dalhousie scales during maximal cycle exercise were compared in 24 healthy adults and 17 with various pulmonary disorders. Scale ratings for perceived exertion were plotted against work while ratings for dyspnea were plotted against ventilation using previously developed alternative models to simple power law. Goodness of fit was determined by lowest root-mean-square error or by corrected Akaike information criterion. Results: Pictorial ratings of dyspnea and perceived exertion measured by both scale ratings rose as expected with increasing exercise intensity, and individual trajectories obtained by either scale were virtually superimposable in 90 % of subjects. In general, the lowest root-mean-square error or corrected Akaike information criterion was found with models which incorporated a time delay, defined as the fraction of maximum work or ventilation at which point a clear increase in ratings above resting level was reported. Conclusions: The Dalhousie Dyspnea and Exertion Scales offer an equally good alternative to the Borg scale for measuring dyspnea and perceived exertion in adults.