IJCS | Volume 32, Nº4, July/August 2019

DOI: 10.5935/2359-4802.20190064 Claudio Gil Soares de Araújo, MD, PhD Director of Research and Education Exercise Medicine Clinic - CLINIMEX cgaraujo@iis.com.br 331 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(4):331-342 Mailing Address: Claudio Gil Araujo Clínica de Medicina do Exercício - CLINIMEX - Rua Siqueira Campos, 93- 101. Postal Code: 22031-072, Rio de Janeiro, RJ - Brazil. E-mail: cgaraujo@iis.com.br CLINIMEX Aerobic Fitness Questionnaire: Proposal and Validation Claudio Gil S. Araúj o, C laudia Lucia Castr o, J oão Felipe Franc a, C hristina Grüne de Souza e Silv a Clínica de Medicina do Exercício - CLINIMEX, Rio de Janeiro, RJ - Brazil Manuscript received on May 21, 2019, revised on June 10, 2019, accepted on June 12, 2019. Abstract Background: Cardiorespiratory (aerobic) fitness is strongly and directly related to major health outcomes, including all-cause mortality. Maximum oxygen uptake (VO 2 max), directly measured by maximal cardiopulmonary exercise test (CPET), represents the subject’s aerobic fitness. However, as CPET is not always available, aerobic fitness estimation tools are necessary. Objectives: a) to propose the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ); b) to validate C-AFQ against measured VO 2 max; and c) to analyze the influence of some potentially relevant variables on the error of estimate. Methods: We prospectively studied 1,000 healthy and unhealthy subjects (68.6% men) aged from 14 to 96 years that underwent a CPET. The two-step C-AFQ describes physical activities with corresponding values in metabolic equivalents (METs) — ranging from 0.9 to 21 METs. Results: Application of C-AFQ took less than two minutes. Linear regression analysis indicated a very strong association between estimated (C-AFQ) and measured (CPET) maximal METs - r2 = 0.83 (Sy.x = 1.63; p < .001) - with median difference of only 0.2 METs between both values and interquartile range (percentiles 25 and 75) of 2 METs. The difference between estimated and measured METs was not influenced by age, sex, body mass index, clinical condition, ß-blocker use or sitting-rising test scores. Conclusion: C-AFQ is a simple and valid tool for estimating aerobic fitness when CPET is unavailable and it is also useful in planning individual ramp protocols. However, individual error of estimate is quite high, so C-AFQ should not be considered a perfect substitute for CPET’s measured VO 2 max. (Int J Cardiovasc Sci. 2019;32(4):331-342) Keywords: Exercise; Breathing Exercises; Exercise Test; Exercise Therapy; Health Impact; Validation Studies; Surveys and Questionnaires. Introduction Several long-term cohort studies have clearly shown a strong and direct association between cardiorespiratory (aerobic) fitness and a better and longer survival in adult men and women from different countries. 1-3 Quantified in mL O 2 .kg -1 .min -1 or simply as metabolic equivalents or METs (1 MET = 3.5 mL O 2 .kg -1 .min -1 ), aerobic fitness is also associated with lower chances of developing major clinically relevant diseases, such as coronary artery disease, arterial hypertension and several types of cancer. 4-6 Additionally, functional capacity, which is strongly related to aerobic fitness, has also been recently recognized as a clinical vital sign. 7