International Journal of Cardiology 179 (2015) 122–122
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Editorial
In reply; Heart rate recovery and physical fitness Mehmet G. Kaya a,⁎, Salih Ozgocmen b a b
Department of Cardiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey Division of Rheumatology, Department of PMR, Erciyes University, Faculty of Medicine, Kayseri, Turkey
a r t i c l e
i n f o
Article history: Received 20 October 2014 Accepted 21 October 2014 Available online 22 October 2014 Keywords: Ankylosing spondylitis Heart rate recovery index Exercise test Autonomic nervous system Sudden cardiac death
We thank Tekin and Tekin [1] for their comments on our article [2]. We agreed to the suggestion that studies assessing the heart rate recovery (or parasympathetic tone by using other methods) should have a matched control group regarding the physical activity (PA). However, suggestion on making this by using International Physical Activity Questionnaire (IPAQ) has some concerns. First, IPAQ has been developed as an instrument for cross-national assessment of PA and a Turkish version has been recently validated [3]. Using validated questionnaires is very important to maintain conceptual, metric, linguistic and cross-cultural equivalences and to take robust results among study population who had a wide variety in physical activities. Unfortunately, the validation of IPAQ in Turkish was not published while we were planning this study. Secondly, IPAQ has been developed for monitoring populations' level of PA among 18–65 year old adults in diverse settings. Also the construct validity of IPAQ should also be investigated in specific patient populations including patients with ankylosing spondylitis who had various levels of disability and functional limitations [4]. This has been
⁎ Corresponding author. E-mail address: [email protected] (M.G. Kaya).
http://dx.doi.org/10.1016/j.ijcard.2014.10.104 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
done very recently by Arends et al. [5] who underscored a modest construct validity of IPAQ and Short QUestionnaire to Assess Health (SQUASH). The authors stated that SQUASH is more suitable than IPAQ in assessing daily physical activity in AS population studies and underscored the necessity to add questions on AS-specific physical activity to these questionnaires. Thirdly, IPAQ itself had some limitations like poor correlations with other comparison measures like accelerometer total counts [6]. Last but not the least, we investigated the exercise functional capacity in terms of metabolic equivalents (METs) and documented the difference between patients with AS and age- and gendermatched healthy controls. Physical activity is a multidimensional exposure and such results of functional or exercise capacity with objective physiologic and hemodynamic data during testing gain much more importance in the absence of a true “gold standard” in evaluating physical activity in daily living.
References [1] G. Tekin, A. Tekin, Heart rate recovery and physical fitness, Int. J. Cardiol. (2014). [2] M.G. Kaya, M. Akpek, Y.Y. Lam, et al., Abnormal heart rate recovery on exercise in ankylosing spondylitis, Int. J. Cardiol. 169 (2013) 215–218. [3] M. Saglam, H. Arikan, S. Savci, et al., International physical activity questionnaire: reliability and validity of the Turkish version, Percept. Mot. Skills 111 (2010) 278–284. [4] S. Ozgocmen, O. Akgul, Z. Altay, et al., Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis, Int. J. Rheum. Dis. 15 (2012) 229–238. [5] S. Arends, M. Hofman, Y.P. Kamsma, et al., Daily physical activity in ankylosing spondylitis: validity and reliability of the IPAQ and SQUASH and the relation with clinical assessments, Arthritis Res. Ther. 15 (2013) R99. [6] N. Kurtze, V. Rangul, B.E. Hustvedt, Reliability and validity of the international physical activity questionnaire in the Nord-Trøndelag health study (HUNT) population of men, BMC Med. Res. Methodol. 8 (2008) 63.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Editorial
In reply; Heart rate recovery and physical fitness Mehmet G. Kaya a,⁎, Salih Ozgocmen b a b
Department of Cardiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey Division of Rheumatology, Department of PMR, Erciyes University, Faculty of Medicine, Kayseri, Turkey
a r t i c l e
i n f o
Article history: Received 20 October 2014 Accepted 21 October 2014 Available online 22 October 2014 Keywords: Ankylosing spondylitis Heart rate recovery index Exercise test Autonomic nervous system Sudden cardiac death
We thank Tekin and Tekin [1] for their comments on our article [2]. We agreed to the suggestion that studies assessing the heart rate recovery (or parasympathetic tone by using other methods) should have a matched control group regarding the physical activity (PA). However, suggestion on making this by using International Physical Activity Questionnaire (IPAQ) has some concerns. First, IPAQ has been developed as an instrument for cross-national assessment of PA and a Turkish version has been recently validated [3]. Using validated questionnaires is very important to maintain conceptual, metric, linguistic and cross-cultural equivalences and to take robust results among study population who had a wide variety in physical activities. Unfortunately, the validation of IPAQ in Turkish was not published while we were planning this study. Secondly, IPAQ has been developed for monitoring populations' level of PA among 18–65 year old adults in diverse settings. Also the construct validity of IPAQ should also be investigated in specific patient populations including patients with ankylosing spondylitis who had various levels of disability and functional limitations [4]. This has been
⁎ Corresponding author. E-mail address: [email protected] (M.G. Kaya).
http://dx.doi.org/10.1016/j.ijcard.2014.10.104 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
done very recently by Arends et al. [5] who underscored a modest construct validity of IPAQ and Short QUestionnaire to Assess Health (SQUASH). The authors stated that SQUASH is more suitable than IPAQ in assessing daily physical activity in AS population studies and underscored the necessity to add questions on AS-specific physical activity to these questionnaires. Thirdly, IPAQ itself had some limitations like poor correlations with other comparison measures like accelerometer total counts [6]. Last but not the least, we investigated the exercise functional capacity in terms of metabolic equivalents (METs) and documented the difference between patients with AS and age- and gendermatched healthy controls. Physical activity is a multidimensional exposure and such results of functional or exercise capacity with objective physiologic and hemodynamic data during testing gain much more importance in the absence of a true “gold standard” in evaluating physical activity in daily living.
References [1] G. Tekin, A. Tekin, Heart rate recovery and physical fitness, Int. J. Cardiol. (2014). [2] M.G. Kaya, M. Akpek, Y.Y. Lam, et al., Abnormal heart rate recovery on exercise in ankylosing spondylitis, Int. J. Cardiol. 169 (2013) 215–218. [3] M. Saglam, H. Arikan, S. Savci, et al., International physical activity questionnaire: reliability and validity of the Turkish version, Percept. Mot. Skills 111 (2010) 278–284. [4] S. Ozgocmen, O. Akgul, Z. Altay, et al., Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis, Int. J. Rheum. Dis. 15 (2012) 229–238. [5] S. Arends, M. Hofman, Y.P. Kamsma, et al., Daily physical activity in ankylosing spondylitis: validity and reliability of the IPAQ and SQUASH and the relation with clinical assessments, Arthritis Res. Ther. 15 (2013) R99. [6] N. Kurtze, V. Rangul, B.E. Hustvedt, Reliability and validity of the international physical activity questionnaire in the Nord-Trøndelag health study (HUNT) population of men, BMC Med. Res. Methodol. 8 (2008) 63.
