# IPAQ-L and CPET Usefulness in a North-Eastern Romanian Population Undergoing Cardiac Rehabilitation
## Materials and Methods
### Study Procedures and Outcome Assessment  
Patient assessment included medical history (comorbidities, clinical information, anthropometrics); blood tests, such as lipid profile; and cardiovascular and pulmonary evaluation. PA assessment was conducted using the IPAQ-L, which was presented within the first 24 h of admission. The English version of the questionnaire was translated into Romanian, following current guidelines and recommendations [11]. The interview was conducted by a single physician trained to deal with patient interrogation. The total time spent performing different types of PA was converted into minutes. As short training sessions are known to have insignificant metabolic effects [12], the final analysis of PA level included only activities with a minimum duration of 10 min. Physical activity levels were expressed as the total metabolic equivalent of task (MET)-minutes/week, obtained by multiplying predefined MET scores by the duration of a specific PA (in minutes) [13]. We calculated the total MET-minutes/week, as well as the value for each activity (walking, moderate effort and vigorous effort) and for each domain (work, transportation, leisure and domestic and garden activities), respectively. Furthermore, following IPAQ scoring guidelines [14], we divided our study group in three categories based on patients' PA levels: low, moderate and high. Sitting time/week was reported as the total time in minutes. Sedentary time was quantified as minutes/week.  
Utilizing body mass index (BMI), our study group was categorized as normal weight (18.5-24.9 kg/m\({}^{2}\)), overweight (25-29.9 kg/m\({}^{2}\)), first-degree obesity (30-34.9 kg/m\({}^{2}\)), second-degree obesity (35-39.9 kg/m\({}^{2}\)) and third-degree obesity (>40 kg/m\({}^{2}\)).  
The abdominal circumference (AC) was measured at the midpoint of the line between the rib or costal margin and the iliac crest in the midaxillary line. Abdominal obesity was defined as a waist circumference >88 cm for females and >102 cm for males.  
Fitness was quantified by the percentage of age-predicted maximal heart rate (%HR), exercise resistance (W) and workload (METS) through a symptom-limited cycle ergometer stress test using standard protocol [15].  
Patients in whom the etiology of exercise capacity limitation could not be clearly established were judged suitable for cardiopulmonary exercise testing (CPET). A subgroup of 18 patients was thus formed and this investigation was carried out on the same day as the PA assessment with IPAQ-L, a few hours after the patients completed it. The most important CPET parameters were: the absolute value of maximal oxygen uptake (VO\({}_{2}\) max) and the percentage of this predicted value (VO\({}_{2}\) max%), the absolute value of the maximal work rate (WR) and the percentage of this predicted value (WR%), the oxygen uptake at the anaerobic threshold (AT), the maximal value of the respiratory exchange ratio (RER), the maximal heart rate (HR) and the heart rate reserve (HRR). The HRR is determined by the difference between the maximal HR and the resting HR.  
Figure 1: Study flow chart.