# IPAQ-L and CPET Usefulness in a North-Eastern Romanian Population Undergoing Cardiac Rehabilitation  
[PERSON]  
1 Department of Medical Specialties (I), Faculty of Medicine, \"[PERSON]\" University of Medicine and Pharmacy, University Street nr 16, 700115 Iasi, Romania; [EMAIL_ADDRESS] (A.M.); [EMAIL_ADDRESS] (M.R. ); [EMAIL_ADDRESS] (S.A.C. ); [EMAIL_ADDRESS] (F.M.) 2 Department of Morphofunctional Sciences I, \"[PERSON]\" University of Medicine and Pharmacy, 700115 Iasi, Romania; [EMAIL_ADDRESS] (Saint Mary Emergency Medicine Children Hospital, Vasile Lupu Street nr 62, 700309 Iasi, Romania; cristina. cardiac rehabilitation were documented for the first time by [PERSON] et al. [4]. Recently, a meta-analysis that evaluated the usefulness of the program in patients with heart failure showed an increase in quality of life and exercise capacity, but did not find a significant advantage in terms of mortality and hospitalization [5]. In the absence of physical activity, as in the current COVID-19 pandemic especially, obesity increases significantly and a multidisciplinary approach is essential. Numerous actions must be applied to increase physical activity and decrease obesogenic lifestyles, thus determining a long-term decrease in morbidity and mortality [6]. A study published in 2020 suggested that the variations in moderate to vigorous physical activity and sedentary activity evaluated through the International Physical Activity Questionnaire (IPAQ) or through accelerometry can help define a population's health profile. Furthermore, in overweight/obese adults with hypertension, a 16 week supervised aerobic exercise program was successful in increasing self-reported physical activity, lowering sedentarism and enhancing sleep quality [7]. The development of techniques to accurately assess physical activity (PA) has essential importance for both research and follow-up of CR patients, who frequently struggle with poor adherence to lifestyle changes. PA duration, frequency and intensity should be taken into account in a comprehensive assessment, making such a measurement complex and challenging [1]. Several methods that measure PA have been proposed: direct observation, patient diaries, PA questionnaires and direct measurement [8]. Self-report questionnaires and physical activity monitors are the most common techniques used in the CR program [1]. Despite recent significant advancements in portable and direct physical activity monitors, clinical evidence regarding their reliability in cardiovascular disease patients is still scarce [9]. The monitor must be worn 12 h per day for at least 4 days to produce an acceptable PA assessment. Although it has the benefit of quantifying inactivity periods, such a system is still unavailable for the majority of Romanian middle-aged and elderly adults, who constitute the majority of patients admitted to Romanian Cardiac Rehabilitation Clinics, making self-report questionnaires a better method for such facilities [1,9]. Furthermore, even if these devices are available on the Romanian market--at inaccessible prices for patients--the Clinical Rehabilitation Hospitals in Romania do not have the economic potential to offer these devices to patients. In Romania, CR programs are not funded separately and there are also no policies through which cardiovascular patients are sent to this service, so there are minimal opportunities to address the issue. The major limitation of self-report questionnaires is the patient's ability to remember and categorize their recent PA as easy, moderate and vigorous. The IPAQ questionnaire provides comparable estimations of PA and it has been validated in 14 centers across 12 countries. IPAQ comes in two versions. While the Short Form is recommended for large prevalence studies, the IPAQ Long Form (IPAQ-L) provides the advantage of a more detailed analysis of PA across four different domains (occupation, transportation, home and leisure time) [10].