A Comparison of the Reproducibility and the Sensitivity to Change of Visual Analogue Scales, Borg Scales, and Likert Scales in Normal Subjects During Submaximal Exercise

doi:10.1378/chest.116.5.1208

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Volume 116, Issue 5, November 1999, Pages 1208-1217

https://doi.org/10.1378/chest.116.5.1208 Get rights and content

Objective

To assess which subjective scale, the visual analogue scale (VAS), the Borg CR10 (Borg) scale, or the Likert scale (LS), if any, is decidedly more reproducible and sensitive to change in the assessment of symptoms.

Design

Prospective clinical study.

Setting

Exercise laboratory.

Participants

Twenty-three physically active male subjects (mean ± SD age of 30 ± 4 years old) were recruited.

Intervention

Each subject attended the exercise laboratory on four occasions at intervals of 1 week. Three subjective scales were used: (1) the VAS (continuous scale); (2) the Borg scale (12 fixed points); and (3) the Likert scale (LS; 5 fixed points). Four identical submaximal tests were given (2 min at 60% maximum oxygen uptake [

o₂max] and 6 min at 70%

o₂max). Two tests were undertaken to assess the reproducibility of scores that were obtained with each subjective scale. Two other tests were undertaken to assess the sensitivity of each scale to a change in symptom perception: a double-blind treatment with propranolol, 80 mg, (ie, active therapy; to increase the sensation of breathlessness and general fatigue during exercise) or matching placebo. The subjective scale scores were measured at 1 min 30 s, 5 min 30 s, and 7 min 15 s of exercise. Reproducibility was defined as the proportion of total variance (ie, between-subject plus within-subject variance) explained by the between-subject variance given as a percentage. Sensitivity was defined as the effect of the active drug therapy over the variation within subjects.

Results

Overall, the VAS performed best in terms of reproducibility for breathlessness and general fatigue, with reproducibility coefficients as high as 78%. For sensitivity, the VAS was best for breathlessness (ratio, 2.7) and the Borg scale was most sensitive for general fatigue (ratio, 3.0). The relationships between the respective psychological and physiologic variables were reasonably stable throughout the testing procedure, with overall typical correlations of 0.73 to 0.82

Conclusion

This study suggests that subjective scales can reproducibly measure symptoms during steady-state exercise and can detect the effect of a drug intervention. The VAS and Borg scales appear to be the best subjective scales for this purpose.

Section snippets

Subjects

Twenty-three healthy male volunteers (mean ± SD age of 30 ± 4 years old) gave informed consent to participate in the study. The subjects were recruited by advertising in the local university and hospital. All of the subjects were physically active; the group included runners, hill-walkers, and soccer players. The subjects were recreational exercisers who exercised, on average, two to three times per week. Twenty-four subjects were recruited, but 1 subject became ill during testing and was

Psychological/Subjective Scales

Table 1 gives the mean ± SD values for the VAS, the Borg scale, and the LS for breathlessness and general fatigue for minute 7.15. This table gives the impression that the scores on the active therapy tend to be higher than on the other three interventions.

Reproducibility

The estimated reproducibility coefficients for the three scales at the three different time points are shown in Table 2. At all three time points, there is a clear tendency for the VAS to be better than the other two scales (ie, to have

Breathlessness

In this study, the VAS was more reproducible for the measurement of breathlessness than the Borg scale. The LS tended to perform better than the Borg scale, but there were no significant differences between the scales. The LS scores tended to be lower than the VAS scores.

Several groups have shown that the VAS allows reproducible measurement of breathlessness in the short term in both normal subjects and patients.⁷, ⁸, ⁹ Wilson and Jones¹⁰, ¹¹ have shown that Borg scale measurements of

Breathlessness

All of the scales showed high overall group correlations with

o₂,

co₂, frequency of breathing, heart rate, and Vt. However, it must be stressed that a high correlation does not necessarily imply a causal relationship. When using VAS and Borg scales, a good correlation has been reported between

e and the perception of breathlessness.¹⁰, ¹⁴ However, it would be wrong to suggest that the perception of breathlessness is simply a sensing of

e. With no increase in

e, O’Neill et al⁷ found that

Conclusion

The results of this study demonstrate a similarity in behavior among the VAS, the Borg scale, and the LS. For reproducibility, the VAS produced the highest ratio estimates for breathlessness and general fatigue. For sensitivity, the VAS was best for breathlessness, and the Borg scale had the highest ratio estimates for general fatigue. The findings of this study indicate that during steady-state exercise, subjective scales can reproducibly measure symptoms and are sensitive to changes that

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Chest

Clinical InvestigationsEXERCISEA Comparison of the Reproducibility and the Sensitivity to Change of Visual Analogue Scales, Borg Scales, and Likert Scales in Normal Subjects During Submaximal Exercise

Objective

Design

Setting

Participants

Intervention

Results

Conclusion

Section snippets

Subjects

Psychological/Subjective Scales

Reproducibility

Breathlessness

Breathlessness

Conclusion

Am Heart J

Br J Dis Chest

J Chronic Dis

Fractional utilization of aerobic capacity during distance running

Med Sci Sports Exerc

Physiology of exercise

Optimizing the exercise protocol for cardiopulmonary assessment

J Appl Physiol

Position statement on the physiological assessment of the elite competition

Effects of propranolol and metroprolol and hemodynamic and respiratory indices and on perceived exertion during exercise in hypertensive patients

Br Heart J

The relationship between breathlessness and ventilation during steady-state exercise

Bull Eur Physiopathol Respir

Methods to assess breathlessness in healthy subjects: a critical evaluation and application to analyze the acute effects of diazepam and promethazine on breathlessness induced by exercise or by exposure to raised levels of carbon dioxide

Clin Sci

A comparison of the visual analogue scale and modified Borg scale for the measurement of dyspnoea during exercise

Clin Sci

Long-term reproducibility of Borg scale estimates of breathlessness during exercise

Clin Sci

Breathlessness during exercise with and without resistive loading

J Appl Physiol

Effects of codeine on the respiratory responses to exercise in healthy subjects

Br J Clin Pharmacol

Comparison of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive pulmonary disease

Am Rev Respir Dis

The influence of beta-adrenoceptor antagonists with and without partial agonist activity on exercise tolerance and muscle lactate production

Eur J Clin Pharmacol

Clinical Investigations
EXERCISE
A Comparison of the Reproducibility and the Sensitivity to Change of Visual Analogue Scales, Borg Scales, and Likert Scales in Normal Subjects During Submaximal Exercise