• Daniel S Rubin, Megan Huisingh-Scheetz, Anthony Hung, Ward R Parker RP, Peter Nagele, Ross Arena, and Donald Hedeker.
• From the Departments of Anesthesia and Critical Care (D.S.R., P.N.) Public Health Sciences (D.H.) the Sections of Geriatrics and Palliative Medicine (M.H.-S.) Cardiology (R.P.W.) the Pritzker School of Medicine (A.H.), University of Chicago, Chicago Illinois the Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois (R.A.).
• Anesthesiology. 2019 Nov 1; 131 (5): 992-1003.

BackgroundFunctional capacity assessment is a core component of current perioperative cardiovascular evaluation and management guidelines for noncardiac surgery. The authors investigated the ability of standardized physical function questions to predict whether participants engaged in moderate physical activity as measured by hip accelerometers.MethodsParticipant responses to physical functioning questions and whether they engaged in moderate physical activity were extracted from the National Health and Nutrition Examination Survey (2003 to 2004 and 2005 to 2006). Physical activity intensity was measured using hip accelerometers. Adult participants with at least one Revised Cardiac Risk Index condition were included in the analysis. Standardized physical function questions were evaluated using a classification and regression tree analysis. Training and test datasets were randomly generated to create and test the analysis.ResultsFive hundred and twenty-two participants were asked the physical functioning questions and 378 of 522 (72.4%) had a bout of moderate-vigorous activity. Classification and regression tree analysis identified a "no difficulty" response to walking up 10 stairs and the ability to walk two to three blocks as the most sensitive questions to predict the presence of a 2-min bout of moderate activity. Participants with positive responses to both questions had a positive likelihood ratio of 3.7 and a posttest probability greater than 90% of a 2-min bout of moderate-vigorous activity. The sensitivity and specificity of positive responses to physical functioning questions in the pruned tree were 0.97 (95% CI, 0.94 to 0.98) and 0.16 (95% CI, 0.10 to 0.23) for training data, and 0.88 (95% CI, 0.75 to 0.96) and 0.10 (95% CI, 0.00 to 0.45) for the test data. Participants with at least one 2-min bout of moderate activity had a greater percentage of overall daily active time (35.4 ± 0.5 vs. 26.7 ± 1.2; P = 0.001) than those without.ConclusionsStandardized physical function questions are highly sensitive but poorly specific to identify patients who achieve moderate physical activity. Additional strategies to evaluate functional capacity should be considered.

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