Nomogram-Based Evaluation of Exercise Capacity Based on Metabolic Equivalents (METs), Age, Body Mass Index(BMI), and Waist Circumference
Abstract
Background/Purpose: Raw metabolic-equivalent (MET) cut-offs ignore how age and body size shape oxygen demand. The aim is derivation and validation of sex-specific nomograms that adjust treadmill MET performance for age, body-mass index (BMI) and waist circumference (WC).
Methods: A prospective derivation cohort of 1 067 West-Eurasian adults who completed symptom-limited Bruce tests (January–December 2024) was analysed with multivariable linear regression (predictors: age, BMI, WC, sex). Internal validity used 1 000-fold bootstrap. External performance was assessed, without re-calibration, in an independent retrospective cohort of 900 tests from a separate laboratory.
Results: Age, BMI and WC were independent determinants of absolute METs; smoking and resting heart rate were not. The model explained 24% of variance in women and 20% in men; optimism-corrected calibration was excellent (slope 0.99, intercept +0.08 METs). In the external cohort it retained good accuracy (R² = 0.32; SEE = 1.66 METs) and calibration (slope 1.06, intercept –0.84 METs). Compared with the age-only Gulati (women) and Morris (men) equations, the new model showed negligible bias (–0.12 ± 1.86 METs) and the lowest error (Brier 3.45 vs 11.21/9.68).
Conclusions: Nomograms that integrate age, BMI and WC translate raw treadmill data into personalised, size-adjusted targets and flag values <85% of expectation as “reduced capacity”, enabling earlier identification of functional shortfall and more precise exercise prescription.
Keywords
Exercise Test Nomograms Metabolic Equivalent(METS) Body Mass Index(BMI) Waist Circumference Cardiorespiratory Fitness
Ethical Statement
All procedures involving human participants complied with the Declaration of Helsinki and were approved by the Ethics Committee of T.C. Demiroğlu Bilim University (Protocol 51016662/41201, 28 August 2024). Informed consent was obtained from all participants. The ethics decision letter will be uploaded with the submission.
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Details
| Primary Language | English |
|---|---|
| Subjects | Cardiovascular Medicine and Haematology (Other) |
| Journal Section | Research Articles |
| Authors | |
| Early Pub Date | September 17, 2025 |
| Publication Date | October 1, 2025 |
| Submission Date | August 15, 2025 |
| Acceptance Date | September 1, 2025 |
| Published in Issue | Year 2025 Volume: 16 Issue: 4 |
