Cardiopulmonary exercise testing applied to respiratory medicine: Myths and facts

Neder, J. Alberto

doi:10.1016/j.rmed.2023.107249

Cited by 6 publications

(3 citation statements)

References 98 publications

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“…Poor exercise tolerance is a common indication for incremental cardiopulmonary exercise testing (CPET) in clinical practice. 1 Quantifying objectively the most relevant symptoms prompting early exercise termination (e.g., dyspnea and leg effort) allows proper correlation of the sensory experiences with their physiological underpinnings, a major tenet underlying clinical CPET interpretation. 2,3 For this purpose, cycle ergometry is the preferred modality of testing in most centers due to better safety, higher signalto-noise ratio, and proper quantification of work rate compared to treadmill-based tests.…”

Section: Introductionmentioning

confidence: 99%

Reference values for leg effort during incremental cycle ergometry in non‐trained healthy men and women, aged 19–85

Hijleh,

Wang,

Berton

et al. 2024

Scandinavian Med Sci Sports

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Heightened sensation of leg effort contributes importantly to poor exercise tolerance in patient populations. We aim to provide a sex‐ and age‐adjusted frame of reference to judge symptom's normalcy across progressively higher exercise intensities during incremental exercise. Two‐hundred and seventy‐five non‐trained subjects (130 men) aged 19–85 prospectively underwent incremental cycle ergometry. After establishing centiles‐based norms for Borg leg effort scores (0–10 category‐ratio scale) versus work rate, exponential loss function identified the centile that best quantified the symptom's severity individually. Peak O2 uptake and work rate (% predicted) were used to threshold gradually higher symptom intensity categories. Leg effort‐work rate increased as a function of age; women typically reported higher scores at a given age, particularly in the younger groups (p < 0.05). For instance, “heavy” (5) scores at the 95th centile were reported at ~200 W (<40 years) and ~90 W (≥70 years) in men versus ~130 W and ~70 W in women, respectively. The following categories of leg effort severity were associated with progressively lower exercise capacity: ≤50th (“mild”), >50th to <75th (“moderate”), ≥75th to <95th (“severe”), and ≥ 95th (“very severe”) (p < 0.05). Although most subjects reporting peak scores <5 were in “mild” range, higher scores were not predictive of the other categories (p > 0.05). This novel frame of reference for 0–10 Borg leg effort, which considers its cumulative burden across increasingly higher exercise intensities, might prove valuable to judging symptom's normalcy, quantifying its severity, and assessing the effects of interventions in clinical populations.

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Section: Introductionmentioning

confidence: 99%

Reference values for leg effort during incremental cycle ergometry in non‐trained healthy men and women, aged 19–85

Hijleh,

Wang,

Berton

et al. 2024

Scandinavian Med Sci Sports

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“…This is primarily due to the ability to identify vital prognostic variables through simultaneous measurement of ventilatory gas exchange, even at submaximal exercise levels. 26 - 28 …”

Section: Discussionmentioning

confidence: 99%

Revisiting the clinical utilization of cardiopulmonary exercise testing in Saudi Arabia after 2 decades

Aldhahi,

Alqahtani,

AL-Hazzaa

2024

SMJ

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Objectives: To assess the prevalence of cardiopulmonary exercise testing (CPET) usage and identify barriers among major hospitals and medical centers in Saudi Arabia. We also aim to compare these findings with data from nearly 2 decades ago. Methods: In this cross-sectional study, 70 major hospitals and medical centers were contacted, and 52 (74.2%) responded. The participants involved in this study were healthcare providers proficient in carrying out CPET from different specialties. The survey comprised 21 items covering CPET utilization, exercise mode characteristics, common protocols, types of patients or disorders, and barriers to not carrying out CPET. Results: The majority (n=37; 71.9%) of the centers reported a lack of CPET utilization. Of the 15 centers that used CPET, only 11 carried out regular CPET. Cardiac-related conditions were the most commonly referred clinical cases (n=7), followed by pulmonary conditions and cardiopulmonary fitness. The common barriers to carrying out CPET have remained unchanged compared to 2 decades ago - that is, the lack of equipment or trained technicians. However, there has been a 14.1% increase in the utilization of CPET and a 10.1% increase in the use of treadmill mode compared to a survey carried out 2 decades ago. Conclusion: Although CPET utilization has increased over 2 decades, this still falls below the desired benchmark. This highlights the need for collaborative efforts among policymakers, and healthcare institutions to address barriers and improve CPET integration into clinical practice.

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“…During CPET, VE increases in the initial stage of CPET by augmenting TV, during later stages of the CPET, VE mainly increases by an increase in BF. During exercise tidal volume/inspiratory capacity≥0.7, and a tidal volume plateau reached at an abnormally-low work rate 21 .…”

Section: Methodsmentioning

confidence: 98%

Practical Aspects of Cardiopulmonary Exercise Testing in Children

Takken,

Hulzebos

2023

Int J Sports Med

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The use of cardiopulmonary exercise testing (CPET) in pediatrics provides critical insights into potential physiological causes of unexplained exercise-related complaints or symptoms, as well as specific pathophysiological patterns based on physiological responses or abnormalities. Furthermore, CPET helps evaluate exercise performance in children with chronic (lung/heart) diseases. For instance, it can ascertain any adverse reaction to exercise and estimate the effects of specific treatment measures. It affords a global assessment of the pathophysiological patterns, responses and abnormalities to exercise that is inadequately reflected by resting lung function and/or cardiac function assessment. Clinical interpretation of the results of a CPET in pediatrics requires specific knowledge regarding pathophysiological responses and interpretative strategies that can be adapted to address concerns specific to the child’s medical condition or disability.

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Cardiopulmonary exercise testing applied to respiratory medicine: Myths and facts

Cited by 6 publications

References 98 publications

Reference values for leg effort during incremental cycle ergometry in non‐trained healthy men and women, aged 19–85

Reference values for leg effort during incremental cycle ergometry in non‐trained healthy men and women, aged 19–85

Revisiting the clinical utilization of cardiopulmonary exercise testing in Saudi Arabia after 2 decades

Practical Aspects of Cardiopulmonary Exercise Testing in Children

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