Evaluation of Impairment and Disability: The Role of Cardiopulmonary Exercise Testing

Abstract

Cardiopulmonary exercise testing has a strong physiological basis and well-documented clinical rationale for impairment evaluation. Both determination and quantitation of impairment are enhanced by exercise testing, notably because of the inadequacy of resting pulmonary function tests to predict exercise capacity, and both over-and underestimation of work capacity have been found. Furthermore, exercise arterial blood gases are very sensitive tests for subtle lung disease. Exercise testing can be especially useful in those with co-existing disorders or unsuspected cardiovascular disorders. Exercise testing is not indicated in those who lack complaints of exertional dyspnea or fatigue, and those with severe respiratory impairment (ATS criteria for impairment by FEV 1 or DLCO) also do not require exercise testing. Cardiopulmonary exercise testing can provide objective determination of exercise capacity, increased sensitivity for pulmonary gas exchange abnormalities, and the ability to identify unsuspected or unanticipated non-pulmonary causes of impairment.

Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome

“…The discordance in the results of pulmonary function and exercise testing in the present study supports the recommendation to use CPET in impairment evaluation, especially in patients with symptoms inconsistent with the degree of impairment defined by resting pulmonary function testing [23]. Recently, NEDER et al [24] proposed expressing exercise disability using V9O 2 ,max % pred rather than V9O 2 ,max in mL?kg…”

Relationship Between Lung Function Impairment and Health-Related Quality of Life in COPD and Interstitial Lung Disease

“…We used FEV 1 (% predicted) as the primary measure of ventilatory impairment, because FEV 1 predicts ventilatory capacity on average. 25 Correlation between FEV 1 and maximal exercise ventilation and oxygen uptake has been demonstrated in both patients with COPD and patients with ILD. 26 Moreover, FEV 1 correlates with severity of dyspnea relative to exercise intensity in COPD and ILD.…”