Modalities of Clinical Exercise Testing

Abstract

Currently, clinical exercise testing is increasingly utilized in clinical practice in order to optimize patient management and provide answers to questions not available from resting cardiopulmonary tests. There are several modalities of clinical exercise testing designed to evaluate and to answer different clinical question(s). The selection of clinical exercise testing modality should be based on the clinical question, facilities and expertise available including consideration of the cost effectiveness of the different tests. The most popular clinical exercise tests are the 6-minute walk test, exercise-induced bronchospasm test, cardiac stress test and cardiopulmonary exercise test. The main applications of clinical exercise testing include the evaluation of exercise intolerance and unexplained dyspnea; early diagnosis of cardiopulmonary diseases; evaluation of coronary artery disease and exercise-induced asthma; assessment of functional capacity; preoperative surgical evaluation; prognosis of cardiopulmonary diseases; evaluation of therapeutic interventions; oxygen prescription, and prescription for pulmonary rehabilitation.Clinical exercise tests are utilized in a variety of clinical situations [1]. They provide functional information useful for patient management which cannot be obtained from resting pulmonary and/or cardiac measurements [2-The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. 5]. Furthermore, exertional symptoms correlate poorly with resting cardiopulmonary measurements [4,6].There are several modalities of clinical exercise testing used in clinical practice. Some provide basic information, are low tech, and simple to perform, while others provide a more complete assessment of all the physiological systems involved in exercise and require more complex technology. Table 1 shows the most popular clinical exercise tests in order of increasing complexity.Modality selection should be based on the clinical question(s) to be addressed and on the available equipment and facilities. Some examples of clinical scenarios that can be encountered and the appropriate clinical exercise modality to be used follow. A test for exerciseinduced bronchospasm would be appropriate for a patient who is young and complains of breathing difficulties postexercise. However, asthma has a bimodal distribution and exercise-induced bronchoconstriction as a cause of unexplained dyspnea occurs commonly in older patients [7]. For a patient over 40 years old with chest tightness and/or chest pain triggered by exercise, a cardiac stress test on a treadmill would be the first choice, although the use of a cycle ergometer would also be acceptable. If these modalities were not available, a Master two-step test could be another less frequently used alternative. If the reason for testing is the diagnosis of unexplained dyspnea or exercise intolerance, early cardiopulmonary exercise...

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