Reference values for cardiopulmonary exercise testing in healthy subjects – an updated systematic review

Takken, Tim; Mylius, C. F.; Paap, Davy; Broeders, W.H.M.; Hulzebos, H.J.; Brussel, Marco van; Bongers, Bart C.

doi:10.1080/14779072.2019.1627874

Cited by 62 publications

(58 citation statements)

References 47 publications

(53 reference statements)

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“…In contrast to past studies, [8,10] which have established that the absolute value of VO2/kg can serve as a survival predictor, our study highlighted the importance of the difference between the predicted and observed oxygen consumption. Typically, the maximal oxygen consumption in a healthy person can be predicted on the basis of age, sex, body height, and body weight, [41] and older women demonstrate lower oxygen consumption and older male patients with IPF demonstrate higher mortality. [25] Therefore, using the absolute value of VO2/kg instead of FAI in female patients with IPF could have the potential hazard of overestimating mortality.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cardiopulmonary Exercise Test, Pulmonary Function Test , and Questionnaires on Mortality in Patients With Idiopathic Pulmonary Fibrosis: A Prospective Pilot Study

Cheng

Lin

Chang

et al. 2020

Preprint

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Background and Objective: Idiopathic pulmonary fibrosis (IPF) is a lung disease with a high mortality rate. Finding an effective predictor of survival is therefore important for clinicians and patients. Several parameters have been established to predict mortality, but none of these have been validated in the Asian population. In this study, we evaluated the prognostic value of the parameters of cardiopulmonary exercise test (CPET), pulmonary function test (PFT), 6-min walk test (6MWT), and certain questionnaires on mortality in Asian patients with IPF. Methods: This prospective observational study analysed patient data, including age, gender, height, and body weight; scores of Saint George’s Respiratory Questionnaire (SGRQ), Modified Medical Research Council (mMRC) for dyspnoea, and Short Form-36 (SF-36); and parameters of PFT, 6MWT, and CPET. Results: In total, 24 patients diagnosed as having IPF were followed up for 14 months, during which 3 patients died. The nonsurvivors had significantly lower body weight; lower forced vital capacity (FVC); higher ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC); higher gender, age, and pulmonary physiology (GAP) index; shorter walk distance in 6MWT; lower end-tidal pressure of carbon dioxide (DLCO); higher functional aerobic impairment (FAI) during exercise; and higher mMRC score. FEV1/FVC, FAI, GAP index, and mMRC dyspnoea score demonstrated an area under curve (AUC) of >0.7, and the corresponding cut-off values were 89%, 54%, 7, and 3. Conclusions: The predictive abilities of PFT, CPET, and mMRC scores were validated successfully in the study cohort of Asian patients with IPF.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Cardiopulmonary Exercise Test, Pulmonary Function Test , and Questionnaires on Mortality in Patients With Idiopathic Pulmonary Fibrosis: A Prospective Pilot Study

Cheng

Lin

Chang

et al. 2020

Preprint

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“…More males than females were included in these two studies, with the second including male participants only (Hansen et al, 1984). A recently updated systematic review showed that, in studies establishing CPET reference values in healthy adults, females are underrepresented and account for 38% of the total number of included study participants (Takken et al, 2019). Although an increasing number of hospitals in the UK use CPET to assess surgical risk, separate reference values for males and females have not been reported in recent perioperative CPET publications (Levett et al, 2018;Reeves et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Why women are not small men: sex-related differences in perioperative cardiopulmonary exercise testing

et al. 2020

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Background: The use of preoperative cardiopulmonary exercise testing (CPET) to evaluate the risk of adverse perioperative outcomes is increasingly prevalent. CPET-derived information enables personalised perioperative care and enhances shared decision-making. Sex-related differences in physical fitness are reported in non-perioperative literature. However, little attention has been paid to sex-related differences in the context of perioperative CPET. Aim: We explored differences in the physical fitness variables reported in a recently published multi-centre study investigating CPET before colorectal surgery. We also report the inclusion rate of females in published perioperative CPET cohorts that are shaping guidelines and clinical practice. Methods: We performed a post hoc analysis of the trial data of 703 patients who underwent CPET prior to major elective colorectal surgery. We also summarised the female inclusion rate in peer-reviewed published reports of perioperative CPET. Results: Fitness assessed using commonly used perioperative CPET variables-oxygen consumption at anaerobic threshold (AT) and peak exercise-was significantly higher in males than in females both before and after correction for body weight. In studies contributing to the development of perioperative CPET, 68.5% of the participants were male. Conclusion: To our knowledge, this is the first study to describe differences between males and females in CPET variables used in a perioperative setting. Furthermore, there is a substantial difference between the inclusion rates of males and females in this field. These findings require validation in larger cohorts and may have significant implications for both sexes in the application of CPET in the perioperative setting.

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“…(11), and Takken et al(12) published two systematic reviews in 2014 and 2019, where they studied refer-VO 2 max in females…”

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confidence: 99%

Is population's cardiorespiratory fitness really declining?

Sovová

Asswad

et al. 2020

Cent Eur J Public Health

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Objective: Cardiorespiratory fitness (CRF) is defined as the capacity of the cardiovascular and pulmonary systems to meet the oxygen demands of the body during physical work. Poor CRF is connected with a higher risk for the development of various noninfectious diseases such as cardiovascular disease or malignancies. The standard test for the assessment of CRF is exercise testing with the measurement of maximal oxygen consumption (VO 2 max). Standard VO 2 max values for adult men and women in the Czech Republic have been available since the 1970s without being updated. According to experts, these standard values are now unusable for contemporary CRF measurements of the population in the Czech Republic. The Fitness Registry and the Importance of Exercise: a National Database (FRIEND)-4,494 patients (1,717 men) defined new standard values for bicycle ergometry CRF for the population in the United States of America. The aim of the study was the statistical comparison of VO 2 max values (reference standards) in the 1970s population in the Czech Republic with the new reference standards of the FRIEND registry. Methods: All analyses were performed using IBM SPSS statistics and all tests with a p-value of less than 0.05 were considered statistically significant. Results: VO 2 max norms for women in the Czech population were higher in all age categories with statistically significant differences in the categories 30-39, 40−49 and 50-59 (p < 0.001). In the male population aged 20-29 years, VO 2 max was significantly higher in the FRIEND registry (p < 0.001) in contrast to the other age categories, 30-39, 40-49 and 50-59, which were significantly higher in the Czech population (p < 0.001). Conclusions: Czech VO 2 max population norms from the 1970s are (with the exception of age category 20-29 years) higher than values from the recent FRIEND registry.

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Reference values for cardiopulmonary exercise testing in healthy subjects – an updated systematic review

Cited by 62 publications

References 47 publications

Prognostic Value of Cardiopulmonary Exercise Test, Pulmonary Function Test , and Questionnaires on Mortality in Patients With Idiopathic Pulmonary Fibrosis: A Prospective Pilot Study

Prognostic Value of Cardiopulmonary Exercise Test, Pulmonary Function Test , and Questionnaires on Mortality in Patients With Idiopathic Pulmonary Fibrosis: A Prospective Pilot Study

Why women are not small men: sex-related differences in perioperative cardiopulmonary exercise testing

Is population's cardiorespiratory fitness really declining?

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