English Chapter


Day 1: TUESDAY 7th November 2017
09.30-9.45 Welcome and Introduction Mike Grocott
09.45-10.30 Physiological basis of exercise performance part 1 Susan Ward
10.30-11.00 Physiological basis of exercise performance part 2 Susan Ward
11.00-11.10 Questions and discussion
11.10-11.40 Coffee
11.40-12.40 Facilitated learning group 1: Normal responses
12.40-13.10 Pathophysiology of exercise Piergiuseppe Agostoni
13.10-14.10 LUNCH
14.10-14.40 Laboratory methodology and calibration Richard Casaburi
14.40-15.20 Exercise test design: ramp and constant work-rate Marshall Riley
15.20-15.50 COFFEE
15.50-16.50 Facilitated group learning 2: Test procedures
16.50-17.20 Formatting exercise test results Richard Casaburi
17.20-18.05 My life in CPET Paul Older
18.10-19.00 Welcome reception

Day 2: WEDNESDAY 8th November 2017
08.30-09.00 CPET in heart failure Daniel Dumitrescu
09.00-09.30 CPET in cardiac ischaemia Romueldo Bellardinelli
09.30-10.00 CPET in congenital heart disease Alfred Hager
10:00-10:30 CPET in cardiac rehabilitation Piergiuseppe Agostoni
10.30-11.00 COFFEE
11.00-12.00 Facilitated group earning – 3. Cardiac
12.00-13.00 Lab 1: Ramp exercise test
13.00-13.50 LUNCH
13.50-14.20 CPET in lung diseases Marshall Riley
14.20-14.50 CPET in pulmonary hypertension Paolo Palange
14.50-15:20 CPET in pulmonary rehabilitation Richard Casaburi
15.20-16.20 Facilitated group learning: 4. Respiratory
16.20-16.50 COFFEE
16.50-17.50 Lab 2: Constant work-rate exercise test
17.50-18.35 Exercise on Everest Denny Levett


Day 3: THURSDAY 9th November 2017

08.30-09.00 Exercise is (perioperative) medicine Denny Levett
09.00-09.30 CPET and perioperative care Mike Grocott
09.30-10.00 Perioperative pre- and rehabilitation Sandy Jack
10.00-10.30 CPET in athletes Bob Smith
10.30-11.00 COFFEE
11.00-12.00 Facilitated group learning: 5. Divided by topic
12.00-12.30 Normal values Paolo Palange
12.30-13.00 CPET in children tbc
13.00-14.00 LUNCH
15.00-15.45 Writing the report Daniel Dumitrescu
15.45-16.10 COFFEE
16.10-17.40 Analysis: diagnostic CPET interactive session

Cardiopulmonary exercise testing (CPET, frequently referred to as CPX in the UK) is having something of a renaissance in the UK, in part driven by anaesthetists and intensivists with an interest in evaluating peri-operative risk.


Several distinct areas of practice are active.  Physician led cardiac and respiratory services conduct tests evaluating diverse conditions including pulmonary hypertension, cardiac transplant, surgically corrected congenital heart disease, and unexplained breathlessness. Anaesthetists, sometimes in collaboration with physicians, provide Peri-operative risk evaluation using CPET.  In a minority of cases consultant clinical scientists provide CPET services for a variety of medical departments.

Probably a majority of tests in the UK are now conducted to assess clinical risk prior to elective major surgery,  An open session at the 2nd National Peri-operative CPET Meeting (2009) suggested that more than 10,000 tests per year are being conducted for this indication within the UK.   A recent survey identified more than 30 centres currently active in this area with a further 12 in the process of setting up services (2008, 66% response rate).  The majority of the peer reviewed literature relating to Peri-operative CPET now derives from UK centres.    The early enthusiasm for sub-maximal tests (a la Older) is increasingly being replaced by exercise to exhaustion. Several controversies remain: which patients to test, appropriate level of medical supervision, which variables to sue as risk criteria and how best to manage patients identified as high risk.


The 3rd annual National Peri-operative CPET Meeting will take place in June with an anticipated attendance in excess of the 120 delegates in 2009.  The National organisation is developing rapidly with a new set of consensus guidelines in development.

Several courses cater specifically for the aspiring Peri-operative CPET practitioner. See:
www.ebpom.org and www.artp.org.uk.

There is also a small but active medical CPET community also meet regularly with a national meeting in September.


Several nationally funded studies (National Institute of Health Research, Medical Research Council) are utilising CPET to evaluate diverse phenomena including activity in normal aging, recovery following intensive care, and the adverse effects of neo-adjuvent chemotherapy.  A multi-centre randomised controlled trial is currently underway testing the “Older” hypothesis that using CPET derived variables to determine postoperative care (intensive care vs. ward care) improves outcomes when compared with clinician judgement.

For further information please contact Dr Mike Grocott, CPEX International Board Member: mike.grocott@ucl.ac.uk