Cardiopulmonary Exercise Testing: Basics of Methodology and Measurements

Mezzani A

Ann Am Thorac Soc. 2017 Jul;14(Supplement_1):S3-S11. doi:

Cardiopulmonary exercise testing adds measurement of ventilation and volume of
oxygen uptake and exhaled carbon dioxide to routine physiological and performance
parameters obtainable from conventional exercise testing, furnishing an
all-around vision of the systems involved in both oxygen transport from air to
mitochondria and its use during exercise. Peculiarities of cardiopulmonary
exercise testing methodology are the use of ramp protocols and calibration
procedures for flow meters and gas analyzers. Among the several parameters
provided by this technique, peak oxygen uptake, first and second ventilatory
thresholds, respiratory exchange ratio, oxygen pulse, slope of ventilation
divided by exhaled carbon dioxide relationship, exercise oscillatory ventilation,
circulatory power, and partial pressure of end-tidal carbon dioxide are among the
most relevant in the clinical setting. The choice of parameters to be considered
will depend on the indication to cardiopulmonary exercise testing in the
individual subject or patient, namely, exercise tolerance assessment, prognostic
stratification, training prescription, treatment efficacy evaluation, diagnosis
of causes of unexplained exercise tolerance reduction, or exercise
(patho)physiology evaluation for research purposes. Overall, cardiopulmonary
exercise testing is a methodology now widely available and supported by sound
scientific evidence. Despite this, its potential still remains largely underused.
Strong efforts and future investigations are needed to address these issues and
further promote the use of cardiopulmonary exercise testing in the clinical and
research setting.