ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases.

Radtke T, Crook S, Kaltsakas G, et al

Eur Respir Rev. 2019 Dec 18;28(154). pii: 180101. doi:
10.1183/16000617.0101-2018. Print 2019 Dec 31.

The objective of this document was to standardise published cardiopulmonary
exercise testing (CPET) protocols for improved interpretation in clinical
settings and multicentre research projects. This document: 1) summarises the
protocols and procedures used in published studies focusing on incremental CPET
in chronic lung conditions; 2) presents standard incremental protocols for CPET
on a stationary cycle ergometer and a treadmill; and 3) provides patients’
perspectives on CPET obtained through an online survey supported by the European
Lung Foundation. We systematically reviewed published studies obtained from
EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception
to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects
were included. The literature supports a test protocol with a resting phase
lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental
phase with work rate increased linearly at least every minute, followed by a
recovery phase of at least 2-3 min. Patients responding to the survey (n=295)
perceived CPET as highly beneficial for their diagnostic assessment and informed
the Task Force consensus. Future research should focus on the individualised
estimation of optimal work rate increments across different lung diseases, and
the collection of robust normative data.