Staes M; University Hospitals Leuven, Belgium.
Gyselinck I; Goetschalckx K; Troosters T; Janssens W

European Respiratory Review. 33(173), 2024 Jul.

Abstract
Cardiopulmonary exercise testing (CPET) is a comprehensive and invaluable
assessment used to identify the mechanisms that limit exercise capacity.
However, its interpretation remains poorly standardised. This scoping
review aims to investigate which limitations to exercise are
differentiated by the use of incremental CPET in literature and which
criteria are used to identify them. We performed a systematic, electronic
literature search of PubMed, Embase, Cochrane CENTRAL, Web of Science and
Scopus. All types of publications that reported identification criteria
for at least one limitation to exercise based on clinical parameters and
CPET variables were eligible for inclusion. 86 publications were included,
of which 57 were primary literature and 29 were secondary literature. In
general, at the level of the cardiovascular system, a distinction was
often made between a normal physiological limitation and a pathological
one. Within the respiratory system, ventilatory limitation, commonly
identified by a low breathing reserve, and gas exchange limitation, mostly
identified by a high minute ventilation/carbon dioxide production slope
and/or oxygen desaturation, were often described. Multiple terms were used
to describe a limitation in the peripheral muscle, but all variables used
to identify this limitation lacked specificity. Deconditioning was a
frequently mentioned exercise limiting factor, but there was no consensus
on how to identify it through CPET. There is large heterogeneity in the
terminology, the classification and the identification criteria of
limitations to exercise that are distinguished using incremental CPET.
Standardising the interpretation of CPET is essential to establish an
objective and consistent framework.