Physiological testing

Exercise Tests ◽

Objective Evidence ◽

Testing Protocols ◽

Incremental Increase

Physiological testing 34Types of exercise tests 36Bruce exercise testing 37Metabolic exercise testing 38Exercise testing provides objective evidence of performance in cardiac disease. There are many testing protocols available but they usually involve incremental increase in exercise either on a treadmill or an exercise bike. Metabolic or cardiopulmonary exercise testing (CPEX) measures ventilation and the inspired and expired oxygen (O...

Physiological testing

10.1093/med/9780198759959.003.0004 ◽

2017 ◽

Author(s):

Sara Thorne ◽

Sarah Bowater

Keyword(s):

Exercise Testing ◽

Cardiac Disease ◽

Functional Ability ◽

Functional Performance ◽

Clinical Question ◽

Exercise Tests ◽

Objective Evidence ◽

The Subject

Exercise testing provides objective evidence of functional performance in cardiac disease. There are several modalities available; the method used will depend on the clinical question to be addressed, the equipment available, and the functional ability of the subject being investigated. This chapter explores types of exercise tests and metabolic exercise testing.

Prognostic Value of Heart Rate Profiles During Cardiopulmonary Exercise Testing in Patients With Cardiac Disease

International Heart Journal ◽

10.1536/ihj.50.59 ◽

2009 ◽

Vol 50 (1) ◽

pp. 59-71 ◽

Cited By ~ 2

Author(s):

Ayumi Goda ◽

Akira Koike ◽

Masayo Hoshimoto- Iwamoto ◽

Osamu Nagayama ◽

Kaori Yamaguchi ◽

...

Keyword(s):

Heart Rate ◽

Exercise Testing ◽

Cardiac Disease ◽

Prognostic Value ◽

Cardiopulmonary Exercise

Comparison of the 6-minute walk test with established parameters for assessment of cardiopulmonary capacity in adults with complex congenital cardiac disease

Cardiology in the Young ◽

10.1017/s1047951105000818 ◽

2005 ◽

Vol 15 (4) ◽

pp. 385-390 ◽

Cited By ~ 13

Author(s):

Andreas Niedeggen ◽

Erik Skobel ◽

Philipp Haager ◽

Wolfgang Lepper ◽

Eberhard Mühler ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Exercise Testing ◽

Cardiac Disease ◽

Walk Test ◽

Congenital Cardiac Disease ◽

6 Minute Walk Test ◽

Minute Walk

Background:Objective assessment of the cardiopulmonary capacity in patients with complex congenital cardiac disease often remains difficult in clinical practice. The cardiopulmonary exercise test and determination of the levels of brain natriuretic peptide in the plasma are established tests, but expensive. The 6-minute walk test is also validated, but has not often been used in patients with heart failure due to congenital heart disease, nor compared with other tests. We sought to compare its value with the results of cardiopulmonary exercise testing and measuring the levels of brain natriuretic peptide in the plasma.Methods:We carried out a standardized 6-minute walk test in 31 patients with complex congenital cardiac disease on the same day that they underwent cardiopulmonary exercise testing and determination of levels of brain natriuretic peptide in the plasma. Of the patients, 7 had functionally univentricular hearts, 9 had transposition, 9 had tetralogy of Fallot, 3 had common arterial trunk, and 3 had pulmonary atresia with intact interventricular septum. Uptakes of oxygen at peak exercise, and at the anaerobic threshold, were determined using cardiopulmonary exercise testing, and classified as suggested by Weber. The 6-minute walk test was performed according to a standard protocol.Results:There was a significant correlation between brain natriuretic peptide, oxygen uptakes at peak exercise and 6-minute walk. The correlation between the 6-minute walk test and oxygen uptakes at the anaerobic threshold, however, was not significant.Conclusions:The 6-minute walk test can be performed easily, is inexpensive, widely available, and correlates well with measurements of brain natriuretic peptide and cardiopulmonary exercise testing, even in patients with corrected or palliated congenital cardiac malformations. A cut-off value of 450 metres in the 6-minute walk test allows a semi-quantitative classification in analogy to the classification suggested by Weber for cardiopulmonary exercise testing, and to a level of brain natriuretic peptide in the plasma of less or more than 100 picograms per millilitre.

Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome

Physical Therapy ◽

10.2522/ptj.20110368 ◽

2013 ◽

Vol 93 (11) ◽

pp. 1484-1492 ◽

Cited By ~ 49

Author(s):

Christopher R. Snell ◽

Staci R. Stevens ◽

Todd E. Davenport ◽

J. Mark Van Ness

Keyword(s):

Chronic Fatigue Syndrome ◽

Exercise Testing ◽

Exercise Test ◽

Chronic Fatigue ◽

Peak Exercise ◽

Exercise Tests ◽

Discriminative Validity ◽

Fatigue Syndrome

BackgroundReduced functional capacity and postexertion fatigue after physical activity are hallmark symptoms of chronic fatigue syndrome (CFS) and may even qualify for biomarker status. That these symptoms are often delayed may explain the equivocal results for clinical cardiopulmonary exercise testing in people with CFS. Test reproducibility in people who are healthy is well documented. Test reproducibility may not be achievable in people with CFS because of delayed symptoms.ObjectiveThe objective of this study was to determine the discriminative validity of objective measurements obtained during cardiopulmonary exercise testing to distinguish participants with CFS from participants who did not have a disability but were sedentary.DesignA prospective cohort study was conducted.MethodsGas exchange data, workloads, and related physiological parameters were compared in 51 participants with CFS and 10 control participants, all women, for 2 maximal exercise tests separated by 24 hours.ResultsMultivariate analysis showed no significant differences between control participants and participants with CFS for test 1. However, for test 2, participants with CFS achieved significantly lower values for oxygen consumption and workload at peak exercise and at the ventilatory or anaerobic threshold. Follow-up classification analysis differentiated between groups with an overall accuracy of 95.1%.LimitationsOnly individuals with CFS who were able to undergo exercise testing were included in this study. Individuals who were unable to meet the criteria for maximal effort during both tests, were unable to complete the 2-day protocol, or displayed overt cardiovascular abnormalities were excluded from the analysis.ConclusionsThe lack of any significant differences between groups for the first exercise test would appear to support a deconditioning hypothesis for CFS symptoms. However, the results from the second test indicated the presence of CFS-related postexertion fatigue. It might be concluded that a single exercise test is insufficient to reliably demonstrate functional impairment in people with CFS. A second test might be necessary to document the atypical recovery response and protracted fatigue possibly unique to CFS, which can severely limit productivity in the home and workplace.

An Evaluation of Integrated Cardiopulmonary Exercise Testing in a Pulmonary Function Laboratory

Scottish Medical Journal ◽

10.1177/003693309504000404 ◽

1995 ◽

Vol 40 (4) ◽

pp. 113-116 ◽

Cited By ~ 10

Author(s):

M.K. Sridhar ◽

R. Carter ◽

S.W. Banham ◽

F. Moran

Keyword(s):

Pulmonary Function ◽

Exercise Testing ◽

Clinical Investigation ◽

Cardiac Response ◽

Response To Treatment ◽

Exercise Tests ◽

Cardiopulmonary Disease ◽

Response To Exercise

Clinical exercise testing has been used mainly to assess the cardiac response to exercise. Integrative cardiopulmonary exercise tests (CPET) involving the measurement of the ventilatory, circulatory and metabolic response to exercise has largely been a research tool. We analysed the results of one hundred tests randomly chosen from a total of 472 exercise tests performed between January 1992 and June 1993 as clinical investigation in a pulmonary function laboratory. CPET was used (a) to identify the cause of effort limitation in patients where more than one illness could be relevant (26); (b) to obtain an objective measure of the exercise capacity of patients with respiratory or cardiac disease (31); (c) as monitor of response to treatment (11) and (d) in the investigation of unexplained dyspnoea (32). In 94 of the 100 cases CPET was able to provide an answer to the specific clinical question posed. In patients with unexplained dyspnoea CPET identified a group who exhibit an inappropriate hyperventilatory response to exercise with no supportive evidence of cardiopulmonary disease. In a small minority of cases CPET gave non-specific results. We conclude that CPET is a useful investigation in the management of patients with cardiopulmonary disease and complements the various other investigations offered by a pulmonary function laboratory.

Cardiopulmonary exercise testing with supramaximal verification produces a safe and valid assessment of V̇o2max in people with cystic fibrosis: a retrospective analysis

Journal of Applied Physiology ◽

10.1152/japplphysiol.00454.2018 ◽

2018 ◽

Vol 125 (4) ◽

pp. 1277-1283 ◽

Cited By ~ 10

Author(s):

Adam J. Causer ◽

Janis K. Shute ◽

Michael H. Cummings ◽

Anthony I. Shepherd ◽

Victoria Bright ◽

...

Keyword(s):

Cystic Fibrosis ◽

Oxygen Uptake ◽

Exercise Testing ◽

Peak Oxygen Uptake ◽

Valid Measure ◽

Exercise Tests ◽

Adolescents And Adults ◽

Maximal Effort

The validity and safety of using supramaximal verification (Smax) to confirm a maximal effort during cardiopulmonary exercise testing (CPET) in people with cystic fibrosis (CF) and/or those with severe disease has been questioned. Therefore, this study aimed to investigate these concerns in children, adolescents, and adults with mild-to-severe CF lung disease. Retrospective analysis of 17 pediatric and 28 adult participants with CF [age range: 9.2–62.9 y; forced expiratory volume in 1 s: 66.7% (range: 29.9%–102.3%); 30 men] who completed a routine ramp-incremental cycling test to determine peak oxygen uptake (V̇o2peak) was studied. Maximal oxygen uptake (V̇o2max) was subsequently confirmed by Smax at 110% of peak power output. All participants satisfied the criteria to verify a maximal effort during CPET. However, Smax-V̇o2peak exceeded ramp-V̇o2peak in 3/14 (21.4%) of pediatric and 6/28 (21.4%) adult exercise tests. A valid measurement of V̇o2max was attained in 85.7% of pediatric and 96.4% of adult exercise tests, as Smax-V̇o2peak did not exceed ramp-V̇o2peak by >9%. Adults ( n = 9) experienced a ≥5% reduction in arterial O2 saturation during CPET, 4 during both the ramp and Smax, 3 during only the ramp, and 2 during only Smax. Smax did not significantly worsen perceived breathing effort, chest tightness, throat narrowing, or exertion compared with ramp-incremental testing. Given the clinical importance of aerobic fitness in people with CF, incorporating Smax is recommended to provide a safe and valid measure of V̇o2max in children, adolescents, and adults who span the spectrum of CF disease severity. NEW & NOTEWORTHY Incorporating supramaximal verification into cardiopulmonary exercise testing protocols did not increase the frequency of adverse events or perceived discomfort versus a single-phase incremental exercise test in people with mild-to-severe cystic fibrosis. Furthermore, a valid measure of maximal oxygen uptake (V̇o2max) was obtained from 85.7% of pediatric and 96.4% of adult exercise tests, whereas peak oxygen uptake underestimated aerobic fitness in comparison with V̇o2max in 21.4% of cases (by up to 24.4%).

Feasibility and safety of cardiopulmonary exercise testing in children with pulmonary hypertension

Cardiology in the Young ◽

10.1017/s1047951115001961 ◽

2015 ◽

Vol 26 (6) ◽

pp. 1144-1150 ◽

Cited By ~ 6

Author(s):

Mohammad R. Abumehdi ◽

Andrew J. Wardle ◽

Rewa Nazzal ◽

Athanasios Charalampopoulos ◽

Ingram Schulze-Neick ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Exercise Testing ◽

Peak Oxygen Uptake ◽

Cardiopulmonary Exercise Test ◽

World Health ◽

Peak Exercise ◽

Exercise Tests ◽

Patient Reported

AbstractBackgroundCardiopulmonary exercise testing helps prognosticate and guide treatment in adults with pulmonary hypertension. Concerns regarding its feasibility and safety limit its use in children with pulmonary hypertension. We aimed to assess the feasibility and safety of cardiopulmonary exercise testing in a large paediatric pulmonary hypertension cohort.MethodsWe reviewed all consecutive cardiopulmonary exercise tests performed between March, 2004 and November, 2013. The exclusion criteria were as follows: height <120 cm, World Health Organization class IV, history of exercise-induced syncope, or significant ischaemia/arrhythmias. Significant events recorded were as follows: patient-reported symptoms, arrhythmias, electrocardiogram abnormalities, and abnormal responses of arterial O2 saturation.ResultsA total of 98 children underwent 167 cardiopulmonary exercise tests. The median age was 14 years (inter-quartile range 10–15 years). Peak oxygen uptake was 20.4±7.3 ml/kg/minute, corresponding to 51.8±18.3% of the predicted value. Peak respiratory quotient was 1.08±0.16. All the tests except two were maximal, being terminated prematurely for clinical reasons. Baseline Oxygen saturation was 93.3±8.8% and was 81.2±19.5% at peak exercise. A drop in arterial O2 saturation >20% was observed in 23.5% of the patients. Moreover, five patients (3.0%) experienced dizziness, one requiring termination of cardiopulmonary exercise testing; five children (3.0%) experienced chest pain, with early cardiopulmonary exercise test termination in one patient. No significant arrhythmias or electrocardiogram changes were observed.ConclusionExercise testing in non-severely symptomatic children with pulmonary hypertension is safe and practical, and can be performed in a large number of children with pulmonary hypertension in a controlled environment with an experienced team. Side-effects were not serious and were resolved promptly with test termination.