Cardiopulmonary Exercise Testing (CPET) In Adults

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (27/10/2020)

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed, Kim Jackson and Lucinda hampton

Introduction

Cardiopulmonary exercise testing (CPET) is an exercise test for analyzing both diagnostic and prognostic assessment by evaluating both submaximal and peak exercise response involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems[1], CPET is aimed at the evaluation of exercise performance, functional capacity, and impairment by assessing undiagnosed exercise intolerance and exercise-related symptoms. the patient is performing the exercise (walking and jogging) on a Treadmill or a Bicycle ergometer for a period of time, and exercise grade. This exercise test can be used, for patient management with lung and heart surgeries, COPD, Unexplained Dyspnea, cardio and respiratory disease, and also used for training tools in athletes. In CPET different patients have different exercise protocols and exercise grades to follow.

Cardiopulmonary exercise testing (CPET) is the study of responses of the cardiovascular and ventilatory systems to known exercise stress. This is because gas exchange at the airway is a consequence of cardiac output and pulmonary blood flow, as well as peripheral O2 extraction coupled to ventilation. Thus, the heart, with the circulation, couples gas exchanges (O2 and CO2) of muscle respiration with that at the lungs. The adequacy of the cardiovascular transport of O2 for known exercise work rates is described by the lung gas exchange.[2]

CPET involves mainly the analysis of respiratory gases including.

  • Respiratory oxygen uptake (Vo2),
  • Carbon dioxide production (Vco2),
  • Ventilatory measures during a symptom‐limited exercise test.

Purpose

  • Diagnostic and prognostic evaluation of cardiovascular and pulmonary diseases.
  • Evaluation of the disease severity and functional effects.
  • Assessment for suitability of treatment, (i.e. surgery, transplantation, supplemental oxygen therapy)
  • Evaluation of efficacy of the therapeutic intervention
  • The Outcome variable for clinical trials
  • Measurable goals to improve fitness
  • To measure exercise rehabilitative training intensity
  • Development of knowledge and understanding of the disease.

Technique

Cardiopulmonary exercise testing (CPET) can be assessed by the Laboratory method

  • Treadmill
  • Bicycle ergometer

Measurements

Common measurements like

There are several clinical measurements used in the CPET depends on the type of exercise and diagnose

Protocols

BRUCE PROTOCOL
Bruce protocol
There are many different CPET protocols used in the different patients,
treadmill protocol
Treadmill protocol

Common protocols are[1]

  • Bruce treadmill test is one of the most commonly used in CPET
  • Bruce or Ellestad is better suited for screening younger and/or physically active individuals (larger progressive workload)
  • Naughton or Balke-Ware is preferable for older or deconditioned individuals and patients with chronic diseases. (smaller progressive workload)

Indication

  1. Evaluation of Exercise Intolerance[1]
  2. Unexplained Dyspnea[1]
  3. Evaluation of Patients with Cardiovascular Disease[1]
  4. Evaluation of Patients with Respiratory Disease 216[1]
  5. Preoperative Evaluation[1]
  6. Exercise Prescription for Pulmonary Rehabilitation[1]
  7. Evaluation of Impairment/Disability[1]

Contraindication

Absolute Relative
Acute myocardial infarction (3–5 days) Left main coronary stenosis or its equivalent
Unstable angina Moderate stenotic valvular heart disease
Uncontrolled arrhythmias causing symptoms Severe untreated arterial hypertension at rest
or hemodynamic compromise (> 200 mm Hg systolic, > 120 mm Hg diastolic)
Syncope Tachyarrhythmias or bradyarrhythmias
Active endocarditis High-degree atrioventricular block
Acute myocarditis or pericarditis Hypertrophic cardiomyopathy
Symptomatic severe aortic stenosis Significant pulmonary hypertension
Uncontrolled heart failure Advanced or complicated pregnancy
Acute pulmonary embolus or pulmonary infarction Electrolyte abnormalities
Thrombosis of lower extremities Orthopedic impairment that compromises exercise performance
Suspected dissecting aneurysm
Uncontrolled asthma
Pulmonary edema
Room air desaturation at rest ⩽ 85%[null *]
Respiratory failure
Acute noncardiopulmonary disorder that may affect
exercise performance or be aggravated by exercise
  

(i.e. infection, renal failure, thyrotoxicosis)

Mental impairment leading to inability to cooperate

[1]


Resources

ATS/ACCP Statement on Cardiopulmonary Exercise Testing

ACSM's Guidelines for Exercise Testing and Prescription

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003 Jan 15;167(2):211-77. doi: 10.1164/rccm.167.2.211. Erratum in: Am J Respir Crit Care Med. 2003 May 15;1451-2. PMID: 12524257.
  2. Karlman Wasserman. Principles of Exercise Testing and Interpretation Including Pathophysiology and Clinical Application. 5th edition. Wolters Kluwer Bussiness. 2012
  3. Cardiopulmonary Exercise testing CPET. Natural Medicine & Detox. Available from: https://youtu.be/UBupw-HNXI4
  4. A Basic Introduction of Cardio-Pulmonary Exercise Testing -- BAVLS.American Thoracic Society. Available from: https://youtu.be/xOvSU_ZI5Hw