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Risk stratification based on CPET results from patients with CHF (Modified from Ribeiro JP, Stein R, Chiappa GR. J Cardiopulm Rehabil. 2006 MarApr;26(2):63-71). CPET: cardiopulmonary exercise test; VO 2 : oxygen consumption; R: respiratory exchange ratio; VE/VCO 2 slope: ratio between pulmonary ventilation and carbon dioxide production; PETCO 2 : extrapolated end-tidal carbon dioxide tension; T 1/2 : time necessary for a post-exertion 50% drop in VO 2 measured; OUES: oxygen uptake efficiency slope; HRR: heart rate recovery.
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Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: venti...
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Introduction
Step climbing is a potentially useful modality for testing exercise capacity. However, there are significant variations between test protocols and lack of consistent validation against gold standard cycle ergometry cardiopulmonary exercise testing (CPET). The purpose of the study was to validate a novel technique of exercise testing us...
Citations
... The peak HR was 81.6 % of the predicted value of HRmax with the patient's best efforts, suggesting a lesser risk of chronotropic insufficiency in the patient. The 20-W cycling exercise test revealed an HRR of 28 and a maximum exercise capacity of 7.8 METs (maximum oxygen uptake: 27.3 ml/ 11 The slope of VE/VCO 2 was 28.8, indicating sufficient ventilation efficiency. No myocardial ischemia or arrhythmia were found during exercise, and the maximum oxygen consumption standard defined by ACSM guidelines was reached. ...
... Cardiopulmonary exercise testing is commonly used for the evaluation of exercise intolerance and exercise-related symptoms and exercise responses involving the pulmonary and cardiovascular system [98]. Cardiopulmonary exercise testing provides reliable data on patients' current health conditions and shows the changes during the given period [99]. During the whole measurement, a real-time electrocardiogram (ECG) was detected for patients' safety [62]. ...
The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group ( n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021–31/DEC/2022, while an age-matched control group ( n = 100) received a single check-up. To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05). Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption ( p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome.
... The results of our study confirmed that even professional athletes were not spared from COVID-19 infection in terms of impaired cardiorespiratory function, which includes ventilatory efficiency. Furthermore, OUES, as an index of cardiorespiratory functional reserve [29], was numerically decreased after SARS-CoV-2 infection, which could explain the overall drop in exercise tolerance among athletes. Decreased values of OUES after COVID-19 coincided with an early transition from aerobic to anaerobic metabolism at submaximal levels of intensity. ...
Background and Objectives: The aim of the study was to evaluate the health status of professional athletes after recovering from COVID-19 and the impact that SARS-CoV-2 had on their overall cardiorespiratory fitness, which was done by conducting cardiopulmonary exercise testing (CPET). Materials and Methods: A total of twenty-seven professional basketball players (Euroleague Basketball and the ABA League) participated in the study. CPET was performed before (as part of their regular preparticipation exam, during the pre-season period), as well as after SARS-CoV-2 infection (after two weeks of home isolation, during the competitive part of the season). CPET was performed on a treadmill, while cardiovascular, respiratory, and metabolic functions were evaluated by using a breath-by-breath analysis technique (Quark CPET system manufactured by Cosmed, Rome, Italy). Results: Maximal oxygen consumption and aerobic efficiency were significantly reduced after SARS-CoV-2 infection (p = 0.000). An obvious decrease in oxygen pulse was observed during CPET after recovering from COVID-19 (p = 0.001), as was deterioration of ventilatory efficiency. Internal respiration was the most negatively affected. An early transition from aerobic to anaerobic mechanisms of creating energy for work and intensive metabolic fatigue were obvious after SARS-CoV-2 infection. Conclusions: Although it was believed that SARS-CoV-2 only affects the cardiopulmonary status of the elderly population and people with associated comorbidities, it is clear from this research that professional athletes can also be at certain risk. Even though no pathological cardiovascular and respiratory changes were found in athletes after COVID-19, results showed significantly decreased cardiorespiratory fitness, with an emphasis on internal respiration.
... It involves incremental exercise, typically on a treadmill or stationary bike, while continuously monitoring various physiological parameters. These parameters include oxygen consumption, heart rate, blood pressure, ventilation, gas exchange (oxygen and carbon dioxide levels), and other relevant data (57)(58)(59)(60). By measuring and integrating these data at different levels of physical effort, CPET provides valuable insights into an individual's exercise capacity, cardiorespiratory fitness, and any abnormalities or limitations in the cardiopulmonary system (61)(62)(63)(64). ...
... Muscular fatigue could also be assessed by monitoring exercise capacity and an early onset of anaerobic metabolism. Overall, The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion (57). Therefore, the CPET is a useful tool to assess the impairment of cardiopulmonary homeostasis and function in FD patients. ...
Fabry disease (FD), also known as Anderson-Fabry disease, is a hereditary disorder of glycosphingolipid metabolism, caused by a deficiency of the lysosomal alpha-galactosidase A enzyme. This causes a progressive accumulation of glycosphingolipids in tissues and organs which represents the main pathogenetic mechanism of FD. The disease is progressive and multisystemic and is characterized by early symptoms and late complications (renal, cardiac and neurological dysfunction). Fatigue and exercise intolerance are early common symptoms in FD patients but the specific causes are still to be defined. In this narrative review, we deal with the contribution of cardiac and pulmonary dysfunctions in determining fatigue and exercise intolerance in FD patients.
... CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs [34]. During the test, different parameters were recorded. ...
Background
Fatigue is frequent in people with multiple sclerosis (pwMS) impacting physical and cognitive functions. Lower aerobic capacity and regional thalamic volume may be involved in the pathophysiology of fatigue in pwMS.
Objectives
To identify associations between thalamic nuclei volumes, aerobic capacity and fatigue and to investigate whether the influence of aerobic capacity on fatigue in pwMS is mediated by thalamic integrity.
Methods
Eighty-three pwMS underwent a clinical evaluation with assessment of fatigue (Modified Fatigue Impact Scale [MFIS]), including physical (pMFIS) and cognitive (cMFIS) components, and peak of oxygen uptake (VO2peak). PwMS and 63 sex- and age-matched healthy controls (HC) underwent a 3 T brain MRI to quantify volume of the whole thalamus and its nuclei.
Results
Compared to HC, pwMS showed higher global MFIS, pMFIS and cMFIS scores, and lower VO2peak and thalamic volumes (p < 0.001). In pwMS, higher VO2peak was significantly associated with lower MFIS and pMFIS scores (r value = − 0.326 and − 0.356; pFDR ≤ 0.046) and higher laterodorsal thalamic nucleus (Dor) cluster volume (r value = 0.300; pFDR = 0.047). Moreover, lower Dor thalamic cluster volume was significantly associated with higher MFIS, pMFIS and cMFIS scores (r value range = − 0.305; − 0.293; pFDR ≤ 0.049). The volume of Dor thalamic cluster partially mediated the positive effects of VO2peak on both MFIS and cMFIS, with relative indirect effects of 21% and 32% respectively. No mediation was found for pMFIS.
Conclusions
Higher VO2peak is associated with lower fatigue in pwMS, likely acting on Dor thalamic cluster volume integrity. Such an effect might be different according to the type of fatigue (cognitive or physical).
... [14]. All procedures followed international recommendations [15,16]. Additionally, participants were assessed for their ability to maintain a cadence between 50 and 60 revolutions per minute (rpm) for one minute, as part of the comprehension evaluation. ...
Peak oxygen uptake (VO2peak) is a crucial health marker, extensively studied in adults for its prognostic value. However, its significance in the older persons, especially octogenarians, remains underexplored due to limited representation in research. This study aims to assess the predictive power of VO2peak for survival in individuals aged 80 and above.
We included individuals aged 80 or older who underwent cardiopulmonary exercise tests at a single center. Mortality rates were compared based on VO2peak relative to 80% of predicted values (%VO2peak). We employed three multivariate Cox regression models: Model 1 (unadjusted), Model 2 (adjusted for age) and Model 3 (adjusted for age and stroke).
Among 188 participants (mean age 83.3 ± 3 years, 68.9% male), 22 (11.7%) passed away during a median follow-up of 494 days. Non-survivors tended to be older with lower VO2peak and %VO2peak. All models demonstrated associations between %VO2peak ≤ 80% and mortality: HR = 3.19 (95% CI: 1.30–7.86, p = 0.011) for M1; HR = 3.12 (95% CI: 1.26–7.74, p = 0.013) for M2 and HR = 2.80 (95% CI: 1.11–7.06, p = 0.028) for M3.
In the context of an aging population, this study underscores the enduring significance of VO2peak as a survival predictor among the older person, including octogenarians. These findings carry profound implications for tailoring healthcare strategies to address the evolving demographic landscape.
... Functional capacity, the ability to perform daily activities independently, 1 is commonly assessed using standardized tests like the 6-minute walk test, 2 Timed Up and Go Test (TUGT), 3 and one-minute sit-to-stand test. 4 However, the gold standard for evaluating functional or cardiorespiratory capacity is cardiopulmonary exercise testing (CPET), 5 which measures peak oxygen consumption (VO 2 peak). CPET involves gradually increasing exercise intensity until exhaustion or symptom onset. ...
... Numerous studies consistently demonstrate a strong inverse association between VO 2 peak and cardiovascular events, cardiovascular mortality, and all-cause mortality, 5,6 underscoring the pivotal role of functional capacity in the context of cardiovascular diseases. Moreover, in heart failure, regardless of ejection fraction status, poor performance on the 6-minute walk test has been linked to elevated risks of all-cause mortality and heart failure. ...
Functional capacity, the ability to perform daily activities independently, 1 is commonly assessed using standardized tests like the 6-minute walk test, 2 Timed Up and Go Test (TUGT), 3 and one-minute sit-to-stand test. 4 However, the gold standard for evaluating functional or cardiorespiratory capacity is cardiopulmonary exercise testing (CPET), 5 which measures peak oxygen consumption (VO 2 peak). CPET involves gradually increasing exercise intensity until exhaustion or symptom onset. Numerous studies consistently demonstrate a strong inverse association between VO 2 peak and cardiovascular events, cardiovascular mortality, and all-cause mortality, 5,6 underscoring the pivotal role of functional capacity in the context of cardiovascular diseases. Moreover, in heart failure, regardless of ejection fraction status, poor performance on the 6-minute walk test has been linked to elevated risks of all-cause mortality and heart failure. 7 In this issue of the Arquivos Brasileiros de Cardiologia, Santos et al. 8 explored the relationship between the TUGT, a measure of the time it takes for a person to rise from a chair, walk a distance of 3 meters and then sit down again, and VO 2 peak in individuals with heart failure or coronary artery disease. The study included 200 participants (aged 36 to 92 years; 70% males) enrolled in a cardiac rehabilitation program. Remarkably, 30% of the participants had heart failure, while 70% had coronary artery disease. All participants underwent both TUGT and CPET to evaluate their functional capacity. The researchers devised an equation based on TUGT performance that accurately predicted VO 2 peak, achieving an area under the curve of 0.80. A TUGT cutoff point of 5.47 seconds was identified to predict a VO 2 peak ≥ 20 ml.kg-¹.min-¹, with a sensitivity of 83% and a specificity of 67%. 8 This cutoff point holds clinically significant as it can be utilized to stratify risk in patients with heart failure. Individual with a VO 2 peak > 20 ml.kg-¹.min-¹ exhibit a low risk, ensuring over 95% event-free survival at 1 year. Conversely, those with a VO 2 peak < 14 ml.kg-¹.min-¹ face a greater than 20% mortality risk at the same one-year mark. 9 The predictive capacity of the TUGT for VO 2 peak has significant clinical implications, offering healthcare providers a convenient and efficient means to evaluate an individual's functional capacity and, subsequently, their risk of adverse cardiovascular outcomes. Moreover, the TUGT goes beyond its role as a predictor of VO 2 peak, serving as a valuable tool for assessing overall functionality. By quantifying the time required for an individual to rise from a chair, cover a short distance, and then return to a seated position, the TUGT provides insights into the person's ability to perform essential daily activities. This information is pivotal for rehabilitation planning, patient monitoring, and comprehensive assessment of overall quality of life. Despite the compelling hypothesis presented by the authors, it is crucial to acknowledge the inherent limitations of the study. Its external validity is constrained by its single-center design in Brazil and a relatively small sample size. Moreover, the absence of information regarding potential variations in testing procedures between the heart failure and coronary artery disease groups introduces an additional layer of complexity. The ethnic profile of the participants (white, black, etc.) and its potential impact on the results also remains unclear. Notably, the majority of patients in this study belonged to NYHA functional classes I and II, with only 10% falling into classes III and IV. Therefore, caution should be exercised when extrapolating these findings to individuals with heart failure, particularly those with more limited physical capacity. Finally, while we commend the authors' efforts, a comprehensive assessment and validation of the associations between the TUGT test and directly measured VO 2 peak is necessary. Larger-scale investigations encompassing a broader spectrum of participants are indispensable.
... The lactate threshold was determined by the agreement of the V-Slope and Ventilatory Equivalent methods. The respiratory compensation point was determined from the moment of sustained fall in end-expiratory pressure of CO 2 and increase in expiratory pressure of O 2 (Herdy et al., 2016). ...
Cajuína is a processed drink derived from cashew and is widely consumed in the northeast region of Brazil. This study evaluated the effect of a cajuína-based hydroelectrolytic drink on the aerobic performance and hydration status of recreational runners. Seventeen males (31.9 ± 1.6 years, 51.0 ± 1.4 ml/kg/min) performed three time-to-exhaustion running sessions on a treadmill at 70% VO2max, ingesting cajuína hydroelectrolytic drink (CJ), high carbohydrate commercial hydroelectrolytic drink (CH) and mineral water (W) every 15 min during the running test. The participants ran 80.3 ± 8.4 min in CJ, 70.3 ± 6.8 min in CH and 71.8 ± 6.9 min in W, with no statistical difference between procedures. Nevertheless, an effect size of η² = 0.10 (moderate) was observed. No statistical difference was observed in the concentrations of sodium, potassium, and osmolality in both serum and urine between the three conditions. However, the effect size was moderate (urine sodium) and high (serum sodium, potassium, and osmolality). Urine specific gravity, sweating rate and heart rate were not significantly different between drinks. The cajuína-based hydroelectrolytic drink promotes similar effects compared to commercial hydroelectrolytic drink and water, considering specific urine gravity, heart rate, sweating, and time to exhaustion in recreational runners.
... The CPX was performed using a cycle ergometer (Corival, Lode, Netherlands) with a breath-by-breath gas analysis system (Quark CPET, Cosmed, Italy or Metalyser 3B, Cortex, Germany) following international recommendations [26][27][28]. Symptom-limited maximal exercise testing was performed with an individualized ramp protocol. The load increase rate was linear and adjusted according to age, sex, and clinical assessment. ...
COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann–Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56 years (IQR: 43–63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104–212) versus 121 (74–163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91–95) versus 94 (93–96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r² = 0.167; p = 0.009; GWE: r² = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.
Graphical abstract
... The CPET is used to assess the exercise tolerance of subjects and the causes of exercise limitation through abnormal physiological indicators that occur in patients during exercise and is widely used to assess the cardiopulmonary function of subjects and for exercise instruction [21]. When combined with exercise testing, adjunctive imaging provides greater diagnostic accuracy, additional information about cardiac structure and function, and additional prognostic information. ...
Review Association between Cardiopulmonary Exercise Test and Severity of Obstructive Sleep Apnea Syndrome Jianyu Wang 1,2, * , Shishi Zhang 2, Luying Jiang 3, Chunran Zhang 3, and Houjuan Zuo 2 1 Tianyou Hospital, Wuhan University of Science and TechnologyWuhan430064China 2 Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan430030China 3 The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi UniversityShihezi832008China * Correspondence: Wangjianyu1003@163.com Received: 17 April 2023 Accepted: 6 June 2023 Published: 27 December 2023 Abstract: Obstructive sleep apnea syndrome (OSAS) is becoming widespread, especially in people with obesity. As it is usually measured by polysomnography (PSG), the role of cardiopulmonary exercise test (CPET), a new exercise capacity test, has not attracted enough attention in OSAS research. In this article, we explore the relationship between CPET results and patients with OSAS. 68 individuals were recruited and divided into three groups: negative/mild group (n = 22, apnea hypopnea index (AHI) < 15), moderate group (n = 22, 15 ≤ AHI < 30) and severe group (n = 24, AHI ≥ 30). Clinical parameters, cardiopulmonary exercise test (CPET) indexes, and apnea hypopnea index (AHI) were compared among the three groups. A multivariate analysis was carried out to assess which factors determine the index of AHI. The ANOVA analyses were used to evaluate the difference among the three groups. Receiver operating characteristic analyses were chosen to detect the prediction efficiency of the CPET index for AHI. The predictive power of using the CPET index (VO2/kg peak) combined with the body mass index (BMI) of patients in the detection of AHI was significantly better when compared with using the CPET index only. There was a notable correlation between VO2 and the index of AHI (r = 0.249, P = 0.04). Also, the CPET data (VO2/kg peak) combined with the BMI of patients has powerful predictive value for the severity of OSAS in patients. It is expected to be a promising way to predict the severity of OSAS in the future. Our study provides a new strategy for predicting whether a patient is in the early phase OSAS.
