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Recommendations on the use of exercise testing in clinical practice

¹ Servizio di Fisiopatologia Respiratoria, Dipartimento di Medicina Clinica, University of Rome "La Sapienza", Rome, Italy. ² Institute of Membrane and Systems Biology, University of Leeds, Leeds, and ¹⁰ Dept of Respiratory Medicine, Glenfield Hospital, Leicester, UK. ³ Voksentoppen Research Institute and Children's National Hospital of Asthma, Allergy and Chronic Lung Diseases, University of Oslo, Oslo, Norway. ⁴ Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA. ⁵ Dept of Respiratory Medicine and the National Referral Centre for Adult Cystic Fibrosis, St Vincent's University Hospital, Dublin, Ireland. ⁶ Respiratory Rehabilitation and Respiratory Division, University Hospital Gasthuisberg, Leuven, Belgium. ⁷ Respiratory Investigation Unit, Department of Medicine, Queen's University, Kingston, ON, Canada. ⁸ Servicio de Neumología, Hospital General Universitario Gregorio Marañon, Madrid, Spain. ⁹ Dept of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands.

CORRESPONDENCE: P. Palange, Dipartimento di Medicina Clinica, University of Rome "La Sapienza", v.le Università 37, 00185 Rome, Italy. Fax: 39 064940421. E-mail: paolo.palange{at}uniroma1.it

Keywords: Cardiopulmonary exercise testing, evaluation of interventions, exercise testing, prognosis, walking tests

Received: April 4, 2006
Accepted August 16, 2006

Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.

For symptom-limited incremental exercise, CPET indices, such as peak O₂ uptake (V'O₂), V'O₂ at lactate threshold, the slope of the ventilation–CO₂ output relationship and the presence of arterial O₂ desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.

In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) "When should an evaluation of exercise intolerance be sought?"; 2) "Which particular form of test should be asked for?"; and 3) "What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?"

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