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From the authors

¹ Respiratory Physiopathology Service, Dept of Clinical Medicine, University of Rome "La Sapienza", Rome, Italy. ² Institute of Membrane and Systems Biology, University of Leeds, Leeds, UK.

We thank S. Kostianev and co-workers for their comments relating to the recent European Respiratory Society Task Force document 1. In contrast to the attention given to the utility of recovery indices in athletic populations, there has been little systematic analysis of the recovery phase in a clinical context, with the few existing studies being mostly in patients with chronic heart failure 2–4. This apart, it is not clear what advantage the inclusion of such indices might provide, particularly in prognostic evaluation and in the evaluation of therapeutic interventions. This lack of a critical mass of experimental data is the main reason why the recovery issue was not addressed in the 2007 Task Force document, which was intended to provide "the evidence-based indications to the use of exercise testing in clinical practice".

As S. Kostianev and co-workers state, analysis of the recovery phase could well provide additional information related to the metabolic (and also ventilatory and cardiovascular) demands imposed by exercise 5. While some "new" physiological concepts relating to issues such as pulmonary gas exchange kinetics and the power–duration relationship were included in the online supplement, we nonetheless recognise that the recovery phase in patients with ventilatory and cardiac diseases would benefit from further investigation.

REFERENCES

1. Palange P, Ward SA, Carlsen K-H, et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007;29:185–209.[Abstract/Free Full Text]
2. Lacasse M, Maltais F, Poirier P, et al. Post-exercise heart rate recovery and mortality in chronic obstructive pulmonary disease. Respir Med 2005;99:877–886.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
3. Bilsel T, Terzi S, Akbulut T, Sayar N, Hobikoglu G, Yesilcimen K. Abnormal heart rate recovery immediately after cardiopulmonary exercise testing in heart failure patients. Int Heart J 2006;47:431–440.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
4. Stevenson NJ, Calverley PM. Effect of oxygen on recovery from maximal exercise in patients with chronic obstructive pulmonary disease. Thorax 2004;59:688–672.
5. Whipp BJ. Dynamics of pulmonary gas exchange. Circulation 1987;76:18–28.

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