What are some relative contraindications for cardiopulmonary exercise testing?

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Introduction[edit | edit source]
Purpose[edit | edit source]
Technique[edit | edit source]
Measurement[edit | edit source]
Protocols[edit | edit source]
Indication[edit | edit source]
Contraindication[edit | edit source]
Resources[edit | edit source]
References[edit | edit source]
What should be monitored during a cardiopulmonary exercise evaluation?
When should I stop cardiopulmonary exercise test?
What does a cardiopulmonary exercise test measure?
What does a cardiopulmonary test consist of?

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Introduction[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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

Treadmill
Bicycle ergometer[3]

Common measurements like

Measurement[edit | edit source]

Blood pressure
Heart rate
ECG changes
Subjective ratings
Signs and symptoms
Ventilatory expired gas analysis responses
Arterial blood gas analysis

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

Protocols[edit | edit source]

There are many different CPET protocols used in the different patients,

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[edit | edit source]

Evaluation of Exercise Intolerance[1]
Unexplained Dyspnea[1]
Evaluation of Patients with Cardiovascular Disease[1]
Evaluation of Patients with Respiratory Disease 216[1]
- Chronic Obstructive Pulmonary Disease (COPD)
- Interstitial Lung Disease (ILD)
- Chronic Pulmonary Vascular Disease (PVD)
- Cystic Fibrosis
- Exercise-Induced bronchospasm (EIB)
Preoperative Evaluation[1]
- Preoperative Evaluation for Lung Cancer Resectional Surgery
- Lung Volume Reduction Surgery (LVRS)
- Evaluation for Lung or Heart-Lung Transplantation
- Preoperative Evaluation of Other Procedures
Exercise Prescription for Pulmonary Rehabilitation[1]
Evaluation of Impairment/Disability[1]

Contraindication[edit | edit source]

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[edit | edit source]

ATS/ACCP Statement on Cardiopulmonary Exercise Testing

ACSM's Guidelines for Exercise Testing and Prescription

References[edit | edit source]

↑ 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.
↑ Karlman Wasserman. Principles of Exercise Testing and Interpretation Including Pathophysiology and Clinical Application. 5th edition. Wolters Kluwer Bussiness. 2012
↑ Cardiopulmonary Exercise testing CPET. Natural Medicine & Detox. Available from: https://youtu.be/UBupw-HNXI4

What should be monitored during a cardiopulmonary exercise evaluation?

The primary physiologic measurements during CPET include the following physiologic information: Cardiac monitoring: Continuous heart rate, rhythm, and ECG changes. Hemodynamic monitoring: Blood pressure at set intervals. Breath-by-breath analysis of inspired and expired gas: V_O2, V.

When should I stop cardiopulmonary exercise test?

Indications for terminating CPET A decrease in systolic blood pressure below the resting pressure is a sign of insufficient increase in cardiac output to compensate for the exercise‐induced systemic vasodilatation, and is an indication to stop the test.

What does a cardiopulmonary exercise test measure?

Cardiopulmonary exercise testing (CPET or CPEX), also referred to as a VO2 (oxygen consumption) test, is a specialized type of stress test or exercise test that measures your exercise ability. Information about the heart and lungs is collected to understand if the body's response to exercise is normal or abnormal.

What does a cardiopulmonary test consist of?

You will be asked to either walk on a treadmill or pedal on a bicycle for approximately 5-‐15 minutes, or walk up and down a single step for 3 minutes. During this time your heart rate, blood pressure, oxygen saturation, electrocardiogram and respiratory gas exchange will be recorded.