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ReviewsImpact of Integrative Cardiopulmonary Exercise Testing on Clinical Decision Making
Section snippets
What Is an Integrative Cardiopulmonary Exercise Test?
The integrative cardiopulmonary exercise test allows the simultaneous measurement during known exercise stress of the following: (1) the balance between oxygen supply to the myocardium and myocardial oxygen requirement, assessed primarily from changes indicating ischemia on the electrocardiogram; (2) the adequacy of oxygen delivery (a cardiovascular function) to the muscles of locomotion; and (3) the ability to transfer O2 into and eliminate CO2 from the blood (a pulmonary and cardiovascular
What Does Gas Exchange during Exercise Measure?
In practical terms, there are two clinical questions asked of the integrative cardiopulmonary exercise test: (1) Can the patient perform exercise at the level predicted for a normal person of similar age and size? (2) If exercise capacity is abnormally low, what is the cause of that reduction? These questions are addressed by measuring such important gas exchange variables as the maximum or peak O2 uptake, CO2 output, the anaerobic threshold (AT), and others. These variables, when compared with
Interpreting Gas Exchange Measurments During Exercise
The responses of the cardiovascular system (heart and systemic circulation), pulmonary system (lungs and pulmonary circulation), and the exercising muscles must be closely coupled during exercise. Thus, there is interaction between the organs requiring increased transport of O2 and CO2 and the organ systems responsible for delivery of O2 and CO2 to and from the atmosphere. This is conceptualized in Figure 1. From this scheme of interaction between organ systems comes two important
Impact of the Integrative Cardiopulmonary Exercise Test on Clinical Decision-Making
As discussed, exercise requires the closely coupled interaction between the various organ systems needed for gas transport between the air and the exercising muscles. Because the integrative cardiopulmonary exercise test may be useful for identifying the mechanism of exercise impairment or the degree of impairment, the integrative cardiopulmonary exercise test is likely to be of value as a screening test for patients with exercise limitation or exertional dyspnea.
Because of the quantitative
When Should Integrative Cardiopulmonary Exercise Testing Be Used?
The integrative cardiopulmonary exercise test can be thought of as having two components. The first is the exercise metabolic stress that amplifies the responses of the organ systems that interact to allow exercise to be performed. The second is the measurement of the gas exchange variables that allow identification of the work capacity of the subject and the organ systems that limit exercise, if any. These two features make the integrative cardiopulmonary exercise test a unique application of
What Questions About Integrative Cardiopulmonary Exercise Testing Should Be Addressed at This Time?
The physiologic basis for integrative cardiopulmonary exercise testing is well established, while the clinical basis for such testing is fast becoming established. This process can be expedited in several ways. First, methodology should be clearly reported in studies describing clinical uses. These include the methods of measuring gas exchange and the type of exercise protocol employed. A potential advantage would be the adoption of standard protocols for treadmill and cycle exercise and the
Conclusion
Integrative cardiopulmonary exercise testing is an important application of physiology to clinical medicine. The understanding that gas exchange into and out of the lungs during exercise provides information about the function of the heart, lungs, pulmonary circulation, and systemic circulation and their interactions has led to increasing use of exercise testing in a variety of medical conditions. At present, there is considerable evidence supporting the use of integrative cardiopulmonary
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Exercise Capacity, Heart Failure Risk, and Mortality in Older Adults: The Health ABC Study
2017, American Journal of Preventive MedicineCitation Excerpt :Tests of varying complexity have been used to evaluate exercise capacity, ranging from distance completed in a predefined time (e.g., the 6-minute walk test) to simultaneous acquisition of several cardiovascular, ventilatory, and gas exchange variables (cardiopulmonary exercise testing). The latter provide pathophysiologic insights that are important for diagnosis,19 risk assessment,19 and decision making19; however, these tests cannot be widely performed owing to the requirement of special equipment and expertise. Therefore, walking tests have been introduced, allowing for wider implementation of exercise capacity testing; and evaluation of patients who are unable to complete complex protocols because of underlying comorbidities or advanced age.
Safety, adherence and efficacy of exercise training in solid-organ transplant candidates: A systematic review
2016, Transplantation ReviewsCitation Excerpt :Exercise testing is increasingly utilized to measure cardiorespiratory fitness (CRF) and exercise capacity to assist in pre-transplant surgical risk stratification [1–3].
Oxygen upta ke effi ciency slope, an objecti ve submaxi mal parameter in evaluating exercise capacity in pulmonary thromboembolism
2016, American Journal of the Medical SciencesCitation Excerpt :Arterial blood pressure was measured every 2 minutes with an automatic cuff. The protocol consisted of 3 minutes of rest and 3 minutes of unloaded cycling at 60 revolutions per minute, followed by a progressively increasing work rate of 5-15 W/minute for the patients and 20-25 W/minute for the normal subjects to the maximum tolerance, and 2 minutes of recovery.18 Direct measurements of VO2, carbon dioxide output (VCO2), VE, AT, peak oxygen uptake in mL/kg/minute (peak VO2/kg), respiratory rate and several derived variables such as the respiratory exchange ratio (RER), heart rate (HR), oxygen pulse (VO2/HR) and OUE were obtained.
Pre-Transplant Aerobic Capacity and Prolonged Hospitalization After Liver Transplantation
2015, GE Portuguese Journal of GastroenterologyCitation Excerpt :Although LT success is traditionally measured using variables related to graft function along with patient survival, it may be accounted in terms of health-related quality of life scores or even through cardiopulmonary parameters such as aerobic capacity (AC), exercise capacity, skeletal muscle strength and body composition.5–7 An effective interaction of several physiologic mechanisms is necessary to sustain exercise and maintain gas exchange between the environment and the cells.8 The gold standard for AC analysis is the oxygen uptake at peak exercise (VO2peak) during symptom-limited cardiopulmonary exercise testing (CPET).
Response to exercise in patients with liver cirrhosis: Implications for liver transplantation
2013, Digestive and Liver DiseaseCitation Excerpt :The multiple organ systems ensuring oxygen transport and utilization during exercise have been elegantly conceptualized by the analogy of meshing gears transmitting oxygen from mouth to mitochondria (Fig. 2). According to this model, first described by Wasserman et al., an abnormality on any step – or gear – of the coupled oxygen transport chain results in impaired exercise capacity [18]. On the other hand, as the gears are connected in series, a decreased VO2 peak may reveal any damage to one or several organ involved in the oxygen transmission process.
Is trait anxiety associated with improving fitness?
2012, Apunts Medicina de l'EsportCitation Excerpt :Thus, obtaining VO2max can help to identify the cardiac functional level. In normal population an indicator of cardiovascular system adaptability has been proven useful to the tasks of daily life,11 while in the sports field it is one of the key elements to identify the potential to achieve high athletic performance.12,13 Nevertheless, recent examinations of physical activity and exercise training studies have yielded inconsistent results.