Figures
- FIGURE 1
Flow chart describing the usual practice by Task Force members on different protocol phases and specifications during cardiopulmonary exercise testing. It is not intended as a recommendation for clinical practice.
- FIGURE 2
Algorithm for determining maximal effort and cause of exercise limitation. This figure describes how the Task Force members determine the maximal effort and cause of exercise limitation. It is not intended as a recommendation for clinical practice. V′O2: oxygen uptake; V′O2peak: peak oxygen uptake; V′Epeak: peak minute ventilation; MVV: maximum voluntary ventilation; RER: respiratory exchange ratio; HR: heart rate; AT: anaerobic threshold; IC: inspiratory capacity; SpO2: arterial oxygen saturation measured by pulse oximetry.
Tables
- TABLE 1
Exercise mode and protocols used for cardiopulmonary exercise testing
Lung diseases/lung conditions Studies n Cycle test Treadmill test 1-min stages Ramp Unclear 1-min stages Ramp Unclear COPD/emphysema 323 162 (50.2) 92 (28.5) 36 (11.1) 27 (8.4) 4 (1.2) 2 (0.6) Asthma 19 7 (36.8) 6 (31.6) 1 (5.3) 5 (26.3) 0 0 Interstitial lung disease 18 5 (27.8) 12 (66.7) 1 (5.6) 0 0 0 Pulmonary arterial hypertension 64 24 (37.5) 37 (57.8) 3 (4.7) 0 0 0 Cystic fibrosis 78 51 (65.4) 22 (28.2) 0 3 (3.8) 2 (2.6) 0 Primary ciliary dyskinesia 1 1 (100) 0 0 0 0 0 Sarcoidosis 12 2 (16.7) 6 (50.0) 4 (33.3 0 0 0 Lung cancer 39 9 (23.1) 21 (53.8) 7 (17.9) 2 (5.1) 0 0 Unclear respiratory diagnosis 3 3 (100) 0 0 0 0 0 Patients undergoing lung transplant or volume reduction surgery or other thoracic surgeries 23 6 (26.1) 10 (43.5) 4 (17.4) 1 (4.3) 0 2 (8.7) Other# 15 2 (13.3) 10 (66.7) 2 (13.3) 0 1 (6.7) 0 Total 595 272 (45.7) 216 (36.3) 58 (9.7) 38 (6.4) 7 (1.2) 4 (0.7) Data are n (%) for each disease/disease condition. No data were available for tuberculosis and irradiation of the lung. #: this group contains a mix of different lung diseases (i.e. restrictive and obstructive), asbestosis and obstructive sleep apnoea–hypopnea syndrome.
- TABLE 2
Reported protocol specifications during cardiopulmonary exercise testing
Protocol specification Cycle test Treadmill test n (%)# Median (IQR) n (%)¶ n (%)# Median (IQR) n (%)¶ Work rate increments 487 (89.2) 45 (91.8) Rest phase 264 (48.4) 10 (20.4) Rest phase duration min+ 229 (42.0) 3 (3–3) 139 (59) 7 (14.3) 3 (2–3) 4 (57) Unloaded phase warm-up 329 (60.3) 25 (51.0) Unloaded duration min+ 314 (57.5) 3 (2–3) 182 (58) 19 (38.8) 3 (3–4) 10 (53) Incremental phase duration 104 (19.0) 19 (38.8) Recovery 71 (13.0) 5 (10.2) Recovery duration min+ 56 (10.3) 3 (2–6) 18 (32) 4 (8.2) 3 (2–4) 1 (25) Data are presented as n (%) or median (interquartile range). #: studies reporting test protocol details; ¶: studies using test duration supported by the literature review; +: percentages are calculated of studies that reported on rest, unloaded and recovery phases.
- TABLE 3
Criteria of maximal effort and prediction equations
Variable Cycle test Treadmill test Children Adults Children Adults 1 V′O2peak Change of V′O2 <2 mL·min−1·kg−1 for a 5–10% increase in exercise intensity or of <2sd of the average increase in V′O2 during the preceding stages [13] Change in V′O2 of <2.1 mL·min−1·kg−1 between consecutive stages [14] Change of V′O2 <2 mL·min−1·kg−1 for a 5–10% increase in exercise intensity or of <2sd of the average increase in V′O2 during the preceding stages [13] Change in V′O2 of <2.1 mL·min−1·kg−1 between consecutive stages [14] 2 V′Epeak/MVV % ≥85 [11] ≥85 [11] ≥85 [11] ≥85 [11] 3 IC Decrease in IC >150 mL during exercise [15] Decrease in IC >150 mL during exercise [15] Decrease in IC >150 mL during exercise [15] Decrease in IC >150 mL during exercise [15] 4 RER >1.05 [16] >1.05 [17] >1.05 [16] >1.05 [17] 5 HRpeak % pred or beats·min−1 ≥195 bpm [18] >100% pred [11]
231 men and women (aged 20–80 years) [19]
Female: 209–0.86×age
Male: 207–0.78×age≥200 bpm [18] >100% pred [11]
3320 healthy men and women (aged 19–89 years) [17]
211–0.64×age6 V′O2peak % pred ≥100% predicted
V′O2peak (L·min−1) [20]:
Female: V′O2peak=3.08806×height (m)−2.877
Male: V′O2peak=4.4955×height (m)−4.640≥100% predicted
V′O2peak (L·min−1) [21]:
V′O2peak=0.046×height (cm)−0.021×age−0.62×sex (0 male, 1 female)−4.31≥100% predicted
V′O2peak (mL·min−1·kg−1) [22]:
Female: 58.90–1.15×age
Male: 52.35+0.071×age
V′O2peak (L·min−1): 3703 male and 1234 female children and adolescents (aged 8–16 years) [23]
Male: 0.623+0.230×age (R2=0.748)
Female: 0.253+0.124×age (R2=0.529)≥100% predicted
V′O2peak (mL·min−1·kg−1) [24]:
4637 healthy men and women (aged 20–90 years)
Female: 17.21+(0.582×inclination)+(3.317×velocity)−(0.116×weight)−(0.099×age)
Male: 24.24+(0.599×inclination)+(3.197×velocity)−(0.122×weight)−(0.126×age)
7783 healthy men and women (aged 20–79 years) [25]
V′O2 max (mL·min−1·kg−1): 79.9-(0.39×age)−13.7×sex [0 male, 1 female])−(0.127×weight [lbs])6 Blood lactate Usually not informative, since there is considerable variability in post-exercise blood lactate in children (e.g. max values between 4–13 mmol·L−1 in 11–13-year old children) [26] Minimum post-exercise cut-off values to be validated [27] Post-exercise blood lactate levels ≥8 mmol·L−1 [28, 29] Usually not informative, since there is considerable variability in post-exercise blood lactate in children (e.g. max values between 4–13 mmol·L−1 in 11–13-year old children) [26]
Minimum post-exercise cut-off values to be validated [27]Post-exercise blood lactate levels ≥8 mmol·L−1 [28, 29] V′O2peak: peak oxygen uptake; V′O2: oxygen uptake; V′Epeak: peak minute ventilation; MVV: maximum voluntary ventilation; IC, inspiratory capacity; RER, respiratory exchange ratio; HRpeak, peak heart rate.
- TABLE 4
Outcome values to report in standard clinical cardiopulmonary exercise testing as employed by the Task Force members
Exercise capacity Cardiovascular limitation Gas exchange limitation Ventilatory limitation Variable relevance V′O2peak HRpeak V′E/V′CO2 slope V′Epeak in % MVVrest Peak WR V′O2/WR slope Lowest V′E/V′CO2 value (nadir) AT O2pulsepeak
HR/V′O2 slopeSpO2peak
Borg symptom scoresFor studies featuring additional measurements VD/VT# VT/IC¶ PA–aO2peak# IRVpeak¶ V′O2peak: peak oxygen uptake; WR: work rate; AT: anaerobic threshold; HR: heart rate; V′E: minute ventilation; V′CO2: carbon dioxide production; V′Epeak: peak minute ventilation; MVVrest: maximum voluntary ventilation at rest; V′O2: oxygen uptake; SpO2peak: peak arterial oxygen saturation measured by pulse oximetry; VD/VT: dead space/tidal volume ratio; IC: inspiratory capacity; PA–aO2peak: peak alveolar–arterial oxygen tension difference; IRVpeak: peak inspiratory reserve volume. #: in studies featuring arterial blood gas measurements; ¶: in studies featuring serial inspiratory capacity measurements.
Supplementary Material
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ERR-0101-2018_Supplementary_material ERR-0101-2018_Supplementary_material
