ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

Thomas Radtke, Sarah Crook, Georgios Kaltsakas, Zafeiris Louvaris, Danilo Berton, Don S. Urquhart, Asterios Kampouras, Roberto A. Rabinovich, Samuel Verges, Dimitris Kontopidis, Jeanette Boyd, Thomy Tonia, Daniel Langer, Jana De Brandt, Yvonne M.J. Goërtz, Chris Burtin, Martijn A. Spruit, Dionne C.W. Braeken, Sauwaluk Dacha, Frits M.E. Franssen, Pierantonio Laveneziana, Ernst Eber, Thierry Troosters, J. Alberto Neder, Milo A. Puhan, Richard Casaburi, Ioannis Vogiatzis, Helge Hebestreit
  • European Respiratory Review, December 2019, European Respiratory Society (ERS)
  • DOI: 10.1183/16000617.0101-2018

What is it about?

Cardiopulmonary exercise testing (CPET) – the measurement of gas exchange during an incremental exercise test on a stationary cycle ergometer or treadmill is useful in the assessment of people with lung diseases. To enable comparisons of individual test results to normal values or to measure effects of interventions such as pulmonary rehabilitation programmes or exercise training, the test protocols must be standardised (for example the duration of the warm-up, incremental and recovery phase). The aim of this Task Force was threefold: First, we aimed to summarise test protocols and procedures used in published studies focusing on CPET in patients with various chronic lung diseases. Second, we aimed to present standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill. Third, we wanted to implement collect patients’ perspectives on CPET and conducted by conducting an online survey that was supported by the European Lung Foundation. We did a comprehensive systematic literature review on published studies from inception to January 2017. We identified 7914 studies, of which 595 studies with 26,523 subjects were included in this Task Force report. The literature review supports a test protocol with a resting phase lasting at least 3 minutes, a 3-min warm-up phase at minimal exercise intensity, and an 8- to 12-min incremental phase followed by a recovery phase of at least 2-3 minutes. Patients responding to the survey (N=295) perceived CPET as a highly beneficial part of their diagnostic assessments. The patients´ feedback was compatible with the test protocol described above. Future work is needed focusing on the estimation of optimal work rate increments across different lung diseases, and the collection of normal values based on large sample sizes.

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