ATS/ACCP statement on cardiopulmonary exercise testing

Ross, Robert

doi:10.1164/ajrccm.167.10.950

Cited by 491 publications

(229 citation statements)

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“…Direct measurement of oxygen consumption during an incremental exercise stress test is the most accurate method to determine VO 2max . 23,24 The use of a non-weightbearing form of exercise should minimize the risk for confounding by body weight. We use an electrically braked cycle ergometer, the preferred device for exercise testing in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study

et al. 2011

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OBJECTIVE: Cardiorespiratory fitness is currently estimated by dividing maximal oxygen consumption (VO 2max ) by body weight (per-weight standard). However, the statistically correct way to neutralize the effect of weight on VO 2max in a given population is adjustment for body weight by regression techniques (adjusted standard). Our objective is to quantify the bias introduced by the per-weight standard in a population distributed across different categories of body mass. DESIGN: This is a cross-sectional study. SUBJECTS AND METHODS: Baseline measures from participants of the Dose-Responses to Exercise Training Study (DR's EXTRA), 635 men (body mass index (BMI): 19--47 kg m À2 ) and 638 women (BMI: 16--49 kg m À2 ) aged 57--78 years who performed oral glucose tolerance tests and maximal exercise stress tests with direct measurement of VO 2max . We compare the increase in VO 2max implied by the per-weight standard with the real increase of VO 2max per kg body weight. A linear logistic regression model estimates odds for abnormal glucose metabolism (either impaired fasting glycemia or impaired glucose tolerance or Type 2 diabetes) of the least-fit versus most-fit quartile according to both per-weight standard and adjusted standard. RESULTS: The per-weight standard implies an increase of VO 2max with 20.9 ml min À1 in women and 26.4 ml min À1 in men per additional kg body weight. The true increase per kg is only 7.0 ml min À1 (95% confidence interval: 5.3--8.8) and 8.0 ml min À1 (95% confidence interval: 5.3--10.7), respectively. Risk for abnormal glucose metabolism in the least-fit quartile of the population is overestimated by 52% if the per-weight standard is used. CONCLUSIONS: In comparisons across different categories of body mass, the per-weight standard systematically underestimates cardiorespiratory fitness in obese subjects. Use of the per-weight standard markedly inflates associations between poor fitness and co-morbidities of obesity.

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Section: Discussionmentioning

confidence: 99%

The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study

et al. 2011

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“…Although lack of standardisation and insufficient expertise in performing cardiopulmonary exercise testing were identified as the main reasons explaining this discrepancy [81], the 6-MWT remains until now the only Food and Drug Administration-and European Agency for the Evaluation of Medicinal Productsaccepted exercise end-point for studies evaluating treatment effects in PAH. Despite detailed recommendations [84,85], a generally accepted standardisation of cardiopulmonary exercise testing with respect to data acquisition and analysis in PAH is lacking.…”

Section: Exercise Capacitymentioning

confidence: 99%

Guidelines for the diagnosis and treatment of pulmonary hypertension

Hoeper¹,

Humbert²,

Torbicki³

et al. 2009

Eur Respir J

1,081

490

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“…DLco was a poor predictor of ∆SpO 2 -6MWT (PPV 36% and NPV 88%) and of peak AaDO 2 (PPV 66% and NPV 78%). Importantly, normal DLco was a good predictor of the absence of severe desaturation during the 6MWT and at peak exercise during CPET (NPV 94% and 100%, [31] 97 [19] 83 [25] 90 [11] 66 [30] a,b,c 0.00001 FVC (% pred) 92 [24] 98 [26] 96 [21] 102 [19] 79 [32] a,b,c 0.001 TLC (% pred) 90 [19] 88 [14] 90 [21] 93 [29] 88 [24] 0.644 FEV 1 /FVC (%) 75 [15] 80 [8] 75 [15] 79 [12] 71 [24] a,b,c 0.011 DLco (% pred) 71 [25] 82 [18] 76 [23] 73 [17] 55 [23] a,b,c 0.00001…”

Section: Predictive Valuesmentioning

confidence: 99%

Oxygen desaturation during a 6-minute walk test as a predictor of maximal exercise-induced gas exchange abnormalities in sarcoidosis

et al. 2016

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Background: Common tests for evaluating gas exchange impairment have different strengths and weaknesses. Alveolar-to-arterial oxygen pressure difference (AaDO 2 ) at peak exercise is a sensitive indicator but it cannot be measured repeatedly. Diffusing capacity of the lung for carbon monoxide (DLco) is measured at rest and may be too insensitive to predict the effects of exercise on gas exchange impairment.Oxygen desaturation during a 6-minute walk test (∆SpO 2 -6MWT) can be measured repeatedly, but its value in sarcoidosis is unknown. Here, we evaluated the ability of ∆SpO 2 -6MWT and DLco to predict gas exchange impairment during exercise in sarcoidosis.Methods: This retrospective study of 130 subjects with sarcoidosis investigated the relationship between DLco, ∆SpO 2 -6MWT, and peak AaDO 2 using correlation tests, inter-test reliability analyses, and predictive values. For the analyses of inter-test reliability and predictive values, DLco, peak AaDO 2 , and ∆SpO 2 -6MWT were considered as binary variables (normal/abnormal) according to previously defined thresholds.Results: Correlation coefficients between DLco, ∆SpO 2 -6MWT, and peak AaDO 2 were intermediate (0.53-0.67, P<0.0003) and Kappa coefficients were low (0.21-0.42, P=0.0003-0.02). DLco predicted (I) increased peak AaDO 2 with a positive predictive value (PPV) of 66% and a negative predictive value (NPV) of 78% and (II) increased ∆SpO 2 -6MWT with a PPV at 36% and an NPV at 88%. Normal DLco was a good predictor of the absence of severe desaturation during the 6MWT (94% NPV) and at peak exercise during cardiopulmonary exercise test (CPET) (100% NPV). ∆SpO 2 -6MWT predicted peak AaDO 2 increase with a PPV of 74% and an NPV of 60%. Conclusions:In a large population of sarcoidosis patients, neither ∆SpO 2 -6MWT nor DLco was a good predictor of increased peak AaDO 2 . In contrast, normal DLco was a good predictor of the absence of severe desaturation during the 6MWT and at peak exercise during CPET.

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ATS/ACCP statement on cardiopulmonary exercise testing

Cited by 491 publications

References 1 publication

The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study

The current standard measure of cardiorespiratory fitness introduces confounding by body mass: the DR's EXTRA study

Guidelines for the diagnosis and treatment of pulmonary hypertension

Oxygen desaturation during a 6-minute walk test as a predictor of maximal exercise-induced gas exchange abnormalities in sarcoidosis

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