Reference values for cardiopulmonary exercise testing in healthy volunteers: the SHIP study

Abstract

Cardiopulmonary exercise testing (CPET) is a widely applied clinical procedure. The aim of the present study was to acquire a comprehensive set of reference values for cardiopulmonary responses to exercise and to evaluate possible associations with sex, age and body mass index (BMI).A standardised progressive incremental exercise protocol on a cycle ergometer was applied to 1,708 volunteers of a cross-sectional epidemiologic survey, called ''Study of Health in Pomerania''. Individuals with cardiopulmonary disorders, or echocardiographic or lung function pathologies, were excluded. The influence of potential confounding factors, such as smoking, taking b-blockers, hypertension, diastolic dysfunction, BMI and physical activity, were analysed for their influencing power. Reference values of CPET parameters were determined by regression analyses.Of the volunteers, 542 current smokers and obese individuals were excluded for not being representative of a healthy population. The final sample size was 534 (253 males), with age 25-80 yrs. The current study provides a representative set of reference values for CPET parameters based on age and weight.Sex and age have a significant influence on exercise parameters. While addressing the problem of a selection bias, the current study provides the first comprehensive set of reference values obtained in a large number of healthy volunteers within a population-based survey.KEYWORDS: Cardiopulmonary exercise testing, oxygen uptake, reference values, Study of Health in Pomerania, ventilatory efficiency C ardiopulmonary exercise testing (CPET) is a widely applied routine procedure in daily clinical work, used for the investigation of cardiac and pulmonary disorders. Due to their prognostic and therapeutic implications [1,2], the normalcy of response to incremental exercise is usually considered with respect to particular functional indices, such as the peak oxygen uptake (V9O 2 ,peak), the estimated lactate threshold (hL) and the characterisation of ventilatory efficiency expressed by the minute ventilation (V9E) changes as a function of the pulmonary carbon dioxide output (V9E-V9CO 2 slope). Reference values for these indices have been established, usually with respect to sex, age, body features and physical activity, by several investigators [3][4][5]. The interpretation of the results of exercise tests requires knowledge of the normal response [6], but a consensus has not been reached on the definition of normalcy. The commonly used reference values are based on exercise capacities of shipyard workers [3] or university members [4]. ''Healthy volunteers'' were usually defined as subjects without self-reported evidence or clinical symptoms and signs of heart and lung disease, a normal resting electrocardiogram (ECG), a normal 12-lead ECG response to an exercise stress test and the absence of any medication, especially any with cardiorespiratory effects. However, obtainable reference data sets show relevant limitations, considering their sample recruitment, age distributi...

Enhancing performance during inclined loaded walking with a powered ankle–foot exoskeleton

“…While these end-test measures are a little lower than expected for a maximal exercise test, they are corresponding to the reported values for the weighted walking test (Klimek and Klimek 2007) and situated within the boundaries of reported maxima for exercise testing (Herdy and Uhlendorf 2011;Koch et al 2009;Midgley et al 2007). Therefore, given the specific characteristics of this uphill walking task, subjects reached maximal oxidative metabolism and at least a near maximal effort.…”

Cardiopulmonary Exercise Testing Demonstrates Maintenance of Exercise Capacity in Patients With Hypoxemia and Pulmonary Arteriovenous Malformations

“…32 Reference ranges were derived from published values. [31][32][33] 34 From the Fick equation, the oxygen pulse is the product of the stroke volume and tissue oxygen extraction (the arterio-venous oxygen content difference [C(a-v)O2]). 34,35 In the current study, the peak oxygen pulse was calculated by peak oxygen consumption/heart rate at peak exercise.…”

“…[31][32][33] Four stopped because they were short of breath; two because of generalexhaustion (one with a headache), and two were stopped because of hypertension.…”

Pulmonary rehabilitation in moderate pulmonary hypertension

“…26 Finally, Chan's study showed an average improvement of 56 meters compared to the initial measurement. 27 Some previous studies have suggested that PR improves the ability of the muscle to increase its VO2 during exercise; 28 Chronic respiratory diseases can limit patients more for muscle fatigue than for ventilatory disorders such as TB, 29 although no muscle strength data were collected in the present study, it could be hypothesized that physiological changes occurred at the muscular level that make the person walk more meters; go according to an increase in muscle strength.…”