Complete exercise testing is more than simply running on a treadmill or riding on a cycle ergometer. These simple measures may be used to evaluate endurance, peak heart rate, blood pressure, and the presence or absence of dysrhythmias during exercise. With the use of rapid gas analyzers and microcomputers, information about ventilation, oxygen supply and use, and the metabolism at the muscle level may be obtained noninvasively. The concept of the ventilatory anaerobic threshold and the transition from aerobic to anaerobic metabolism during a graded exercise test are discussed. Tests that evaluate only anaerobic performance (i.e., the Wingate test) will not be discussed.
Gas Exchange During ExerciseThe amount of oxygen required to perform a given amount of work exclusively aerobically is known and appears to be independent of the degree of fitness, age, or gender of the subject [8,22]. Thus, the failure of the circulation to deliver oxygen at the required rate to sustain exercise will slow the rate of aerobic regeneration of ATP by the muscle. The oxygen supply to the exercising muscles depends on the blood flow, hemoglobin concentration, the partial pressure of oxygen in the patient's arterial blood, and the iron content of the patient's blood. Failure of the circulation to deliver oxygen at the rate needed to sustain exercise will limit the rate of aerobic regeneration of ATP and the oxygen consumption by the muscles (VO 2 ).At very low exercise intensities, the concentration of the blood lactate is nearly identical to levels recorded at rest. At some particular level of exercise intensity, which varies among subjects, blood lactate concentration begins to increase. As the oxygen demand of the exercising muscle exceeds the oxygen supply, anaerobic metabolism is used to supply the energy required to continue work. Lactic acid is a by-product of this anaerobic metabolism. Once formed, lactic acid will be almost completely dissociated in the serum, and it is buffered predominantly by the bicarbonate system.