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(Paul Older, Adrian Hall, Raymond Hader et al. Cardiopulmonary Exercise Testing as a Screening Test for Perioperative
Management of Major Surgery in the Elderly. Chest 1999;116;355-362)

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ABSTRACT
Until recently, cardiopulmonary exercise testing (CPX or CPET) was a highly specialized procedure but due to
recent technological advances it has progressed from the research laboratory and now is in clinical use, even in
the field of primary health care. Exercise testing provides a comprehensive functional assessment that helps to
quantitate and differentiate the disorders of such diverse organ systems as heart, lung, blood vessels and
nervous system. The procedure involves measuring oxygen uptake (VO 2 ), carbon dioxide output (VCO 2 ),
minute ventilation (VE), monitoring of the 12 lead ECG, blood pressure and pulse oximetry (SpO 2 ) during a
maximal symptom-limited incremental exercise test on the cycle ergometer or treadmill. At a primary care

level it has indications such as assessment of dyspnea (helping in exclusion or not of an organic cause), exercise
disability, measuring the benefits of an exercise program and diagnose exercise induced bronchospasm.
Generally CPX can be used to systematically address limiting symptoms and their origins whether cardiac or
ventilatory, objectively grade the severity of functional capacity, determine the progressive nature of the
illness, develop a prescription for exercise training and rehabilitation and access the response to medical or
surgical management. Cardiopulmonary exercise testing is thus a reliable, easier to use and useful tool and
should be used in clinical medicine, in sports and in rehabilitation.

1. American Thoracic Society; American College of Chest Physicians, ATS/ACCP Statement on
Cardiopulmonary Exercise Testing. Am J Respir Crit Care Med 2003; 167:211277.
2. ERS Task Force on Standardization of Clinical Exercise Testing, Clinical exercise testing with reference to
lung diseases: indications, standardization and interpretation strategies. Eur Respir J 1997; 10: 26622689.
3. Roca J, Whipp BJ, eds. Clinical Exercise Testing. Eur Respir Mon 1997;
4. Wasserman K, Hansen JE, Sue DY, Stringer W, Whipp BJ, eds. Principles of Exercise Testing and
th
Interpretation, 4 Edn. Philadelphia, Lea & Febiger, 2004.
5. Whipp BJ, Davis JA, Torres F, Wasserman K. A test to determine the parameters of aerobic function during
exercise. J Appl Physiol 1981; 50: 217221.
6. Cooper BC, Storer TW. Exercise testing and interpretation. A practical approach. Ed. Cambridge Univ.
st
Press 1 edition. 2001
7. Curfman G. D., Hillis L. D. A New Look at Cardiac Exercise Testing N Engl J Med 2003; 348:775-776
8. Weissman IM, Zeballos RJ. Cardiopulmonary exercise testing. Pulm. Crit. Care Update 1995, 11:1-9
9. Gallagher CG. Exercise limitation and clinical exercise testing in chronic obstructive pulmonary disease.
Clin Chest Med 1994; 15: 305326.

10. . . . 1
2004

MD, MHCS, MESC, MHSEER




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