Integrating the Whole: Cardiopulmonary Exercise Testing

  • J. Alberto Neder
  • Andrew R. Tomlinson
  • Tony G. Babb
  • Denis E. O’DonnellEmail author
Part of the Respiratory Medicine book series (RM)


Most diagnostic tests assess the function of a single organ or organ system at rest. Conversely, exercise requires the integrated function of multiple systems under stress, including the cardiovascular, pulmonary, and musculoskeletal systems. The physical stress of exercise can expose physiological limitations not otherwise apparent at rest. This is particularly relevant for patients with respiratory and/or heart diseases in whom the increased physical demands of exercise quickly exhaust their reduced functional reserves, leading to the disabling symptoms of dyspnea, leg discomfort, and fatigue. The present chapter provides a framework for CPET performance and interpretation aimed at maximizing its clinical relevance. This approach underscores the principle that measurement of exertional symptoms, using validated scales and parameters of ventilatory control and dynamic respiratory mechanics, should be routinely used to optimize clinical CPET interpretation.


Exercise testing Cardiopulmonary exercise testing Exercise physiology Dyspnea Dyspnea on exertion Functional capacity 

Selected References

  1. American Thoracic Society. American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167:211–77.CrossRefGoogle Scholar
  2. ERS Task Force, Palange P, Ward SA, Carlsen K-H, Casaburi R, Gallagher CG, Gosselink R, O’Donnell DE, Puente-Maestu L, Schols AM, Singh S, Whipp BJ. Recommendations on the use of exercise testing in clinical practice. Eur Respir J. 2007;29:185–209.Google Scholar
  3. Babb TG, Rodarte JR. Estimation of ventilatory capacity during submaximal exercise. J Appl Physiol. 1993;74:2016–22.CrossRefGoogle Scholar
  4. Babb TG. Exercise ventilatory limitation: the role of expiratory flow limitation. Exerc Sport Sci Rev. 2013;41:11–8.CrossRefGoogle Scholar
  5. Bernhardt V, Babb TG. Exertional dyspnoea in obesity. Eur Respir Rev. 2016;25(142):487–95.CrossRefGoogle Scholar
  6. Neder JA, Ramos RP, Ota-Arakaki JS, Hirai DM, D’Arsigny CL, O’Donnell D. Exercise intolerance in pulmonary arterial hypertension. The role of cardiopulmonary exercise testing. Ann Am Thorac Soc. 2015;12:604–12.CrossRefGoogle Scholar
  7. Neder JA, Berton DC, Arbex FF, Alencar MCN, Rocha A, Sperandio PA, Palange P, O’Donnell DE. Physiological and clinical relevance of exercise ventilatory efficiency in COPD. Eur Respir J. 2017;49(3) pii: 1602036.CrossRefGoogle Scholar
  8. O’Donnell DE, Elbehairy AF, Faisal A, Webb KA, Neder JA, Mahler DA. Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing. Eur Respir Rev. 2016;25:333–47.CrossRefGoogle Scholar
  9. O’Donnell DE, Elbehairy AF, Berton DC, Domnik NJ, Neder JA. Advances in the evaluation of respiratory pathophysiology during exercise in chronic lung diseases. Front Physiol. 2017;8:82.PubMedPubMedCentralGoogle Scholar
  10. Ramos RP, Alencar MC, Treptow E, Arbex F, Ferreira EM, Neder JA. Clinical usefulness of response profiles to rapidly incremental cardiopulmonary exercise testing. Pulm Med. 2013;2013:359021. Scholar
  11. Whipp BJ. The bioenergetic and gas exchange basis of exercise testing. Clin Chest Med. 1994;15:173–92.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • J. Alberto Neder
    • 1
  • Andrew R. Tomlinson
    • 2
  • Tony G. Babb
    • 2
  • Denis E. O’Donnell
    • 1
    Email author
  1. 1.Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Division of Respirology and Sleep Medicine, Department of MedicineQueen’s University and Kingston General HospitalKingstonCanada
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineUniversity of Texas Southwestern Medical Center and Institute for Exercise and Environmental Medicine, Texas Health Presbyterian HospitalDallasUSA

Personalised recommendations