Cardiopulmonary exercise testing for a tailored exercise prescription

Keywords: CPET, exercise, training, cardiovascular diseases, rehabilitation

Authors: Prof. Flavio D’Ascenzi* and Prof. Dominique Hansen^

*Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy

^ Hasselt University, Diepenbeek, Belgium

 

This blog provides highlights of a recent paper regarding the use of cardiopulmonary exercise tests in tailored exercise prescription (1). 

 

Why is this study important?

Exercise-based cardiovascular (CV) rehabilitation in patients with established CV disease (CVD), and exercise intervention in patients at high risk for CVD, are highly effective in preventing CVD or its complications. To maximize the benefits of such interventions, appropriate tailoring of the exercise prescription is crucial. However, such high-level tailoring is only achievable when an exercise test is executed, specifically a cardiopulmonary exercise test (CPET). What is clarified in the paper is how to execute and interpret the CPET variables and data in order to tailor the exercise prescription. This study is therefore important to all clinicians providing exercise intervention to patients at risk of and with CVD.


How did the study go about this?

A panel of international experts executed a literature review on the aims, methods, and interpretation of CPET in light of exercise prescription for patients at risk of and with CVD. They consider the latest evidence and European position statements/guidelines (EAPC and ESC) on CPET and exercise-based rehabilitation or exercise intervention in CVD (risk).


What did the study find?

CPET is still used too infrequently in clinical practice, which can lead to exercise prescriptions that are not appropriate. Hence, there is great room for improvement in this field. In particular, using fixed percentages of maximal heart rate or peak oxygen uptake can lead to too low or too high exercise intensities and/or volumes. The latter is a consequence of disturbed chronotropic responses, physical deconditioning, and medication intake, among others. Certain CVDs have been identified in which this could be particularly relevant and should thus prompt the clinician to execute CPET at the entry of intervention. Moreover, the progression of exercise intensities and volumes during an exercise intervention should be based on outcomes from the CPET since there are no standard schemes that can be followed. The paper explains how to interpret the variables and data from CPET in light of exercise prescription. In this regard, particularly the ventilatory thresholds (VTs) are of key interest: they allow the personalization of exercise prescription in these patients. Therefore, the concept of the first and second VT is explained in greater detail in the paper.


What are the key take-home points?

CPET helps personalize exercise prescriptions for patients at risk of and with CVD. In particular, using the VTs to set the correct exercise intensities is a key issue and will avoid setting too low or too high exercise intensities and volumes. The latter thus also assists in guaranteeing the medical safety of exercise intervention and good progression.

 

References 

  1. D’Ascenzi F, Cavigli L, Pagliaro A, Focardi M, Valente S, Cameli M, Mandoli GE, Mueller S, Dendale P, Piepoli M, Wilhelm M, Halle M, Bonifazi M, Hansen D. Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease. Br J Sports Med. 2022 Jun 9:bjsports-2021-105261. doi: 10.1136/bjsports-2021-105261. Epub ahead of print. PMID: 35680397.

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