History and clinical context Relevant medical history, specifics of exercise intolerance, prior exercise test results, relevant studies (eg, echocardiography, pulmonary function tests, complete blood cell count), relevant medications (eg, beta-blockers) |
Resting data Weight, body mass index, percent body fat, heart rate, blood pressure, pulse oximetry, screening spirometry, hemoglobin, electrocardiogram |
Exercise protocol Treadmill, cycle, or arm geometry; rate of ramp increase; peak workload |
Reason for test termination Fatigue, symptoms, abnormal electrocardiographic findings |
Subjective responses Peak rating of perceived exertion Specific symptoms and comparison to index symptoms |
Validity of test Peak respiratory exchange ratio ≥ 1.1, rating of perceived exertion≥17 |
Oxygen responses Peak Vo2 relative to norms, Vo2 per ideal weight, Vo2 at ventilatory threshold |
Specific cardiac responses Reflected in exercise and recovery heart rate, blood pressure, O2-pulse, electrocardiogram |
Specific pulmonary responses Peak respiratory rate, ventilations; ventilatory reserve , (Ve/Mvv) pulse oximetry, blood gases |
Markers of central cardiopulmonary inefficiency |
Ve/Vco2 slope, end-tidal Pco2 responses, exercise oscillatory breathing, oxygen uptake efficiency slope |
Summary statement The bottom line for referring provider; normal vs abnormal; if abnormal, suggest differential diagnoses; CPET score for heart failure (see Table 3) |
Recommendations To guide referring provider Reassurance if normal Formal exercise program for fitness or weight loss Suggest adjunctive tests if abnormal (eg, formal spirometry, right heart catheterization, chest computed tomography, natriuretic peptide measurement) Beta-blocker modification or pacemaker if chronotropically incompetent |