ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

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Abstract

The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minute, followed by a recovery phase of at least 2–3 min. Patients responding to the survey (n=295) perceived CPET as highly beneficial for their diagnostic assessment and informed the Task Force consensus. Future research should focus on the individualised estimation of optimal work rate increments across different lung diseases, and the collection of robust normative data.

Abstract

The document facilitates standardisation of conducting, reporting and interpreting cardiopulmonary exercise tests in chronic lung diseases for comparison of reference data, multi-centre studies and assessment of interventional efficacy. http://bit.ly/31SXeB5

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Author and article information

Journal

Journal ID (nlm-ta): Eur Respir Rev

Journal ID (iso-abbrev): Eur Respir Rev

Journal ID (publisher-id): ERR

Journal ID (hwp): errev

Title: European Respiratory Review

Publisher: European Respiratory Society

ISSN (Print): 0905-9180

ISSN (Electronic): 1600-0617

Publication date Collection: 31 December 2019

Publication date (Electronic): 18 December 2019

Volume: 28

Issue: 154

Electronic Location Identifier: 180101

Affiliations

[1 ]Dept of Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

[2 ]Epidemiology, Biostatistics and Prevention Institute, Division of Occupational and Environmental Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland

[3 ]Lane Fox Respiratory Service, St Thomas’ Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK

[4 ]First Dept of Respiratory Medicine, National & Kapodistrian University of Athens, Athens, Greece

[5 ]Faculty of Kinesiology and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Dept of Rehabilitation Sciences KU Leuven, University Hospital Leuven, Leuven, Belgium

[6 ]Unidade de Fisiologia Pulmonar, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

[7 ]Dept of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK

[8 ]Paediatric Dept, 424 General Military Hospital, Thessaloniki, Greece

[9 ]ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen`s Medical Research Institute, University of Edinburgh, Edinburgh, UK

[10 ]Respiratory Medicine Dept, Royal Infirmary of Edinburgh, Edinburgh, UK

[11 ]HP2 Laboratory, Grenoble Alpes University, INSERM, Grenoble, France

[12 ]Hellenic Cystic Fibrosis Association, Athens, Greece

[13 ]European Lung Foundation, Sheffield, UK

[14 ]Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

[15 ]Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium

[16 ]REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium

[17 ]Depat of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands

[18 ]Dept of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands

[19 ]Dept of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand

[20 ]Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire Expérimentale et clinique, Paris, France

[21 ]AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée du Département “R3S”, Paris, France

[22 ]Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria

[23 ]Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium

[24 ]Pulmonary Rehabilitation, University Hospital Gasthuisberg, Leuven, Belgium

[25 ]Laboratory of Clinical Exercise Physiology & Respiratory Investigation Unit, Kingston Health Science Center, Queen's University, Kingston, ON, Canada

[26 ]Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA

[27 ]Dept of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK

[28 ]Paediatric Dept, University Hospital Würzburg, Würzburg, Germany

[29 ]Task Force Co-Chair

Author notes

Helge Hebestreit, Universitäts-Kinderklinik, Member of ERN-LUNG, Josef-Schneider-Str. 2, 97080 Würzburg, Germany. E-mail: hebestreit@ 123456uni-wuerzburg.de