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Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults: A Scientific Statement From the American Heart Association
Open accessAbstract
Arteriovenous oxygen difference EOB Exercise oscillatory breathing FECO 2 Fraction of carbon dioxide in expired air FEO 2 Fraction of oxygen in expired air FEV 1 Forced expiratory volume in 1 second MET Metabolic equivalent MVV Maximum voluntary ventilation O 2 Oxygen OUES Oxygen-uptake efficiency slope P ET CO 2 Partial pressure of end-tidal carbon dioxide P ET O 2 Partial pressure of end-tidal oxygen RER Respiratory exchange ratio V ˙CO 2 Carbon dioxide output VD Volume of dead space V ˙E Minute ventilation V ˙E/V ˙CO 2 Ventilatory equivalent of carbon dioxide V ˙E/V ˙O2 Ventilatory equivalent of oxygen V ˙O2 Oxygen uptake VT Ventilatory threshold 192
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“Cardiologists have tended to regard peak V˙o2 as a particularly valuable index for heart function because V˙o2 can be applied as a proxy for cardiac output,8 and this is most commonly used as part of heart failure (HF) management.”
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Cardiopulmonary Exercise Testing in Heart Failure
MYERS, J. N., Arena, R. A., Cahalin, L. P., Labate, V., & Guazzi, M. (2015) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2015.01.009 · Cited by 100
Self-citationExercise Ventilatory Inefficiency in Post-COVID-19 Syndrome: Insights from a Prospective Evaluation
Aparisi, Á., Ybarra-Falcón, C., Gomez, M. G., Tobar, J., Iglesias-Echeverría, C., Largo, S. J., Ladrón, R., Uribarri, A., Catalá, P., Hinojosa, W., et al. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10122591 · Cited by 109
Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair
Grant, S. W., Hickey, G. L., Wisely, N. A., Carlson, E. D., Hartley, R. A., Pichel, A. C., Atkinson, D., & McCollum, C. N. (2014) · British Journal of Anaesthesia · doi:10.1093/bja/aeu383 · Cited by 99
Using metabolic equivalents in clinical practice
Franklin, B. A., Brinks, J., Berra, K., Lavie, C. J., Gordon, N. F., & Sperling, L. S. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2017.10.033 · Cited by 94
Self-citationHeart Failure and Midrange Ejection Fraction
Nadruz, W., West, E., Santos, M., Skali, H., Groarke, J. D., Forman, D. E., & Shah, A. M. (2016) · Circulation Heart Failure · doi:10.1161/circheartfailure.115.002826 · Cited by 98
Self-citationCardiorespiratory Abnormalities in Patients Recovering from Coronavirus Disease 2019
Szekely, Y., Lichter, Y., Sadon, S., Lupu, L., Taieb, P., Banai, A., Sapir, O. P. R., Granot, Y. N., Hochstadt, A., Friedman, S., et al. (2021) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2021.08.022 · Cited by 109
Matura, S., Fleckenstein, J., Deichmann, R., Engeroff, T., Füzéki, E., Hattingen, E., Hellweg, R., Lienerth, B., Pilatus, U., Schwarz, S., et al. (2017) · Translational Psychiatry · doi:10.1038/tp.2017.135 · Cited by 97
Benefits of physical exercise in postmenopausal women
Mendoza, N., de Teresa, C., Cano, A., Godoy‐Izquierdo, D., Hita‐Contreras, F., Lapotka, M., Llaneza, P., Manonelles, P., Martínez‐Amat, A., Ocón, O. M., et al. (2016) · Maturitas · doi:10.1016/j.maturitas.2016.04.017 · Cited by 97
Anselmi, F., Cavigli, L., Pagliaro, A., Valente, S., Valentini, F., Cameli, M., Focardi, M., Mochi, N., Dendale, P., Hansen, D., et al. (2021) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14007 · Cited by 96
Mentz, R. J., Schulte, P. J., Fleg, J. L., Fiuzat, M., Kraus, W. E., Piña, I. L., Keteyian, S. J., Kitzman, D. W., Whellan, D. J., Ellis, S. J., et al. (2012) · American Heart Journal · doi:10.1016/j.ahj.2012.10.029 · Cited by 100
Self-citationGuth, S., Wiedenroth, C. B., Rieth, A. J., Richter, M. J., Grünig, E., Ghofrani, H. A., Arlt, M., Liebetrau, C., Prüfer, D., Rolf, A., et al. (2018) · European Respiratory Journal · doi:10.1183/13993003.00458-2018 · Cited by 95
Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients
Hoshino, J. (2021) · Nutrients · doi:10.3390/nu13051444 · Cited by 107
Hyperventilation as one of the mechanisms of persistent dyspnoea in SARS-CoV-2 survivors
Motiejūnaitė, J., Balagny, P., Arnoult, F., Mangin, L., Bancal, C., Vidal‐Petiot, E., Flamant, M., Jondeau, G., Solal, A. C., d’Ortho, M., et al. (2021) · European Respiratory Journal · doi:10.1183/13993003.01578-2021 · Cited by 95
Mohanty, S., Santangeli, P., Mohanty, P. K., Biase, L. D., Holcomb, S., Trivedi, C. G., Bai, R., BURKHARDT, D. J., Hongo, R. H., Hao, S. C., et al. (2014) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12467 · Cited by 95
Targeting Interleukin-1 in Heart Failure and Inflammatory Heart Disease
Tassell, B. W. V., Raleigh, J. M. V., & Abbate, A. (2014) · Current Heart Failure Reports · doi:10.1007/s11897-014-0231-7 · Cited by 91
McGregor, G., Powell, R., Begg, B., Birkett, S. T., Nichols, S., Ennis, S., McGuire, S., Prosser, J., Fiassam, O., Hee, S. W., et al. (2023) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwad039 · Cited by 109
Berry, N. C., Agarwal, M. A., Oldham, W. M., Stephens, T. E., Goldstein, R. H., Waxman, A. B., Tracy, J. A., Leary, P. J., Leopold, J. A., Kinlay, S., et al. (2015) · Pulmonary Circulation · doi:10.1086/683815 · Cited by 88
“Additional common relative contraindications to exercise testing apply to iCPET, including severe/symptomatic aortic stenosis, decompensated congestive heart failure, unstable coronary syndromes, inability to exercise, severe pulmonary hypertension, unstable arrhythmias, or syncope.(25)”
BackgroundCardiopulmonary fitness is a function of lean mass, not total body weight: The DR’s EXTRA study
Krachler, B., Savonen, K. P., Komulainen, P., Hassinen, M., Lakka, T. A., & Rauramaa, R. (2014) · European Journal of Preventive Cardiology · doi:10.1177/2047487314557962 · Cited by 92
Oliveira, A. B., Bachi, A. L. L., Ribeiro, R. T., de Mello, M. T., Tufik, S. B., & Peres, M. F. P. (2017) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2017.09.008 · Cited by 87
Rehn, T. A., Munkvik, M., Lunde, P., Sjaastad, I., & Sejersted, O. M. (2011) · Heart Failure Reviews · doi:10.1007/s10741-011-9289-4 · Cited by 86
Impact of Cardiorespiratory Fitness on the Obesity Paradox in Patients With Systolic Heart Failure
Clark, A. L., Fonarow, G. C., & Horwich, T. B. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2014.10.023 · Cited by 89
Noor, M. R., Bowles, C. T., & Banner, N. R. (2012) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfs042 · Cited by 86
McCabe, C., Deboeck, G., Harvey, I., Ross, R. M., Gopalan, D., Screaton, N. J., & Pepke‐Żaba, J. (2013) · Thrombosis Research · doi:10.1016/j.thromres.2013.09.032 · Cited by 87
“The normal exercise response is associated with a fall in Vd/Vt to values b 20% [21], hence we suggest that patients with CTED suffer a failure of adequate recruitment of the pulmonary vascular bed on exercise.”
BackgroundCardiopulmonary exercise testing for detecting pulmonary arterial hypertension in systemic sclerosis
Dumitrescu, D., Nagel, C., Kovács, G., Bollmann, T., Halank, M., Winkler, J., Hellmich, M., Grünig, E., Olschewski, H., Ewert, R., et al. (2017) · Heart · doi:10.1136/heartjnl-2016-309981 · Cited by 85
Strayer, D. R., Carter, W. A., Stouch, B. C., Stevens, S. R., Bateman, L., Cimoch, P. J., Lapp, C. W., Peterson, D. L., the Chronic Fatigue Syndrome AMP-516 Study Group, & Mitchell, W. M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0031334 · Cited by 84
“Subjects rated their perceived exertion, generally considered to be a reliable indicator of fatigue [20], using the Borg Scale and progressed through stages successively until they could no longer continue.”
MethodPapasavvas, T., Bonow, R. O., Alhashemi, M., & Micklewright, D. P. (2015) · Sports Medicine · doi:10.1007/s40279-015-0409-5 · Cited by 85
“Maximum oxygen consumption (VO2max or VO2peak), measured using a symptomlimited CPET, was used for measuring CRF, and validated scales measuring depressive symptoms were used for measuring depression symptom severity.”
BackgroundInfluentialDemark‐Wahnefried, W., Jones, L. W., Snyder, D. C., Sloane, R. J., Kimmick, G. G., Hughes, D. C., Badr, H., Miller, P. E., Burke, L. E., & Lipkus, I. M. (2014) · Cancer · doi:10.1002/cncr.28761 · Cited by 84
Jung, M. H., Hansen, P. B., Sander, K., Olsen, P. S., Rossing, K., Boesgaard, S., Russell, S. D., & Gustafsson, F. (2014) · European Journal of Heart Failure · doi:10.1002/ejhf.52 · Cited by 81
Perioperative Management of the Hemodialysis Patient
Trainor, D. M., Borthwick, E. M., & Ferguson, A. J. (2011) · Seminars in Dialysis · doi:10.1111/j.1525-139x.2011.00856.x · Cited by 84
Aamot, I., Forbord, S. H., Gustad, K., Løckra, V., Stensen, A., Berg, A. T., Dalen, H., Karlsen, T., & Støylen, A. (2013) · European Journal of Preventive Cardiology · doi:10.1177/2047487313488299 · Cited by 89
“However, as the main outcome measure was peak VO2, the effort of the participants can be compared through the respiratory exchange ratio.(27) Another study limitation is that the most exercise-motivated patients tend to sign up for participation in exercise trials.”
BackgroundStevens, S. R., Snell, C., Stevens, J., Keller, B. A., & VanNess, J. M. (2018) · Frontiers in Pediatrics · doi:10.3389/fped.2018.00242 · Cited by 81
The Role of Cardiovascular Magnetic Resonance Imaging in the Assessment of Highly Trained Athletes
Gati, S., Sharma, S., & Pennell, D. J. (2018) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2017.11.016 · Cited by 83
Pinkstaff, S. O., Peberdy, M. A., Kontos, M. C., Finucane, S., & Arena, R. A. (2010) · Mayo Clinic Proceedings · doi:10.4065/mcp.2010.0357 · Cited by 80
“00 is generally considered an indicator of poor patient effort.(13) The results of the current study indicate that traditional HR and BP parameters are ineffective indicators of achieving a peak RER of 1.”
ResultSelf-citationPeak Blood Pressure Responses During Maximum Cardiopulmonary Exercise Testing
Sabbahi, A., Arena, R. A., Kaminsky, L. A., MYERS, J. N., & Phillips, S. A. (2017) · Hypertension · doi:10.1161/hypertensionaha.117.10116 · Cited by 80
Self-citationRusso, N., Compostella, L., Tarantini, G., Setzu, T., Napodano, M., Bottio, T., D’Onofrio, A., Isabella, G., Gerosa, G., Iliceto, S., et al. (2013) · European Journal of Preventive Cardiology · doi:10.1177/2047487313494029 · Cited by 78
Minnella, E. M., Ferreira, V., Awasthi, R., Charlebois, P., Stein, B., Liberman, A. S., Scheede‐Bergdahl, C., Morais, J. A., & Carli, F. (2020) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001215 · Cited by 78
Validation of a Cardiopulmonary Exercise Test Score in Heart Failure
MYERS, J. N., Oliveira, R. B., Dewey, F. E., Arena, R. A., Guazzi, M., Chase, P. J., Bensimhon, D., Peberdy, M. A., Ashley, E. A., West, E., et al. (2013) · Circulation Heart Failure · doi:10.1161/circheartfailure.112.000073 · Cited by 79
Self-citationJayawardene, D., McAuley, S. A., Horsburgh, J. C., Gerche, A. L., Jenkins, A. J., Ward, G. M., MacIsaac, R. J., Roberts, T. J., Grosman, B., Kurtz, N., et al. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0461 · Cited by 82
“Breath-by-breath analysis of the volume and concentration of expired gases was achieved using an automated system ( Jaeger Oxycon Pro, Germany) to determine maximal oxygen consumption (VO2 max) and anaerobic threshold (AT) by standardized criteria.(12) VO2 max and AT were then used to determine the experimental parame…”
MethodObstructive Sleep Apnea Is Associated with Impaired Exercise Capacity: A Cross-Sectional Study
Beitler, J. R., Awad, K. M., Bakker, J. P., Edwards, B. A., DeYoung, P. N., Djonlagic, I. E., Forman, D. E., Quan, S. F., & Malhotra, A. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.4200 · Cited by 84
“23 Maximum predicted heart rate was calculated using the Astrand formula.”
Self-citationNayor, M. G., Xanthakis, V., Tanguay, M., Blodgett, J. B., Shah, R. V., Schoenike, M., Sbarbaro, J., Farrell, R., Malhotra, R. K., Houstis, N. E., et al. (2020) · Circulation Heart Failure · doi:10.1161/circheartfailure.119.006729 · Cited by 78
Carbone, S., Canada, J. M., Buckley, L. F., Trankle, C. R., Billingsley, H., Dixon, D. L., Mauro, A. G., Dessie, S., Kadariya, D., Mezzaroma, E., et al. (2017) · JACC Basic to Translational Science · doi:10.1016/j.jacbts.2017.06.009 · Cited by 77
“Subjects underwent symptom-limited CPX, following the American College of Cardiology and American Heart Association guidelines for exercise testing (27).”
MethodSelf-citationMediterranean diet- and exercise-induced improvement in age-dependent vascular activity
Klonizakis, M., AlKhatib, A. H., Middleton, G., & Smith, M. F. (2012) · Clinical Science · doi:10.1042/cs20120412 · Cited by 76
Trankle, C. R., Canada, J. M., Cei, L., Abouzaki, N. A., Oddi, C., Kadariya, D., Christopher, S., Viscusi, M. M., Buono, M. G. D., Kontos, M. C., et al. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.07.002 · Cited by 76
Self-citationFunctional Cardiovascular Reserve Predicts Survival Pre-Kidney and Post-Kidney Transplantation
Ting, S. M. S., Iqbal, H. M., Kanji, H., Hamborg, T., Aldridge, N., Krishnan, N. S., Imray, C., Banerjee, P., Bland, R., Higgins, R. M., et al. (2013) · Journal of the American Society of Nephrology · doi:10.1681/asn.2013040348 · Cited by 74
Bioimpedance and bioreactance methods for monitoring cardiac output
Jakovljević, D. G., Trenell, M. I., & MacGowan, G. A. (2014) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2014.09.003 · Cited by 74
Revisiting age-predicted maximal heart rate: Can it be used as a valid measure of effort?
Arena, R. A., MYERS, J. N., & Kaminsky, L. A. (2015) · American Heart Journal · doi:10.1016/j.ahj.2015.12.006 · Cited by 74
“clinical perspective, there is poor agreement between APMHR and maximal HR, and (2) agreement is influenced by values derived from the APMHR equation.”
MethodInfluentialSelf-citationRegular exercise improves asthma control in adults: A randomized controlled trial
Jaakkola, J. J. K., Aalto, S. A. M., Hernberg, S., Kiihamäki, S.-P., & Jaakkola, M. S. (2019) · Scientific Reports · doi:10.1038/s41598-019-48484-8 · Cited by 84
Cardiopulmonary Exercise Test Parameters in Athletic Population: A Review
Mazaheri, R., Schmied, C. M., Niederseer, D., & Guazzi, M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10215073 · Cited by 73
“Exercise training improves cardio espiratory fitness by about 10–25% in previously sedentary indiv duals [15,19].”
BackgroundMethodInfluentialSelf-citationLeft Ventricular Assist Devices: A Primer For the General Cardiologist
Chaudhry, S., DeVore, A. D., Vidula, H., Nassif, M. E., Mudy, K., Birati, E. Y., Gong, T., Atluri, P., Pham, D. T., Sun, B., et al. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.122.027251 · Cited by 73
Barron, A., Dhutia, N. M., Mayet, J., Hughes, A. D., Francis, D. P., & Wensel, R. (2014) · European Journal of Preventive Cardiology · doi:10.1177/2047487313518474 · Cited by 72
“73m(2)), symptomatic coronary artery disease, recent acute cardiorespiratory illness/decompensation, anaemia, morbid obesity, and all standard contraindications to exercise testing.(9) The study conformed to the principles of the Declaration of Helsinki and was approved by the Research Ethics Committee of Imperial Col…”
Endurance Exercise Intensity Determination in the Rehabilitation of Coronary Artery Disease Patients
Hansen, D., Stevens, A., Eijnde, B. O., & Dendale, P. (2011) · Sports Medicine · doi:10.2165/11595460-000000000-00000 · Cited by 72
“0, while sitting on a bike before exercise testing.([71]) However, it remains difficult to determine whether CAD patients performed exercise up to their true maximal level of physical exertion.”
BackgroundInfluentialChase, P. J., Kenjale, A. A., Cahalin, L. P., Arena, R. A., Davis, P. G., MYERS, J. N., Guazzi, M., Forman, D. E., Ashley, E. A., Peberdy, M. A., et al. (2013) · JACC Heart Failure · doi:10.1016/j.jchf.2013.05.008 · Cited by 72
Self-citationPrognostic Value of Indeterminable Anaerobic Threshold in Heart Failure
Agostoni, P., Corrà, U., Cattadori, G., Veglia, F., Battaia, E., Gioia, R. L., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., et al. (2013) · Circulation Heart Failure · doi:10.1161/circheartfailure.113.000471 · Cited by 72
Self-citationKeller, K., Stelzer, K., Ostad, M. A., & Post, F. (2017) · Advances in Medical Sciences · doi:10.1016/j.advms.2016.11.010 · Cited by 72
Oudegeest‐Sander, M. H., Rikkert, M. G. M. O., Smits, P., Thijssen, D. H. J., van Dijk, A. P. J., Levine, B. D., & Hopman, M. T. E. (2013) · Experimental Gerontology · doi:10.1016/j.exger.2013.10.009 · Cited by 71
“An incremental maximal exercise stress test on a bicycle ergometer (Lode, Excalibur Sport, Groningen, the Netherlands) was performed to measure maximal oxygen uptake (VO2max) (Balady et al., 2010).”
MethodEvaluation of coronary artery disease in potential liver transplant recipients
Hogan, B. J., Gonsalkorala, E. S., & Heneghan, M. A. (2016) · Liver Transplantation · doi:10.1002/lt.24679 · Cited by 71
Tassell, B. W. V., Buckley, L. F., Carbone, S., Trankle, C. R., Canada, J. M., Dixon, D. L., Abouzaki, N. A., Oddi, C., Biondi‐Zoccai, G., Arena, R. A., et al. (2017) · Clinical Cardiology · doi:10.1002/clc.22719 · Cited by 70
Self-citationSmart, N. A., Meyer, T., Butterfield, J. S., Faddy, S. C., Passino, C., Malfatto, G., Jónsdóttir, S., Sarullo, F. M., Wisløff, U., Vigorito, C., et al. (2011) · European Journal of Preventive Cardiology · doi:10.1177/1741826711409171 · Cited by 66
Excess Ventilation during Exercise and Prognosis in Chronic Heart Failure
Sue, D. Y. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201006-0965ci · Cited by 69
Priebe, H.-J. (2011) · British Journal of Anaesthesia · doi:10.1093/bja/aer121 · Cited by 69
Cardiopulmonary Exercise Testing
Tran, D. (2018) · Methods in molecular biology · doi:10.1007/978-1-4939-7614-0_18 · Cited by 72
Guazzi, M., Cahalin, L. P., & Arena, R. A. (2013) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2013.05.005 · Cited by 68
Self-citationLoe, H., Steinshamn, S., & Wisløff, U. (2014) · PLoS ONE · doi:10.1371/journal.pone.0113884 · Cited by 75
“Consequently, CPET is a valuable tool in clinical decision making [2].”
MethodChanges in the Functional Status Measures of Heart Failure Patients With Mechanical Assist Devices
Leibner, E., Cysyk, J., Eleuteri, K., el-Banayosy, A., Boehmer, J., & Pae, W. (2013) · ASAIO journal (1992) · doi:10.1097/mat.0b013e3182816cb7 · Cited by 67
Węgrzynowska‐Teodorczyk, K., Mozdzanowska, D., Josiak, K., Siennicka, A. E., Nowakowska, K., Banasiak, W., Jankowska, E. A., Ponikowski, P. P., & Woźniewski, M. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487315625235 · Cited by 67
Scott, J. M., Thomas, S. M., Peppercorn, J. M., Herndon, J. E., Douglas, P. S., Khouri, M. G., Dang, C. T., Yu, A. F., Catalina, D., Ciolino, C., et al. (2020) · Circulation · doi:10.1161/circulationaha.119.043483 · Cited by 74
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“Although this is hopeful, we should acknowledge that, compared to healthy adults, the patients’ level of peakVO2 at longer term was still Bpoor^ [14].”
BackgroundInfluentialCardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy
Magrì, D., Limongelli, G., Re, F., Agostoni, P., Zachara, E., Correale, M., Mastromarino, V., Santolamazza, C., Casenghi, M., Pacileo, G., et al. (2016) · Heart · doi:10.1136/heartjnl-2015-308453 · Cited by 66
Response to Exercise Training During Cardiac Rehabilitation Differs by Sex
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Obesity and its cardiovascular effects
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Effects of Exercise on ASC Methylation and IL-1 Cytokines in Heart Failure
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“Patients underwent symptom-limited cardiopulmonary exercise testing on a cycle ergometer (Elema, Solna, Sweden) in accordance with published guidelines [18].”
BackgroundMethodThe Ventilatory Anaerobic Threshold in Heart Failure: A Multicenter Evaluation of Reliability
MYERS, J. N., Goldsmith, R. L., Keteyian, S. J., Brawner, C. A., Brazil, D. A., Aldred, H. A., Ehrman, J. K., & Burkhoff, D. (2009) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2009.08.009 · Cited by 64
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“Klidjian [33] 1982 Case control Elective general 120 60 [24-86] 55 Complications Not stated Non dominant”
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Wijshoff, R. W. C. G. R., Mischi, M., & Aarts, R. M. (2016) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2016.2553060 · Cited by 66
“Motion can also affect SpO 2 measurements, e.g., causing false positive desaturations during CPX [16], [17].”
InfluentialSkielboe, A. K., Bandholm, T., Hakmann, S., Mourier, M., Kallemose, T., & Dixen, U. (2017) · PLoS ONE · doi:10.1371/journal.pone.0170060 · Cited by 69
“Maximal exercise capacity was termed peak VO2 as recommended when testing non-healthy subjects [22].”
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“However, VO2max has demonstrated prognostic value in both healthy persons and patients with heart disease [28].”
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“Peak oxygen consumption (VO2) and the minute ventilation/carbon dioxide production (VE/VCO2) slope are two wellvalidated CPX ventilatory indices used to assess prognosis of heart failure (HF) patients.(1-8) In a seminal study Williams et al.”
BackgroundSelf-citationdos Santos, M. R., Sayegh, A. L. C., Bacurau, A. V. N., Arap, M. A., Brum, P. C., Pereira, R. M. R., Takayama, L., Barretto, A. C. P., Negrão, C. E., & Alves, M. J. D. N. N. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.02.014 · Cited by 62
Obesity and cardiovascular risk
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Exercise and Heart Failure: Advancing Knowledge and Improving Care
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Gonzales, T. I., Westgate, K., Strain, T., Hollidge, S., Jeon, J., Christensen, D. L., Jensen, J., Wareham, N. J., & Brage, S. (2021) · Scientific Reports · doi:10.1038/s41598-021-94768-3 · Cited by 59
Neuromuscular fatigue and exercise capacity in fibromyalgia syndrome
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“Subjects performed a maximal incremental exercise test on a computer-controlled electrically braked cycle ergometer (Ergometrics 800, Ergoline) with expired gas analysis and electrocardiogram (Medisoft) (32).”
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“1 indicates maximal exercise [29–31].”
Exercise training in chronic heart failure
Maeyer, C. D., Beckers, P. J., Vrints, C. J., & Conraads, V. M. (2013) · Therapeutic Advances in Chronic Disease · doi:10.1177/2040622313480382 · Cited by 58
“More detailed information on the principles of CPET and the assessment of functional capacity can be found in a recent extensive review [Balady et al. 2010].”
MethodCardiopulmonary Exercise Testing Is a Core Assessment for Patients With Heart Failure
Arena, R. A., MYERS, J. N., & Guazzi, M. (2011) · Congestive Heart Failure · doi:10.1111/j.1751-7133.2011.00216.x · Cited by 59
Self-citationPrehabilitation for kidney transplant candidates: Is it time?
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Self-citationdos Santos, T. D., Pereira, S. N., Portela, L. O. C., Cardoso, D. M., Lago, P. D., Guarda, N. D. S., Moresco, R. N., Pereira, M. B., & de Albuquerque, I. M. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.12.013 · Cited by 59
Implications of obesity across the heart failure continuum
Elagizi, A., Carbone, S., Lavie, C. J., Mehra, M. R., & Ventura, H. O. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.09.005 · Cited by 64
“Cardiopulmonary exercise testing (CPX) is the gold standard for evaluating CRF,(3) and allows for breath-by-breath measurements of oxygen uptake (Vo2), carbon dioxide output and ventilation.(43) CPX does have limitations, as peak Vo2 may underestimate CRF in obese patients.”
Self-citationLaukkanen, J. A., de Araújo, C. G. S., Kurl, S., Khan, H., Jae, S. Y., Guazzi, M., & Kunutsor, S. K. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318761679 · Cited by 58
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“In our current study individualized protocols resulted in similar, and recommended, exercise times (1), suggesting that cardiovascular limitation may lower the slope even with optimal exercise duration.”
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Effectiveness of Aerobic Exercise Programs for Health Promotion in Metabolic Syndrome
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“1 and a HR >85% of estimated maximal HR, were considered (20).”
BackgroundOral Iron Therapy for Heart Failure With Reduced Ejection Fraction
Lewis, G. D., Semigran, M. J., Givertz, M. M., Malhotra, R. K., Anstrom, K. J., Hernandez, A. F., Shah, M., & Braunwald, E. (2016) · Circulation Heart Failure · doi:10.1161/circheartfailure.115.000345 · Cited by 59
Relation Among Body Mass Index, Exercise Training, and Outcomes in Chronic Systolic Heart Failure
Horwich, T. B., Broderick, S., Chen, L., McCullough, P. A., Strzelczyk, T. A., Kitzman, D. W., Fletcher, G. F., Safford, R. E., Ewald, G. A., Fine, L. J., et al. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.07.051 · Cited by 56
Self-citation
Metadata
- Authors
- Balady, G. J., Arena, R., Sietsema, K., Myers, J., Coke, L., Fletcher, G. F., Forman, D., Franklin, B., Guazzi, M., Gulati, M., Keteyian, S. J., Lavie, C. J., Macko, R., Mancini, D., Milani, R. V., Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, & Interdisciplinary Council on Quality of Care and Outcomes Research
- Affiliations
- IRCCS Policlinico San Donato (IT)
- ORCID
- Venue
- Circulation
- Published
- 2010-07-13
- Volume
- 122
- Issue
- 2
- Pages
- 191-225
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2074602210
- Cited by
- 1,964
- References
- 255
- Citations by year
- 2026: 148 · 2025: 128 · 2024: 177 · 2023: 138 · 2022: 156 · 2021: 150 · 2020: 138 · 2019: 139 · 2018: 125 · 2017: 140 · 2016: 122 · 2015: 90 · 2014: 100 · 2013: 78 · 2012: 70
- FWCI
- 177.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK6 RX002477)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- cardiopulmonary exercise testing, oxygen consumption, ventilatory threshold, oxygen uptake efficiency slope, respiratory exchange ratio, ventilatory equivalents, end-tidal carbon dioxide, end-tidal oxygen, arteriovenous oxygen difference, carbon dioxide output, dead space, forced expiratory volume, metabolic equivalents, maximal voluntary ventilation, adults
- MeSH terms
- Adult, American Heart Association, Cardiovascular Diseases, Exercise Test, Female, Humans, Lung Diseases, Male, United States
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