Cited by 1,964Cardiovascular and exercise physiologyChronic Obstructive Pulmonary Disease (COPD) ResearchPhysical Activity and Health

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Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults: A Scientific Statement From the American Heart Association

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Balady, Gary J., Arena, Ross, Sietsema, Kathy, Myers, Jonathan, Coke, Lola, Fletcher, Gerald F., Forman, Daniel, Franklin, Barry, Guazzi, Marco, Gulati, Martha, Keteyian, Steven J., Lavie, Carl J., Macko, Richard, Mancini, Donna, Milani, Richard V., Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, Interdisciplinary Council on Quality of Care and Outcomes Research·2010·Circulation

DOI 10.1161/cir.0b013e3181e52e69

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Abstract

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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Relation Between New York Heart Association Functional Class and Objective Measures of Cardiopulmonary Exercise in Adults With Congenital Heart Disease
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Effects of Blood Transfusion on Exercise Capacity in Thalassemia Major Patients
Benedetto, D., Rao, C. M., Cefalù, C., Aguglia, D. O., Cattadori, G., D’Ascola, D. G., Benedetto, F. A., Agostoni, P., & Sciomer, S. (2015) · PLoS ONE · doi:10.1371/journal.pone.0127553 · Cited by 18
Identifying limitations to exercise with incremental cardiopulmonary exercise testing: a scoping review
Staes, M., Gyselinck, I., Goetschalckx, K., Troosters, T., & Janssens, W. (2024) · European Respiratory Review · doi:10.1183/16000617.0010-2024 · Cited by 17
“Although CPET rarely pinpoints a specific diagnosis, it helps to narrow the differential diagnosis and guide further investigations [7].”
Cardiopulmonary Exercise Testing for Characterization of Hypertrophic Cardiomyopathy: A Meta‐Analysis
Landsteiner, I., Masri, A., Saberi, S., Maron, M. S., McGinnis, S., Griskowitz, C., Newlands, C., Villa, R. B., OWENS, A. T., & Lewis, G. D. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.039551 · Cited by 19
Heightened innate immunity may trigger chronic inflammation, fatigue and post-exertional malaise in ME/CFS
Che, X., Ranjan, A. K., Guo, C., Zhang, K., Goldsmith, R., Levine, S. M., Moneghetti, K. J., Zhai, Y., Ge, L., Mishra, N., et al. (2025) · npj Metabolic Health and Disease · doi:10.1038/s44324-025-00079-w · Cited by 23
Making Cardiopulmonary Exercise Testing Interpretable for Clinicians
Andonian, B. J., Hardy, N., Bendelac, A., Polys, N. F., & Kraus, W. E. (2021) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000895 · Cited by 17
Role of cardiopulmonary exercise test in the prediction of hemodynamic impairment in patients with pulmonary arterial hypertension
Pezzuto, B., Badagliacca, R., Muratori, M., Farina, S., Bussotti, M., Correale, M., Bonomi, A., Vignati, C., Sciomer, S., Papa, S., et al. (2022) · Pulmonary Circulation · doi:10.1002/pul2.12044 · Cited by 17
Peak O2-Pulse Predicts Exercise Training-Induced Changes in Peak VO2 in Heart Failure with Preserved Ejection Fraction
Mueller, S., Haller, B., Feuerstein, A., Winzer, E. B., Beckers, P. J., Haykowsky, M. J., Gevaert, A. B., Hommel, J., Azevedo, L. F., Duvinage, A., et al. (2022) · ESC Heart Failure · doi:10.1002/ehf2.14070 · Cited by 17
Epidemiological, mechanistic, and practical bases for assessment of cardiorespiratory fitness and muscle status in adults in healthcare settings
Gallo‐Villegas, J., & Calderón, J. C. (2023) · European Journal of Applied Physiology · doi:10.1007/s00421-022-05114-y · Cited by 20
Exercise in cold: Friend than foe to cardiovascular health
Feng, Z., Hu, Y., Yu, S., Bai, H., Sun, Y., Gao, W., Li, J., Qin, X., & Zhang, X. (2023) · Life Sciences · doi:10.1016/j.lfs.2023.121923 · Cited by 20
Regular Practice of Physical Activity Improves Cholesterol Transfers to High-Density Lipoprotein (HDL) and Other HDL Metabolic Parameters in Older Adults
Braga, P. G. S., Freitas, F. R., Bachi, A. L. L., Amirato, G. R., Baroni, R. V., Alves, M. J. D. N. N., Vieira, R. P., Vaisberg, M. W., Aldin, M. N., Filho, R. K., et al. (2023) · Nutrients · doi:10.3390/nu15234871 · Cited by 22
Development of deep-learning models for real-time anaerobic threshold and peak VO2 prediction during cardiopulmonary exercise testing
Watanabe, T., Tohyama, T., Ikeda, M., Fujino, T., Hashimoto, T., Matsushima, S., Kishimoto, J., Todaka, K., Kinugawa, S., Tsutsui, H., et al. (2023) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwad375 · Cited by 21
Expression of mitochondrial oxidative stress response genes in muscle is associated with mitochondrial respiration, physical performance, and muscle mass in the Study of Muscle, Mobility, and Aging
Tranah, G. J., Barnes, H. N., Cawthon, P. M., Coen, P. M., Esser, K. A., Hepple, R. T., Huo, Z., Kramer, P. A., Toledo, F. G. S., Zhang, X., et al. (2024) · Aging Cell · doi:10.1111/acel.14114 · Cited by 16
The effect of probiotics and casein supplementation on aerobic capacity parameters of male soccer players
Imanian, B., Hemmatinafar, M., Daryanoosh, F., Koureshfard, N., Sadeghi, R., Niknam, A., Rezaei, R., & Qashqaei, A. (2024) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2024.2382165 · Cited by 18
“…rise without an increase in ventilatory equivalent for carbon dioxide (VE/VCO 2 )) and end-tidal meth-ods (partial pressure of end-tidal oxygen tension (PetO 2 ) starts to grow without a decrease in partial pressure of end-tidal carbon dioxide (PetCO 2 )) was used as a complement [23] (Figure 3).”
Method
Creatinine and myoglobin are poor predictors of anaerobic threshold in colorectal cancer and health
Nyasavajjala, S. M., Phillips, B. E., Lund, J. N., & Williams, J. P. (2015) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12020 · Cited by 17
“Unfortunately, CPET is not universally available and exposes the patient to a small risk of non-fatal adverse event, of approximately one in 2000, dependent upon pre-existing comorbidity.(13,14) Similarly, skeletal muscle mass has also been shown to be”
Background
Pedaling rate is an important determinant of human oxygen uptake during exercise on the cycle ergometer
Formenti, F., Minetti, A. E., & Borrani, F. (2015) · Physiological Reports · doi:10.14814/phy2.12500 · Cited by 17
“…capacity to estimate maximal _Vo2 ( _Vo2max) in populations where direct assessment of individuals’ maximal exercise aerobic power may not be feasible [e.g., patients with heart failure (Noonan and Dean 2000; Balady et al. 2010)], or where equipment or expertise to measure _Vo2 are not available.”
Background
Quantifying and communicating peri‐operative risk
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Impaired Myocardial Relaxation with Exercise Determines Peak Aerobic Exercise Capacity in Heart Failure with Preserved Ejection Fraction
Trankle, C. R., Canada, J. M., Buckley, L. F., Carbone, S., Dixon, D. L., Arena, R. A., Tassell, B. W. V., & Abbate, A. (2017) · ESC Heart Failure · doi:10.1002/ehf2.12147 · Cited by 17
Self-citation
Body mass index in adults with congenital heart disease
Zaqout, M., Vandekerckhove, K., Michels, N., Demulier, L., Bové, T., François, K., Backer, J. F. A. D., Henauw, S. D., & Wolf, D. D. (2019) · Congenital Heart Disease · doi:10.1111/chd.12751 · Cited by 17
Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study
Cannière, H. D., Smeets, C. J. P. P., Schoutteten, M., Varon, C., Hoof, C. A. V., Huffel, S. V., Groenendaal, W., & Vandervoort, P. M. (2020) · Journal of Medical Internet Research · doi:10.2196/17326 · Cited by 17
“Notwithstanding, participation in a CR program has shown to increase cardiorespiratory fitness, thereby improving physiological responses to physical effort [5].”
Background
Immunoregulation induced by autologous serum collected after acute exercise in obese men: a randomized cross-over trial
Dorneles, G. P., da Silva, I. M., Santos, M. A., Elsner, V. R., Fonseca, S. G., Peres, A., & Romão, P. R. T. (2020) · Scientific Reports · doi:10.1038/s41598-020-78750-z · Cited by 17
Transferability of Cardiopulmonary Parameters between Treadmill and Cycle Ergometer Testing in Male Triathletes—Prediction Formulae
Wiecha, S., Price, S., Cieśliński, I., Kasiak, P. S., Tota, Ł. M., Ambroży, T., & Śliż, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031830 · Cited by 17
“Considering these results, the MAE observed in this study appear to be acceptable, the prediction error being similar to the test–retest measurement error, where the 5% error is commonly accepted [25].”
Result
Mitral stenosis after IMR ETlogix ring annuloplasty for ischemic regurgitation
Martín, C.-E., Castaño, M., Gómez‐Plana, J., Gualis, J., Comendador, J. M. M., & Iglesias, I. (2012) · Asian Cardiovascular and Thoracic Annals · doi:10.1177/0218492312439478 · Cited by 17
Autonomic dysfunction predicts poor physical improvement after cardiac rehabilitation in patients with heart failure
Compostella, L., Nicola, R., Setzu, T., Compostella, C., & Bellotto, F. (2014) · Research in Cardiovascular Medicine · doi:10.5812/cardiovascmed.25237 · Cited by 17
“Peak exercise capacity was expressed in Watt as the maximum sustained workload (Watt-max) (16).”
A comparison of energy consumption between the use of a walking frame, crutches and a Stride-on rehabilitation scooter
Patel, N., Batten, T., Roberton, A., Enki, D. G., Wansbrough, G., & Davis, J. (2016) · The Foot · doi:10.1016/j.foot.2016.04.002 · Cited by 17
“This is therefore a good and sensitive marker of energy consumption and reflects all aspects of cardiopulmonary function [8,9].”
Background
Physical Activity After Breast Cancer Surgery: Does Depression Make Exercise Feel More Effortful than It Actually Is?
Padin, A. C., Wilson, S. J., Bailey, B. E., Malarkey, W. B., Lustberg, M. B., Farrar, W. B., Povoski, S. P., Agnese, D. M., Reinbolt, R. E., Wesolowski, R., et al. (2019) · International Journal of Behavioral Medicine · doi:10.1007/s12529-019-09778-3 · Cited by 17
“Peak RER is a validated measure of subject effort during cardiovascular exercise testing [27].”
Cardiac sympathetic dysfunction in pulmonary arterial hypertension: lesson from left‐sided heart failure
Mercurio, V., Pellegrino, T., Bosso, G., Campi, G., Parrella, P., Piscopo, V., Tocchetti, C. G., Hassoun, P. M., Petretta, M., Cuocolo, A., et al. (2019) · Pulmonary Circulation · doi:10.1177/2045894019868620 · Cited by 17
Prevalence and risk factors for low bone density in adults with a Fontan circulation
D’Ambrosio, P., Tran, D., Verrall, C. E., Attard, C., Singh, M. F., Ayer, J. G., d’Udekem, Y., Twigg, S. M., Celermajer, D. S., & Cordina, R. (2019) · Congenital Heart Disease · doi:10.1111/chd.12836 · Cited by 17
Hemodynamic mechanisms of the attenuated blood pressure response to mental stress after a single bout of maximal dynamic exercise in healthy subjects
Neves, F. J., Carvalho, A. C., Rocha, N. G., Silva, B. M., Sales, A. R. K., de Castro, R. R. T., Rocha, J., Thomaz, T. G., & da Nóbrega, A. C. L. (2012) · Brazilian Journal of Medical and Biological Research · doi:10.1590/s0100-879x2012007500083 · Cited by 17
“However, the maximal dynamic exercise test is a standardized protocol used to evaluate integrative cardiovascular, respiratory and muscular functions and health [Statement from the American Heart Association (37,38)].”
Method
Heart failure with preserved ejection fraction (HFpEF) pathophysiology study (IDENTIFY-HF): does increased arterial stiffness associate with HFpEF, in addition to ageing and vascular effects of comorbidities? Rationale and design
Ali, D., Callan, N., Ennis, S., Powell, R., McGuire, S., McGregor, G., Weickert, M. O., Miller, M. A., Cappuccio, F. P., & Banerjee, P. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027984 · Cited by 16
Clinical and neuroimaging correlates of cardiorespiratory fitness in adolescents with bipolar disorder
Popel, N., Kennedy, K. G., Fıksenbaum, L., Mitchell, R. H. B., MacIntosh, B. J., & Goldstein, B. I. (2020) · Bipolar Disorders · doi:10.1111/bdi.12993 · Cited by 16
Performance of Heart Failure Patients with Severely Reduced Ejection Fraction during Cardiopulmonary Exercise Testing on Treadmill and Cycle Ergometer; Similarities and Differences
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“There is compelling evidence supporting the finding of higher peak VO2 values measured on treadmill tests than cycle ergometer; however, these differences have been shown only in a range between 5–10% [9] to 10–20% [13,14] and 5–20% [4].”
Background
Cardiorespiratory Optimal Point Is a Submaximal Exercise Test Variable and a Predictor of Mortality Risk
Peterman, J. E., Harber, M. P., Fleenor, B. S., WHALEY, M. H., de Araújo, C. G. S., & Kaminsky, L. A. (2022) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000711 · Cited by 16
Cardiorespiratory Coordination in Collegiate Rowing: A Network Approach to Cardiorespiratory Exercise Testing
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“, ventilation, VE; heart rate, HR; oxygen saturation, SpO2; ventilatory threshold, VT; expired fraction of oxygen, FeO2; expired fraction of carbon dioxide, FeCO2) linked to metabolic, cardiovascular and pulmonary responses during the CPET [7,9].”
Background
Effect of High-Intensity Interval, Moderate-Intensity Continuous, and Self-Selected Intensity Training on Health and Affective Responses
Oliveira, G. T. A., Costa, E. C., Santos, T. M., Bezerra, R. A., Lemos, T. M. A. M., Mortatti, A. L., & Elsangedy, H. M. (2023) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2022.2141674 · Cited by 17
“For the test to be considered valid, participants should meet at least one of the following criteria: respiratory exchange ratio ≥1.10 and reach at least 85% of the maximum heart rate expected for age (220 – age) (Balady et al., 2010).”
MethodInfluential
Comparison of VO2max Estimations for Maximal and Submaximal Exercise Tests in Apparently Healthy Adults
Dugas, M.-O., Paradis‐Deschênes, P., Simard, L., Chevrette, T., Blackburn, P., & Lavallière, M. (2023) · Sports · doi:10.3390/sports11120235 · Cited by 21
Carotid body dysregulation contributes to Long COVID symptoms
El‐Medany, A. Y., Adams, Z. H., Blythe, H. C., Hope, K. A., Kendrick, A. H., Sheikh, A. P. A., Paton, J. F. R., Nightingale, A. K., & Hart, E. C. (2024) · Communications Medicine · doi:10.1038/s43856-024-00447-5 · Cited by 19
Effects of a combined exercise and dietary intervention on body composition, physical functioning and fatigue in patients with ovarian cancer: results of the PADOVA trial
Kenkhuis, M., Stelten, S., Hartman, Y., Brouwer, C. G., ten Tusscher, M. R., van Lonkhuijzen, L. R. C. W., Kenter, G. G., van Driel, W. J., Winkels, R. M., Bekkers, R. L. M., et al. (2024) · British Journal of Cancer · doi:10.1038/s41416-024-02694-8 · Cited by 16
Higher expression of denervation‐responsive genes is negatively associated with muscle volume and performance traits in the study of muscle, mobility, and aging (SOMMA)
Lukasiewicz, C. J., Tranah, G. J., Evans, D. S., Coen, P. M., Barnes, H. N., Huo, Z., Esser, K. A., Zhang, X., Wolff, C. A., Wu, K. G., et al. (2024) · Aging Cell · doi:10.1111/acel.14115 · Cited by 15
“A standardized CPET, using a modified Balke or manual protocol, was administered to participants to measure ventilatory gases, oxygen and carbon dioxide inhaled and exhaled during exercise (Balady et al., 2010).”
Method
Cardiopulmonary exercise test in patients with subacute pulmonary emboli
Topilsky, Y., Hayes, C. L., Khanna, A. D., & Allison, T. G. (2011) · Heart & Lung · doi:10.1016/j.hrtlng.2011.06.009 · Cited by 16
Effect of physical exercise training in patients with Chagas heart disease: study protocol for a randomized controlled trial (PEACH study)
Mendes, F. D. S. N. S., Sousa, A., Souza, F. C. D. C. C., Pinto, V. L., Silva, P. S., Saraiva, R., Xavier, S., Veloso, H. H., Holanda, M. T., Costa, A. R., et al. (2016) · Trials · doi:10.1186/s13063-016-1553-4 · Cited by 17
“[18].”
Performance of Fixed Heart Rate Increment Targets of 20 vs 30 Beats per Minute for Exercise Rehabilitation Prescription in Outpatients With Heart Failure
Reed, J. L., Blais, A. Z., Keast, M.-L., Pipe, A., & Reid, R. D. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.01.022 · Cited by 16
Dynamic bicycle exercise to assess cardiac output at multiple exercise levels during magnetic resonance imaging
Heiberg, J., Asschenfeldt, B., Maagaard, M., & Ringgaard, S. (2017) · Clinical Imaging · doi:10.1016/j.clinimag.2017.07.010 · Cited by 16
Protocol, and practical challenges, for a randomised controlled trial comparing the impact of high intensity interval training against standard care before major abdominal surgery: study protocol for a randomised controlled trial
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Impact of High Respiratory Exchange Ratio During Submaximal Exercise on Adverse Clinical Outcome in Heart Failure
Kakutani, N., Fukushima, A., Yokota, T., Katayama, T., Nambu, H., Shirakawa, R., Maekawa, S., Abe, T., Takada, S., Furihata, T., et al. (2018) · Circulation Journal · doi:10.1253/circj.cj-18-0103 · Cited by 16
“It is well known that peak RER >1.1 is an objective criterion of maximal effort, 17 but the clinical relevance of RER during submaximal exercise remains to be elucidated.”
Influential
Small unrepaired atrial septal defects display impaired exercise capacity compared with healthy peers
Udholm, S., Rex, C. E., Eckerström, F., Hald, M. O., Nyboe, C., & Hjortdal, V. E. (2018) · Congenital Heart Disease · doi:10.1111/chd.12740 · Cited by 16
Peak oxygen uptake, six-minute walk distance, six-meter walk speed, and pulse pressure as predictors of seven year all-cause and cardiovascular mortality in community-living older adults
Woo, J., Yau, F. C., Leung, J. C. S., & Chan, R. (2019) · Experimental Gerontology · doi:10.1016/j.exger.2019.110645 · Cited by 16
Determinants of Maximal Oxygen Uptake in Patients with Heart Failure
Pravio, J. R., Caballero, E. B., Barbeito‐Caamaño, C., Martín, M. J. P., Caballero, G. B., Mallón, D. C., Pardo-Martínez, P., Cancela, Z. G., Canosa, P. B., Pinilla, J. M. G., et al. (2021) · ESC Heart Failure · doi:10.1002/ehf2.13275 · Cited by 16
“In clinical practice, VO2max is determined in a protocolized way using the cardiopulmonary exercise testing (CPET) on a cycle ergometer or on a treadmill.(6) This parameter represents an objective estimation of the functional capacity in patients OR IG INAL RESEARCH ART ICLE”
Method
Using Machine Learning to Identify Organ System Specific Limitations to Exercise via Cardiopulmonary Exercise Testing
Portella, J. J., Andonian, B. J., Brown, D. E., Mansur, J., Wales, D., West, V. L., Kraus, W. E., & Hammond, W. E. (2022) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2022.3163402 · Cited by 16
“, diagnosis and prognosis of patients with cardiopulmonary disorders and those undergoing heart transplant) [2]–[4], CPET is used to identify impairments in individual body systems critical in sustaining the work of exercise: the lungs, heart, circulatory system, and skeletal muscle O2-CO2 exchange and mitochondrial m…”
Method
Exercise and heart failure in the elderly
Kappagoda, T. C., & Amsterdam, E. A. (2012) · Heart Failure Reviews · doi:10.1007/s10741-011-9297-4 · Cited by 16
Comparison of Heart Rate Recovery After the Six-Minute Walk Test to Cardiopulmonary Exercise Testing in Patients With Heart Failure and Reduced and Preserved Ejection Fraction
Cahalin, L. P., Arena, R. A., & Guazzi, M. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.05.002 · Cited by 15
Self-citation
The presence of the NOS3 gene polymorphism for intron 4 mitigates the beneficial effects of exercise training on ambulatory blood pressure monitoring in adults
Sponton, C. H., Esposti, R. D., Rodovalho, C. D. M., Ferreira, M. J., Jarrete, A. P., Anaruma, C. P., Bacci, M., & Zanesco, A. (2014) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00844.2013 · Cited by 16
The slope of the oxygen pulse curve does not depend on the maximal heart rate in elite soccer players
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A comparison of methods for determining the ventilatory threshold: implications for surgical risk stratification
Vainshelboim, B., Rao, S., Chan, K., Lima, R. M., Ashley, E. A., & MYERS, J. N. (2017) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-017-0862-8 · Cited by 14
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Improvement in exercise capacity and delayed anaerobic metabolism induced by far-infrared-emitting garments in active healthy subjects: A pilot study
Mantegazza, V., Contini, M. C., Botti, M., Ferri, A., Dotti, F., Berardi, P., & Agostoni, P. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318768598 · Cited by 16
Exercise Periodization over the Year Improves Metabolic Syndrome and Medication Use
Morales‐Palomo, F., Ramírez-Jiménez, M., ORTEGA, J. F., & Mora‐Rodríguez, R. (2018) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001659 · Cited by 17
Critical inspiratory pressure – a new methodology for evaluating and training the inspiratory musculature for recreational cyclists: study protocol for a randomized controlled trial
Rehder‐Santos, P., Minatel, V., Milan‐Mattos, J. C., Signini, É. D. F., de Abreu, R. M., Dato, C. C., & Catai, A. M. (2019) · Trials · doi:10.1186/s13063-019-3353-0 · Cited by 16
Lymphopenia in adults after the Fontan operation: prevalence and associations
Alsaied, T., Possner, M., Brown, N. M., Almeneisi, H., Szugye, C., Trout, A. T., Niss, O., Palermo, J. J., Zafar, F., Dillman, J. R., et al. (2020) · Cardiology in the Young · doi:10.1017/s1047951120000694 · Cited by 16
Normative Cardiopulmonary Exercise Test Responses at the Ventilatory Threshold in Canadian Adults 40 to 80 Years of Age
Lewthwaite, H., Sewify, O. E., Niro, F., Bourbeau, J., Guenette, J. A., Maltais, F., Marciniuk, D. D., O’Donnell, D. E., Smith, B. M., Stickland, M. K., et al. (2020) · CHEST Journal · doi:10.1016/j.chest.2020.11.009 · Cited by 16
Permanent chronotropic impairment after closure of atrial or ventricular septal defect
Heiberg, J., Nyboe, C., & Hjortdal, V. E. (2017) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2017.1337216 · Cited by 16
“not differ between the groups that are compared [29].”
Background
Effectiveness of Resistance Training with the Use of a Suspension System in Patients after Myocardial Infarction
Nowak, A., Morawiec, M., Gabrys, T. T., Nowak, Z., Szmatlan-Gabrys, U. B., & Salcman, V. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17155419 · Cited by 15
Outpatient Cardiac Rehabilitation Closure and Home-Based Exercise Training During the First COVID-19 Lockdown in Austria: A Mixed-Methods Study
Kulnik, S. T., Sareban, M., Höppchen, I., Droese, S., Egger, A., Gutenberg, J., Mayr, B., Reich, B., Wurhofer, D., & Niebauer, J. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.817912 · Cited by 16
Cardio-Pulmonary Dysfunction Evaluation in Patients with Persistent Post-COVID-19 Headache
Aparisi, Á., Ybarra-Falcón, C., Iglesias-Echeverría, C., Gomez, M. G., Marcos-Mangas, M., Valle‐Peñacoba, G., Moraleja, M. C., Fernández‐de‐las‐Peñas, C., Peral, Á. L. G., & García‐Azorín, D. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19073961 · Cited by 17
The influence of exercise and postural changes on ventricular repolarization in the long QT syndrome: a systematic scoping review
Harvey, A., Curnier, D. Y., Dodin, P., Abadir, S., Jacquemet, V., & Caru, M. (2022) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwac081 · Cited by 15
Functional Assessment Based on Cardiopulmonary Exercise Testing in Mild Heart Failure: A Multicentre Study
Zimerman, A., da Silveira, A. D., Borges, M. S., Engster, P. H. D. B., Schaan, T., de Souza, G. C., de Souza, I. P. M. A., Ritt, L. E. F., Stein, R., Berwanger, O. B., et al. (2023) · ESC Heart Failure · doi:10.1002/ehf2.14287 · Cited by 15
A preoperative supervised exercise program potentially improves long-term survival after elective abdominal aortic aneurysm repair
Sethi, S., Ravindhran, B., Long, J. A., Gurung, R., Huang, C., Smith, G., Carradice, D., Wallace, T., Ibeggazene, S., Chetter, I. C., et al. (2023) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2023.09.004 · Cited by 15
Brazilian Guideline for Exercise Test in the Adult Population – 2024
de Carvalho, T., de Freitas, O. G. A., Chalela, W. A., Hossri, C. A. C., Milani, M., Buglia, S., Précoma, D. B., Falcão, A. M. G. M., Mastrocola, L. E., Castro, I., et al. (2024) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20240110i · Cited by 15
The influence of aerobic fitness status on ventilatory efficiency in patients with coronary artery disease
do Prado, D. M. L., Rocco, E. A., Silva, A. G., Silva, P. F., Lazzari, J. M. A., Assumpção, G. L., Thies, S. B., Suzaki, C. Y., Puig, R. S. N., & Furlan, V. (2015) · Clinics · doi:10.6061/clinics/2015(01)09 · Cited by 15
“5; group CLINICS 2015;70(1):46-51 Ventilatory efficiency in CAD patients Prado DML et al.”
BackgroundMethodInfluential
Altered Breathing Syndrome in Heart Failure: Newer Insights and Treatment Options
Tomita, Y., Kasai, T., Kisaka, T., Rossiter, H. B., Kihara, Y., Wasserman, K., & Daida, H. (2015) · Current Heart Failure Reports · doi:10.1007/s11897-014-0250-4 · Cited by 16
Abnormal End-Tidal PO2 and PCO2 at the Anaerobic Threshold Correlate Well With Impaired Exercise Gas Exchange in Patients With Left Ventricular Dysfunction
Kano, H., Koike, A., Hoshimoto, M., Nagayama, O., Sakurada, K., Suzuki, T., Tsuneoka, H., Sawada, H., Aizawa, T., & Wasserman, K. (2011) · Circulation Journal · doi:10.1253/circj.cj-11-0599 · Cited by 15
Exercise Oscillatory Breathing and NT-proBNP Levels in Stable Heart Failure Provide the Strongest Prediction of Cardiac Outcome When Combining Biomarkers With Cardiopulmonary Exercise Testing
Guazzi, M., Boracchi, P., Labate, V., Arena, R. A., & Rèina, G. (2012) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2012.01.006 · Cited by 15
Self-citation
The effect of aerobic physical rehabilitation on the quality of life in patients with chronic atrial fibrillation; A randomized controlled clinical trial study.
Nourmohammadi, Z., Khalifehzadeh, A., Eftekhari, M., & Sanei, H. (2019) · PubMed Central · doi:10.22122/arya.v15i1.1705 · Cited by 15
Cardiorespiratory factors related to the increase in oxygen consumption during exercise in individuals with stroke
Oyake, K., Baba, Y., Ito, N., Suda, Y., Murayama, J., Mochida, A., Kondo, K., Otaka, Y., & Momose, K. (2019) · PLoS ONE · doi:10.1371/journal.pone.0217453 · Cited by 15
Thromboembolic Events Are Independently Associated with Liver Stiffness in Patients with Fontan Circulation
Alsaied, T., Possner, M., Lubert, A. M., Trout, A. T., Gandhi, J., Garr, B., Palumbo, J. S., Palermo, J. J., Lorts, A., VELDTMAN, G. R., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9020418 · Cited by 15
“Peak VO2 was indexed to weight [20].”
MethodInfluential
Duration of neonatal oxygen supplementation, erythropoiesis and blood pressure in young adults born preterm
Flahault, A., Girard‐Bock, C., Fernandes, R. O., Cloutier, A., Pastore, Y. D., Luu, T. M., & Nuyt, A. M. (2020) · Thorax · doi:10.1136/thoraxjnl-2019-214307 · Cited by 15
Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA)
Pedretti, R. F. E., Iliou, M., Israel, C. W., Abreu, A., Miljoen, H., Corrà, U., Stellbrink, C., Gevaert, A. B., Theuns, D. A. M. J., Piepoli, M. F., et al. (2021) · EP Europace · doi:10.1093/europace/euaa427 · Cited by 15
Percentage of age-predicted cardiorespiratory fitness and risk of sudden cardiac death: A prospective cohort study
Laukkanen, J. A., Kurl, S., Khan, H., & Kunutsor, S. K. (2021) · Heart Rhythm · doi:10.1016/j.hrthm.2021.03.010 · Cited by 15
Increased Oxidative Stress During Exercise Predicts Poor Prognosis in Patients with Acute Decompensated Heart Failure
Shibata, A., Izumiya, Y., Yamaguchi, Y., Kitada, R., Iwata, S., Ehara, S., Izumi, Y., Hanatani, A., & Yoshiyama, M. (2021) · ESC Heart Failure · doi:10.1002/ehf2.13538 · Cited by 15
Impact of intracoronary reinfusion of bone marrow-derived mononuclear progenitor cells on cardiopulmonary exercise capacity in patients with chronic postinfarction heart failure
Honold, J., Fischer‐Rasokat, U., Seeger, F. H., Leistner, D. M., Lotz, S., Dimmeler, S., Zeiher, A. M., & Aßmus, B. (2013) · Clinical Research in Cardiology · doi:10.1007/s00392-013-0574-1 · Cited by 15
Prognostic Impact of the Addition of Ventilatory Efficiency to the Seattle Heart Failure Model in Patients With Heart Failure
Levy, W. C., Arena, R. A., Wagoner, L. E., Dardas, T., & Abraham, W. T. (2012) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2012.06.417 · Cited by 15
Self-citation
Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients
Neves, L. M. T., Karsten, M., Neves, V. R., Beltrame, T., Borghi‐Silva, A., & Catai, A. M. (2014) · Brazilian Journal of Physical Therapy · doi:10.1590/s1413-35552012005000134 · Cited by 15
Clinical Predictors of Ventilatory Threshold Achievement in Patients with Claudication
Farah, B. Q., Ritti‐Dias, R. M., Cucato, G. G., Menêses, A. L., & Gardner, A. W. (2014) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000434 · Cited by 15
“I muscle fibers (1) and muscle capillary density (1), affecting oxygen consumption in skeletal muscles (2).”
Background
The effect of an expanded long-term periodization exercise training on physical fitness in patients with coronary artery disease: study protocol for a randomized controlled trial
Pinto, R., Angarten, V. G., Santos, V., Melo, X., & Clara, S. (2019) · Trials · doi:10.1186/s13063-019-3292-9 · Cited by 15
Autophagy gene expression in skeletal muscle of older individuals is associated with physical performance, muscle volume and mitochondrial function in the study of muscle, mobility and aging ( SOMMA )
Coen, P. M., Huo, Z., Tranah, G. J., Barnes, H. N., Zhang, X., Wolff, C. A., Wu, K., Cawthon, P. M., Hepple, R. T., Toledo, F. G. S., et al. (2024) · Aging Cell · doi:10.1111/acel.14118 · Cited by 17
Exercise-Based Prehabilitation Before Cardiac Surgery: A Systematic Review, Meta-Analysis, Meta-Regression, and Proposal for a Clinical Implementation Model
Hurtado-Borrego, J. C., Bayonas‐Ruiz, A., & Bonacasa, B. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14228195 · Cited by 17
“…was that only López-Hernández et al. [10] evaluated functional capacity with CPET, reporting a significant increase in endurance time, which suggests that prehabilitation may also enhance global exercise tolerance, a key factor in withstanding surgical stress and facilitating recovery [3,20].”
Discordance Between Severity of Heart Failure as Determined by Patient Report Versus Cardiopulmonary Exercise Testing
Michelis, K. C., Grodin, J. L., Zhong, L., Pandey, A., Toto, K. H., Ayers, C. R., Thibodeau, J. T., & Drazner, M. H. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.019864 · Cited by 14
“22,23”
Prognostic value of key variables from cardiopulmonary exercise testing in patients with COPD: 42-month follow-up
Goulart, C. D. L., Oliveira, M. R., Alburquerque‐Sendín, F., Mendes, R. G., Arena, R. A., & Borghi‐Silva, A. (2022) · Respiratory Medicine · doi:10.1016/j.rmed.2022.106856 · Cited by 14
Self-citation
Automatic Cardiopulmonary Endurance Assessment: A Machine Learning Approach Based on GA-XGBOOST
Deng, J., Fu, Y. H., Liu, Q., Chang, L., Li, H., & Liu, S. (2022) · Diagnostics · doi:10.3390/diagnostics12102538 · Cited by 14
“Cardio Pulmonary Exercise Testing (CPET) is a cardiological test that measures the heart’s ability to respond to external stress in a controlled clinical environment [3].”
Background
CatBoost-based improved detection of P-wave changes in sinus rhythm and tachycardia conditions: a lead selection study
Venkatesh, N. P., Kumar, R. P., Neelapu, B. C., Pal, K., & Sivaraman, J. (2023) · Physical and Engineering Sciences in Medicine · doi:10.1007/s13246-023-01274-z · Cited by 14
Effects of a telerehabilitation program and detraining on cardiorespiratory fitness in patients with post‐ COVID ‐19 sequelae: A randomized controlled trial
Pleguezuelos, E., Carmen, A. D., Moreno, E., Miravitlles, M., Serra, M., & Garnacho‐Castaño, M. V. (2023) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14543 · Cited by 14
“36 The mechanical efficiency was calculated as follows.”
Method
Ergophysiological evaluation of heart failure patients with reduced ejection fraction undergoing exercise-based cardiac rehabilitation: A systematic review and meta-analysis
Christou, G. A., Christou, M., Davos, C. H., Markozannes, G., Christou, K., Mantzoukas, S., Christodoulou, D. K., Kiortsis, D. N., Christou, P. A., Tigas, S. K., et al. (2024) · Hellenic Journal of Cardiology · doi:10.1016/j.hjc.2024.01.004 · Cited by 14
Cardiopulmonary Fitness and Personalized Exercise Prescription in Patients With Hypertrophic Cardiomyopathy
Cavigli, L., Ragazzoni, G. L., Vannuccini, F., Targetti, M., Mandoli, G. E., Senesi, G., Pastore, M. C., Focardi, M., Cameli, M., Valente, S., et al. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.124.036593 · Cited by 17
Preventing Allogeneic Stem Cell Transplant–Related Cardiovascular Dysfunction: ALLO-Active Trial
Dillon, H. T., Saner, N. J., Ilsley, T., Kliman, D. S., Foulkes, S., Brakenridge, C. J., Spencer, A. G., Avery, S., Claus, P., Dunstan, D. W., et al. (2024) · Circulation · doi:10.1161/circulationaha.124.070709 · Cited by 14
Low-Dose Caffeine Supplementation Is a Valuable Strategy for Increasing Time to Exhaustion, Explosive Power, and Reducing Muscle Soreness in Professional Male Kickboxers
Saremi, M., Shahriari, F., Hemmatinafar, M., Rezaei, R., Niknam, A., Nordvall, M., Wong, A., & Bagheri, R. (2024) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2024.104538 · Cited by 14
Abnormalities of the Ventilatory Equivalent for Carbon Dioxide in Patients with Chronic Heart Failure
Ingle, L., Sloan, R., Carroll, S., Goode, K. M., Cleland, J. G. F., & Clark, A. L. (2012) · Pulmonary Medicine · doi:10.1155/2012/589164 · Cited by 14
“Cardiopulmonary exercise testing (CPET) is used to stratify risk in patients with cardiorespiratory disease [1].”
Method
Myocardial perfusion defects detected by cardiopulmonary exercise testing: Role of VE/VCO2 slope in patients with chest pain suspected of coronary artery disease
Domínguez‐Rodríguez, A., Abreu-González, P., Gómez, M. Á., García-Baute, M. D. C., Arroyo, E., y, P. A., Jiménez, A., & Lara‐Padrón, A. (2012) · International Journal of Cardiology · doi:10.1016/j.ijcard.2011.12.063 · Cited by 14
The usefulness of cardiopulmonary exercise testing in assessment of patients with suspected coronary artery disease
Mazaheri, R., Shakerian, F., Vasheghani‐Farahani, A., Halabchi, F., Mirshahi, M., & Mansournia, M. A. (2016) · Postgraduate Medical Journal · doi:10.1136/postgradmedj-2015-133576 · Cited by 14
Sildenafil and Exercise Capacity in the Elderly at Moderate Altitude
Rodway, G. W., Lovelace, A. J., Lanspa, M. J., McIntosh, S. E., Bell, J., Briggs, B., Weaver, L. K., Yanowitz, F. G., & Grissom, C. K. (2016) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2016.01.006 · Cited by 14
Severely Impaired Cardiorespiratory Fitness in Patients With Recently Decompensated Systolic Heart Failure
Canada, J. M., Trankle, C. R., Buckley, L. F., Carbone, S., Abouzaki, N. A., Kadariya, D., Shah, K. B., Cooke, R. H., Kontos, M. C., Patel, J., et al. (2017) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2017.07.099 · Cited by 14
Self-citation
Use of ‘ideal’ alveolar air equations and corrected end-tidal PCO2 to estimate arterial PCO2 and physiological dead space during exercise in patients with heart failure
Iterson, E. H. V., & Olson, T. P. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.10.021 · Cited by 14

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: Balady, Gary J.
Arena, Ross
Myers, Jonathan
Forman, Daniel
Franklin, Barry
Guazzi, Marco
Gulati, Martha
Lavie, Carl J.
Macko, Richard
Mancini, Donna
Milani, Richard V.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2010-07-13
Volume: 122
Issue: 2
Pages: 191-225
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/cir.0b013e3181e52e69
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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Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults: A Scientific Statement From the American Heart Association

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