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Eur Respir Rev. 2019 Dec 18;28(154). pii: 180101. doi: 10.1183/16000617.0101-2018. Print 2019 Dec 31.

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

Author information

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
Task Force Co-Chair.
29
Paediatric Dept, University Hospital Würzburg, Würzburg, Germany hebestreit@uni-wuerzburg.de.

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.

PMID:
31852745
DOI:
10.1183/16000617.0101-2018
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Conflict of interest statement

Conflict of interest: T. Radtke reports personal fees for registration and travel/accomodation for conferences from Vifor Pharma, outside of the submitted work. Conflict of interest: S. Crook has nothing to disclose. Conflict of interest: G. Kaltsakas has nothing to disclose. Conflict of interest: G. Louvaris has nothing to disclose. Conflict of interest: D. Berton has nothing to disclose. Conflict of interest: D.S. Urquhart has nothing to disclose. Conflict of interest: A. Kampouras has nothing to disclose. Conflict of interest: R.A. Rabinovich has nothing to disclose. Conflict of interest: S. Verges has nothing to disclose. Conflict of interest: D. Kontopidis is President of the Hellenic Cystic Fibrosis Association. Conflict of interest: J. Boyd reports is an employee of the European Lung Foundation. Conflict of interest: T. Tonia reports acting as ERS Methodologist. Conflict of interest: D. Langer has nothing to disclose. Conflict of interest: J. De Brandt has nothing to disclose. Conflict of interest: Y.M.J. Goërtz has nothing to disclose. Conflict of interest: C. Burton has nothing to disclose. Conflict of interest: M.A. Spruit reports grants and personal fees from Boehringer-Ingelheim and AstraZeneca, personal fees from GSK and Novartis, congress travel support from TEVA, and grants from the Netherlands Lung Foundation, outside the submitted work. Conflict of interest: D.C.W. Braeken has nothing to disclose. Conflict of interest: S. Dacha has nothing to disclose. Conflict of interest: F.M.E. Franssen reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and TEVA, and grants and personal fees from Novartis, outside the submitted work. Conflict of interest: P. Laveneziana reports personal fees from Novartis France and Boehringer France, outside the submitted work. Conflict of interest: E. Eber has nothing to disclose. Conflict of interest: T. Troosters has nothing to disclose. Conflict of interest: J.A Neder has nothing to disclose. Conflict of interest: M.A. Puhan has nothing to disclose. Conflict of interest: R. Casaburi reports that he shares patent US 7927251 B1, relating to a linear treadmill testing protocol, issued to Los Angeles Biomedical Research Institute. Conflict of interest: I. Vogiatzis has nothing to disclose. Conflict of interest: H. Hebestreit reports grants and personal fees from Vertex Pharmaceuticals, grants from Mukoviszidose e.V. (German CF Organization), outside the submitted work; and is the Coordinator of the European Cystic Fibrosis Society Exercise Working Group who discuss exercise testing and organise respective symposia.

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