Cardiopulmonary Exercise Testing and Prescription of Exercise

Abstract

Cardiorespiratory fitness (CRF) is a vital sign and being physically active is a preventive and therapeutic strategy to prevent and treat disease, especially cardiovascular disease. Cardiopulmonary exercise testing (CPET), when performed according to recommended guidelines by qualified personnel, is the gold standard for assessing CRF and is a valuable, although underutilized tool in the prescription of aerobic exercise. With the population in many countries living longer lives, individuals are living with cardiovascular disease (CVD) and other chronic conditions for a longer time, placing more importance on the extension of time free of the deleterious effects of chronic disease and a higher quality of life. CVD remains the leading cause of morbidity and mortality in the western world and the leading cause of preventive death. Although physical activity meets the highest standards for American Heart Association (AHA) recommendations for CV health, most people still do not exercise or meet the guidelines of 150 minutes per week of moderate to high intensity exercise. Many begin an exercise program only to stop exercising after a short time. Individuals cease exercise programs because of lack of time and/or enjoyment, discomfort and/or injury. Regular physical activity is an established component of secondary prevention and therapy in patients with CVD (i.e., cardiac rehabilitation). Those with CVD who do exercise tend to exercise at either too low or too high exercise intensities and volumes. An individualized exercise prescription based on the results of CPET may have the potential to resolve some of these issues while also increasing safety and improving health and fitness outcomes for those with and without CVD. This chapter reviews the available evidence and strategies on CPET and exercise prescription for those with and without CVD.