Cardiopulmonary Exercise Stress Test and VO2 Max
The gold standard measurement of cardiorespiratory fitness
What is a cardiopulmonary exercise stress test (CPET)?
Cardiopulmonary exercise stress test (CPET) is a comprehensive assessment of circulatory, respiratory, and metabolic responses to exercise.
It is the gold standard for quantifying peak exercise capacity (VO2 max) as well as determining the cause of exercise limitations, if any. Unlike static tests that provide a snapshot of your health at rest, CPET evaluates your body's performance under stress, offering invaluable insights into your functional capacity and potential limitations.
Directly measured peak VO2 - the gold standard for determining cardiorespiratory fitness - is the most robust predictor of cardiovascular mortality as well as all-cause mortality in all populations, healthy or with disease
CPET allows for the earliest detection of atherosclerosis - coronary microvascular dysfunction - providing for an opportunity to intervene early in the subclinical atherosclerosis process with exercise and/or medical therapy. Direct and accurate measurement of cardiorespiratory fitness also allows for precise exercise prescriptions and serial testing to monitor disease response to lifestyle and pharmacologic treatment.
Why get a CPET and VO2 max test?
Obtain VO2 max and anaerobic threshold - VO2max is the maximum amount of oxygen your body can utilize during intense exercise and is the best test of cardiovascular fitness (aka how in shape you are). Studies have shown that low VO2max levels are associated with increased cardiovascular risk and mortality.
Anaerobic Threshold (AT) aka lactate threshold is the exercise intensity at which lactate production exceeds its clearance, leading to a rise in blood lactate levels. AT serves as a marker of endurance capacity and can help tailor exercise prescriptions for optimal training outcomes
Cardiovascular disease - CPET aids in the diagnosis and risk stratification of coronary artery disease, heart failure, and valvular disorders. By assessing functional capacity and identifying abnormal responses to exercise, CPET helps tailor treatment strategies and predict outcomes. CPET also picks up endothelial dysfunction, the earliest sign of cardiovascular disease - this allows us to intervene early
Exercise Prescription - Beyond diagnostics, CPET serves as a valuable tool for exercise prescription and monitoring. By identifying individualized training zones based on physiological parameters, CPET optimizes the efficacy and safety of exercise interventions, whether for athletic performance enhancement or chronic disease management
Determining the cause of exercise limitation if present - CPET is the gold standard for diagnosing the cause of unexplained exercise limitations. It can distinguish between cardiac causes, pulmonary causes, and metabolic causes
Who should have a CPET (VO2 max)?
The test is available to anyone who would like to screen for early signs of atherosclerosis or know their VO2 max.
Common reasons for the test include
unexplained exercise symptoms like chest pain or shortness of breath
risk assessment for patients with a history of heart failure, coronary artery disease, or risk factors for heart disease
patients interested in their resting metabolic rate and VO2 max
patients interested in an exercise prescription
serial testing to monitor response to lifestyle changes and medications in patients with heart disease
preoperative assessment
concern for microvascular disease or diastolic heart failure
What to Expect
During the cardiopulmonary exercise stress test (CPET), you will exercise on a stationary bicycle while wearing a specialized mask that measures gas exchange. As you exert yourself, the test progressively increases in intensity, with increments in workload tailored to your fitness level. Meanwhile, your heart rate, blood pressure, EKG, oxygen consumption, and carbon dioxide production are continuously monitored.
Your appointment will take about an hour for a CPET and 75 minutes for CPET + resting metabolic rate (RMR).
No food, caffeine, tobacco products, or liquids, except water, for 3 hours prior to CPET and 5 hours for RMR
Water may be consumed as needed. Feel free to bring a water bottle.
Do not exercise 5 hours prior to test
If you use an inhaler please bring it to the test
Medications may be taken as usual, unless directed otherwise by your physician
Wear comfortable, non-restrictive clothing and sneakers for cycling. Sports bras for women suggested
You will receive a formal report in about 2-3 business days
