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Physiotherapy, Rehabilitation and Sport medicine

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The Cardio-Pulmonary Exercise Test

THE CARDIO-PULMONARY EXERCISE TEST

The cardio-pulmonary exercise test is a completion of a normal ECG exercise test, a cardiologic functional examination which is widespread in medicine. However, this test exceeds the traditional ECG, because, while the latter basically evaluates two parameters, namely the electrocardiographic behaviour and the blood pressure behaviour under stress, the cardio-pulmonary test also considers the respiratory and metabolic aspects of the individual.

Although this test has been used for quite some time, it has only recently become a routine examination in clinical practice.

The cardio-pulmonary test, therefore, in addition to evaluating the same parameters of the normal exercise ECG, measures the ventilation, the oxygen consumption and the carbon dioxide production during exercise. In this way the measured parameters provide an overall picture of the patient’s physiological state.

THE INDICATIONS FOR THE CARDIO-PULMONARY EXERCISE TEST

This test is mainly used for two types of patient:

A) Cardiac patients

B) Athletes and amateur sportspeople

A) In the case of patients with cardiac disease and/or bronchial and lung disorders, the test is strongly indicated in three very frequent conditions of illness. The first condition relates to ischemic heart diseases for which it is necessary to check the coronary reserve; for example, postoperative patients of a coronary by-pass for which the test is used to check for the presence of residual ischemia from stress. A second group of patients concerns those with heart disease and/or chronic bronchitis who undergo a rehabilitation program. A third group of patients are the bearers of a more or less severe heart failure.
Other diseases, especially respiratory ones, are a specific indication, especially for those suffering from emphysema or chronic bronchitis, because this examination can provide important information on the severity of the disease, its evolution, and provide guidance on the rehabilitative therapy approach.
In all these cases, thanks to its completeness, the functional test allows an evaluation of the physiological profile of the subject both from a cardiac and a respiratory and metabolic point of view and it allows the assessment of the anaerobic threshold, which is very important for the establishment of the subject’s functional limitations. This allows for both an adequate control of the cardiac patient’s physical activity during a rehabilitation program, but also for the precise assessment of the parameters to be used to establish a proper therapy.

B) In sports, it implies the evaluation of healthy people, athletes or sportspersons with previous mild cardiovascular disease who plan a return to normal sports activities. The cardio-pulmonary exercise test is particularly recommended for middle-aged people and even more so for older people who want and need to understand what their physical limit is in improving their sports performance and, in particular, the assessment of the extent to which they may practice a sport. What is really important is to measure the anaerobic threshold of the subject, and then schedule a training able to elevate the level, in order to obtain the best performances without incurring into the formation of lactic acid in excess and without the risk of major pathological events, such as the heart attack.

There are many people who have the good habit of training two or three times a week: for these subjects it may be useful to perform the cardio-pulmonary exercise test to know precisely the critical level of the aerobic threshold and the precise level of muscle work in the anaerobic phase; this helps understand precisely if the chosen exercise is actually productive for the subject or not, or if it can become dangerous as well as unproductive in terms of performances. Therefore, with the cardiopulmonary evaluation one establishes the current physical conditions of a subject to ensure the possibility of optimal and healthy workouts; it is therefore recommended for people, aged 35-40 and up, doing any type of sport.

It goes without saying that in professional sports, athletes, particularly those who are put through particularly intense efforts such as cyclists, runners, football players etc., need to undergo periodic tests with a cardio-pulmonary exercise test to assess their athletic potential. The same thing, however, is desirable and is therefore extremely useful for non-professionals and so-called amateurs who put themselves through training schedules that are sometimes too demanding or even inadvisable.