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

Thomas Radtke; Sarah Crook; Georgios Kaltsakas; Zafeiris Louvaris; Danilo Berton; Don S. Urquhart; Asterios Kampouras; Roberto A. Rabinovich; Samuel Verges; Dimitris Kontopidis; Jeanette Boyd; Thomy Tonia; Daniel Langer; Jana De Brandt; Yvonne M. J. Goertz; Chris Burtin; Martijn A. Spruit; Dionne C. W. Braeken; Sauwaluk Dacha; Frits M. E. Franssen; Pierantonio Laveneziana; Ernst Eber; Thierry Troosters; J. Alberto Neder; Milo A. Puhan; Richard Casaburi; Ioannis Vogiatzis; Helge Hebestreit

doi:10.1183/16000617.0101-2018

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

Thomas Radtke, Sarah Crook, Georgios Kaltsakas, Zafeiris Louvaris, Danilo Berton, Don S. Urquhart, Asterios Kampouras, Roberto A. Rabinovich, Samuel Verges, Dimitris Kontopidis, Jeanette Boyd, Thomy Tonia, Daniel Langer, Jana De Brandt, Yvonne M. J. Goertz, Chris Burtin, Martijn A. Spruit, Dionne C. W. Braeken, Sauwaluk Dacha, Frits M. E. FranssenPierantonio Laveneziana, Ernst Eber, Thierry Troosters, J. Alberto Neder, Milo A. Puhan, Richard Casaburi, Ioannis Vogiatzis, Helge Hebestreit^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Article number	1901441
Number of pages	25
Journal	European Respiratory Review
Volume	28
Issue number	154
DOIs	https://doi.org/10.1183/16000617.0101-2018
Publication status	Published - 31 Dec 2019

Keywords

MAXIMAL VOLUNTARY VENTILATION
OBSTRUCTIVE PULMONARY-DISEASE
RESPIRATORY GAS-EXCHANGE
VISUAL ANALOG SCALES
HEART-RATE RECOVERY
SCIENTIFIC STATEMENT
PULSE-OXIMETRY
OXYGEN-UPTAKE
PHYSIOLOGICAL-RESPONSES
NONINVASIVE ASSESSMENT

Access to Document

10.1183/16000617.0101-2018Licence: CC BY-NC

Cite this

Radtke, T., Crook, S., Kaltsakas, G., Louvaris, Z., Berton, D., Urquhart, D. S., Kampouras, A., Rabinovich, R. A., Verges, S., Kontopidis, D., Boyd, J., Tonia, T., Langer, D., De Brandt, J., Goertz, Y. M. J., Burtin, C., Spruit, M. A., Braeken, D. C. W., Dacha, S., ... Hebestreit, H. (2019). ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases. European Respiratory Review, 28(154), Article 1901441. https://doi.org/10.1183/16000617.0101-2018

@article{09e5abbcdb534a12b42b3faee896c6c1,

title = "ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases",

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.",

keywords = "MAXIMAL VOLUNTARY VENTILATION, OBSTRUCTIVE PULMONARY-DISEASE, RESPIRATORY GAS-EXCHANGE, VISUAL ANALOG SCALES, HEART-RATE RECOVERY, SCIENTIFIC STATEMENT, PULSE-OXIMETRY, OXYGEN-UPTAKE, PHYSIOLOGICAL-RESPONSES, NONINVASIVE ASSESSMENT",

author = "Thomas Radtke and Sarah Crook and Georgios Kaltsakas and Zafeiris Louvaris and Danilo Berton and Urquhart, {Don S.} and Asterios Kampouras and Rabinovich, {Roberto A.} and Samuel Verges and Dimitris Kontopidis and Jeanette Boyd and Thomy Tonia and Daniel Langer and {De Brandt}, Jana and Goertz, {Yvonne M. J.} and Chris Burtin and Spruit, {Martijn A.} and Braeken, {Dionne C. W.} and Sauwaluk Dacha and Franssen, {Frits M. E.} and Pierantonio Laveneziana and Ernst Eber and Thierry Troosters and Neder, {J. Alberto} and Puhan, {Milo A.} and Richard Casaburi and Ioannis Vogiatzis and Helge Hebestreit",

note = "Funding Information: Support statement: Funding was received from the European Respiratory Society, grant number TF-2016-12. The research of Jana De Brandt is financially supported by FWO (grant #11B4718N) and the research of Chris Burtin is partially sponsored by Limburg Kankerfonds. Funding information for this article has been deposited with the Crossref Funder Registry. Funding Information: Conflict of interest: T. Radtke reports personal fees for registration and travel/accomodation for conferences from Vifor Pharma, outside of the submitted work. S. Crook has nothing to disclose. G. Kaltsakas has nothing to disclose. G. Louvaris has nothing to disclose. D. Berton has nothing to disclose. D.S. Urquhart has nothing to disclose. A. Kampouras has nothing to disclose. R.A. Rabinovich has nothing to disclose. S. Verges has nothing to disclose. D. Kontopidis is President of the Hellenic Cystic Fibrosis Association. J. Boyd reports is an employee of the European Lung Foundation. T. Tonia reports acting as ERS Methodologist. D. Langer has nothing to disclose. J. De Brandt has nothing to disclose. Y.M.J. Go{\"e}rtz has nothing to disclose. C. Burton has nothing to disclose. 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. D.C.W. Braeken has nothing to disclose. S. Dacha has nothing to disclose. 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. P. Laveneziana reports personal fees from Novartis France and Boehringer France, outside the submitted work. E. Eber has nothing to disclose. T. Troosters has nothing to disclose. J.A Neder has nothing to disclose. M.A. Puhan has nothing to disclose. R. Casaburi reports that he shares patent US 7927251 B1, relating to a linear treadmill testing protocol, issued to Los Angeles Biomedical Research Institute. I. Vogiatzis has nothing to disclose. 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. Funding Information: The ERS Task Force was formed in October 2016, composed primarily of experts from the ERS Rehabilitation and Chronic Care Group, the Clinical Respiratory Physiology, Exercise and Functional Imaging group, the Paediatric Assembly, the Physiotherapists Group, and an ERS methodologist. Task Force members were clinical scientists and (exercise) physiologists with experience in CPET in a broad range of paediatric and adult lung diseases. The Task Force received support from the European Lung Foundation (ELF) throughout the project. Publisher Copyright: {\textcopyright} ERS 2019.",

year = "2019",

month = dec,

day = "31",

doi = "10.1183/16000617.0101-2018",

language = "English",

volume = "28",

journal = "European Respiratory Review",

issn = "0905-9180",

publisher = "European Respiratory Society",

number = "154",

}

Radtke, T, Crook, S, Kaltsakas, G, Louvaris, Z, Berton, D, Urquhart, DS, Kampouras, A, Rabinovich, RA, Verges, S, Kontopidis, D, Boyd, J, Tonia, T, Langer, D, De Brandt, J, Goertz, YMJ, Burtin, C, Spruit, MA, Braeken, DCW, Dacha, S, Franssen, FME, Laveneziana, P, Eber, E, Troosters, T, Neder, JA, Puhan, MA, Casaburi, R, Vogiatzis, I & Hebestreit, H 2019, 'ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases', European Respiratory Review, vol. 28, no. 154, 1901441. https://doi.org/10.1183/16000617.0101-2018

TY - JOUR

T1 - ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases

AU - Radtke, Thomas

AU - Crook, Sarah

AU - Kaltsakas, Georgios

AU - Louvaris, Zafeiris

AU - Berton, Danilo

AU - Urquhart, Don S.

AU - Kampouras, Asterios

AU - Rabinovich, Roberto A.

AU - Verges, Samuel

AU - Kontopidis, Dimitris

AU - Boyd, Jeanette

AU - Tonia, Thomy

AU - Langer, Daniel

AU - De Brandt, Jana

AU - Goertz, Yvonne M. J.

AU - Burtin, Chris

AU - Spruit, Martijn A.

AU - Braeken, Dionne C. W.

AU - Dacha, Sauwaluk

AU - Franssen, Frits M. E.

AU - Laveneziana, Pierantonio

AU - Eber, Ernst

AU - Troosters, Thierry

AU - Neder, J. Alberto

AU - Puhan, Milo A.

AU - Casaburi, Richard

AU - Vogiatzis, Ioannis

AU - Hebestreit, Helge

N1 - Funding Information: Support statement: Funding was received from the European Respiratory Society, grant number TF-2016-12. The research of Jana De Brandt is financially supported by FWO (grant #11B4718N) and the research of Chris Burtin is partially sponsored by Limburg Kankerfonds. Funding information for this article has been deposited with the Crossref Funder Registry. Funding Information: Conflict of interest: T. Radtke reports personal fees for registration and travel/accomodation for conferences from Vifor Pharma, outside of the submitted work. S. Crook has nothing to disclose. G. Kaltsakas has nothing to disclose. G. Louvaris has nothing to disclose. D. Berton has nothing to disclose. D.S. Urquhart has nothing to disclose. A. Kampouras has nothing to disclose. R.A. Rabinovich has nothing to disclose. S. Verges has nothing to disclose. D. Kontopidis is President of the Hellenic Cystic Fibrosis Association. J. Boyd reports is an employee of the European Lung Foundation. T. Tonia reports acting as ERS Methodologist. D. Langer has nothing to disclose. J. De Brandt has nothing to disclose. Y.M.J. Goërtz has nothing to disclose. C. Burton has nothing to disclose. 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. D.C.W. Braeken has nothing to disclose. S. Dacha has nothing to disclose. 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. P. Laveneziana reports personal fees from Novartis France and Boehringer France, outside the submitted work. E. Eber has nothing to disclose. T. Troosters has nothing to disclose. J.A Neder has nothing to disclose. M.A. Puhan has nothing to disclose. R. Casaburi reports that he shares patent US 7927251 B1, relating to a linear treadmill testing protocol, issued to Los Angeles Biomedical Research Institute. I. Vogiatzis has nothing to disclose. 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. Funding Information: The ERS Task Force was formed in October 2016, composed primarily of experts from the ERS Rehabilitation and Chronic Care Group, the Clinical Respiratory Physiology, Exercise and Functional Imaging group, the Paediatric Assembly, the Physiotherapists Group, and an ERS methodologist. Task Force members were clinical scientists and (exercise) physiologists with experience in CPET in a broad range of paediatric and adult lung diseases. The Task Force received support from the European Lung Foundation (ELF) throughout the project. Publisher Copyright: © ERS 2019.

PY - 2019/12/31

Y1 - 2019/12/31

N2 - 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.

AB - 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.

KW - MAXIMAL VOLUNTARY VENTILATION

KW - OBSTRUCTIVE PULMONARY-DISEASE

KW - RESPIRATORY GAS-EXCHANGE

KW - VISUAL ANALOG SCALES

KW - HEART-RATE RECOVERY

KW - SCIENTIFIC STATEMENT

KW - PULSE-OXIMETRY

KW - OXYGEN-UPTAKE

KW - PHYSIOLOGICAL-RESPONSES

KW - NONINVASIVE ASSESSMENT

U2 - 10.1183/16000617.0101-2018

DO - 10.1183/16000617.0101-2018

M3 - Article

SN - 0905-9180

VL - 28

JO - European Respiratory Review

JF - European Respiratory Review

IS - 154

M1 - 1901441

ER -

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

Abstract

Keywords

Access to Document

Fingerprint

Cite this