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Cardiopulmonary exercise testing (CPEX) (CPET)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Cardiopulmonary exercise (CPEX) testing (CPET) is used to establish the degree of exercise limitation, to identify the underlying mechanisms responsible in patients with breathlessness, and to monitor functional status in cardiovascular disease

  • provides an important prognostic tool and decision-aid in the assessment of peri-operative risk
    • as well as the routine parameters measured during the exercise electrocardiogram (ECG) stress test, CPEX can provide measurements of oxygen (O2) consumption, carbon dioxide (CO2) production, and lung ventilation to provide valuable information about respiratory, cardiovascular and muscle metabolic function, as well as the subject's effort during the test
    • use of CPET in patient management is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status correlates better with exercise tolerance rather than with resting measurements (1)

Suggested possible indications for CPEX include:

  • Evaluation of exercise tolerance

  • Determination of functional impairment or capacity (peak VO2)

  • Determination of exercise-limiting factors and pathophysiologic mechanisms

  • Evaluation of undiagnosed exercise intolerance e.g. assessing contribution of cardiac and pulmonary aetiology in coexisting disease

  • Evaluation of patients with cardiovascular disease e.g. functional evaluation and prognosis in patients with heart failure, selection for cardiac transplantation

  • Evaluation of patients with respiratory disease
    • functional impairment assessment
    • chronic obstructive pulmonary disease e.g. establishing exercise limitation(s) and assessing other potential contributing factors, especially occult heart disease (ischaemia)
    • interstitial lung diseases e.g. detection of early (occult) gas exchange abnormalities
    • pulmonary vascular disease (careful risk-benefit analysis required)
    • cystic fibrosis
    • exercise-induced bronchospasm
    • specific clinical applications e.g. preoperative evaluation lung resectional surgery, elderly patients undergoing major abdominal surgery

Suggested absolute contraindications include:

  • acute myocardial infarction (3-5 days)
  • acute myocarditis or pericarditis
  • symptomatic severe aortic stenosis
  • uncontrolled heart failure
  • acute pulmonary embolus or pulmonary infarction
  • uncontrolled arrhythmias causing symptoms at rest or hemodynamic compromise


  • however "..the test has been performed safely in conditions like severe aortic stenosis. Indications to perform the test are also increasing, as in the diagnosis of heart failure with normal ejection fraction, and in exercise prescription for heart failure patients.." (2)


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