Cardiopulmonary Exercise Testing (CPET)

25 Jun Cardiopulmonary Exercise Testing (CPET)

A cardiopulmonary exercise test is considered a non-invasive procedure to assess cardiac and respiratory function.

Why perform a CPET:

• Investigation of unexplained dyspnoea.
• Evaluation of cardiovascular disease.
• Evaluation of respiratory disease.
• Preoperative assessment for major surgery.
• Exercise prescription.
• Evaluation of impairment/disability.
• Evaluation of exercise tolerance.

With a low complication rate:

• Incidence of a complication requiring hospitalisation of ≤2 in 1000.
• Incidence of a major cardiac event of 1.2 per 10 000.
• Incidence of mortality of 2–5 per 100 000.

Test preparation:

• Refrain from exercise on the day of the test and be well rested.
• Eat a light meal or breakfast no less than 2 hours previously.
• Maintain hydration by drinking water.
• Avoid caffeine and alcohol prior to the test.
• Take all routine/normal medication and bring along a medication list.
• Bring along all rescue medications, for example, inhalers or nitrolingual sprays.
• Wear light comfortable clothing and shoes suitable to exercise in.
• Avoid use of body lotion on the upper body, as this may affect ECG electrode placement.
• Abstain from smoking for at least 8 hours prior to the test.
• Refrain from wearing any nail varnish or false nails.

What does the test involve:

• Resting objective measures
  • ECG
  • Blood pressure
  • SpO2
• Exercise Component (bike)
  • Warm up phase
  • Exercise phase
  • Recovery phase
• Return to baseline measures

Points to note:

• Please bring with you any relevant medical history or have this provided on the initial referral.
• A current medication list should also be brought along.
• This is important as the test can be terminated early if certain events arise, these include but not limited to
• Angina:
  • Symptomatic: >2 mm ST depression.
  • Asymptomatic: 3 mm ST depression.
  • >1 mm ST elevation.
  • Significant arrhythmias causing symptoms or haemodynamic compromise
  • Fall in systolic blood pressure >20 mm Hg from the highest value during the test
  • Hypertension >250 mm Hg systolic and >120 mm Hg diastolic
    • Patients with abdominal aortic aneurysms undergoing preoperative assessment >200 mm Hg systolic or >110 mm Hg diastolic.
  • Severe desaturation: SpO₂<80% (lower may be accepted in patients with known underlying lung disease or congenital heart disease if agreed with referring clinician).
  • Loss of coordination.
  • Mental confusion.
  • Dizziness or faintness.
• However, a patient will commonly report
  • Dyspnoea (shortness of breath)
  • Leg fatigue.
  • Chest pain.
  • Pain/physical discomfort.
  • Dizziness
  • Saddle discomfort.
  • Palpitations.

At the Wesley Lung Function Lab a physician, nursing and scientific staff are present whilst performing a CPET.

For more information on CPET testing visit:

• ARTP statement on cardiopulmonary exercise testing 2021 | BMJ Open Respiratory Research