CEPT & More

• MED 213 Clinical exercise testing
• Dr James Shelley

  23rd & 24th October 2023
• Clinical Exercise Physiologist (CEP)

  Specialises in exercise testing and assessment, design, delivery and evaluation of evidence-based exercise interventions
• CEP scope of practice

  • Encompasses apparently healthy individuals to those with chronic and complex conditions
  • Includes health and physical activity education, advice and support for lifestyle modification and behaviour change
  • Works in a range of primary, secondary and tertiary care settings
• Assessment of health status

  1. Undertake and record a thorough assessment

  2. Guide exercise risk stratification using evidence-based methods
• Cardiopulmonary Exercise Test (CPET)

  Allows simultaneous study of respiratory, cardiovascular and muscular systems
• CPET can provide answers to why someone is breathless/unwell in a way that other functional tests cannot
• CPET uses

  • Disability evaluation
  • Intervention assessment
  • Rehabilitation prescription
  • Pre-operative risk assessment
• Absolute contraindications for CPET

  • Recent change in resting ECG
  • Unstable angina
  • Dysrhythmias
  • Symptomatic severe aortic stenosis
  • Uncontrolled symptomatic heart failure
  • Acute pulmonary embolus
  • Acute myocarditis or pericarditis
  • Suspected or known dissecting aneurysm
  • Acute systemic infection
• Relative contraindications for CPET

  • Left main coronary stenosis
  • Moderate stenotic valvular heart disease
  • Electrolyte abnormalities
  • Severe arterial hypertension
  • Tachy/bradydysrhythmia
  • Hypertrophic cardiomyopathy
  • Neuromotor, musculoskeletal, or rheumatoid disorders
  • High-degree AV block
  • Ventricular aneurysm
  • Uncontrolled metabolic disease
  • Chronic infectious disease
  • Mental or physical impairment
• CPET Protocol

  1. Step: Incremental increase in external work

  2. Ramp: Constant and continuous increase in external work

  3. Cycle ergometer: Convenient for blood sampling

  4. Treadmill: Mimics daily activity
• When interpreting a CPET test, consider whether the test is technically acceptable, maximal, normal exercise capacity, and normal or abnormal response to exercise
• Peak Oxygen Uptake (VO2 peak)


  In clinical populations, they may not reach VO2 max as symptom-limited
• Anaerobic Threshold

  The physiological dividing line between moderate and heavy intensity exercise
• Ventilation (VE) adapts to energy needs, meeting demands for VO2 and CO2 elimination
• RER

  Energy generation requires the metabolism of carbohydrate and lipid substrates
• Heart Rate (HR) increases linearly with work rate
• EqO2 and EqCO2

  Measure of instantaneous ventilatory and gas exchange efficiency
• Peak Flow is a very simple measurement to determine how fast a patient can exhale
• Spirometry

  Method of assessing lung function by measuring the amount of air expelled from the lungs following maximal inspiration
• Spirometry Preparation

  1. Calibrate the spirometer

  2. Have patient details ready

  3. Review patient’s medical history

  4. Explain the test to the patient
• Performing the Spirometry Test

  1. Instruct the patient to take a deep breath

  2. Seal lips around mouthpiece

  3. Blow as hard and fast as possible
• Obstructive lung diseases

  • COPD
  • Asthma
  • Bronchiectasis
  • Cystic Fibrosis
• Restrictive lung diseases

  • Obesity
  • Interstitial lung disease
  • Scoliosis
  • Neuromuscular causes
• Exercise Induced Asthma can cause an asthma attack in reactive patients during forced manoeuvre of the FVC