ABSTRACT
A CPET is ordinarily requested when a routine diagnostic workup for a loss of exercise tolerance has failed to yield a satisfactory answer. The planning for a CPET should include reviewing the patient history and reviewing the results of relevant tests performed. Based on that prior information, the first step is to ascertain that the patient does not have any of the few high-risk conditions in which a maximal exercise effort would pose an unacceptable risk. From the patient history and information desired, an appropriate exercise mode and exercise protocol should be selected with the goal of achieving measurements spanning at least ten minutes of exercise time. It is essential for the patient to understand the risks and benefits of a maximal exercise test and the safety precautions that will be followed. Following acquisition of signed consent, the patient is connected to the cardiac- and respiratory-measurement monitors and instructed on the treadmill or ergometer exercise protocol. The test requires continuous monitoring of both the patient and the ECG and blood pressure monitors during exercise and recovery. A progressive increase in systolic blood pressure is expected in the final stages of exercise that should return toward normal within the initial few minutes of recovery. During initial recovery, the ECG should be monitored carefully as exercise-associated ST depression or arrhythmias are most apparent at that time. Specific questions about the patient's exercise-limiting symptoms should be obtained immediately following the maximal effort.
