Introduction to Cardiopulmonary Exercise Testing

Abstract Introduction This resource serves as a primer on cardiopulmonary exercise testing and is intended for first-year fellows in pulmonary and critical care medicine, and senior internal medicine residents who will be supervising and interpreting cardiopulmonary exercise tests during their rotations on a pulmonary diagnostic service. Cardiopulmonary exercise testing is a standard diagnostic tool in pulmonary medicine. Several leading textbooks are available which provide detailed explanations of exercise physiology and the conduct and interpretation of these tests, but many of these texts are very long and detailed, and, as a result, are difficult for the trainee to cover in a short period of time while busy with other clinical responsibilities. Methods This primer was designed to address this problem by providing a concise explanation of the physiology of exercise, the role of cardiopulmonary exercise testing in clinical practice, how to conduct and interpret these tests and a series of case studies. Through coverage of these topics, the primer will give learners a basis upon which they can then build in the future by referring to more detailed sources on this topic. Results The 2008–2009 fellowship class was asked to evaluate the primer at the conclusion of the clinical rotation during which they do the bulk of their cardiopulmonary exercise tests. On Likert scale questions, six out of six residents stated agreement with statements that the primer helped them understand the key physiologic responses to exercise, how to conduct an exercise test, how to interpret test results, and how to identify the ventilatory threshold. All six fellows thought the sample cases were useful and three of the six fellows stated that the primer was more useful overall than other materials they consulted on cardiopulmonary exercise testing. One fellow stated that it was as useful as other resources, while another stated that it was less useful. Discussion The primer is designed to be an introduction to the process of conducting and interpreting tests. As a result, the known and unknown cases presented in the primer are ideal cases with clean data. In reality, many cases are more complex than those presented in the primer and additional learning and supervision will be necessary before the learner is able to handle such tests. Apart from a qualitative survey of the pulmonary and critical care fellows to assess their general impressions of the primer, we have not conducted a more formal study to evaluate in more objective terms whether this primer is an effective teaching tool.