Cardiopulmonary Exercise Testing at Incremental and Steady State Exercise

Descriptive Report
Topic: Cardiopulmonary Exercise Testing at Incremental and Steady state Exercise
Name:
Institutional Affiliations

Descriptive Report 2
Cardiopulmonary Exercise Testing (CPET) is an essential clinical tool to analyze the
functional capacity and exercise intolerance in patients with cardiac problems (Datta, 2015).
CPET assess the integrated response of body to the exercise including cardiovascular,
pulmonary, neuropsychological, haematopoietic and skeletal muscle system (Howard & Wensel,
2012).
We, performed CPET at incremental and steady state exercise on a 19 year old healthy male,
with height 174 cm, weight 69 kg, FEV1 of 4.29 L and Resting Hemoglobin Level 148 g/L.
Fig.1. 2 min incremental protocol for cycle ergometry
During the incremental state exercise protocol, the client was evaluated every 30 W/ 2 minutes.
It involved the variables like initial starting rate, rate of consecutive works, the number of
increments and the duration of every increment. After an initial aerobic phase of 195 seconds,

Descriptive Report 3
the threshold for oxygen intake is reached and the expired work load increased in linear manner
along with time.
0.00 30.00 60.00 90.00 120.00 150.00 180.00 210.00 240.00 270.00 300.00 330.00
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
Work rate (W)
VO2 (litres.min-1)
Fig.2
Maximal Oxygen consumption is the oxygen intake that reaches a maximum level, beyond
which no increase in the exercise efforts can increase it (Hawkins et al., 2007). In this case V O2
max was achieved at 3.06 L/min at a work rate of 330 W.
The Predicted Equations for Maximal Oxygen Consumption and Work rate for the client is as
follows:
■ MEN – Predicted ⩒O2max (L/min) = (3.45* Height in cm /100) -(0.028* Age in years)
+(0.022* Weight in Kg)-3.76
■ Predicted = 3.22 L/min
■ Actual = 3.06 L/min

Descriptive Report 4
■ Achieved = 95.03%
■ MEN – Predicted Maximum Work Rate (Watts) - Bike = ((2169* Height cm /100) -
(9.63* Age in years) +(4* Weight in Kg)-2413)/6.1
■ Predicted = 238 W
■ Actual = 330 W
■ Achieved = 138.66%
0 30 60 90 120 150 180 210 240 270 300 330 360
0
5
10
15
20
25
30
35
40
45
50
VO2 Max Relative to Body Weight
Work Rate (W)
VO2 (ml/min)
Fig.3. VO2 Max relative to Body Weight
The client has the age of 19 years and relative to the body weight (69 kg), the VO2 Max was
44.30 ml/kg/min. According to Maximal Oxygen Uptake Norms, this value reflects an Average
health condition in men of this age group.

Descriptive Report 5
The VO2 slope reflects the amount of oxygen consumed per heart beat. During the incremental
exercise, the oxygen slope expressed as linear slope in which the VO2 increases with work rate
reaching at a maximum value of 7.75 ml/ min/W, relative to body weight.
0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00
0.00
0.50
1.00
1.50
2.00
2.50
3.00
VO2 Max During CWR Protocol
Moderate Heavy
Time (min)
VO2 (L/min)
Fig. 4. VO2 Max during CWR(Constant Work Rate) protocol
The Constant Work Rate Protocol starts with 1-3 minute (here 2 minute) time period of warm up
and unloaded pedaling (Albouaini & Wright, 2007). After that the workload is elevated to a high
level of maximal work rate of the patient. The exercise activity is maintained at a maximum
level. The breadth by breadth evaluation of inspired and expired Oxygen and CO2 volume is
estimated. The graph shows that during heavy exercise, the VO2 max increased by approx. 1
L/min than in moderate exercise activity.

Descriptive Report 6
The Oxygen Deficit refers to a condition when the Oxygen consumption in the body is more than
the intake of oxygen. It is a natural process occurring during the exercise. The body works to
compensate the demanded oxygen levels in recovery periods. In this case, the Oxygen Deficit
Area is higher during heavy exercise (125.27 L/min) while at moderate exercise, it is 43.93
L/min. In heavy exercise, the demand for Oxygen exceeds the supply of oxygen.
During the initial phase lasting for few minutes of exercise, the anaerobic glycolysis supplies the
required ATP for satisfying the energy demand. Then a steady rate of Oxygen consumption is
achieved, switching to mitochondrial respiration as a form of dominant source of energy.
Metabolic Blood Lactate Data was collected during the incremental exercise phase with data 1st
taken at rest, and then in the final 30 seconds of each 3 minute interval. Data was taken by first
putting on latex gloves and then wiping the participant’s finger with an alcohol swipe, before
drying it. A lancet was then pressed against a finger and the button was pressed to release the
scalpel. Haemoglobin data was collected using a Hemocue slide and then placing the slide in an
analyser, which gave a reading for haemoglobin. The lactate data was collected by filling a
capillary tube with blood with no air bubbles, then placing in a labelled Eppendorf and shaking
for a few seconds. This was repeated during the last 30 seconds of each increment. After the
testing was finished, the Eppendorf’s were placed in a Biosen Lactate analyser, which gave a
reading for the lactate of the blood at each increment.
Ventilatory Threshold