Exercise Testing and Interpretation: An Overview

• Why Measure Gas Exchange to Evaluate Cardiovascular Function and Cellular Respiration?
• Cardiac Stress Test and Pulmonary Stress Test: Nomenclature and Fallacies
• Cell Respiration and Bioenergetics
• Normal Coupling of External to Cellular Respiration
• Quantifying State and Time Course of Cellular Respiration from Measurements Of External Respiration
• Patterns of Change in External Respiration (O2 Uptake and CO2 Output) as Related to Function, Fitness and Disease
• Factors Limiting Exercise
  • Fatigue
  • Dyspnea
  • Pain
• Evidence of Systemic Dysfunction Uniquely Revealed by Integrative Cardiopulmonary Exercise Testing

Physiology of Exercise

• Skeletal Muscle
  • Mechanical Properties and Fiber Types
  • Energetics
• Oxygen Cost of Work
  • Work Efficiency
  • VO2 Non-Steady State
• Lactate Increase
  • Lactate Increase as Related to Work Rate
  • Lactate Increase as Related to Time
  • Lactate Increase in Response to Increasing Work Rate
  • Mechanisms of Lactate Increase
• Buffering the Exercise-induced Lactic Acidosis
• The Anaerobic Threshold (AT) Concept
  • Identifying AT by Gas Exchange
  • Altered Physiological Responses to Exercise Above the AT
  • Anaerobic, Lactate and Lactic Acidosis Thresholds
• Metabolic-Cardiovascular-Ventilatory Coupling
  • Cellular Respiration and High Energy Phosphate Regeneration
  • Cardiovascular Coupling to Metabolism: Muscle O2 Supply
  • Ventilatory Coupling to Metabolism
  • Effect of Dietary Substrate
• Control of Breathing
  • Overview
  • Acid-Base Regulation
  • Physical Factors
  • Reflexes Regulating Breathing During Exercise
• Gas Exchange Kinetics
  • Oxygen Uptake Kinetics
  • CO2 Output Kinetics

Measurements During Integrative Cardiopulmonary Exercise Testing

• What is an Integrative Cardiopulmonary Exercise Test?
• When Should Integrative Cardiopulmonary Exercise Testing Be Used?
• Measurements
  • Electrocardiogram
  • Maximal Oxygen Uptake (VO2max) Maximum
  • Oxygen Uptake (Peak VO2)
  • Oxygen Uptake and Work Rate
  • Pattern of Work Rate Increase and the VO2 Response
  • Upward Displacement of VO2 as A Function of Work Rate
  • Cardiac Output and Stroke Volume
  • Anaerobic (Lactate, Lactic Acidosis) Threshold (AT, LT, LAT)
  • Heart Rate-Oxygen Uptake Relationship and Heart Rate Reserve
  • Oxygen Pulse (VO2/HR) and Stroke Volume
  • Arterial Blood Pressure
  • Breathing Reserve
  • Expiratory Flow Pattern
  • Tests of Uneven VA/Q
  • Arterial Bicarbonate and Acid-Base Response
  • Tidal Volume/Inspiratory Capacity Ratio (VT/IC)
  • Measurements Unique to Constant Work Rate Exercise Testing
• Data Display and Interpretation

Pathophysiology of Disorders Limiting Exercise

• Obesity
• Peripheral Arterial Diseases
• Heart Disease
  • Coronary Artery Disease
  • Myopathic Heart Disease
  • Valvular Heart Disease
  • Congenital Heart Disease