Principles of Exercise Testing and Interpretation

Part 1 Exercise testing and interpretation - an overview: why measure gas exchange to evaluation cardiovascular function and cellular respiration?; cardiac stress testing and pulmonary stress testing - a fallacy; 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 (02 uptake and CO2 output) as related to function, fitness, and disease; factors limiting exercise; evidence of systemic dysfunction uniquely revealed by integrative cardiopulmonary exercise testing. Part 2 Physiology of exercise: skeletal muscle; oxygen cost of work; lactate increase and the anaerobic threshold; metabolic-cardiovascular-ventilatory coupling; gas exchange kinetics - O2 uptake, CO2 output, O2 debt and O2 deficit; control of breathing; dietary substrate and the physiological responses to exercise; summary. Part 3 Measurement during integrative cardiopulmonary exercise testing: what is an integrated cardiopulmonary exercise test?; when should integrative cardiopulmonary exercise testing be used?; progressively increasing work rate exercise testing; constant work rate - exercise testing; summary. Part 4 Pathophysiology of disorders limiting exercises: obesity; peripheral vascular diseases; heart disease; pulmonary vascular diseases; ventilatory disorders; defects in hemaglobin content and quality; chronic metabolic acidosis; muscle disorders & endocrine abnormalities; anxiety, and malingering; defect combinations; summary. Part 5 Protocols for exercise testing: description and use of incremental work rate tests; description and use of constant work rate tests; treadmill test for detecting myocarcial ischemia; test suitable for fitness evaluation; arm ergometry; twelve-minute walking test; isometric exercise; evaluating therapy; summary. Part 6 Normal values: maximum oxygen uptake; maximum heart rate and heart rate reserve (HRR); relationship of VO2 and heart rate; the maximum oxygen pulse; brachial artery blood pressure; anaerobic (lactate, lactic acidosis) threshold; oxygen uptake-work rate relationship (AV02/AWR); ventilation, breathing reserve, tidal volume, and breathing frequency; ventilatory equivalents for carbon dioxide (V2/VC02) and oxygen (V2/V02); physiological dead space/tidal volume ratio (Vd/Vt); arterial and end-tidal carbon dioxide (PaCO2, PetCO2, and P(A-a)O2), and arterial oxyhemoglobin saturation (SaO2); mixed venous values; acid-base balance; summary. Part 7 Principles of interpretation: introduction to flow charts; establishing the pathophysiological basis of exercise intolerance; interpretation of constant work rate test; summary. Part 8 Cases illustrating pathophysiology.