Pulmonary - Critical Care Associates
of East Texas

Jeffrey M. Shea, M.D., F.C.C.P.
                              Catherine M. Martinez, M.D.

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ExerciseTesting.gif (2825 bytes)

Indications for Exercise Testing

Diseases that affect the heart, lungs, circulation, or blood, will cause an abnormal response to exercise. Exercise testing is useful to help evaluate the cause of shortness of breath that otherwise cannot be determined at rest (heart vs. lungs). It also may be diagnostic in the following conditions: myocardial ischemia, abnormal blood pressure response to exercise, poor circulation, blood clots to the lungs (pulmonary embolism), exercise-induced asthma, unfitness, and hyperventilation syndromes.

Clinical Usefulness of Exercise Testing

  1. The quality of exercise capacity and anaerobic threshold of the individual (fitness).
  2. To evaluate unexplained dyspnea.
  3. To diagnose and quantitate exercise-induced asthma.
  4. To determine factors (cardiac vs. pulmonary) which limit the patient’s activity.
  5. For industrial and sports evaluations.
  6. Determine extent of impairment in disability evaluations and compensation cases.
  7. Formulate exercise prescriptions for safe reconditioning and to evaluate the effectiveness of rehabilitation.
  8. Follow responses to therapy in patients with cardiopulmonary disease.
  9. Help assess the extent and follow the course of interstitial lung disease, including response to therapy.
  10. Help detect and follow pulmonary fibrosis caused by chemotherapy.

Evaluation of the Patient

  1. History and physical examination- Included in this is:
    • occupation;
    • exposure to noxious agents
    • degree of physical activity
    • habits (smoking, alcohol)
    • diet
    • medications
    • Does the patient have diabetes, hypertension, coronary artery disease, anemia, asthma, etc?
    • Is the patient taking nitroglycerin, anticoagulants, or beta-blocking agents?
    • The beta-blocking drug is especially important: it may significantly lower the pulse rate and effect exercise performance.
    • Does the patient have shortness of breath, wheezing, cough, sputum production and chest pain?
  1. A complete blood count done.
  2. Spirometry- this is done to detect and quantitate any obstructive or restrictive lung disease. It’s used to calculate the ventilatory limit to exercise.
  3. Arterial blood gases (ABG's)- an arterial sample is obtained pre-exercise, with the patient at rest. A vital part of the test is to obtain another ABG at maximal exercise, just prior to stopping exercise. This maneuver is not difficult with the patient on a bicycle. When indicated an arterial catheter is used.
  4. EKG and chest x-ray is obtained.

 

Preparation of the Patient

  1. The last meal before exercise should be light and should precede the test by at least 2 hours.
  2. Cigarettes, coffee, tea, carbonated beverages, and alcohol should be avoided prior to the test.
  3. Heavy exercise should not be done earlier on the same day of the test.
  4. Properly fitting drawstring pants, shirts with short sleeves, and comfortable sneakers should be worn.

Preliminary Procedure

  1. Explain the procedure thoroughly to the patient and answer any questions they may have. The patient will then sign a consent form once he understands the procedure and their questions have been answered.
  2. Showing the patient how to pedal the bicycle, adjust the seat to the appropriate height. Familiarize the patient to the surroundings and equipment. Have the patient pedal the bicycle with low resistance.
  3. Wrapping the blood pressure cuff on the patient’s upper arm.
  4. Attaching the 12-lead EKG (monitoring the heart).
  5. Attaching an oximeter to the patient’s finger or ear (monitor the oxygen saturation).
  6. Applying a mouth/face mask

Exercise Testing

Now the patient is ready for testing. Present during testing is the doctor and respiratory therapist. During testing you are being well monitored. You are instructed when to start pedaling. The workload on the pedals is increased the longer the test proceeds. The patient is encouraged to exercise until they reach the maximal workload and exercise. The patient is instructed to let the physician and therapist know if they experience chest pain, leg cramps, and shortness of breath. You may be asked to rate the exercise load on a scale of 1-10. Once you have reached maximal exercise the workload is decreased and the patient is encouraged to keep pedaling to prevent leg cramps (cool down). The patient is then monitored for a short time and then released to go home.

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