Advancements in the application of cardiopulmonary exercise testing for overweight and obese populations

Abstract

Objective: To evaluate the advancements in cardiopulmonary exercise testing (CPET) among overweight or obese patients.

Methods: Reviewed the recent studies on clinical trials of CPET in overweight and obese patients, thought about the CPET advantage in obesity, while CPET equipment use for elucidating the principles underlying obesity and using CPET kinematic scheme to explore fat metabolism.

Results: The exercise program developed by CPET is scientific, sustainable and advantageous. With this trial, we can develop a relatively effective, fast and measurable amount of exercise, on the basis of the exercise test in obese people, CPET can provide scientific and digital motion reducing weight for overweight patients. At the same time, the trial has become widely applied in research into drug and surgical treatments for overweight patients. It is possible to quantify the efficacy of a trial and ultimately assess the merits of CPET.

Conclusion: CPET is considered as a fundamental criterion for designing motion schemes. Despite limitations of equipment errors and patient endurance, the benefits of CPET in program formulation have been gradually recognized, which made it a promising tool in the field of obesity management.

Keywords

bicycle test / cardiopulmonary exercise testing / exercise test / obesity / overweight / sports medicine

References

[1] Nutrition and Metabolic Management Care , Clinical Nutrition Branch of Society , Chinese Medical Doctor Association Chinese Society of Nutritionists . Medical nutrition treatment guidelines for overweight and obesity in China (2021). Chin Front Med J. 2021; 13 (11): 1- 55.

[2] Garvey WT , Mechanick JI , Brett EM , et al. American association of clinical endocrinologists and American college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016; 22 (Suppl 3): 1- 203.

[3] Wang H . Clean T , Shiluo LL , et al. Epidemiological characteristics and influencing factors of central obesity among community residents in Xichang city. Mod Prev Med. 2022; 49 (23): 4241- 4245.

[4] Lu J , Shao J , Liu W , et al. To analyze the prevalence and influencing factors of obesity among adult residents in Yantai city. China Health Statist. 2022; 39 (04): 607- 609.

[5] Pereira WVC , Vancea DMM , de Andrade OR , et al. Position of Brazilian Diabetes Society on exercise recommendations for people with type 1 and type 2 diabetes. Diabetol Metab Syndr. 2022; 15 (1): 2.

[6] Wang X , Xie Y , Sun X , et al. Cardiopulmonary exercise testing precision setting individualized intensity exercise prescription effect on heart and lung function in patients with metabolic syndrome. Chinese J Sports Med. 2019; 38 (01): 3- 9.

[7] Löllgen H , Leyk D . Exercise testing in sports medicine. Dtsch Arztebl Int. 2018; 115 (24): 409- 416.

[8] Taylor C , Nichols S , Ingle L . A clinician's guide to cardiopulmonary exercise testing 1: an introduction. Br J Hosp Med. 2015; 76 (4): 192- 195.

[9] Nichols S , Taylor C , Lee I . A clinician's guide to cardiopulmonary exercise testing 2: test interpretation. Br J Hosp Med. 2015; 76 (5): 281- 289.

[10] Fung E , Lui LT , Finn G , et al. Predicting 10-year mortality in older adults using VO2max, oxygen uptake efficiency slope and frailty class. Eur J Prev Cardiol. 2021; 28 (10): 1148- 1151.

[11] DeCato TW , Haverkamp H , Hegewald MJ . Cardiopulmonary exercise testing (CPET). Am J Respir Crit Care Med. 2020; 201 (1): 1- 2.

[12] Puente-Maestu L . Physiological rationale of commonly used clinical exercise tests. Pulmonology. 2020; 26 (3): 159- 165.

[13] American Thoracic Society ATS , American College of Chest ACCP . ATS/ACCP Statement on Cardiopulmonary Exercise Testing; 2003.

[14] Jamnick NA , Pettitt RW , Granata C , et al. An examination and critique of current methods to determine exercise intensity. Sports Med. 2020; 50 (10): 1729- 1756.

[15] Wood G , Taylor E , Ng V , et al. Estimating the effect of aerobic exercise training on novel lipid biomarkers: a systematic review and multivariate meta-analysis of randomized controlled trials. Sports Med. 2023; 53 (4): 871- 886.

[16] Collins SÉ , Phillips DB , Brotto AR , Rampuri ZH , Stickland MK . Ventilatory efficiency in athletes, asthma and obesity. Eur Respir Rev. 2021; 30 (161): 200206.

[17] Collins KA , Ross LM , Piner LW , et al. Amount and intensity effects of exercise training alone versus a combined diet and exercise lifestyle intervention on health-related quality of life in the STRRIDE-PD randomized trial. BMJ Open Diabetes Res Care. 2022; 10 (1): e2584.

[18] Koschker AC , Warrings B , Morbach C , et al. Cardio-psycho-metabolic outcomes of bariatric surgery: design and baseline of the WAS trial. Endocr Connect. 2022; 11 (2): e210338.

[19] Wang X , Hu L , Zhao D , et al. To evaluate the effect of prescribing aerobic exercise based on cardiopulmonary exercise testing on maximal oxygen uptake and metabolic equivalent. Journal of Integrated Traditional Chinese and Western Medicine Cardiocerebral Vascular Disease. 2020; 18 (01): 191- 192.

[20] Salokari E , Laukkanen JA , Lehtimaki T , et al. The Duke treadmill score with bicycle ergometer: exercise capacity is the most important predictor of cardiovascular mortality. Eur J Prev Cardiol. 2019; 26 (2): 199- 207.

[21] Ren C , Zhu J , Shen T , et al. Comparison between treadmill and bicycle ergometer exercises in terms of safety of cardiopulmonary exercise testing in patients with coronary heart disease. Front Cardiovasc Med. 2022; 9: 864637.

[22] Joshi D , Jamadarkhana P , Kumbhare S , et al. Safety, tolerability, and pharmacokinetics of a novel mitochondrial modulator, TRC150094, in overweight and obese subjects: a randomized phase-I clinical trial. Front Pharmacol. 2021; 12: 729424.

[23] Davila CD , Udelson JE . Trials and tribulations of assessing new imaging protocols: combining vasodilator stress with exercise. JACC Cardiovasc Imaging. 2018; 11 (3): 494- 504.

[24] Corrà U , Giuseppe Agostoni P , Stefan D , et al. Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018; 20 (1): 3- 15.

[25] Burstein DS , McBride MG , Min J , et al. Normative values for cardiopulmonary exercise stress testing using ramp cycle ergometry in children and adolescents. J Pediatr. 2021; 229: 61- 69.

[26] Kindermann W . Validity of exercise ECG. Dtsch Arztebl Int. 2018; 115 (43): 731.

[27] Wallen MP , Hall A , Dias KA , et al. Impact of beta-blockers on cardiopulmonary exercise testing in patients with advanced liver disease. Aliment Pharmacol Ther. 2017; 46 (8): 741- 747.

[28] Liu LC , Hummel YM , van der Meer P , et al. Effects of sildenafil on cardiac structure and function, cardiopulmonary exercise testing and health-related quality of life measures in heart failure patients with preserved ejection fraction and pulmonary hypertension. Eur J Heart Fail. 2017; 19 (1): 116- 125.

[29] Wiklund P , Alen M , Eveliina M , et al. 6 weeks aerobic exercise training and diet to often do not exercise metabolic reactions of overweight and obese premenopausal women: a randomized trial. J Sport Health Sci. 2014; 3 (03): 217- 224.

[30] Skrypnik D , Bogdański P , Mądry E , et al. Effects of endurance and endurance strength training on body composition and physical capacity in women with abdominal obesity. Obes Facts. 2015; 8 (3): 175- 187.

[31] Reant P , Dufour M , Peyrou J , et al. Upright treadmill vs. semi-supine bicycle exercise echocardiography to provoke obstruction in symptomatic hypertrophic cardiomyopathy: a pilot study. Eur Heart J Cardiovasc Imaging. 2018; 19 (1): 31- 38.

[32] Peteiro J , Bouzas-Mosquera A , Estevez R , et al. Head-to-head comparison of peak supine bicycle exercise echocardiography and treadmill exercise echocardiography at peak and at post-exercise for the detection of coronary artery disease. J Am Soc Echocardiogr. 2012; 25 (3): 319- 326.

[33] Craven TP , Tsao CW , La Gerche A , et al. Exercise cardiovascular magnetic resonance: development, current utility and future applications. J Cardiovasc Magn Reson. 2020; 22 (1): 65.

[34] Johnson DC . Cardiopulmonary exercise testing reference equations. Chest. 2021; 159 (6): 2510.

[35] Inuzuka R , Diller GP , Borgia F , et al. Comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term. Circulation. 2012; 125 (2): 250- 259.

[36] Na H , Wang C , Wang P , et al. To evaluate the clinical rehabilitation advantages of cardiovascular disease based on cardiopulmonary exercise testing. Heart J. 2021; 33 (01): 95- 100.

[37] Balady GJ , Arena R , Sietsema K , et al. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010; 122 (2): 191- 225.

[38] Myers J , Forman DE , Balady GJ , et al. Supervision of exercise testing by nonphysicians: a scientific statement from the American Heart Association. Circulation. 2014; 130 (12): 1014- 1027.

[39] Liu D , Gu XJ , Liu X , et al. Cardiopulmonary endurance type pre- diabetes abdominal obesity related research. Hebei Medicine. 2021; 43 (11): 1689- 1692.

[40] Lebel A , Auclair A , Pettigrew M , et al. Is the 6 minute walk test a maximal test in severe obesity: comparison with the cardiopulmonary exercise test, the VO₂ max? Can J Cardiol. 2019; 35 (10 Supplement): S113- S114.

[41] Rosa SA , Agapito A , Soares RM , et al. Congenital heart disease in adults: assessment of functional capacity using cardiopulmonary exercise testing. Rev Port Cardiol. 2018; 37 (5): 399- 405.

[42] Lan C , Liu Y , Wang Y . Effects of different exercise programs on cardiorespiratory fitness and body composition in college students. J Exerc Sci Fit. 2022; 20 (1): 62- 69.

[43] Jurio-Iriarte B , Maldonado-Martín S . Effects of different exercise training programs on cardiorespiratory fitness in overweight/obese adults with hypertension: a pilot study. Health Promot Pract. 2019; 20 (3): 390- 400.

[44] Li P , Wang L , Overweightness CL . Obesity and arterial stiffness in healthy subjects: a systematic review and meta-analysis of literature studies. Postgrad Med. 2017; 129 (2): 224- 230.

[45] Borasio N , Neunhaeuserer D , Andrea G , et al. Ventilatory response at rest and during maximal exercise testing in patients with severe obesity before and after sleeve gastrectomy. Obes Surg. 2021; 31 (2): 694- 701.

[46] National Guideline Centre UK . Preoperative Tests (Update): Routine Preoperative Tests for Elective Surgery. National Institute for Health and Care Excellence (NICE); 2016.

[47] Otto JM , Levett DZH , Grocott MPW . Cardiopulmonary exercise testing for preoperative evaluation: what does the future hold? Curr Anesthesiol Rep. 2020; 10 (1): 1- 11.

[48] Zumerkorn Pipek L , Moraes WAF , Nobetaniet RM , et al. Surgery is associated with better long-term outcomes than pharmacological treatment for obesity: a systematic review and meta-analysis. Sci Rep. 2024; 14 (1): 9521.

[49] Levett DZH , Jack S , Swart M , et al. Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth. 2018; 120 (3): 484- 500.

[50] Nelson JE , Sanchez KM , Yao Y , et al. Cardiopulmonary exercise testing among pediatric patients with severe obesity prior to bariatric surgery. Prog Pediatr Cardiol. 2024; 72: 101708.

[51] Salgado-Garcia C , Jimenez-Heffernan A , Lopez-Martin J , et al. Influence of body mass index and type of low-level exercise on the side effect profile of regadenoson. Eur J Nucl Med Mol Imag. 2017; 44 (11): 1906- 1914.

[52] Katsikis A , Kyrozi E , Manira V , et al. Gender-related differences in side-effects and hemodynamic response to regadenoson in patients undergoing SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imag. 2019; 46 (12): 2590- 2600.

[53] AlJaroudi WA , Alraies MC , Cerquiera MD , et al. Safety and tolerability of regadenoson in 514 SPECT MPI patients with and without coronary artery disease and submaximal exercise heart rate response. Eur J Nucl Med Mol Imag. 2013; 40 (3): 341- 348.

[54] Song M , Lee I , Kang H . Cardiorespiratory fitness without exercise testing can predict all-cause mortality risk in a representative sample of Korean older adults. Int J Environ Res Publ Health. 2019; 16 (9): 1633.

[55] Qiuhua W , Jianmei L , Tao G , et al. Characteristics of cardiopulmonary exercise testing in obese patients. Biomed Eng Clinic. 2022; 26 (01): 72- 75.

[56] Cavalheri V , Burtin C , Formico VR , et al. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database Syst Rev, 2019, 6 (6): CD9955.

[57] Faria EW , Parker DL , Faria IE . The science of cycling: physiology and training - part 1. Sports Med. 2005; 35 (4): 285- 312.

[58] Guazzi M , Bandera F , Ozemek C , et al. Cardiopulmonary exercise testing: what is its value? J Am Coll Cardiol. 2017; 70 (13): 1618- 1636.

[59] Baba R , Nagashima M , Goto M , et al. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol. 1996; 28 (6): 1567- 1572.

[60] Lewthwaite H , Benedetti A , Stickland MK , et al. Normative peak cardiopulmonary exercise test responses in Canadian adults aged ≥40 years. Chest. 2020; 158 (6): 2532- 2545.

[61] Nordby P , Rosenkilde M , Ploug T , et al. Independent effects of endurance training and weight loss on peak fat oxidation in moderately overweight men: a randomized controlled trial. J Appl Physiol. 2015; 118 (7): 803- 810.

[62] Besnier F , Lenclume V , Gérardin P , et al. Individualized exercise training at maximal fat oxidation combined with fruit and vegetable-rich diet in overweight or obese women: the LIPOXmax-réunion randomized controlled trial. PLoS One. 2015; 10 (11): e139246.

[63] Voltan C , Concer F , Pecoraro L , et al. Exploring the Complex Interplay of Obesity, Allergic Diseases, and Sleep-Disordered Breathing in Children; 2024.

[64] Wilhite D , Bhammar D , Martinez-Fernandez T , et al. Cardiorespiratory fitness in children with obesity and respiratory symptoms. Physiology. 2024; 39 (S1): 1823.

[65] Liu S , Zhang H , Lan Z , et al. Associations of obesity with chronic inflammatory airway diseases and mortality in adults: a population-based investigation. BMC Public Health, 2024, 24 (1): 1.

[66] Arzt M , Schulz M , Wensel R , et al. Nocturnal continuous positive airway pressure improves ventilatory efficiency during exercise in patients with chronic heart failure. Chest. 2005; 127 (3): 794- 802.

[67] Hebestreit H , Hulzebos EHJ , Schneiderman JE , et al. Cardiopulmonary exercise testing provides additional prognostic information in cystic fibrosis. Am J Respir Crit Care Med. 2019; 199 (8): 987- 995.

[68] Chen L . To investigate the effects of incremental load exercise on cardiovascular function in adults of different ages. J. Beijing Sport. Univ. 2012; 35 (04): 74- 79.

[69] Bai F , Zhu LJ , Yongmei M , et al. Benefits of cardiac rehabilitation in patients with coronary heart disease after percutaneous coronary intervention. Combine traditional Chinese and western medicine Journal of Cardio-Cerebrovascular Disease. 2020; 18 (03): 466- 469.

[70] Opina MTD , Brinkley TE , Gordon M , et al. Association of breathing reserve at peak exercise with body composition and physical function in older adults with obesity. J Gerontol A Biol Sci Med Sci. 2019; 74 (12): 1973- 1979.

[71] Cheng H , Dong H . Exercise prescription and the influence of nutritional intervention in patients with senile obesity research. Techni Inform. 2021; 19 (10): 3.

[72] Niu Z . To Investigate the Association between Lipid Metabolism-Related Gene Polymorphisms and Hyperlipidemia in the Elderly with Long-Term Aerobic Exercise. Shanghai Institute of Physical Education; 2016: 1- 35.

[73] Carr KA , Epstein LH . Choice is relative: reinforcing value of food and activity in obesity treatment. Am Psychol. 2020; 75 (2): 139- 151.

[74] Lowe CJ , Morton JB , Reichelt AC . Adolescent obesity and dietary decision making-a brain-health perspective. Lancet Child Adolesc Health. 2020; 4 (5): 388- 396.

[75] Poston L , Bell R , Croker H , et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 2015; 3 (10): 767- 777.

[76] Dodd JM , Louise J , Deussen AR , et al. Effect of metformin in addition to dietary and lifestyle advice for pregnant women who are overweight or obese: the GRoW randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019; 7 (1): 15- 24.

[77] Sorimachi H , Omote K , Omar M , et al. Sex and central obesity in heart failure with preserved ejection fraction. Eur J Heart Fail. 2022; 24 (8): 1359- 1370.

[78] Mora S , Redberg RF , Cui Y , et al. Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA. 2003; 290 (12): 1600- 1607.

[79] Correia JM , Santos I , Pezarat-Correia P , et al. Effects of intermittent fasting on specific exercise performance outcomes: a systematic review including meta-analysis. Nutrients. 2020; 12 (5): 1390.

[80] Van Hooren B , Fuller JT , Buckley JD , et al. Is motorized treadmill running biomechanically comparable to overground running? A systematic review and meta-analysis of cross-over studies. Sports Med. 2020; 50 (4): 785- 813.

[81] Berntsen S , Malnes L , Langåker A , et al. Physical activity when riding an electric assisted bicycle. Int J Behav Nutr Phys Activ. 2017; 14 (1): 55.

[82] Dewolf AH , Mesquita RM , Willems PA . Comment on: is motorized treadmill running biomechanically comparable to overground running? A systematic review and meta-analysis of cross-over studies. Sports Med. 2020; 50 (9): 1695- 1698.

[83] Miller JR , Van Hooren B , Bishop C , et al. A systematic review and meta-analysis of crossover studies comparing physiological, perceptual and performance measures between treadmill and overground running. Sports Med. 2019; 49 (5): 763- 782.

[84] Hsieh CJ , DeJong G , Vita M , et al. Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty: a randomized clinical trial. JAMA Netw Open. 2020; 3 (9): e2016571.

[85] Ridgway ZA , Howell SJ . Cardiopulmonary exercise testing: a review of methods and applications in surgical patients. Eur J Anaesthesiol. 2010; 27 (10): 858- 865.

[86] Wetherbee JN , Bamrah VS , Ptacin MJ , et al. Comparison of ST segment depression in upright treadmill and supine bicycle exercise testing. J Am Coll Cardiol. 1988; 11 (2): 330- 337.

[87] MacNamara JP , Dias KA , Hearon CM , et al. Randomized controlled trial of moderate- and high-intensity exercise training in patients with hypertrophic cardiomyopathy: effects on fitness and cardiovascular response to exercise. J Am Heart Assoc. 2023; 12 (20): e31399.

[88] Bárbara DBG , Di Ostolin TLV , Brisola Barbosa AC , et al. Dynamic physiological responses in obese and non-obese adults submitted to cardiopulmonary exercise test. PLoS One. 2021; 16 (8): e255724.

[89] Ek A , Christine DN , Adela C-E , et al. A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study - an intervention within the STOP project. BMC Publ Health. 2019; 19 (1): 945.

RIGHTS & PERMISSIONS

2024 The Author(s). Advanced Chinese Medicine published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.