A practical approach to Cardiopulmonary Exercise Testing: from functional evaluation to adapted exercise prescription

This expert opinion paper focuses on the clinical implementation, execution and interpretation of Cardiopulmonary Exercise Testing (CPET), providing comprehensive insights into its recognised prognostic, diagnostic and prescriptive value in everyday clinical practice. A practical guide offers step-by-step instructions on conducting and interpreting CPET, emphasising the importance of high-quality testing for the benefit of patients, healthy individuals and athletes. The approach considers test objectives, how to adapt procedures for different medical inquiries and reporting. A systematic method for interpreting CPET data is outlined, covering aerobic/exercise capacity evaluations with subsequent analyses of ventilatory, cardiovascular, cardiorespiratory gas-exchange and muscular-metabolic responses to exercise. Special attention is given to post-exercise recovery and other novel parameters for informed clinical decision-making. The outcomes emphasise the need for better implementation of CPET for prognostic evaluations and in diagnostic pathways. Barriers to its adoption are discussed, including logistical challenges or resource constraints, and strategies for integrating CPET into routine care pathways are proposed. The statement provides further details on how to utilise CPET outcomes to tailor exercise prescription based on identified functional limitations and adjust exercise intensity using different physiological and pathological thresholds for both patients and athletes. Finally, the latest advancements in CPET are explored, including novel portable systems and integration with transcutaneous blood-gas monitoring, imaging, and (non-)invasive haemodynamic measures, also addressing the potential for smaller clinics, improving accessibility in clinical practice. This expert opinion statement aims to offer a roadmap for making CPET a more standardised and accessible tool in clinical care.