Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years

Hayley Lewthwaite; Andrea Benedetti; Michael K Stickland; Jean Bourbeau; Jordan A Guenette; Francoic Maltais; Dacy D Marciniuk; Denis E O'Donnell; Benjamin M Smith; Wan C Tan; Dennis Jensen; CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network

doi:10.1016/j.chest.2020.06.074

Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years

Chest. 2020 Dec;158(6):2532-2545. doi: 10.1016/j.chest.2020.06.074. Epub 2020 Jul 14.

Collaborators

CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network:
S E AaronK, R Chapman, P Hernandez, D D Sin, B Walker

Affiliations

¹ Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada; Innovation, Implementation And Clinical Translation in Health, School of Health Sciences, University of South Australia, Adelaide, SA, Australia. Electronic address: Hayley.Lewthwaite@mcgill.ca.
² Departments of Medicine and Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada; Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.
³ Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; G. F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada.
⁴ Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.
⁵ Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁶ Centre de recherche, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, QB, Canada.
⁷ Respiratory Research Centre and Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
⁸ Laboratory of Clinical Exercise Physiology, Kingston Health Science Center & Queen's University, ON, Canada.
⁹ Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
¹⁰ Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada; Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada; Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, QC, Canada; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.

PMID: 32679236
DOI: 10.1016/j.chest.2020.06.074

Abstract

Background: Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings.

Research question: This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations for predicting peak CPET responses.

Study design and methods: Participants were healthy adults who were ≥40 years old from the Canadian Cohort Obstructive Lung Disease who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) with the use of quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters that were measured and predicted in the validation cohort were assessed for equivalence (two one-sided tests of equivalence for paired-samples and level of agreement (Bland-Altman analyses). Two one-sided tests of equivalence for paired samples assessed differences between responses in the derivation cohort using previously recommended reference equations.

Results: Normative reference ranges (5th-95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) who were 64 ± 10 years old. In the validation cohort (n = 84), peak CPET responses that were predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by the previously recommended reference equations by Jones and colleagues and Hansen and colleagues were significantly higher.

Interpretation: This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange, and symptom responses to incremental CPET and presents the most comprehensive reference set to date in Canadian adults who were ≥40 years old to be identified with population-based sampling.

Keywords: cardiopulmonary exercise testing; external validation; prediction model.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Adult
Canada / epidemiology
Cohort Studies
Exercise Test* / methods
Exercise Test* / standards
Exercise Tolerance / physiology
Female
Humans
Male
Middle Aged
Oxygen Consumption / physiology
Reference Values
Reproducibility of Results

Grants and funding

93326/CIHR/Canada