Wasserman and Whipp’s Principles of Exercise Testing and Interprthy 6th edition by Kathy Sietsema, Darryl Sue, William Stringer, Susan Ward ISBN 1975136438‎ 978-1975136437

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ISBN 10: 1975136438
ISBN 13:‎ 978-1975136437
Author: Kathy Sietsema, Darryl Sue, William Stringer, Susan Ward 

Thoroughly revised and updated for today’s clinicians, Wasserman & Whipp’s Principles of Exercise Testing and Interpretation, Sixth Edition, provides a comprehensive, practical overview of cardiopulmonary exercise testing (CPET) ideally suited for pulmonologists, cardiologists, anesthesiologists, and others with an interest in clinical exercise testing. Written by authors who are uniquely positioned to convey relevant aspects of research and apply them to clinical contexts, this volume offers in-depth coverage of essential information for conducting CPET, or for utilizing data from this discipline in clinical practice or research.

• Clearly defines terminology throughout and focuses on the core elements of CPET that are common to all users, ensuring that content is easily accessible to clinicians from a wide variety of backgrounds.
• Reviews the central aspects of exercise physiology and metabolism important for understanding measurements used in CPET.
• Identifies core procedures and measurements for conducting tests and laboratory quality control.
• Outlines systematic, step-by-step approaches to the interpretation of exercise data, including the scientific and technical basis of the methods and analyses.
• Includes a new chapter on approach to data and interpretation – focused on practical approaches to viewing, summarizing, and reporting results of a test.
• Illustrates normal and abnormal results of exercise tests through discussion of dozens of actual case presentations.
• Draws on the extensive experience and expertise of authors from the fields of pulmonary medicine and physiology with experience in research and clinical studies related to cardiology, metabolism, sports medicine, and other areas.

Wasserman & Whipp’s Principles of Exercise Testing and Interprthy 6th Table of contents:

1    Exercise Testing and Interpretation

WHAT IS CARDIOPULMONARY EXERCISE TESTING?

CELL RESPIRATION AND BIOENERGETICS

NORMAL COUPLING OF EXTERNAL TO CELLULAR RESPIRATION

WHY MEASURE GAS EXCHANGE TO EVALUATE CARDIORESPIRATORY FUNCTION AND CELLULAR RESPIRATION?

CARDIAC STRESS TESTS AND PULMONARY STRESS TESTS

PATTERNS OF CHANGE IN EXTERNAL RESPIRATION (VO2 AND VCO2) AS RELATED TO FUNCTION, FITNESS, AND DISEASE

FACTORS LIMITING EXERCISE

Fatigue

Dyspnea

Pain

EVIDENCE OF SYSTEMIC DYSFUNCTION UNIQUELY REVEALED BY INTEGRATIVE CARDIOPULMONARY EXERCISE TESTING

Diagnosis of Exercise Intolerance, Especially Exertional Dyspnea and Myocardial Ischemia

Cardiopulmonary Exercise Testing and Prognosis in Patients With Known Disorders

Cardiopulmonary Exercise Testing and Preoperative Assessment

SUMMARY

2    Physiology of Exercise

SKELETAL MUSCLE: MECHANICAL PROPERTIES AND FIBER TYPES

BIOENERGETICS

Sources of High-Energy Phosphate and Cellular Respiration

Phosphocreatine Breakdown

Substrate Utilization

Carbohydrates

Lipids

Amino Acids

OXYGEN COST OF WORK

VO2 Steady State and Work Efficiency

VO2 Nonsteady State

ARTERIAL LACTATE INCREASE

Arterial Lactate Increase as a Function of Work Rate

Arterial Lactate Increase as a Function of Time

Mechanisms of Arterial Lactate Increase

Increasing Glycolytic Flux and Exercise Intensity

Sequential Recruitment of Type II Muscle Fibers

Pyruvate Dehydrogenase Activity

Change in Cytosolic Redox State Limiting Mitochondrial Proton Shuttles

Lactate Production and Clearance

Oxygen Supply and Critical Capillary PO2

pH Change and Oxyhemoglobin Dissociation Above the Anaerobic Threshold

BUFFERING THE EXERCISE-INDUCED LACTIC ACIDOSIS

CARDIOVASCULAR RESPONSES TO EXERCISE

Cardiac Output

Oxygen Pulse

Distribution of Peripheral Blood Flow

Arterial PO2

Oxyhemoglobin Dissociation

Hemoglobin Concentration

Arterial Oxygen Content

GAS EXCHANGE KINETICS

Oxygen Uptake Kinetics

Moderate Exercise

Supra-AT Exercise

Mean Response Time

Oxygen Deficit

Oxygen Debt

Carbon Dioxide Output Kinetics

Moderate Exercise

Supra-AT Exercise

Power-Duration Curve and Critical Power

VENTILATORY RESPONSES TO EXERCISE

Arterial and Venous PCO2 and Carbon Dioxide Content

Ventilatory Determinants

Carbon Dioxide and H+ Elimination

Alveolar Ventilation

Dead Space Ventilation

Total (or Expired) Ventilation

Breathing Pattern

Ventilatory Control

Moderate Exercise

Supra-AT Exercise

SUMMARY

3    Measurements During Integrative Cardiopulmonary Exercise Testing

measurements

Electrocardiographic Changes With Exercise

Maximal and Peak Oxygen Uptake

Oxygen Uptake and Work Rate

Normal Subjects

Upward Displacement of VO2 as a Function of Work Rate in Obesity

Slope of VO2 as a Function of Work Rate (ΔVO2/ΔWR)

Linearity of VO2 as a Function of Work Rate

Can VO2 or METs Be Predicted From the Work Rate?

Cardiac Output and Stroke Volume

Cardiac Output Measurement

Indirect Fick Method Using VCO2 and Estimated CVCO2

Direct Fick Method

Noninvasive Cardiac Output and Stroke Volume by the Fick Principle

Oxygen Pulse and Stroke Volume

Anaerobic (Lactate, Lactic Acidosis) Threshold

Methods of Measurement

V-Slope Method

Ventilatory Equivalent Method

Improving Estimation of the Anaerobic Threshold

False Positives

Heart Rate–Oxygen Uptake Relationship and Heart Rate Reserve

Arterial Blood Pressure

Breathing Reserve

Expiratory Flow Pattern

Inspiratory Capacity

Tests of Uneven VA/Q

Wasted Ventilation and Dead Space–Tidal Volume Ratio

Arterial PO2 and Alveolar–Arterial PO2 Difference

Arterial–End-Tidal PCO2 Difference

Ventilatory Equivalents as Indices of Uneven VA/Q

Differentiating Uneven Ventilation From Uneven Perfusion as the Cause of Uneven VA/Q

Other Measures of Uneven VA/Q

Arterial Bicarbonate and Acid-Base Response

Tidal Volume/Inspiratory Capacity Ratio

Measurements Unique to Constant Work Rate Exercise Testing

VO2 Response in Phase I

VO2 Response in Phase II

VO2 Response Above the Anaerobic Threshold

The Power-Duration Relationship and Endurance Time

Noninvasive Estimation of Metabolic Acidosis Buffering

Carotid Body Contribution to Ventilation

Detecting Exercise-Induced Bronchospasm

SUMMARY

4    Pathophysiology of Disorders Limiting Exercise

OBESITY

PATTERNS OF EXERCISE GAS EXCHANGE COMMON TO CARDIOVASCULAR DISEASES

VO2 Response to Increasing Work Rate (ΔVO2/ΔWR) in Patients With Cardiovascular Abnormalities

Why Do Cardiovascular Disorders Impair Gas Transport?

HEART DISEASES

Coronary Artery Disease

Myopathic Heart Disease (Heart Failure)

Valvular Heart Disease

Congenital Heart Disease

PULMONARY VASCULAR DISEASES

Causes of Increased Ventilation

Exercise Arterial Hypoxemia

Effect on Systemic Hemodynamics

PERIPHERAL ARTERIAL DISEASES

VENTILATORY DISORDERS

Obstructive Lung Diseases

Ventilatory Capacity–Ventilatory Requirement Imbalance

Oxygen Transport–Oxygen Requirement Imbalance

Physiological Markers of Inadequate Oxygen Transport

Restrictive Lung Diseases

Chest Wall (Respiratory Pump) Disorders

DEFECTS IN HEMOGLOBIN CONTENT AND QUALITY

Anemia

Left-Shifted Oxyhemoglobin Dissociation Curve

Carboxyhemoglobinemia and Cigarette Smoking

CHRONIC METABOLIC ACIDOSIS

METABOLIC MUSCLE DISORDERS

Disorders of Carbohydrate Metabolism

Disorders of Lipid Metabolism

Disorders of Mitochondrial Electron Transport Chain

Toxin- or Drug-Induced Muscle Impairment

Endocrine Disorders

NONMETABOLIC CAUSES OF EXERCISE LIMITATION AND DYSPNEA

Anxiety Reactions

Poor Effort and Manipulated Exercise Performance

COMBINATIONS OF DEFECTS

SUMMARY

5    Performance of Clinical Cardiopulmonary Exercise Testing

EXERCISE LABORATORY AND EQUIPMENT

General Laboratory Environment

Gas Exchange Measurement

Mixing Chambers

Breath-by-Breath Systems

Measurement of Volume, Flow Rate, and Ventilation

Breathing Valves, Mouthpieces, and Masks

Gas Analyzers

Elevated Inspired Fractional Oxygen Concentration

Ergometers: Treadmills and Cycles

Treadmill

Cycle Ergometer

Cycle Versus Treadmill

Work and Work Rate (Power)

Electrocardiogram and Systemic Blood Pressure

Exercise Electrocardiogram

Systemic Blood Pressure

Oximetry, Blood Sampling, and Arterial Catheters

Pulse Oximetry

Single Samples of Arterial Blood by Puncture

Multiple Samples of Arterial Blood by Catheterization

Free-Flowing Ear Capillary Blood

Invasive Cardiopulmonary Exercise Testing With Pulmonary Artery Catheter

Data Sampling and Computation

Quality Control, Validation, and Maintenance

PREPARING FOR THE EXERCISE TEST

Requesting the Test and Notifying the Patient

The Patient in the Exercise Laboratory

Preliminary Tests

Physician Evaluation

Equipment Familiarization

Ending the Exercise

Arterial Blood Sampling and Use of Catheter

PERFORMING THE EXERCISE TEST

Incremental Exercise Test to Symptom-Limited Maximum

Selecting the Rate of Work Rate Increase

Resting Measures

Unloaded Exercise and Cycling Rate

Incremental Exercise

Recovery

Postexercise Questioning and Review

Incremental Tests

Constant Work Rate Exercise Tests

Treadmill Test for Detecting Myocardial Ischemia

Comment

Treadmill Tests With Even Increments in Work Rate

Arm Ergometry

Critique

Other Tests Suitable for Fitness or Serial Evaluations

Harvard Step Test and Modifications

600-Yard Run-Walk

12-Minute Field Test

12-Minute Walk Test

6-Minute Walk Test

Incremental Shuttle Walk Test and Endurance Shuttle Walk Tests

SUMMARY

6    Approaches to Data Summary and Interpretation

CONSIDERATIONS IN FORMATTING AND SUMMARIZING DATA

Averaging Breath-by-Breath Data

Formatting Data for Viewing During and After Testing

Quantifying Peak Values

Characterizing Submaximal Exercise Patterns

ORGANIZING DATA: APPROACH TO REVIEW OF A NINE-PANEL GRAPHICAL DISPLAY

Data Reflecting Cardiovascular and Metabolic Responses

Cardiovascular and Metabolic Variables: Summary

Data Reflecting Ventilation Responses to Exercise

Ventilatory Variables: Summary

Data Reflecting Efficiency of Pulmonary Gas Exchange

Pulmonary Gas Exchange Efficiency: Summary

Graphing Strategies to Facilitate Data Analysis

Summarizing Key Variables

EXAMPLES OF FINDINGS IN THE NINE-PANEL DISPLAY IN SELECTED CARDIORESPIRATORY DISORDERS

Panel 1: VO2, VCO2, and Work Rate as Related to Time

Panel 3: Heart Rate and Carbon Dioxide Output as a Function of Oxygen Uptake

Panel 2: Heart Rate and Oxygen Pulse as a Function of Time

Panel 9: Tidal Volume as a Function of Exercise Minute Ventilation

Panel 6: Exercise Minute Ventilation as a Function of Carbon Dioxide Output

Panel 4: Ventilatory Equivalents for Oxygen and Carbon Dioxide Versus Time

Panel 7: End-Tidal Oxygen and Carbon Dioxide Tensions Versus Time

Panel 5: Minute Ventilation as a Function of Time

Panel 8: Respiratory Exchange Ratio at Rest, Increasing Work Rate Exercise, and Recovery

Summary of Sample Response Patterns

WRITING AN EXERCISE TEST REPORT

Elements of the Report

Interpretation

Interpretation of Tests Conducted for Determination of Selected Variables

Interpretation of CPETs Conducted for Diagnostic Purposes

Confounding Factors

7    Normal Values

POTENTIAL LIMITATIONS OF PUBLISHED REFERENCE VALUES FOR CARDIOPULMONARY EXERCISE TESTING

PREDICTED VALUES FOR ADULTS

Peak Oxygen Uptake

Age and Gender

Activity Level

Matching Predicting or Reference Equations to Body Size

Exercise Mode

Recommendations

Peak Heart Rate and Heart Rate Reserve

Recommendations

Relationship of Oxygen Uptake and Heart Rate: Peak Oxygen Pulse

Recommendations

Relationship of Heart Rate and VO2: ΔHR/ΔVO2

Systemic Blood Pressure

Recommendations

Anaerobic Threshold

Recommendations

Oxygen Uptake–Work Rate Relationship

Recommendations

Ventilatory Limitation During Exercise

Exercise Ventilation and Breathing Reserve

Tidal Volume and Breathing Frequency

Recommendations

Gas Exchange Relationships and Ventilatory Efficiency: VE and VCO2

Slope of VE (BTPS) versus VCO2 (STPD)

VE/VCO2 Near the AT

Recommendations

Oxygen Uptake Efficiency Slope: VE and VO2

Physiological Dead Space–Tidal Volume Ratio

Recommendations

Arterial, End-Tidal, and Mixed-Expired Carbon Dioxide Pressures

Recommendations

Arterial, Alveolar, and End-Tidal Oxygen Tensions and Arterial Oxyhemoglobin Saturation

Recommendations

Femoral and Mixed Venous Values and Estimation of Cardiac Output

Recommendations

Acid-Base Balance

Recommendations

PREDICTED VALUES FOR CHILDREN

Peak VO2 in Children

Recommendations

Peak Heart Rate and Heart Rate Reserve

Recommendations

Relationship of Oxygen Uptake and Heart Rate: The Peak Oxygen Pulse

Recommendations

Anaerobic Threshold

Recommendations

Oxygen Uptake–Work Rate Relationship

Recommendations

Ventilatory Efficiency

Recommendations

SUMMARY

8    Clinical Applications of Cardiopulmonary Exercise Testing

CARDIOPULMONARY EXERCISE TESTING IN THE DIAGNOSTIC EVALUATION OF EXERCISE INTOLERANCE

Disorders With Unique or Distinctive Findings During Cardiopulmonary Exercise Testing

Myocardial Dyskinesis Secondary to Myocardial Ischemia During Exercise

Chronic Heart Failure With Preserved Left Ventricular Ejection Fraction

Pulmonary Vascular Occlusive Disease and Clinical Pulmonary Arterial Hypertension (Pulmonary Vasculopathy)

Development of a Right-to-Left Shunt During Exercise

Pulmonary Vascular Disease Limiting Exercise in Chronic Obstructive Pulmonary Disease

Impaired Muscle Bioenergetics

Exercise-Induced Airflow Obstruction

Psychogenic Dyspnea and Behavioral Causes of Exercise Intolerance

GRADING SEVERITY OF HEART FAILURE

CPET FOR EVALUATING PROGNOSIS IN HEART AND LUNG DISEASES

Prognosis in Heart Failure

Peak VO2, Anaerobic Threshold, and Prognosis in Chronic Heart Failure

Decreased “Ventilatory Efficiency” and Prognosis in Chronic Heart Failure

Prognosis in Heart Failure Based on Oscillatory Breathing During Exercise

Cardiopulmonary Exercise Testing and Evolving Management of Chronic Heart Failure

Prognosis in Structural Heart Diseases

Recommendations for Prognostic Evaluation for Potential Cardiac Transplantation

Prognosis in Pulmonary Arterial Hypertension and Prioritizing Patients for Lung Transplantation

Prognosis in Lung Diseases

Chronic Obstructive Pulmonary Disease and Prioritizing Patients for Lung Volume Reduction Surgery

Use of CPET for Prognosis in Other Lung Diseases Including Idiopathic Pulmonary Fibrosis

PREOPERATIVE EVALUATION OF SURGICAL RISK

Thoracic Surgery

Abdominal Surgery

Current Recommendations for the Use of Preoperative Exercise Training (“PreHab”) Prior to Thoracic or Abdominal Surgery

Who Should Undergo Cardiopulmonary Exercise Testing Preoperatively?

DETERMINING IMPAIRMENT FOR DISABILITY EVALUATION

Impairment and Disability

Assessing Impairment in Lung or Heart Disease Only Using Resting Measurements

Exercise Testing and Impairment Evaluation

Oxygen Cost of Work

EXERCISE TRAINING OR REHABILITATION

Physiological Basis of Exercise Rehabilitation

Skeletal Muscle

Cardiac Output and Heart Rate

Arterial Blood [Lactate]

Oxygen Uptake

Ventilation

Other Physiological Responses

Exercise Rehabilitation in Heart Disease

Exercise Rehabilitation in Chronic Obstructive Pulmonary Disease

ASSESSING THE EFFECTIVENESS OF TREATMENT

SCREENING FOR DEVELOPMENT OF DISEASE IN AT-RISK PATIENTS

GRADED EXERCISE TESTING AND THE ATHLETE

SUMMARY

9    Diagnostic Specificity of Exercise Intolerance: A Flowchart Approach

INTRODUCTION TO FLOWCHARTS

PEAK VO2 AND ANAEROBIC THRESHOLD (FLOWCHART 1)

EXERCISE INTOLERANCE WITH NORMAL PEAK OXYGEN UPTAKE (FLOWCHART 2)

LOW PEAK OXYGEN UPTAKE WITH NORMAL ANAEROBIC THRESHOLD (FLOWCHART 3)

LOW PEAK OXYGEN UPTAKE WITH LOW ANAEROBIC THRESHOLD (FLOWCHART 4)

LOW PEAK OXYGEN UPTAKE WITH ANAEROBIC THRESHOLD NOT DETERMINED (FLOWCHART 5)

SUMMARY

10  Case Presentations

PURPOSE AND MATERIAL

FORMAT FOR CASE PRESENTATIONS

Graphing Conventions

CHARACTERISTICS OF CASES

Scope

Conditions

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Tags: Kathy Sietsema, Darryl Sue, William Stringer, Susan Ward, Whipp’s Principles, Exercise Testing