title: Feasibility and Safety of Cardiopulmonary Exercise Testing in Multiple Sclerosis: A Systematic Review.
abstract: OBJECTIVE
  To investigate the feasibility and safety of cardiopulmonary exercise testing (CPET) in patients with multiple sclerosis (MS).
  
  
  METHODS
  PubMed, EMBASE, CINAHL, SPORTDiscus, PsycINFO, ERIC, and the Psychology and Behavioral Sciences Collection were searched up to October 2014. References from retrieved articles were examined to identify additional relevant studies.
  
  
  METHODS
  Inclusion of original studies was on the basis of performance of maximal CPET, description of the protocol, and participants with definite MS aged ≥18 years. No language restrictions were applied.
  
  
  METHODS
  The quality of CPET reporting in included studies was scored according to a structured checklist considering 10 feasibility (eg, test abnormalities) and 12 safety quality criteria (eg, adverse events). Structured data extraction was performed for these feasibility and safety features of CPET.
  
  
  RESULTS
  Forty-six studies were included, comprising 1483 patients with MS, with a mean age ± SD of 42.0±5.8 years and a median Expanded Disability Status Scale (EDSS) score of 2.8 (first quartile=2.1; third quartile=3.9; range of average EDSS scores, .75-5.8). Quality of reporting on CPET varied from 3 to 13 out of a possible 22 quality points. The percentage of test abnormalities (feasibility) was 10.0%, primarily because of an inability to maintain pedaling at a specific resistance. The percentage of adverse events (safety) was 2.1%. All adverse events were temporary.
  
  
  CONCLUSIONS
  Based on the available data, we conclude that CPET is feasible provided that the CPET modality is tailored to the physical abilities of the patient. Furthermore, CPET is safe when recommended precautions and safety measures are implemented. However, future optimization of CPET will require protocolized testing and the implementation of standard reporting procedures.
authors.affiliation: Department of Rehabilitation Medicine, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands. Electronic address: l.vandenakker@vumc.nl.
authors.forename: Lizanne Eva
authors.initials: LE
authors.lastname: van den Akker
authors.affiliation: Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Heine
authors.affiliation: Department of Rehabilitation Medicine, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands; Faculty of Medicine, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Nikki
authors.initials: N
authors.lastname: van der Veldt
authors.affiliation: Department of Rehabilitation Medicine, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.affiliation: Department of Rehabilitation Medicine, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: de Groot
authors.affiliation: Department of Rehabilitation Medicine, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Beckerman
mesh_terms: D006233:Persons with Disabilities; D005080:Exercise Test / Q000379:methods*; D006801:Humans; D009103:Multiple Sclerosis / Q000534:rehabilitation*; D061214:Patient Safety
keywords: Cardiopulmonary exercise test; Multiple sclerosis; Physical fitness; Rehabilitation; Safety