title: Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement.
abstract: This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others.
authors.affiliation: Servicio de Neumología del Hospital Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain lpuente@separ.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Puente-Maestu
authors.affiliation: Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Palange
authors.affiliation: Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Casaburi
authors.affiliation: UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC Université Paris 06, INSERM, Paris, France Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.
authors.forename: Pierantonio
authors.initials: P
authors.lastname: Laveneziana
authors.affiliation: Institut Universitaire Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Maltais
authors.affiliation: Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada Division of Respirology, Clinical Exercise Physiology Unit, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: J Alberto
authors.initials: JA
authors.lastname: Neder
authors.affiliation: Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada.
authors.forename: Denis E
authors.initials: DE
authors.lastname: O'Donnell
authors.affiliation: Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy Ospedale Civile di Alghero, ASL1-Sassari, Alghero (SS), Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Onorati
authors.affiliation: Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Janos
authors.initials: J
authors.lastname: Porszasz
authors.affiliation: ELEGI Colt Laboratory, Centre for Inflammation Research, The Queen`s Medical Research Institute, University of Edinburgh, Edinburgh, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rabinovich
authors.affiliation: Rehabilitation Clinical Trials Center, Division of Pulmonary and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA Faculty of Biological Sciences, University of Leeds, Leeds, UK.
authors.forename: Harry B
authors.identifier: http://orcid.org/0000-0002-7884-0726
authors.initials: HB
authors.lastname: Rossiter
authors.affiliation: Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leciester NHS Trust, Leciester, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Singh
authors.affiliation: Dept of Rehabilitation Sciences, KU Leuven, Leuven, Belgium Respiratory Rehabilitation Division, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Troosters
authors.affiliation: Human Bio-Energetics Research Centre, Crickhowell, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Ward
mesh_terms: D026683:Advisory Committees; D001944:Breath Tests; D002245:Carbon Dioxide; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology*; D005060:Europe; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D007320:Inspiratory Capacity; D017063:Outcome Assessment, Health Care; D010101:Oxygen Consumption; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D015272:Pulmonary Medicine; D012123:Pulmonary Ventilation; D015203:Reproducibility of Results; D012140:Respiratory Tract Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012955:Societies, Medical; D016138:Walking
chemical_list: D002245:Carbon Dioxide