The potential benefits of assessing post-cardiopulmonary exercise testing (CPET) in aging: a narrative review

Abstract

Cardiopulmonary exercise testing (CPET) is an important tool to measure the cardiopulmonary fitness of an individual and has been widely used in athletic, clinical and research settings. Most CPET focus on analyzing physiological responses during exercise. We contend that the post-CPET recovery physiological responses offer further diagnostic and prognostic information about the health of the cardiopulmonary and metabolic systems, especially when testing apparently healthy middle-aged and older adults. However, there are limited studies that investigate physiological responses during the post-CPET recovery, and even less so in middle-aged and older adults. Therefore, this current review is aimed at discussing the contribution of post-CPET recovery parameters to cardiopulmonary health and their potential applications in aging populations. In addition to the existing methods, we propose to examine the aerobic and anaerobic recovery threshold post-CPET as novel potential diagnostic and/or prognostic tools.

Keywords: Aerobic/anaerobic thresholds; Cardiopulmonary exercise testing (CPET); Cardiorespiratory; Excess post-exercise oxygen consumption (EPOC).

Fig. 1

Variables that can be analyzed post-CPET, for the study of systemic function during post-exercise

Fig. 2

An example of a typical EPOC absolute measurements (red boxes and arrows: magnitude, duration, and area under curve) and the proposed recovery threshold measurements (blue boxes and arrows: anaerobic and aerobic recovery thresholds)

Fig. 3

Schematic illustration plots of ˙V̇CO₂ against V̇O₂ a during exercise and b post-exercise of a younger female adult, and c during exercise and d post-exercise of a middle-aged female adult e hypothetical 3-dimensional graph across time (during CPET and post-CPET), comparing one younger and one middle-aged adults, where a to d are expressed in a 3-dimensional graph across time (illustration not drawn to scale). Dotted lines represent aerobic threshold of a younger (a; blue dotted line) and a middle-aged adult (c; red dotted line). Proposed recovery aerobic threshold of a younger (b; blue dotted line) and a middle-aged female adult (d; red dotted line) (unpublished results)