Optimizing the Interpretation of Cardiopulmonary Exercise Testing in Endurance Athletes: Precision Approach for Health and Performance

Abstract

The present review summarizes findings from the NOODLE ("predictioN mOdels fOr enDurance athLetEs") study. The research aimed to refine variables obtained during cardiopulmonary exercise testing (CPET) in a large cohort of highly trained endurance athletes by adjusting general reference values and predictive equations to better reflect the unique physiological profiles of this population. Ventilatory efficiency, oxygen uptake efficiency slope, oxygen uptake efficiency plateau, and peak oxygen pulse were analyzed, as they were recently applied in various models concerning risk stratification and treatment optimization. As more people engage in endurance sports, tailored CPET assessments are crucial for accurate performance evaluation and health monitoring. By characterizing differences between general formulas and those suited for endurance athletes, we offered improved tools for optimizing training and ensuring athlete safety. The findings are in line with the existing trend of precision medicine that tailors diagnostics, treatments, and interventions to individual patients' characteristics. Moreover, we review the recent advances from widely applied CPET-obtained indices, such as maximum oxygen uptake, maximum heart rate, and breathing reserve. We also gave the recommendation for a comprehensive CPET assessment based on the relationships between all of the variables.

Keywords: cardiopulmonary exercise testing; cardiorespiratory fitness; endurance athletes; exercise physiology; sports cardiology.

Figure 1

Visual summary of key findings for discussed cardiorespiratory variables among endurance athletes. Abbreviations: VE/VCO₂-slope, ventilatory efficiency slope; EA, endurance athletes; OUES, oxygen uptake efficiency slope; OUEP, oxygen uptake efficiency plateau; O₂P_peak, peak oxygen pulse.