Two-day cardiopulmonary exercise test: Difference between revisions
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'''Two-day cardiopulmonary exercise | '''Two-day cardiopulmonary exercise test''' or [[2-day CPET]] is an accepted, reliable test for [[post-exertional malaise]] (PEM), one of the cardinal symptoms that distinguishes between individuals with and without [[ME/CFS]].<ref>Davenport TE, Stevens SR, Baroni K, Van Ness M, Snell CR. (2011). Diagnostic accuracy of symptoms characterising chronic fatigue syndrome. ''Disability and Rehabilitation, 33''(19-20):1768-75. doi: 10.3109/09638288.2010.546936. Epub 2011 Jan 6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21208154</ref> The hypothesis is that ME/CFS patients are almost unique in having a severe deterioration in the second of the two cardiopulmonary exercise tests performed on consecutive days.<ref>Logan, Russell. 2-Day CPET: A gold standard test for ME fatigue. (24 Sept 2014). ''Shoutout About ME'' blog. Retrieved from http://www.shoutoutaboutme.com/testing/the-2-day-cpet-a-gold-standard-test-for-mecfs/</ref> | ||
The CPET is the same non-invasive test given to measure the fitness levels of athletics, as well as, people with cardiopulmonary illness.<ref>K Albouaini, M Egred, and A Alahmar, D J Wright. (2007). Cardiopulmonary exercise testing and its application. ''Postgraduate Medical Journal, 83''(985): 675–682. doi: 10.1136/hrt.2007.121558 PMCID: PMC2734442 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734442/</ref> However, if the test is repeated 24 hours later, ME/CFS patients will fare significantly worst than they did on the first day. The [[Institute of Medicine report]] states that: "ME/CFS patients have significantly lower results on CPET 2 than on CPET 1 on one or more of the following parameters: VO2max (Keller et al., 2014; VanNess et al., 2007; Vermeulen et al., 2010),<ref name="Vermeulen2010" /> VO2 at ventilatory threshold (Keller et al., 2014), and maximal workload or workload at ventilatory threshold (Keller et al., 2014; Snell et al., 2013)."<ref>Chapter 4, Review of the Evidence on Major ME/CFS Symptoms and Manifestations." Institute of Medicine. ''Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness.'' Washington, DC: The National Academies Press, 2015. doi:10.17226/19012. Retrieved from http://www.nap.edu/read/19012/chapter/6?term=CPET#83</ref> | The CPET is the same non-invasive test given to measure the fitness levels of athletics, as well as, people with cardiopulmonary illness.<ref>K Albouaini, M Egred, and A Alahmar, D J Wright. (2007). Cardiopulmonary exercise testing and its application. ''Postgraduate Medical Journal, 83''(985): 675–682. doi: 10.1136/hrt.2007.121558 PMCID: PMC2734442 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734442/</ref> However, if the test is repeated 24 hours later, ME/CFS patients will fare significantly worst than they did on the first day. The [[Institute of Medicine report]] states that: "ME/CFS patients have significantly lower results on CPET 2 than on CPET 1 on one or more of the following parameters: VO2max (Keller et al., 2014; VanNess et al., 2007; Vermeulen et al., 2010),<ref name="Vermeulen2010" /> VO2 at ventilatory threshold (Keller et al., 2014), and maximal workload or workload at ventilatory threshold (Keller et al., 2014; Snell et al., 2013)."<ref>Chapter 4, Review of the Evidence on Major ME/CFS Symptoms and Manifestations." Institute of Medicine. ''Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness.'' Washington, DC: The National Academies Press, 2015. doi:10.17226/19012. Retrieved from http://www.nap.edu/read/19012/chapter/6?term=CPET#83</ref> |
Revision as of 00:50, May 22, 2018
Two-day cardiopulmonary exercise test or 2-day CPET is an accepted, reliable test for post-exertional malaise (PEM), one of the cardinal symptoms that distinguishes between individuals with and without ME/CFS.[1] The hypothesis is that ME/CFS patients are almost unique in having a severe deterioration in the second of the two cardiopulmonary exercise tests performed on consecutive days.[2]
The CPET is the same non-invasive test given to measure the fitness levels of athletics, as well as, people with cardiopulmonary illness.[3] However, if the test is repeated 24 hours later, ME/CFS patients will fare significantly worst than they did on the first day. The Institute of Medicine report states that: "ME/CFS patients have significantly lower results on CPET 2 than on CPET 1 on one or more of the following parameters: VO2max (Keller et al., 2014; VanNess et al., 2007; Vermeulen et al., 2010),[4] VO2 at ventilatory threshold (Keller et al., 2014), and maximal workload or workload at ventilatory threshold (Keller et al., 2014; Snell et al., 2013)."[5]
Although the Institute of Medicine report states that 2-day CPET is very reliable to objectively measure PEM, the IOM committee emphasized "that the CPET is not required to diagnose patients with ME/CFS. Further, this test carries substantial risk for these patients as it may worsen their condition (Nijs et al., 2010; VanNess et al., 2010)."[6]
Evidence[edit | edit source]
- 2017, Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study (Lynette Hodges, T. Nielsen, D. Baken)[7]
- 2014, Inability of myalgic encephalomyelitis/chronic fatigue syndrome patients to reproduce VO₂peak indicates functional impairment (Betsy Keller)
- 2013, Discriminative validity of metabolic and workload measurements for identifying people with chronic fatigue syndrome (Christopher Snell, Staci Stevens, Todd Davenport, Mark VanNess)
Cost and availability[edit | edit source]
- Workwell Foundation (United States, CA)
- Betsy Keller at Ithaca College (United States, NY) Cost is $2200. Because they are based in a college setting (not healthcare setting), they cannot process insurance (including Medicare or Medicaid), so the patient would need to work directly with their insurer about reimbursement. (private email)
- Charles Lapp and Laura Black, both at Hunter-Hopkins, Charlotte, NC
- Open Medicine Institute Clinic
- Physiologic 334 Scottsdale Drive, Robina, Gold Coast, Australia
Talks and interviews[edit | edit source]
- 2014, Mark VanNess 'Exercise and ME/CFS' at Bristol Watershed. Part One
- 2013, CPET Presentation by Dr. Christopher Snell, Part ICPET Presentation by Dr. Christopher Snell, Part II
Learn more[edit | edit source]
- The Workwell Foundation: Testing for Disability
- 2013, Busted! Exercise Study Finds Energy Production System is Broken in Chronic Fatigue Syndrome
- 2013, Repeat Test Reveals Dramatic Drop in ME/CFS Exercise Capacity
- 2007, Legal and Scientific Considerations of the Exercise Stress Test
See also[edit | edit source]
References[edit | edit source]
- ↑ Davenport TE, Stevens SR, Baroni K, Van Ness M, Snell CR. (2011). Diagnostic accuracy of symptoms characterising chronic fatigue syndrome. Disability and Rehabilitation, 33(19-20):1768-75. doi: 10.3109/09638288.2010.546936. Epub 2011 Jan 6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21208154
- ↑ Logan, Russell. 2-Day CPET: A gold standard test for ME fatigue. (24 Sept 2014). Shoutout About ME blog. Retrieved from http://www.shoutoutaboutme.com/testing/the-2-day-cpet-a-gold-standard-test-for-mecfs/
- ↑ K Albouaini, M Egred, and A Alahmar, D J Wright. (2007). Cardiopulmonary exercise testing and its application. Postgraduate Medical Journal, 83(985): 675–682. doi: 10.1136/hrt.2007.121558 PMCID: PMC2734442 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2734442/
- ↑ Vermeulen, RC; Kurk, RM; Visser, FC; Sluiter, W; Scholte, HR (October 2010), "Patients with chronic fatigue syndrome performed worse than controls in a controlled repeated exercise study despite a normal oxidative phosphorylation capacity", J Transl Med, doi:10.1186/1479-5876-8-93, PMID 20937116
- ↑ Chapter 4, Review of the Evidence on Major ME/CFS Symptoms and Manifestations." Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press, 2015. doi:10.17226/19012. Retrieved from http://www.nap.edu/read/19012/chapter/6?term=CPET#83
- ↑ Chapter 4, Review of the Evidence on Major ME/CFS Symptoms and Manifestations." Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press, 2015. doi:10.17226/19012. Retrieved from http://www.nap.edu/read/19012/chapter/6?term=CPET#83
- ↑ Hodges, Lynette; Nielsen, T.; Baken, D. (August 2017), "Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study", Clinical Physiology and Functional Imaging, Aug 2017, doi:10.1111/cpf.12460