2-day CPET

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2-day CPET
Ergospirometry laboratory.jpg
A CPET being administered

A 2-day CPET is a cardiopulmonary exercise test given on two successive days to measure the effect of post-exertional malaise (PEM) on a patient's ability to exercise. [1] [2] PEM is a cardinal symptom of myalgic encephalomyelitis/chronic fatigue syndrome and is common in long COVID as well. [3]

Background

Several differences have been found between people with and without ME/CFS, including people with other diseases or who are sedentary. On the first test, people with ME/CFS exhibit lower performance and heart rate, and on the second test, performance is even lower, while for controls, it is the same or slightly better. The largest decrease is in anaerobic threshold, which signifies a shift from aerobic to anaerobic metabolism at a lower level of exertion, and is not influenced by effort. [3] [1] [4] Peak power output, heart rate, and VO2max also decrease, and in ME/CFS, but effort and familiarity with the test may affect VO2max and power. [5] [3] Additionally, healthy people generally recover from a CPET within 24 hours while people with ME/CFS do not. [6]

A 2-day CPET can objectively measure PEM and its effect on physical functioning. [7] (Objective indicators of maximal effort during both tests control for effort.) [7] However, its utility has not been completely confirmed, as many studies of it have been small. [4] While it should not be required for a diagnosis, a 2-day CPET can show that symptoms are not due to deconditioning and provide evidence for obtaining disability benefits. [7] Because PEM is also a symptom of long COVID, the 2-day CPET may be useful in evaluating exercise intolerance there as well. [8]

The cause of decreased performance is not understood. Proposals include impaired oxygen transport, impaired aerobic metabolism, and mitochondrial dysfunction. [3]

The test provokes symptoms by design, and recovery may be prolonged. In some cases, it may worsen the illness long-term. [3] [7]

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<span class="mw-page-title-main">Exercise intolerance</span> Inability to perform physical exercise at normal levels

Exercise intolerance is a condition of inability or decreased ability to perform physical exercise at the normally expected level or duration for people of that age, size, sex, and muscle mass. It also includes experiences of unusually severe post-exercise pain, fatigue, nausea, vomiting or other negative effects. Exercise intolerance is not a disease or syndrome in and of itself, but can result from various disorders.

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<span class="mw-page-title-main">Post-exertional malaise</span> Worsening of symptoms with activity

Post-exertional malaise (PEM), sometimes referred to as post-exertional symptom exacerbation (PESE) or post-exertional neuroimmune exhaustion (PENE), is a worsening of symptoms that occurs after minimal exertion. It is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and common in long COVID and fibromyalgia. PEM is often severe enough to be disabling, and is triggered by ordinary activities that healthy people tolerate. Typically, it begins 12–48 hours after the activity that triggers it, and lasts for days, but this is highly variable and may persist much longer. Management of PEM is symptom-based, and patients are recommended to pace their activities to avoid triggering PEM.

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Chronotropic incompetence (CI) is the inability of heart rate to increase as expected in response to exercise. The condition can be defined in different ways and occurs in various diseases. Sufferers have a higher risk of cardiovascular disease and early death.

References

  1. 1 2 "Lessons from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome for Long COVID Part 2: Physiological Characteristics During Acute Exercise Are Abnormal in People With Postexertional Symptom Exacerbation". JOSPT Blog. 2022-02-09. doi:10.2519/jospt.blog.20220209 (inactive 2024-09-23).{{cite journal}}: CS1 maint: DOI inactive as of September 2024 (link)
  2. Joseph, Phillip; Singh, Inderjit; Oliveira, Rudolf; Capone, Christine A.; Mullen, Mary P.; Cook, Dane B.; Stovall, Mary Catherine; Squires, Johanna; Madsen, Kristine; Waxman, Aaron B.; Systrom, David M. (2023). "Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2". Chest. 164 (3): 717–726. doi:10.1016/j.chest.2023.03.049. PMC   10088277 . PMID   37054777.
  3. 1 2 3 4 5 Franklin, John Derek; Graham, Michael (2022-07-03). "Repeated maximal exercise tests of peak oxygen consumption in people with myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review and meta-analysis". Fatigue: Biomedicine, Health & Behavior. 10 (3): 119–135. doi: 10.1080/21641846.2022.2108628 . ISSN   2164-1846. S2CID   251636593.
  4. 1 2 Lim, Eun-Jin; Kang, Eun-Bum; Jang, Eun-Su; Son, Chang-Gue (2020-12-14). "The Prospects of the Two-Day Cardiopulmonary Exercise Test (CPET) in ME/CFS Patients: A Meta-Analysis". Journal of Clinical Medicine. 9 (12): 4040. doi: 10.3390/jcm9124040 . ISSN   2077-0383. PMC   7765094 . PMID   33327624.
  5. Davenport, Todd E.; Lehnen, Mary; Stevens, Staci R.; VanNess, J. Mark; Stevens, Jared; Snell, Christopher R. (2019-03-22). "Chronotropic Intolerance: An Overlooked Determinant of Symptoms and Activity Limitation in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome?". Frontiers in Pediatrics. 7: 82. doi: 10.3389/fped.2019.00082 . ISSN   2296-2360. PMC   6439478 . PMID   30968005.
  6. Twomey, Rosie; et al. (2022-02-02). "Lessons from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome for Long COVID: Postexertional Symptom Exacerbation is an Abnormal Response to Exercise/Activity". JOSPT Blog. doi:10.2519/jospt.blog.20220202 (inactive 2024-09-23).{{cite journal}}: CS1 maint: DOI inactive as of September 2024 (link)
  7. 1 2 3 4 Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness (PDF). National Academies of Medicine Press. pp. 82–83.
  8. Durstenfeld, Matthew S.; Sun, Kaiwen; Tahir, Peggy; Peluso, Michael J.; Deeks, Steven G.; Aras, Mandar A.; Grandis, Donald J.; Long, Carlin S.; Beatty, Alexis; Hsue, Priscilla Y. (2022-10-12). "Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults: A Systematic Review and Meta-analysis". JAMA Network Open. 5 (10): e2236057. doi:10.1001/jamanetworkopen.2022.36057. ISSN   2574-3805. PMC   9557896 . PMID   36223120.