Exercise testing is increasingly utilized to evaluate the level of exercise intolerance in patients with lung and heart diseases. Cardiopulmonary exercise testing (CPET) is considered the gold standard to study a patient’s level of exercise limitation and its causes. The 2 CPET protocols most frequently used in the clinical setting are the maximal incremental and the constant work rate tests. The aim of this review is to focus on the main respiratory diseases for which exercise tolerance is indicated; for example, chronic obstructive pulmonary disease, interstitial lung disease, primary pulmonary hypertension and cystic fibrosis. This review also focuses on the variables/indices that are utilized in the functional and prognostic evaluation. The recognition of abnormal response patterns of ventilatory, cardiac and metabolic limitation to exercise may help in the diagnostic evaluation. In addition, CPET indexes can provide important functional and prognostic information regarding patients with pulmonary disease. Exercise indices, such as peak oxygen uptake (V’O2 peak), ventilatory equivalents for carbon dioxide production (V’E-/V’CO2) and arterial oxygen saturation (SpO2), have in fact proven to be better predictors of prognosis than lung function measurements obtained at rest. Moreover, useful information on the effects of therapeutic interventions may be obtained by CPET by studying the changes in endurance capacity during high-intensity constant work rate protocols.

Keywords:
Lung disease, Exercise testing, prognosis, Oxygen uptake, Ventilatory efficiency, Time to exercise limitation
1.
Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, O’Donnell DE, Puente-Maestu L, Schols AM, Singh S, Whipp BJ: Recommendations on the use of exercise testing in clinical practice. Eur Respir J 2007;29:185–209.
2.
Leidy NK, Wyrwich KW: Bridging the gap: using triangulation methodology to estimate minimal clinically important differences (MCIDs). COPD 2005;2:157–165.
3.
O’Donnell DE, Chau LKL, Bertley JC, Webb KA: Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am J Respir Crit Care Med 1997;155:109–115.
4.
Wasserman K, Whipp BJ, Koyan SN, Cleary MG: Effect of carotid body resection on ventilatory and acid-base control during exercise. J Appl Physiol 1975;39:354–358.
5.
Killian KJ: Limitation to muscular activity in chronic obstructive pulmonary disease. Eur Respir J 2004;24:6–7.
6.
Gandevia B, Hugh-Jones P: Terminology of measurements of ventilatory capacity. Thorax 1957;12:290–293.
7.
Dillard TA, Piantadosi S, Rajagopal KR: Prediction of ventilation at maximal exercise in chronic airflow obstruction. Am Rev Respir Dis 1985;132:230–235.
8.
Sue DY, Hansen JE: Normal values in adults during exercise testing. Clin Chest Med 1984;5:89–98.
9.
Wasserman K, Hansen JE, Sue DY: Principles of Exercise Testing and Interpretation. Philadelphia, Lea & Febiger, 1994.
10.
Jones NL: Clinical Exercise Testing, ed 3. Philadelphia, WB Saunders Co., 1988.
11.
Hansen JE II: Respiratory abnormalities: exercise evaluation of the dyspnoeic patient; in Leff AR (ed): Cardiopulmonary Exercise Testing. New York, Grune & Stratton, 1986, pp 668–688.
12.
Johnson BD, Weisman IM, Zeballos RJ, Beck KC: Emerging concepts in the evaluation of ventilatory limitation during exercise: the exercise tidal flow-volume loop. Chest 1999;116:488–503.
13.
Hansen JE, Sue DY, Wasserman K: Predicted values for clinical exercise testing. Am Rev Respir Dis 1984;129:S49–S55.
14.
Whipp BJ, Wasserman K: Alveolar-arterial gas tension differences during graded exercise. J Appl Physiol 1969;27:361–365.
15.
Badesch DB, Abman SH, Ahearn GS, et al: Medical therapy for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004;126:35S–62S.
16.
Mak VH, Bugler JR, Roberts CM, Spiro SG: Effect of arterial oxygen desaturation on six minute walk distance, perceived effort, and perceived breathlessness in patients with airflow limitation. Thorax 1993;48:33–38.
17.
Poulain M, Durand F, Palomba B, et al: 6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD. Chest 2003;123:1401–1407.
18.
ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211–277.
19.
Oga T, Nishimura K, Tsukino M, et al: The effects of oxitropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease: a comparison of three different exercise tests. Am J Respir Crit Care Med 2000;161:1897–1901.
20.
Palange P, Crimi E, Pellegrino R, et al: Supplemental oxygen and heliox: ‘new’ tools for exercise training in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2005;11:145–148.
21.
Wasserman K, Whipp BJ, Casaburi R: Respiratory control during exercise; in Fishman AP (ed): Handbook of Physiology, section 3, vol 3, part 2: The Respiratory System. Bethesda, American Physiological Society, 1986, pp 595–619.
22.
Casaburi R, Porszasz J, Burns MR, et al: Physiologic benefits of exercise training in rehabilitation of severe COPD patients. Am J Respir Crit Care Med 1997;155:1541–1551.
23.
Wasserman K, Hansen JE, Sue DY, Stringer W, Whipp BJ: Principles of Exercise Testing and Interpretation, ed 4. Philadelphia, Lea & Febiger, 2004.
24.
Paterson DH, Cunningham DA: The gas transporting systems: limits and modifications with age and training. Can J Appl Physiol 1999;24:28–40.
25.
Puente-Maestu L, Sanz ML, Sanz P, Ruiz de Ona JM, Rodriguez-Hermosa JL, Whipp BJ: Effects of two types of training on pulmonary and cardiac responses to moderate exercise in patients with COPD. Eur Respir J 2000;15:1026–1032.
26.
Poole DC, Ward SA, Gardner GW, et al: Metabolic and respiratory profile of the upper limit for prolonged exercise in man. Ergonomics 1988;31:1265–1279.
27.
Poole DC, Ward SA, Whipp BJ: The effects of training on the metabolic and respiratory profile of high-intensity cycle ergometer exercise. Eur J Appl Physiol 1990;59:421–429.
28.
O’Donnell DE, Fluge T, Gerken F, et al: Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J 2004;23:832–840.
29.
Somfay A, Porszasz J, Lee SM, et al: Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients. Eur Respir J 2001;18:77–84.
30.
Palange P, Valli G, Onorati P, et al: Effect of heliox on lung dynamic hyperinflation, dyspnea, and exercise endurance capacity in COPD patients. J Appl Physiol 2004;97:1637–1642.
31.
Emtner M, Porszasz J, Burns M, et al: Benefits of supplemental oxygen in exercise training in non-hypoxemic COPD patients. Am J Respir Crit Care Med 2003;168:1034–1042.
32.
O’Donnell DE, Webb KA: Exercise reconditioning in patients with chronic airflow limitation; in Torg JS, Shepherd RJ (eds): Current Therapy in Sports Medicine, ed 3. St. Louis, Mosby Year Book, 1995, pp 678–684.
33.
O’Donnell DE, Webb KA: Exertional breathlessness in patients with chronic airflow limitation: the role of hyperinflation. Am Rev Respir Dis 1993;148:1351–1357.
34.
Killian KJ, Leblanc P, Martin DH, Summers E, Jones NL, Campbell EJM: Exercise capacity and ventilatory, circulatory and symptom limitation in patients with chronic airflow limitation. Am Rev Respir Dis 1992;146:935–940.
35.
Hamilton AL, Killian KJ, Summers E, Jones NL: Symptom intensity and subjective limitation to exercise in patients with cardiorespiratory disorders. Chest 1996;110:1255–1263.
36.
Harms CA, Babcock MA, McClaran SR, et al: Respiratory muscle work compromises leg blood flow during maximal exercise. J Appl Physiol 1997;82:1573–1583.
37.
Levison H, Cherniack RM: Ventilatory cost of exercise in chronic obstructive pulmonary disease. J Appl Physiol 1968;25:21–27.
38.
Hyatt RE: Expiratory flow limitation. J Appl Physiol 1983;55:1–8.
39.
O’Donnell DE, Webb KA: Exercise; in Calverley P, MacNee W, Rennard S, Pride N (eds): Chronic Obstructive Lung Disease, ed 2. London, Edward Arnold, 2003, pp 243–265.
40.
Diaz O, Villafranco C, Ghezzo H, et al: Role of inspiratory capacity on exercise tolerance in COPD patients with and without tidal expiratory flow limitation at rest. Eur Respir J 2000;16:269–275.
41.
O’Donnell DE, Revill S, Webb KA: Dynamic hyperinflation and exercise intolerance in COPD. Am J Respir Crit Care Med 2001;164:770–777.
42.
Mohsenifar Z, Lee SM, Diaz P, et al: Single-breath diffusing capacity of the lung for carbon monoxide: a predictor of PaO2, maximum work rate, and walking distance in patients with emphysema. Chest 2003;123:1394–1400.
43.
O’Donnell DE: Exercise limitation and clinical exercise testing in chronic obstructive pulmonary disease; in: Weisman IM, Zeballos RJ (eds): Clinical Exercise Testing. Basel, Karger, 2002, pp 138–158.
44.
Oga T, Nissimura K, Tsukino M, Hajiro T, Ikeda A, Mishima M: Relationship between different indices of exercise capacity and clinical measures in patients with chronic obstructive pulmonary disease. Heart Lung 2002;31:374–381.
45.
Potter WA, Olafsson S, Hyatt RE: Ventilatory mechanics and expiratory flow limitation during exercise in patients with obstructive lung disease. J Clin Invest 1971;50:910–919.
46.
Dodd DS, Brancatisano T, Engel LA: Chest wall mechanics during exercise in patients with severe chronic airway obstruction. Am Rev Respir Dis 1984;129:33–38.
47.
Stubbing DG, Pengelly LD, Morse JLC, Jones NL: Pulmonary mechanics during exercise in subjects with chronic airflow obstruction. J Appl Physiol 1980;49:511–515.
48.
Babb TG, Viggiano R, Hurley B, Staats B, Rodarte JR: Effect of mild-to-moderate airflow limitation on exercise capacity. J Appl Physiol 1991;70:223–230.
49.
Yan S, Kaminski D, Sliwinski P: Reliability of inspiratory capacity for estimating end-expiratory lung volume changes during exercise in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;156:55–59.
50.
Pride NB, Macklem PT: Lung mechanics in disease; in Fishman AP (ed): Handbook of Physiology, section 3, vol. 3, part 2: The Respiratory System. Bethesda, American Physiological Society 1986, pp 659–692.
51.
Younes M: Determinants of thoracic excursions during exercise; in Whipp BJ, Wasserman K (eds): Lung Biology in Health and Disease, vol 42: Exercise, Pulmonary Physiology and Pathophysiology. New York, Marcel Dekker, 1991, pp 1–65.
52.
O’Donnell DE, Voduc N, Fitzpatrick M, Webb KA: Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease. Eur Respir J 2004;24:86–94.
53.
Vogiatzis I, Georgiadou O, Golemati S, et al: Patterns of dynamic hyperinflation during exercise and recovery in patients with severe chronic obstructive pulmonary disease. Thorax 2005;60:723–729.
54.
O’Donnell DE, He Z, Lam M, Webb KA, Hamilton A: Reproducibility of measurements of inspiratory capacity, dyspnea intensity and exercise endurance in multicentre trials in COPD. Eur Respir J 2004;24(suppl 48):323s.
55.
O’Donnell DE, Revill SM, Webb KA: Dynamic hyperinflaction and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164:770–777.
56.
Grimby G, Bunn J, Mead J: Relative contribution of rib cage and abdomen to ventilation during exercise. J Appl Physiol 1968;24:159–166.
57.
Ward SA: Discriminating features of responses in cardiopulmonary exercise testing; in Ward SA, Palange P (eds): Clinical Exercise Testing. Eur Respir Mon 2007;40:36–68.
58.
Barbera JA, Roca J, Ramirez J, Wagner PD, Usetti P, Rodriquez-Roisin R: Gas exchange during exercise in mild chronic obstructive pulmonary disease: correlation with lung structure. Am Rev Respir Dis 1991;144:520–525.
59.
Dantzker DR, D’Alonzo GE: The effect of exercise on pulmonary gas exchange in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1986;134:1135–1139.
60.
Hiraga T, Maekura R, Okuda Y, et al: Prognostic predictors for survival in patients with COPD using cardiopulmonary exercise testing. Clin Physiol Funct Imaging 2003;23:324–331.
61.
Palange P, Forte S, Onorati P, Manfredi F, Serra P, Carlone S: Ventilatory and metabolic adaptations to walking and cycling in patients with COPD. J Appl Physiol 2000;88:1715–1720.
62.
Turner SE, Eastwood PR, Cecins NM, Hillman DR, Jenkins SC: Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. Chest 2004;126:766–773.
63.
Man WD, Soliman MG, Gearing J, et al: Symptoms and quadriceps fatigability after walking and cycling in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2003;168:562–567.
64.
Gosselink R, Troosters R, Decramer M: Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996;153:976–980.
65.
Palange P, Forte S, Onorati P, Paravati V, Manfredi F, Serra P, Carlone S: Effect of reduced body weight on muscle aerobic capacity in patients with COPD. Chest 1998;114:12–18.
66.
Kelsen SG, Ference M, Kapoor S: Effects of prolonged undernutrition on structure and function of the diaphragm. J Appl Physiol 1985;58:1354–1359.
67.
Gertz I, Hedenstierna G, Hellers G, Wahren J: Muscle metabolism in patients with chronic obstructive lung disease and acute respiratory failure. Clin Sci Mol Med 1977;52:395–403.
68.
Nery LE, Wasserman K, Andrews JD, Huntsman DJ, Hansen JE, Whipp BJ: Ventilatory and gas exchange kinetics during exercise in chronic airway obstruction. J Appl Physiol 1982;53:1594–1602.
69.
Palange P, Galassetti P, Mannix ET, Farber MO, Manfredi F, Serra P, Carlone S: Oxygen effect on O2 deficit and VO2 kinetics during exercise in obstructive pulmonary disease. J Appl Physiol 1995;78:2228–2234.
70.
Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T: Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status. Am J Respir Crit Care Med 2003;167:544–549.
71.
Schonhofer B, Dellweg D, Suchi S, Kohler D: Exercise endurance before and after long-term noninvasive ventilation in patients with chronic respiratory failure. Respiration 2008;75:296–303.
72.
National Emphysema Treatment Trial Research Group: Cost effectiveness of lung volume reduction surgery for patients with severe emphysema. N Engl J Med 2003;348:2092–2102.
73.
O’Donnell DE, Fitzpatrick MF: Physiology of interstitial lung disease; in Schwartz MI, King TE Jr (eds): Interstitial Lung Disease, ed 4. Hamilton, Decker, 2003, pp 54–74.
74.
Widimsky J, Riedel M, Stonek V: Central hemodynamics during exercise in patients with restrictive pulmonary disease. Bull Eur Physiopathol Respir 1977;13:369–379.
75.
Yernault JC, de Jonghe M, de Coster A, Englert M: Pulmonary mechanics in diffuse fibrosing alveolitis. Bull Eur Physiopathol Respir 1975;22:231–244.
76.
Gibson GJ, Pride NB: Pulmonary mechanics in fibrosing alveolitis: the effects of lung shrinkage. Am Rev Respir Dis 1977;116:637–647.
77.
Jones NL, Rebuck AS: Tidal volume during exercise in patients with diffuse fibrosing alveolitis. Bull Eur Physiopathol Respir 1979;15:321–328.
78.
Marciniuk DD, Sridhar G, Clemens RE, Zintel TA, Gallagher CG: Lung volumes and expiratory flow limitation during exercise in interstitial lung disease. J Appl Physiol 1994;77:963–973.
79.
O’Donnell DE, Chau LKL, Webb KA: Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. J Appl Physiol 1998;84:2000–2009.
80.
Keogh BA, Lakatos E, Price D, Crystal RG: Importance of the lower respiratory tract in oxygen transfer: exercise testing in patients with interstitial and destructive lung disease. Am Rev Respir Dis 1984;129:S76–S80.
81.
Risk C, Epler GR, Gaensler EA: Exercise alveolar-arterial oxygen pressure difference in interstitial lung disease. Chest 1984;5:69–74.
82.
Johnson RL Jr, Spice WS, Bishop JM, Forster RE: Pulmonary capillary blood volume, flow and diffusing capacity during exercise. J Appl Physiol 1960;15:893–902.
83.
Agusti AGN, Roca J, Gea J, Wagner PD, Zaubet A, Rodriguez-Roisin R: Mechanisms of gas exchange impairment in idiopathic pulmonary fibrosis. Am Rev Respir Dis 1991;143:219–225.
84.
Hughes JMB, Lockwood DNA, Jones HA, Clark RJ: DLCO/Q and diffusion limitation at rest and on exercise in patients with interstitial fibrosis. Respir Physiol 1991;83:155–166.
85.
Hamer J: Cause of low arterial oxygen saturation in pulmonary fibrosis. Thorax 1964;19:507–514.
86.
Weitzenblum E, Ehrhart M, Rasaholinjanahary I, Hirth C: Pulmonary hemodynamics in idiopathic pulmonary fibrosis and other interstitial pulmonary diseases. Respiration 1983;44:118–127.
87.
Enson Y, Thomas HM, Bosken CH, et al: Pulmonary hypertension in interstitial lung disease: relation of vascular resistance to abnormal lung structure. Trans Assoc Am Physicians 1975;88:248–255.
88.
McLees B, Fulmer J, Adair N, et al: Correlative studies of pulmonary hypertension in idiopathic pulmonary fibrosis. Am Rev Respir Dis 1977;115:354A.
89.
Jezek V, Michalnanik A, Fucik J, Ramaisl R: Long-term development of pulmonary arterial pressure in diffuse interstitial lung fibrosis. Prog Respir Res 1985;20:170–175.
90.
Hawrylkiewicz I, Izdebska-Makosa Z, Grebska E, Zielinski J: Pulmonary haemodynamics at rest and on exercise in patients with idiopathic pulmonary fibrosis. Bull Eur Physiopathol Respir 1982;18:403–410.
91.
Lupi-Herrera E, Seoane M, Verdejo J, et al: Hemodynamic effects of hydralazine in interstitial lung disease patients with cor pulmonale: immediate and short-term evaluation at rest and during exercise. Chest 1985;87:564–573.
92.
Bush A, Busst CM: Cardiovascular function at rest and on exercise in patients with cryptogenic fibrosing alveolitis. Thorax 1988;43:276–283.
93.
Sturani C, Papiris S, Galavotti V, Gunella G: Pulmonary vascular responsiveness at rest and during exercise in idiopathic pulmonary fibrosis: effects of oxygen and nifedipine. Respiration 1986;50:117–129.
94.
Baughman PR, Gerson M, Bosken CH: Right and left ventricular function at rest and with exercise in patients with sarcoidosis. Chest 1984;85:301–306.
95.
Eklund A, Broman L, Broman M, Holmgren A: V/Q and alveolar gas exchange in pulmonary sarcoidosis. Eur Respir J 1989;2:135–144.
96.
Guttadauria M, Ellman H, Kaplan D: Progressive systemic sclerosis: pulmonary involvement. Clin Rheum Dis 1979;5:151–166.
97.
Miki K, Maekura R, Hiraga T, et al: Impairments and prognostic factors for survival in patients with idiopathic pulmonary fibrosis. Respir Med 2003;97:482–490.
98.
King TE Jr, Tooze JA, Schwarz MI, Brown KR, Cherniack RM: Predicting survival in idiopathic pulmonary fibrosis: scoring system and survival model. Am J Respir Crit Care Med 2001;164:1171–1181.
99.
Markowitz DH, Systrom DM: Diagnosis of pulmonary vascular limit to exercise by cardiopulmonary exercise testing. J Heart Lung Transplant 2004;23:88–95.
100.
Wensel R, Opitz CF, Anker SD, et al: Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation 2002;106:319–324.
101.
Sun XG, Hansen JR, Oudiz RJ, Wasserman K: Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation 2001;104:429–435.
102.
Systrom DM, Cockrill BA, Hales CA: Role of cardiopulmonary exercise testing in patients with pulmonary vascular disease; in Weisman IM, Zeballos RJ (eds): Clinical Exercise Testing. Basel, Karger, 2002, pp 200–204.
103.
Deboeck G, Niset G, Lamotte M, Vachiery JL, Naeije R: Exercise testing in pulmonary arterial hypertension and in chronic heart failure. Eur Respir J 2004;23:747–751.
104.
Yasunobu Y, Oudiz RJ, Sun XG, Hansen JE, Wasserman K: End-tidal PCO2 abnormality and exercise limitation in patients with primary pulmonary hypertension. Chest 2005;127:1637–1646.
105.
Ting H, Sun XG, Chuang ML, Lewis DA, Hansen JE: A noninvasive assessment of pulmonary perfusion abnormality in patients with primary pulmonary hypertension. Chest 2001;119:824–832.
106.
Aguggini G, Clement MG, Widdicombe JG: Lung reflexes affecting the larynx in the pig, and the effect of pulmonary microembolism. Q J Exp Physiol 1987;72:95–104.
107.
Wasserman K, Hansen J, Sue DY, Casaburi R, Whipp B (eds): Principles of Exercise Testing and Interpretation, ed 3. Baltimore, Lippincott, Williams & Wilkins, 1999.
108.
Valli G, Vizza CD, Onorati P, Badagliacca R, Ciuffa R, Poscia R, Brandimarte F, Fedele F, Serra P, Palange P: Pathophysiological adaptations to walking and cycling in primary pulmonary hypertension. Eur J Appl Physiol 2008;102:417–424.
109.
Holverda S, Gan CT, Marcus JT, Postmus PE, Boonstra A, Vonk-Noordegraaf A: Impaired stroke volume response to exercise in pulmonary arterial hypertension. J Am Coll Cardiol 2006;47:1732–1733.
110.
Schneiderman-Walker J, Pollock SL, Corey M, et al: A randomised controlled trial of a 3-year home exercise programme in cystic fibrosis. J Pediatr 2000;136:304–310.
111.
Moorcroft AJ, Dodd ME, Morris J, Webb AK: Individualised unsupervised exercise training in adults with cystic fibrosis: a 1 year randomised controlled trial. Thorax 2004;59:1074–1080.
112.
Godfrey S, Mearns M: Pulmonary function and response to exercise in cystic fibrosis. Arch Dis Child 1971;46:144–151.
113.
Cerny FJ, Pullano TP, Cropp GJ: Cardiorespiratory adaptations to exercise in cystic fibrosis. Am Rev Respir Dis 1982;126:217–220.
114.
Moorcroft AJ, Dodd ME, Webb AK: Long-term change in exercise capacity, body mass, and pulmonary function in adults with cystic fibrosis. Chest 1997;111:338–343.
115.
Selvadurai HC, Allen J, Sachinwalla T, et al: Muscle function and resting energy expenditure in female athletes with cystic fibrosis. Am J Respir Crit Care Med 2003;66:1476–1480.
116.
Moser C, Tirakitsoontorn P, Nussbaum E, Newcomb R, Cooper D: Muscle size and cardiorespiratory response to exercise in cystic fibrosis 2000. Am J Respir Crit Care Med 2000;162:1823–1827.
117.
Shah AR, Gozal D, Keens TG: Determinants of aerobic and anaerobic exercise performance in cystic fibrosis. Am J Respir Crit Care Med 1988;157:1145–1150.
118.
Klijn PH, van der Net J, Kimpen JL, Helders PJ, van der Ent CK: Longitudinal determinants of peak anaerobic performance in children with cystic fibrosis. Chest 2003;124:2215–2219.
119.
Klijn PH, Terheggen-Lagro W, van der Ent CK, van der Net J, Kimpen JL, Helders PJ: Anaerobic exercise in pediatric cystic fibrosis. Pediatr Pulmonol 2003;36:223–229.
120.
Marcotte JE, Grisdale RK, Levison H, Ceates AL, Canny GJ: Multiple factors limit exercise capacity in cystic fibrosis. Pediatr Pulmonol 1986;2:274–281.
121.
Coates AL, Boyce P, Muller D, Mearns M, Godfrey S: The role of nutritional status, airway obstruction, hypoxia, and abnormalities in serum lipid composition in limiting exercise tolerance in children with cystic fibrosis. Acta Paediatr Scand 1980;69:353–358.
122.
Lands LC, Heigenhauser GJ, Jones NL: Analysis of factors imiting maximal exercise performance in cystic fibrosis. Clin Sci 1991;83:391–397.
123.
De Meer K, Gulmans VAM, van der Laag J: Peripheral muscle weakness and exercise capacity in children with cystic fibrosis. Am J Respir Crit Care Med 1999;159:748–754.
124.
Thin AG, Dodd JD, Gallagher CG, et al: Effect of respiratory rate on airway dead space ventilation during exercise in cystic fibrosis. Respir Med 2004;98:1063–1070.
125.
Hjeltnes N, Stanghelle JK, Skyberg D: Pulmonary function and oxygen uptake during exercise in 16-year-old boys with cystic fibrosis. Acta Paediatr Scand 1984;73:548–553.
126.
Martin D, Day J, Ward G, Carter E, Chesrown S: Effects of breathing a normoxic helium mixture on exercise tolerance of patients with cystic fibrosis. Pediatr Pulmonol 1994;18:206–210.
127.
McLoughlin P, McKeogh D, Byrne P, Finlay G, Hayes J, FitzGerald MX: Assessment of fitness in patients with cystic fibrosis and mild lung disease. Thorax 1997;52:425–430.
128.
Nikolaizik WH, Knopfli B, Leister E, de Boer P, Sievers B, Schoni MH: The anaerobic threshold in cystic fibrosis: comparison of V-slope method, lactate turn points, and Conconi test. Pediatr Pulmonol 1998;25:147–153.
129.
Lebecque P, Lapierre JG, Lamarre A, et al: Diffusion capacity and oxygen desaturation effects on exercise in patients with cystic fibrosis. Chest 1987;91:693–697.
130.
Moorcroft AJ, Dodd ME, Morris J, Webb AK: Symptoms, lactate and exercise limitation at peak cycle ergometry in adults with cystic fibrosis. Eur Respir J 2005;25:1050–1056.
131.
Marcotte JE, Canny GJ, Grisdale R, et al: Effects of nutritional status on exercise performance in advanced cystic fibrosis. Chest 1986;90:375–379.
132.
Boas SR, Joswiak ML, Nixon PA, Fulton JA, Orenstein DM: Factors limiting anaerobic performance in adolescent males with cystic fibrosis. Med Sci Sports Exer 1996;28:291–298.
133.
Boucher GP, Lands L, Hay JA, Hornby L: Activity levels and relationship to lung function and nutritional status in children with cystic fibrosis. Am J Phys Med Rehab 1997;76:311–315.
134.
Nixon PA, Orenstein DM, Kelsey SF: Habitual activity in children and adolescents with cystic fibrosis. Med Sci Sports Exer 2001;33:30–35.
135.
Kerem E, Reisman J, Corey M, Canny GJ, Levison H: Prediction of mortality in patients with cystic fibrosis. N Engl J Med 1992;326:1187–1191.
136.
International guidelines for the selection of lung transplant candidates. The American Society for Transplant Physicians (ASTP)/American Thoracic Society (ATS)/European Respiratory Society (ERS)/International Society for Heart and Lung Transplantation (ISHLT). Am J Respir Crit Care Med 1998;158:335–339.
137.
Augarten A, Akons H, Aviram M, et al: Prediction of mortality and timing of referral for lung transplantation in cystic fibrosis patients. Pediat Transplant 2001;5:339–342.
138.
Sharples L, Hathaway T, Dennis C, Caine N, Higenbottam T, Wallwork J: Prognosis of patients with cystic fibrosis awaiting heart and lung transplantation. J Heart Lung Transplant 1993;12:669–674.
139.
Nixon PA, Orenstein DM, Kelsey SF, Doershuk CF: The prognostic value of exercise testing in patients with cystic fibrosis. N Engl J Med 1992;327:1785–1788.
140.
Stanghelle JK, Skyberg D, Haanaes OC: Eight-year follow-up of pulmonary function and oxygen uptake during exercise in 16-year-old males with cystic fibrosis. Acta Paediatr 1992;81:527–531.
141.
Moorcroft AJ, Dodd ME, Webb AK: Exercise testing and prognosis in adult cystic fibrosis. Thorax 1997;52:291–293.
142.
Tantisira KG, Systrom DM, Ginns LC: An elevated breathing reserve index at lactate threshold is a predictor of mortality in patients with cystic fibrosis awaiting lung transplantation. Am J Respir Crit Care Med 2002;165:1629–1633.
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