American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

Cardiopulmonary Exercise Testing (CPET)

Cardiopulmonary exercise testing (CPET or CPEX),
also referred to as a VO2 (oxygen consumption)
test, is a specialized type of stress test or
exercise test that measures your exercise ability.
Information about the heart and lungs is collected
to understand if the body’s response to exercise is
normal or abnormal.
Why am I being asked to perform this test? ■ an acute medical illness or poorly controlled
There are many common reasons CPET is performed chronic medical condition
including to: ■ a recent heart attack (within 30 days)
■ determine a cause of unexplained shortness of ■ severely low oxygen levels
breath ■ severely high blood pressure
■ assess exercise capacity
■ uncontrolled heart rhythm or heart rate problems
■ assess your risk for a planned surgical procedure
Let the lab know if there has been a recent change
CLIP AND COPY

In people who have known heart or lung disease, a in your health status such as acute infection or injury
CPET may be done to: that may prevent exercising.
■ check the severity of respiratory disease (such

as chronic obstructive lung disease, pulmonary How do I prepare for testing?

vascular disease, cystic fibrosis, and others) You should receive instructions from your healthcare
■ determine how much of a limit in exercise is due provider or the pulmonary laboratory where the
to the heart or the lungs in people who have both test is being performed. These instructions may
heart and lung disease vary slightly between labs. Here are some common
■ help define how much impairment or disability a instructions:
person has to help guide what he or she can do ■ Wear comfortable clothing that you can exercise in,

in a rehabilitation programs or to get an exercise including shoes that you can walk/run or bike in.
prescription ■ Do not exercise on the day of the test.

■ define the response to treatments ■ Eat lightly the day of the test. Do not eat 3-4 hours

■ see if advanced treatments like heart (or more) before the test.
transplantation should be considered to help with ■ Try to avoid drinking caffeine on the day of the test.
congestive heart failure (CHF) ■ Do not smoke or vape on the day of the test.

Sometimes CPET is done as a part of a research ■ Bring a list of your medications with you. It is
study. usually recommended that you take all of your
Are there reasons why I might not be able to usual medications on the day of the test, although
perform a CPET? sometimes you may be asked to stop any inhalers
prior to testing.
There are several including:
■ musculoskeletal conditions preventing a person What can I expect during testing?
from being able to walk or run on a treadmill or The testing will start with pulmonary function
pedal a stationary bike tests (PFTs), including spirometry and sometimes

Am J Respir Crit Care Med Vol. 201, P1-P2, 2020

ATS Patient Education Series © 2020 American Thoracic Society
www.thoracic.org
 American Thoracic Society

PATIENT EDUCATION | INFORMATION SERIES

additional tests. For more information about progressively harder until the point that you are
spirometry and lung function testing, see the ATS no longer able to continue, with the entire exercise
Patient Information Series fact sheet at www. period generally lasting 8-12 minutes. It is important
thoracic.org. that you make your best effort to exercise as hard as
Then you prepare for the exercise portion of the test. you can even if you feel uncomfortable to figure out
The lab staff will place monitors on you to watch your what might be limiting your ability to exercise.
heart and breathing during exercise. You will have The staff supervising your test may talk to you during
EKG leads (wires attached to stickers) on the chest. testing with some encouragement or reminders
A blood pressure cuff will be placed on the upper about what to do. When you can no longer continue
arm. You will wear a pulse oximeter (measures the because of exhaustion the test is over but you will
saturation of oxygen to your blood) on your finger, continue to slowly walk or cycle the bike as part of
or sometimes on the ear or forehead. You will wear a cool down period. After the cool down you will
a mouthpiece or a mask that is strapped to the be able to sit down, get a drink of water, and the
head during testing and you will breathe through equipment will be removed.
a flow meter with tubing attached. This is a device You may be monitored for a short period of time after
that measures how deeply and fast you breathe, in exercise and if an arterial catheter is in place this will
addition to the oxygen and carbon dioxide that flow be removed with pressure held for several minutes
in and out. before a bandage is placed.
Your healthcare provider may want an arterial blood
gas sample prior to and during exercise. This is
When will I get my test results?
obtained by either puncturing the artery in the wrist During the test, the information describing your
with a small needle, or placing a catheter (IV tubing) heart and lungs responses to exercise is collected
into the artery so blood can be drawn during exercise continuously and is generally averaged over 20-30
without multiple needle sticks. When this is done the second intervals. Thus, there are large amounts of
blood pressure is directly measured from the artery data and these tests take time for the staff and doctor
and you will not need to wear a blood pressure cuff. to review. Be sure you ask when you can expect to
learn the results from your test. Your healthcare
Depending on the goals of the test and any provider may want you to come into the office to
musculoskeletal problems you may have, the doctor review the findings.
supervising your test will choose a treadmill or
stationary bike for exercise. You will then be given Authors: Thomas W. DeCato MD, Hans Haverkamp
instructions based on the exercise you will perform. PhD, Matthew J. Hegewald MD
For the first 2-3 minutes, information is collected Reviewers: Marianna Sockrider MD, DrPH, David
while you are at rest. Kaminsky MD
At this point you will be instructed not to talk for the
remainder of the test as this can interfere with the Other Resources:
information collected. The staff will tell you how to American Thoracic Society
signal if you have a problem or need to interrupt the • www.thoracic.org/patients/
testing. – Lung function testing
Next a warm-up will begin. This is a walk on the – Arterial blood gas testing
treadmill or free cycling on the bike (no resistance on – Pulse oximetry
the pedals). After a 2-3 minute warm-up, the exercise Association for Respiratory Technology &
portion of the test will begin. Physiology (ARTP) United Kingdom
Depending on the test protocol, you may walk at a • http://www.artp.org.uk/en/patient/exercise/
CPET.cfm
faster pace or run on the treadmill while the incline is
increased. On the bike, the pedaling resistance will be This information is a public service of the American Thoracic Society.
increased, making it harder for you to maintain the The content is for educational purposes only. It should not be used as a
proper pace. The goal is for the exercise to become substitute for the medical advice of one’s healthcare provider.

www.thoracic.org