Cardiopulmonary Exercise Testing (CPET) is considered the best objective test of a person’s functional capacity – testing cardiac, pulmonary, metabolic and ventilatory systems in unison
This is commonly used in athletes but increasingly applicable to patients having major surgery. CPET testing involves the patient exercising on a bike against increasing resistance (workload) allowing gas exchange analysis to measure anaerobic threshold (AT) and peak oxygen consumption (pVO2) and 12-lead ECG monitoring for myocardial ischaemia. The stress from this test is used as a surrogate for the stress experienced during surgery and provides a valuable risk stratification tool for major surgery. Those patients identified to be at high risk can then be sent for a prehabilitation program (see below), be monitored in high dependency areas post operatively, and occasionally offered alternative therapy to surgery if the surgical risk is too high.
The main purpose of CPET is to understand the functional capacity and therefore associated risk of major surgery to patients and then to ensure patients receive the appropriate care during their time at the hospital, with a major focus on reducing the risk of major surgery. Patients identified to be deconditioned and at increased surgical risk can be optimised through a tailored prehabilitation program, using exercise prescription, nutritional optimisation, optimisation of blood haemoglobin levels to carry oxygen in the blood, and through referral to other specialists (cardiologist, respiratory physicians etc) when necessary. Prehabilitation before surgery helps improve the functional capacity (fitness) of the patient to better cope with the stress of major surgery.
CPET can provide useful information for many different types of major surgery. The test itself takes approximately 60-90 minutes, and includes lung function testing, exercising for 12-15 minutes, and then formulating a prehabilitation program around the individual patients functional capacity to ensure he/she is fit for surgery. The risks of CPET is the same as those involved in moderate to intense exercise. However, medical cover is available for every test as a precautionary measure. Patients coming in for CPET should:
- be fasted for at least 2 hours prior to the test
- avoid alcohol 24 hours prior to the test
- avoid consuming caffeine on the day of the test
Patients should wear appropriate/comfortable clothing for the test. Preferably, this should include trainers/walking shoes, trousers or shorts and a top that won’t cause them to get too warm during the test.
If you are likely to benefit from CPET, one of the surgical or anaesthetic team members will usually discuss this with you before organising the test. However, if you would like further information or to see if CPET can help yourself or one of your patients, feel free to contact the people listed below or ask about CPET in one of the pre surgery clinics.
Thursdays 13:30 – 16:30 (only 3 slots available)
Specialist Clinics, Clinic 2D
305 Grattan Street
Melbourne VIC 3000
Phone: 03 8559 5555
Dr Hilmy Ismail