Exploring Maximality Criteria of Cardiopulmonary Exercise Testing in Healthy Subjects and Patients with Chronic Respiratory Disease: A Practical Clinical Framework.
6 affiliations
- 1Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
- 2Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
- 3Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
- 4Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
- 5Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium, [email protected].
- 6Clinical Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium, [email protected].
Abstract
Background
Incremental cardiopulmonary exercise testing (CPET) is used to assess exercise capacity and identify mechanisms of exercise limitation. Identification of test maximality is essential for correct interpretation, yet no consensus exists on the defining criteria. This study evaluated the performance of different V˙O2 plateau definitions and the contribution of secondary maximality criteria in patients with chronic respiratory disease and healthy controls.Methods
We retrospectively analyzed 395 CPETs (84 healthy, 135 chronic obstructive pulmonary disease, 99 interstitial lung disease, 77 pulmonary hypertension), comparing consensus-based visual identification of a V˙O2 plateau by three pulmonologists with three commonly used plateau definitions. Additionally, five secondary maximality criteria were evaluated, using strict and liberal thresholds.Results
The relative V˙O2 plateau definition showed strong agreement with visual assessment (κ = 0.75-0.93), while absolute thresholds were discordant (κ = 0.02-0.31). Overlap between maximality criteria was high in healthy individuals but low in disease groups, suggesting that evaluating multiple criteria in parallel is necessary. However, combining more than 2 secondary criteria in healthy subjects and more than 3 in patients on top of V˙O2 plateau provided minimal additive value.Conclusion
CPET maximality assessment depends strongly on the criteria applied, potentially altering CPET interpretation and clinical decision-making.
Related
- Bridging the Artificial Intelligence Translation Gap in Perioperative Pulmonary and Respiratory Complications: A Practical Framework for Institution-Level Implementation
- Prediction of oxygen uptake at peak exercise in patients with inflammatory bowel disease using submaximal cardiopulmonary exercise testing and the steep ramp test as a practical field test
- Clinical performance and practical limitations of large language models in respiratory medicine
- Cardiopulmonary Resuscitation Knowledge Among Respiratory Therapy and Anesthesia Technology Students in Jordan: A Cross‐Sectional Study
- Exploring Factors and Nonpharmacological Interventions Associated With Respiratory Function in People With Multiple Sclerosis: A Scoping Review
BibTeX
@article{staes2026exploring,
title = {{Exploring Maximality Criteria of Cardiopulmonary Exercise Testing in Healthy Subjects and Patients with Chronic Respiratory Disease: A Practical Clinical Framework.}},
author = {Michaël Staes and Iwein Gyselinck and Maud Lormans and Marieke Wuyts and Thierry Troosters and Maarten De Vos and Wim Janssens},
journal = {Respiration; international review of thoracic diseases},
year = {2026},
month = oct,
doi = {10.1159/res/aepag004},
url = {https://europepmc.org/article/MED/42858305},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Exploring Maximality Criteria of Cardiopulmonary Exercise Testing in Healthy Subjects and Patients with Chronic Respiratory Disease: A Practical Clinical Framework.
AU - Michaël Staes
AU - Iwein Gyselinck
AU - Maud Lormans
AU - Marieke Wuyts
AU - Thierry Troosters
AU - Maarten De Vos
AU - Wim Janssens
PY - 2026
DA - 2026/10/10
JO - Respiration; international review of thoracic diseases
DO - 10.1159/res/aepag004
UR - https://europepmc.org/article/MED/42858305
AB - Background Incremental cardiopulmonary exercise testing (CPET) is used to assess exercise capacity and identify mechanisms of exercise limitation. Identification of test maximality is essential for correct interpretation, yet no consensus exists on the defining criteria. This study evaluated the performance of different V˙O2 plateau definitions and the contribution of secondary maximality criteria in patients with chronic respiratory disease and healthy controls.Methods We retrospectively analyzed 395 CPETs (84 healthy, 135 chronic obstructive pulmonary disease, 99 interstitial lung disease, 77 pulmonary hypertension), comparing consensus-based visual identification of a V˙O2 plateau by three pulmonologists with three commonly used plateau definitions. Additionally, five secondary maximality criteria were evaluated, using strict and liberal thresholds.Results The relative V˙O2 plateau definition showed strong agreement with visual assessment (κ = 0.75-0.93), while absolute thresholds were discordant (κ = 0.02-0.31). Overlap between maximality criteria was high in healthy individuals but low in disease groups, suggesting that evaluating multiple criteria in parallel is necessary. However, combining more than 2 secondary criteria in healthy subjects and more than 3 in patients on top of V˙O2 plateau provided minimal additive value.Conclusion CPET maximality assessment depends strongly on the criteria applied, potentially altering CPET interpretation and clinical decision-making.
SN - 0025-7931
SN - 1423-0356
ER -