Reference values for cardiopulmonary exercise testing in healthy subjects - an updated systematic review

Area of Science:

• Exercise Physiology
• Clinical Diagnostics
• Reference Standards

Background:

• Cardiopulmonary exercise testing (CPET) parameters are vital for evaluating normal exercise responses in patients.
• Establishing accurate reference values impacts clinical decision-making.
• Previous reviews have provided foundational data for CPET interpretation.

Purpose of the Study:

• To systematically review and update reference values for CPET parameters in healthy individuals across the lifespan.
• To identify trends and gaps in the literature regarding CPET reference values.
• To provide an expert opinion on improving the quality of future research in this field.

Main Methods:

• Systematic literature search of MEDLINE, Embase, and PEDro databases.
• Focused on articles published between March 2014 and February 2019.
• Analysis of studies reporting reference values for CPET parameters in healthy subjects.

Main Results:

• A significant increase in published data on CPET reference values occurred in the last five years compared to the preceding 35 years.
• Despite increased data, substantial improvements in study quality are still needed.
• Identified areas for methodological enhancement in future research.

Conclusions:

• Recent literature provides more data on CPET reference values, but quality requires enhancement.
• Future studies should focus on power analysis, equipment quality assurance, and independent validation.
• Standardized reporting of physical activity, racial groups, and exclusion of smokers is recommended for robust reference equations.