Cardiopulmonary Exercise Test (CPET)

Cardiopulmonary Exercise Test (CPET) - What it is

Here at NHCS, both treadmill (top) and bicycle (bottom) modes of conducting CPET are available

A Cardiopulmonary Exercise Test (CPET) is performed like an exercise stress test with added components to provide a deeper analysis into the exercise-related physiological performance of the heart, lungs, circulation and musculoskeletal systems of the body. An electrocardiogram (ECG), pulse oximetry and blood pressure monitoring will also be performed to assess changes in the patient’s heart electrical activity, heart rate and blood pressure in response to exercise.

There are two main components to the CPET:

Resting spirometry:

The patient undergoes supervised breathing into a lung function machine to measure his/her basic lung functions.

Exercise phase:

The patient will be asked to either run on the treadmill or ride a stationary bicycle while wearing a specialised air-tight mask to record and measure inhaled and exhaled gases during exercise. A pulse oximeter probe will also be attached to the patient’s finger to determine oxygen saturation levels during and immediately after the test.

Who needs the CPET?

The CPET is often used to evaluate patients with underlying heart, lung, muscle or circulatory conditions and is useful in:

Evaluation of breathlessness and functional capacity of known or suspected cardiorespiratory conditions
Assessment of peak exercise fitness in athletes
Personalising exercise prescription
Risk classification and prognostication of patients with heart failure, significant valvular heart disease, or pulmonary hypertension.
Assessing patients with congenital heart disease for treatment response or as part of comprehensive pre-surgical work up.

What do I need to prepare before the test?

Please wear comfortable T-shirt, shorts/ track pants and jogging shoes. Avoid any strenuous exercise in the 24-48 hours before the test.
You may be instructed by your doctor to:

Continue taking your medication (if any) as prescribed by your doctor or;
Stop taking your medication up to 3 days before the test.

Please have a light meal, where possible, at least 3 hours before your appointment.
Do not drink caffeinated, carbonated or alcoholic beverages on the day of the test.
Do not smoke for at least 8 hours before the test.
As electrocardiogram (ECG) electrodes will be attached to your chest for the test, male patients may to shave their chest before the appointment; female patients are advised to wear a sleeveless or short-sleeved blouse with a buttoned front.

If possible, please bring along, but do not use or consume any of the following medications:

6 hours before the test

Atrovent
Bronchodilators

8 hours before the test

Aeromir
Bricanyl
Berodual
Berotec
Buventol
Combivent
Respolin
Salbutamol
Ventide
Ventodisk
Ventolin

24 hours before the test

Theo-Dur
Theolin
Theoplus
Neulin
Volmax

48 hours before the test

Theo-24

On the day of the test

Appointments for the Cardiopulmonary Exercise Test at the National Heart Centre Singapore are scheduled on Thursday mornings.

Please arrive 15 minutes before your appointment time.
If you are feeling unwell on the day of the test, please call us at 6704 2000 to change your appointment.

The Cardiopulmonary Exercise Test will take place at 8B Cardiac Rehabilitation Unit located at Level 8 of the National Heart Centre Singapore, and will take about 30 to 45 minutes to complete.

How is the test done?

Your weight and height will be measured and recorded.
The doctor will review your medical history and perform a physical examination on you.
You will undergo a lung function test before the Cardiopulmonary Exercise Test. You will be asked to breathe forcefully and rapidly into a device called a spirometer. You may be required to repeat the breathing task a few times to ensure consistent results, but you will have time to rest in between repetitions.
Electrodes will be pasted on your chest for the electrocardiogram (ECG) monitoring.

Your resting ECG, baseline oxygen saturation (via pulse oximeter), heart rate and blood pressure will be measured.

You will be required to wear a specialised facemask to monitor your breathing during the Cardiopulmonary Exercise Test. A pulse oximeter will also be attached to your finger to track the oxygen level in your blood stream during the exercise.
You will be guided on how to use the exercise equipment during the test.
The data from your test will be analysed by the doctor.

Is the test safe?

The Cardiopulmonary Exercise Test is generally safe with a very low risk of complications. Your blood pressure, heart rate and ECG will be monitored closely by the care team during the test to ensure your safety.

Cardiopulmonary Exercise Test (CPET) - Other Information

Between the treadmill and bicycle Cardiopulmonary Exercise Test

Most people will be assigned to the treadmill CPET because the body’s response to this is most similar to our daily routine. For those with severe back or lower limb musculoskeletal issues, or unsteady gait problems, they will be assigned to the bicycle CPET instead.

For selected individuals like amateur and professional cyclists who want to measure their exercise response on bicycle stress or whose exercise workload is crucial for medical decision-making, a bicycle CPET will be performed. The following table shows the differences between a treadmill and bicycle CPET.

Bicycle CPET	Treadmill CPET
More accurate ECG and blood pressure measurements because there are less movement artefacts	ECG and blood pressure measurements might not be as accurate due to movement artefacts
Low risk of falls	Risk of falls
Suitable for a wide range of demographics and patient profiles	Might not be suitable for sedentary or elderly population
Quieter	Noisier
More controlled measurement of workload	Less controlled measurement of workload
Gradual and smoother increase in exercise stress levels during the test	Certain protocols may mean a significant jump in stress levels is required when changing stages