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Chronic obstructive pulmonary disease (COPD) is a disease defined by airflow obstruction with a high morbidity and mortality and significant economic burden. Although pulmonary function testing is the cornerstone in diagnosis of COPD, it cannot fully characterize disease severity or cause of dyspnea because of disease heterogeneity and variable related and comorbid conditions affecting cardiac, vascular, and musculoskeletal systems. Cardiopulmonary exercise testing (CPET) is a valuable tool for assessing physical function in a wide range of clinical conditions, including COPD. Familiarity with measurements made during CPET and its potential to aid in clinical decision-making related to COPD can thus be useful to clinicians caring for this population. This review highlights pulmonary and extrapulmonary impairments that can contribute to exercise limitation in COPD. Key elements of CPET are identified with an emphasis on measurements most relevant to COPD. Finally, clinical applications of CPET demonstrated to be of value in the COPD setting are identified. These include quantifying functional capacity, differentiating among potential causes of symptoms and limitation, prognostication and risk assessment for operative procedures, and guiding exercise prescription.

Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Exercise capacity is reduced in end-stage renal disease (ESRD). Exercise requires the integrated function of multiple vital organs, and low exercise capacity is an independent predictor of mortality in a number of clinical populations. We analyzed the value of exercise capacity, characterized as peak oxygen uptake (VO2), for predicting survival in a cohort of 175 hemodialysis patients over a median follow-up of 39months. Survival status was determined for 175 ESRD patients who had participated in previous studies for which peak VO2 and other clinical data had been determined. Chi-square and Kaplan-Meier survival analyses were performed, and a minimal model of factors related to mortality was developed by Cox multiple regression. There were 23 deaths during the follow-up period. Peak VO2 (>17.5mL/min/kg) was a powerful predictor of survival (P = 0.009 by Kaplan-Meier). Age (<65years), dialysis vintage (<39months), pulse pressure (<54mm Hg), and absence of diagnoses of diabetes or heart failure were also associated with better survival on univariate analyses. On multivariate analysis peak VO2 contributed significantly to the minimal explanatory model relating clinical variables to mortality (overall χ2= 25.5, P = 0.00001). Among these ambulatory ESRD patients, peak VO2 was a stronger predictor of survival than many traditional prognostic variables, some of which are subject to ceiling effects. Exercise capacity may thus provide incremental prognostic information concerning healthier ESRD patients. Because peak VO2 may be modified by exercise training, the potential of exercise as an intervention to improve survival is suggested.

Thoroughly revised and updated for today's clinicians, Wasserman Whipp's Principles of Exercise Testing and Interpretation, Sixth Edition, provides a comprehensive, practical overview of cardiopulmonary exercise testing (CPET) ideally suited for pulmonologists, cardiologists, anesthesiologists, and others with an interest in clinical exercise testing. Written by authors who are uniquely positioned to convey relevant aspects of research and apply them to clinical contexts, this volume offers in-depth coverage of essential information for conducting CPET, or for utilizing data from this discipline in clinical practice or research.

Background/Aims: Peripheral arterial disease (PAD) has been suggested as a contributing factor to the development of intradialytic muscle cramps in patients on maintenance hemodialysis. Methods: To test this hypothesis, 122 patients from two dialysis centers were studied. The presence of PAD was determined by measurement of the ankle-brachial index (ABI) in the lower extremities of patients pre- and postdialysis. The experience of intradialytic cramps was assessed using patient history and review of medical records. Results: PAD defined as a predialysis ABI ≤0.90 had an overall prevalence of 16.4% among patients studied. The prevalence of PAD was age-dependent, reaching 37.5% in patients 80–89 years old. Intradialytic muscle cramps were common, with 52.1% of patients reporting cramps within the previous two months, but there was no relationship between cramps during dialysis and PAD (p > 0.05). Conclusions: PAD was common in hemodialysis patients, but there was no association between the presence of PAD and the prevalence of intradialytic muscle cramps.