Essentials of Cardiopulmonary Exercise Testing

Key essentials in integrative cardiopulmonary testing are well presented. From physiological response of central and peripheral determinants on VO2max uptake (cardiac output and arterio-venous oxygen difference), factors affecting this response, to methodological considerations (which includes exercise mode, patient preparation, ECG lead systems and patient's effort) and instrument calibration and quality control. O2 kinetics and ventilatory parameters, in particular, ventilatory threshold (VT) or anaerobic threshold received special attention and given good coverage in chapter 4, so had the sampling methods of mixing chamber and breath-by-breath techniques. The author advised against the use of the term "anaerobic threshold" as it is argued that this threshold does not imply the onset of anaerobiosis. Therefore, it is not surprising that publications supporting the concept that lactate increase during exercise is tissue O2-dependent were not well reviewed. Though there is no consensus on this in the literature, readers are referred to the advanced text "Principles of Exercise Testing and Interpretation" (now into its third edition). This book, among others, offers many well-illustrated biochemical pathways and insightful case studies not available in Myer's text. Both texts include a comprehensive glossary of terms.

The inclusion of a brief overview at the beginning of the text on basic statistical concepts (standard error of estimate and regression equations) would have helped enhancing the reader's understanding of later chapter on "normal values". Beginners are warned against the indiscriminate use of population- and protocol-specific normograms in predicting VO2max. Though there is minor inaccuracy in the text, it is still highly recommended to beginners and experienced readers alike.