CPET Testing Evidence

Systematic Reviews

Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery
Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, Graham M, Tandon V, Styles K, Bessissow A, Sessler DI, Bryson G, Devereaux PJ.
Can J Cardiol. 2017 Jan;33(1):17-32.


Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review
O'Doherty AF, West M, Jack S, Grocott MP.
Br J Anaesth. 2013 May;110(5):679-89.


A systematic review of the role of cardiopulmonary exercise testing in vascular surgery
Young EL, Karthikesalingam A, Huddart S, Pearse RM, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJ Eur J Vasc Endovasc Surg. 2012 Jul;44(1):64-71.


Cardiopulmonary exercise testing for the evaluation of perioperative risk in non-cardiopulmonary surgery.
Hennis PJ, Meale PM, Grocott MP.
Postgrad Med J. 2011 Aug;87(1030):550-7.


Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review.
Smith TB, Stonell C, Purkayastha S, Paraskevas P.
Anaesthesia. 2009 Aug;64(8):883-93

Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review
Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J.
Br J Anaesth. 2016 Feb;116(2):177-91. doi: 10.1093/bja/aev454. Review



Interventional studies

Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: A study for 342 cases
Gao K, Yu PM, Su JH, He CQ, Liu LX, Zhou YB, Pu Q, Che GW.
Thorac Cancer. 2015 Jul;6(4):443-9


Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study.
West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, Grocott MP, Jack S
Br J Anaesth. 2015 Feb;114(2):244-51


Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly.
Older P, Hall A, Hader R.
Chest. 1999 Aug;116(2):355-62.


Case-controlled study of critical care or surgical ward care after elective open colorectal surgery.
Swart M, Carlisle JB.
Br J Surg. 2012 Feb;99(2):295-9.


Observational Studies

Total haemoglobin mass, but not haemoglobin concentration, is associated with preoperative cardiopulmonary exercise testing-derived oxygen-consumption variables.
Otto JM, Plumb JOM, Wakeham D, Clisshold E, Loughney L, Schmidt, Montgomery, Grocott MPW, Richards T.
BJA. 2017 May; 118(5): 747-754

Cardiopulmonary reserve as determined by cardiopulmonary exercise testing correlates with length of stay and predicts complications after radical cystectomy.
Tolchard S, Angell J, Pyke M, Lewis S, Dodds N, Darweish A, White P, Gillatt D.
BJU Int. 2015 Apr;115(4):554-61.


Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair
Grant SW, Hickey GL, Wisely NA, Carlson ED, Hartley RA, Pichel AC, Atkinson D, McCollum CN
Br J Anaesth. 2015 Mar;114(3):430-6


Prediction of organ-specific complications following abdominal aortic aneurysm repair using cardiopulmonary exercise testing.
Barakat HM, Shahin Y, McCollum PT, Chetter IC
Anaesthesia. 2015 Jun;70(6):679-85


Cardiopulmonary exercise testing for predicting postoperative morbidity in patients undergoing hepatic resection surgery.
Kasivisvanathan R, Abbassi-Ghadi N, McLeod AD, Oliver A, Rao Baikady R, Jhanji S, Cone S, Wigmore T.
HPB (Oxford). 2015 Jul;17(7):637-43


Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study
Huang GH, Ismail H, Murnane A, Kim P, Riedel B.
Support Care Cancer. 2015 Nov 21


The impact of Cardiopulmonary Exercise Testing (CPET) on patients over 80 years undergoing elective colorectal cancer surgery
Chan KE, Pathak S, Smart NJ, Batchelor N, Daniels IR
Colorectal Dis. 2015 Sep 28


Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery.
West MA, Parry MG, Lythgoe D, Barben CP, Kemp GJ, Grocott MP, Jack S.
Br J Surg. 2014 Aug;101(9):1166-72


Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people.
Snowden CP, Prentis J, Jacques B, Anderson H, Manas D, Jones D, Trenell M.
Ann Surg. 2013 Jun;257(6):999-1004


Cardiopulmonary exercise testing before liver surgery
Dunne DF, Jones RP, Lythgoe DT, Pilkington FJ, Palmer DH, Malik HZ, Poston GJ, Lacasia C, Jack S, Fenwick SW
J Surg Oncol. 2014 Sep;110(4):439-44


Comparison of the prognostic accuracy of scoring systems, cardiopulmonary exercise testing, and plasma biomarkers: a single-centre observational pilot study.
James S, Jhanji S, Smith A, O'Brien G, Fitzgibbon M, Pearse RM.
Br J Anaesth. 2014 Mar;112(3):491-7


Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study.
West MA, Lythgoe D, Barben CP, Noble L, Kemp GJ, Jack S, Grocott MP.Br J Anaesth. 2014 Apr;112(4):665-71


Patients' inability to perform a preoperative cardiopulmonary exercise test or demonstrate an anaerobic threshold is associated with inferior outcomes after major colorectal surgery
Lai CW, Minto G, Challand CP, Hosie KB, Sneyd JR, Creanor S, Struthers RA.
Br J Anaesth. 2013 Oct;111(4):607-11.


Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study.
Goodyear SJ, Yow H, Saedon M, Shakespeare J, Hill CE, Watson D, Marshall C, Mahmood A, Higman D, Imray CH.
Perioper Med (Lond). 2013 May 19;2(1):10


Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection.
Junejo MA, Mason JM, Sheen AJ, Moore J, Foster P, Atkinson D, Parker MJ, Siriwardena AK
Br J Surg. 2012 Aug;99(8):1097-104.


Submaximal exercise testing predicts perioperative hospitalization after aortic aneurysm repair.
Prentis JM, Trenell MI, Jones DJ, Lees T, Clarke M, Snowden CP.
J Vasc Surg. 2012 Dec;56(6):1564-70


Effects of low cardiopulmonary reserve on pancreatic leak following pancreaticoduodenectomy.
Ausania F, Snowden CP, Prentis JM, Holmes LR, Jaques BC, White SA, French JJ, Manas DM, Charnley RM.
Br J Surg. 2012 Sep;99(9):1290-4


Cardiopulmonary exercise testing predicts 5 yr survival after major surgery.
Colson M, Baglin J, Bolsin S, Grocott MP.
Br J Anaesth. 2012 Nov;109(5):735-41.


Preoperative exercise capacity in adult inflammatory bowel disease sufferers, determined by cardiopulmonary exercise testing
Otto JM, O'Doherty AF, Hennis PJ, Mitchell K, Pate JS, Cooper JA, Grocott MP, Montgomery HE.
Int J Colorectal Dis. 2012 Nov;27(11):1485-91


Cardiopulmonary exercise testing predicts postoperative outcome in patients undergoing gastric bypass surgery
Hennis PJ, Meale PM, Hurst RA, O'Doherty AF, Otto J, Kuper M, Harper N, Sufi PA, Heath D, Montgomery HE, Grocott MP.
Br J Anaesth. 2012 Oct;109(4):566-71.


Submaximal cardiopulmonary exercise testing predicts 90-day survival after liver transplantation.
Prentis JM, Manas DM, Trenell MI, Hudson M, Jones DJ, Snowden CP.
Liver Transpl. 2012 Feb;18(2):152-9.


Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery.
Wilson RJ, Davies S, Yates D, Redman J, Stone M.
Br J Anaesth. 2010 Sep;105(3):297-303.


Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery
Snowden CP, Prentis JM, Anderson HL, Roberts DR, Randles D, Renton M, Manas DM.
Ann Surg. 2010 Mar;251(3):535-41.


A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: Physiological capacity compared with the ASA physical status classification system.
Hightower CE, Riedel BJ, Feig BW, Morris GS, Ensor JE Jr, Woodruff VD, Daley-Norman MD, Sun XG
Br J Anaesth. 2010 Apr;104(4):465-71


Is cardiopulmonary exercise testing a useful test before esophagectomy?
Forshaw MJ, Strauss DC, Davies AR, Wilson D, Lams B, Pearce A, Botha AJ, Mason RC

Ann Thorac Surg. 2008 Jan;85(1):294-9.


Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing.
Carlisle J, Swart M.
Br J Surg. 2007 Aug;94(8):966-9.


Cardiorespiratory fitness and short-term complications after bariatric surgery.
McCullough PA, Gallagher MJ, Dejong AT, Sandberg KR, Trivax JE, Alexander D, Kasturi G, Jafri SM, Krause KR, Chengelis DL, Moy J, Franklin BA.
Chest. 2006 Aug;130(2):517-25.


Aerobic capacity is associated with 100-day outcome after hepatic transplantation.
Epstein SK, Freeman RB, Khayat A, Unterborn JN, Pratt DS, Kaplan MM.Liver Transpl. 2004 Mar;10(3):418-24.


Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus.
Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T.
J Thorac Cardiovasc Surg. 2001 Jun;121(6):1064-8.


Cardiopulmonary exercise testing in the pre-operative assessment of patients for repair of abdominal aortic aneurysm.
Nugent AM, Riley M, Megarry J, O'Reilly MJ, MacMahon J, Lowry R.
Ir J Med Sci. 1998 Oct-Dec;167(4):238-41.


The simultaneous evaluation of preoperative cardiopulmonary functions of esophageal cancer patients in the analysis of expired gas with exercise testing (article in Japanese).
Nagamatsu Y, Yamana H, Fujita H, Hiraki H, Matsuo T, Mitsuoka M, Hayashi A, Kakegawa T.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Nov;42(11):2037-40.


Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing.
Older P, Smith R, Courtney P, Hone R.
Chest. 1993 Sep;104(3):701-4.


Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery
West MA, Asher R, Browning M, Minto G, Swart M, Richardson K, McGarrity L, Jack S, Grocott MP;
Perioperative Exercise Testing and Training Society.
Br J Surg. 2016 Feb 23.



Implementation / Surveys

Preoperative cardiopulmonary exercise testing in England - a national survey.
Huddart S, Young EL, Smith RL, Holt PJ, Prabhu PK.
Perioper Med (Lond). 2013 Feb 25;2(1):4


Cardiopulmonary exercise testing - a survey of use in England
Simpson JC, Sutton H, Grocott MPW
Journal of the Intensive Care Society 2009;10:275-278


Narrative Reviews

The Preoperative Assessment and Optimization of Patients Undergoing Major Urological Surgery.
Cui HW, Turney BW, Griffiths J
Curr Urol Rep. 2017 Jul; 18(7): 54


Cardiopulmonary Exercise Testing and Surgery.
Older PO, Levett DZ
Ann Am Thorac Soc. 2017 Jul; 14 (supplement1): S74-S83.


Cardiopulmonary exercise testing for risk prediction in major abdominal surgery.
Levett DZ, Grocott MP
Anesthesiol Clin. 2015 Mar;33(1):1-16


Cardiopulmonary exercise testing before abdominal aortic aneurysm surgery: a validated risk prediction tool?
Hollingsworth A, Danjoux G, Howell SJ.
Br J Anaesth. 2015 Oct;115(4):494-7


Cardiopulmonary exercise testing, prehabilitation, and Enhanced Recovery After Surgery (ERAS)
Levett DZ, Grocott MP.
Can J Anaesth. 2015 Feb;62(2):131-42


Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection
Kallianos A, Rapti A, Tsimpoukis S, Charpidou A, Dannos I, Kainis E, Syrigos K.
In Vivo. 2014 Nov-Dec;28(6):1013-20


Cardiopulmonary exercise testing in lung transplantation: a review.
Dudley KA, El-Chemaly S.
Pulm Med. 2012;2012:237852


Cardiopulmonary exercise testing: does it improve perioperative care and outcome?
Stringer W, Casaburi R, Older P.
Curr Opin Anaesthesiol. 2012 Apr;25(2):178-84


Perioperative exercise training in elderly subjects.
Jack S, West M, Grocott MP.
Best Pract Res Clin Anaesthesiol. 2011 Sep;25(3):461-72.


Perioperative cardiopulmonary exercise testing in the elderly.
West M, Jack S, Grocott MP.
Best Pract Res Clin Anaesthesiol. 2011 Sep;25(3):427-37


Controversies in the physiological basis of the 'anaerobic threshold' and their implications for clinical cardiopulmonary exercise testing.
Hopker JG, Jobson SA, Pandit JJ.
Anaesthesia. 2011 Feb;66(2):111-23.


Preoperative cardiopulmonary risk assessment by cardiopulmonary exercise testing.
Older P, Smith R, Hall A, French C.
Crit Care Resusc. 2000 Sep;2(3):198-208.


Editorial / Commentary

Preoperative functional assessment and optimization in surgical patient: changing the paradigm.
Carli F, Minnella EM.
Minerva Anestesiol. 2017 Feb;83(2):214-218


Cardiopulmonary exercise testing machine fault
Funnell A, Davies RG, Appadurai IR.
Anaesthesia. 2016 Sep; 71(9): 1122-1123. DOI: 10.1111/anae.13608.


Anaerobic threshold, is it a magic number to determine fitness for surgery?
Paul Older.
Perioperative Medicine 2013, 2:2


Cardiopulmonary exercise testing.
Howard L, Grocott MP, Naeije R, Oudiz R, Wensel R.
Pulm Med. 2012;2012:564134.


Prognostic studies of perioperative risk: robust methodology is needed.
Grocott MP, Pearse RM.
Br J Anaesth. 2010 Sep;105(3):243-5.



Study protocols

Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery.
Wijeysundera DN, Pearse RM, Shulman MA, Abbott TE, Torres E, Croal BL, Granton JT, Thorpe KE, Grocott MP, Farrington C, Myles PS, Cuthbertson BH; METS Study Investigators.
BMJ Open. 2016 Mar 11;6(3):e010359