Elsevier

Progress in Cardiovascular Diseases

Volume 67, July–August 2021, Pages 35-39
Progress in Cardiovascular Diseases

Cardiopulmonary exercise testing during the COVID-19 pandemic

https://doi.org/10.1016/j.pcad.2021.04.005Get rights and content

Abstract

The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has presented a global public health emergency. Although predominantly a pandemic of acute respiratory disease, corona virus infectious disease-19 (COVID-19) results in multi-organ damage that impairs cardiopulmonary (CP) function and reduces cardiorespiratory fitness. Superimposed on the CP consequences of COVID-19 is a marked reduction in physical activity that exacerbates CP disease (CPD) risk. CP exercise testing (CPET) is routinely used in clinical practice to diagnose CPD and assess prognosis; assess cardiovascular safety for rehabilitation; and delineate the physiological contributors to exercise intolerance and exertional fatigue. As such, CPET plays an important role in clinical assessments of convalescent COVID-19 patients as well as research aimed at understanding the long-term health effects of SARS-CoV-2 infection. However, due to the ventilatory expired gas analysis involved with CPET, the procedure is considered an aerosol generating procedure. Therefore, extra precautions should be taken by health care providers and exercise physiologists performing these tests. This paper provides recommendations for CPET testing during the COVID-19 pandemic. These recommendations include indications for CPET; pre-screening assessments; precautions required for testing; and suggested decontamination protocols. These safety recommendations are aimed at preventing SARS-CoV-2 transmission during CPET.

Keywords

COVID-19
Gas exchange
Stress testing

Abbreviations

CDC
Centers for Disease Control and Prevention
COVID-19
Corona virus infectious disease-19
CP
Cardiopulmonary
CPD
Cardiopulmonary disease
CPET
Cardiopulmonary exercise testing
CRF
Cardiorespiratory fitness
CV
Cardiovascular
ERS
European Respiratory Society
HEPA
High efficiency particulate air
PA
Physical activity
PCR
Polymerase chain reaction
PPE
Personal and protective equipment
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2

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