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Exercise testing does not have to be complicated

Exercise testing (XT) is a powerful investigative modality with applications in performance assessment, exercise prescription, differential diagnosis, disability evaluation and risk assessment as well as the evaluation of responses to physical training, rehabilitation or therapeutic interventions.1 Yet most would agree that XT is underutilized both in the field of performance exercise testing of athletes and also in clinical exercise testing of patients. Why is it that few sports teams or health clubs embrace XT with direct measurements of maximum oxygen uptake and the opportunity to detect the threshold for lactic acid accumulation from noninvasive gas exchange measures, preferring instead a poor estimate of VO2max from submaximal heart rate and work rate measurements and basing exercise prescription on no knowledge of the physiological domains of exercise intensity (above and below the lactate threshold). Also, why is it that patients are subjected to numerous investigations, some invasive and most of them expensive, before their clinician considers requesting a cardiopulmonary XT to elucidate the etiology of exercise limitation or exertional dyspnea? The answers to these questions are two-fold based on the evolution of XT. First, apparatus for performing XT was costly, and not always readily accessible or user friendly. Furthermore, the equipment was bulky and not easily transportable. Modem apparatus for XT is less expensive, more compact and easier to use. Mobile systems exist that can be employed in the field allowing measurements to be obtained in athletes during competition, in emergency services personnel performing their duties under extreme circumstances and in physician offices for diagnostic purposes. The data obtained from compact flow transducers and miniature rapidlyresponding gas analyzers can even be transmitted by telemetry to a nearby workstation for real-time analysis and display. Secondly, the interpretation of the physiological data has been unnecessarily complicated and often depicted by complex tables and obscure montages of graphical data.2 There are only six essential variables to be derived from an XT (time, work rate, tidal vol-