2-day CPET

Medical test for post-exertional malaise July 2025 6 vanc 2-day CPET Ergospirometry laboratory.jpg Person on a treadmill wearing a mask connected to a metabolic cart A CPET being administered A 2-day CPET is a cardiopulmonary exercise test given on two successive days to measure the effect of post-exertional malaise (PEM) on a patient's ability to exercise.2022-02-09 Lessons from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome for Long COVID Part 2: Physiological Characteristics During Acute Exercise Are Abnormal in People With Postexertional Symptom Exacerbation https://www.jospt.org/do/10.2519/jospt.blog.20220209 JOSPT Blog 10.2519/jospt.blog.20220209 1 July 2025 Joseph Phillip Singh Inderjit Oliveira Rudolf Capone Christine A. Mullen Mary P. Cook Dane B. Stovall Mary Catherine Squires Johanna Madsen Kristine Waxman Aaron B. Systrom David M. 2023 Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2 Chest 164 3 717–726 10.1016/j.chest.2023.03.049 10088277 37054777 PEM is a cardinal symptom of myalgic encephalomyelitis/chronic fatigue syndrome and is common in long COVID as well.Franklin John Derek Graham Michael 2022-07-03 Repeated maximal exercise tests of peak oxygen consumption in people with myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review and meta-analysis Fatigue: Biomedicine, Health & Behavior en 10 3 119–135 10.1080/21641846.2022.2108628 251636593 2164-1846 free Background Most Recent Research According to a new study by Mancini, Cook, Brunjes, Soto, Blate, Quan, Yamazaki, Norweg, and Natelson (2026), consecutive two-day cardiopulmonary exercise test results do not change between testing days, as initially thought, for patients with chronic fatigue syndrome.[13] The researchers investigated the validity of using a two-day consecutive cardiopulmonary exercise test (CPET) protocol to measure post-exertional malaise (PEM) and disability in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Methodology: Researchers tested 58 ME/CFS patients and 25 age- and sex-matched sedentary controls using maximal bicycle ergometer tests over two sequential days (24 hours apart). They tracked peak oxygen consumption (VO2), ventilatory threshold (VT), heart rate, and perceived exertion. Key Findings: ME/CFS patients demonstrated a lower maximum heart rate compared to controls. ME/CFS patients reported a significantly higher level of perceived exertion at all stages of exercise across both days compared to controls. Conclusion: The researchers concluded that the 2-day CPET protocol yields identical exercise-capacity metrics on consecutive days for both ME/CFS patients and healthy controls. Therefore, the data does not support using consecutive 2-day CPETs as a reliable diagnostic tool to define PEM or disability in ME/CFS patients. Prior Research In a past study, several differences were found found between people with and without ME/CFS, including people with other diseases or who are sedentary. On the first test, people with ME/CFS exhibited lower performance and heart rate, and on the second test, performance was even lower, while for controls, it was the same or slightly better. The largest decrease was in anaerobic threshold, which signifies a shift from aerobic to anaerobic metabolism at a lower level of exertion, and was not influenced by effort.Lim Eun-Jin Kang Eun-Bum Jang Eun-Su Son Chang-Gue 2020-12-14 The Prospects of the Two-Day Cardiopulmonary Exercise Test (CPET) in ME/CFS Patients: A Meta-Analysis Journal of Clinical Medicine en 9 12 4040 10.3390/jcm9124040 2077-0383 7765094 33327624 free Peak power output, heart rate, and VO2max also decrease, and in ME/CFS, but effort and familiarity with the test may affect VO2max and power.Davenport Todd E. Lehnen Mary Stevens Staci R. VanNess J. Mark Stevens Jared Snell Christopher R. 2019-03-22 Chronotropic Intolerance: An Overlooked Determinant of Symptoms and Activity Limitation in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome? Frontiers in Pediatrics 7 82 10.3389/fped.2019.00082 2296-2360 6439478 30968005 free Additionally, healthy people generally recovered from a CPET within 24 hours while people with ME/CFS do not.Twomey Rosie etal 2022-02-02 Lessons from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome for Long COVID: Postexertional Symptom Exacerbation is an Abnormal Response to Exercise/Activity https://www.jospt.org/do/10.2519/jospt.blog.20220202/full/ JOSPT Blog 10.2519/jospt.blog.20220202 1 July 2025 A 2-day CPET was hypothesized to measure PEM and its effect on physical functioning. (Objective indicators of maximal effort during both tests control for effort.)https://www.ncbi.nlm.nih.gov/books/NBK274235/pdf/Bookshelf_NBK274235.pdf Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness National Academies of Medicine Press 82–83 However, its utility has not been completely confirmed, as many studies of it have been small. While it should not be required for a diagnosis, a 2-day CPET can show that symptoms are not due to deconditioning and provide evidence for obtaining disability benefits. Because PEM is also a symptom of long COVID, the 2-day CPET may be useful in evaluating exercise intolerance there as well.Durstenfeld Matthew S. Sun Kaiwen Tahir Peggy Peluso Michael J. Deeks Steven G. Aras Mandar A. Grandis Donald J. Long Carlin S. Beatty Alexis Hsue Priscilla Y. 2022-10-12 Use of Cardiopulmonary Exercise Testing to Evaluate Long COVID-19 Symptoms in Adults: A Systematic Review and Meta-analysis https://doi.org/10.1001/jamanetworkopen.2022.36057 JAMA Network Open 5 10 e2236057 10.1001/jamanetworkopen.2022.36057 free 36223120 9557896 2574-3805 The cause of decreased performance was not understood. Proposals include impaired oxygen transport, impaired aerobic metabolism, impaired microvascular blood flow, loss of passive microvascular filtration and mitochondrial dysfunction. This original test provoked symptoms by design, and recovery oulsbe prolonged. In some cases, it may worsen the illness long-term, as such it should only be applied to patients when absolutely necessary. Criticisms A pilot comparison using the same 24 h repeat protocol found multiple-sclerosis patients showed day-2 VO₂ and workload shifts that overlapped CFS, undermining “uniqueness.” Repeat-CPET reliability studies in cardiac, pulmonary and multiple sclerosis cohorts report intra-individual variation of 4-7 % for VO₂-peak; several CFS papers cite falls in the 7-12 % range—just outside that noise band and within confidence limits of small samples. A 2015 PLoS One analysis explicitly questioned the sensitivity of CPET change-scores in fatiguing illness.Hodges L. D. Nielsen T. Baken D. July 2018 Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study Clinical Physiology and Functional Imaging 38 4 639–644 10.1111/cpf.12460 1475-097X 28782878Heine Martin Akker Lizanne Eva van den Verschuren Olaf Visser-Meily Anne Kwakkel Gert TREFAMS-ACE Study Group 2015-03-19 Reliability and Responsiveness of Cardiopulmonary Exercise Testing in Fatigued Persons with Multiple Sclerosis and Low to Mild Disability PLOS ONE en 10 3 2015PLoSO..1022260H 10.1371/journal.pone.0122260 1932-6203 4366200 25789625 free e0122260Balady Gary J. Arena Ross Sietsema Kathy Myers Jonathan Coke Lola Fletcher Gerald F. Forman Daniel Franklin Barry Guazzi Marco Gulati Martha Keteyian Steven J. Lavie Carl J. Macko Richard Mancini Donna Milani Richard V. 2010-07-13 Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association Circulation 122 2 191–225 10.1161/CIR.0b013e3181e52e69 1524-4539 20585013 On top of that PEM itself has been claimed to exist in cancer-related fatigue, however this study did not differentiate between PEM and exercise intolerance.Twomey Rosie Yeung Samuel T. Wrightson James G. Millet Guillaume Y. Culos-Reed S. Nicole August 2020 Post-exertional Malaise in People With Chronic Cancer-Related Fatigue Journal of Pain and Symptom Management 60 2 407–416 10.1016/j.jpainsymman.2020.02.012 1873-6513 32105793 References Category:Medical tests Category:Myalgic encephalomyelitis/chronic fatigue syndrome Category:Long COVID Category:Exercise physiology