Wasserman & Whipp's Principles of Exercise Testing and Interpretation; 6th Edition 2021 by Kathy E.Sietsema

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The sixth edition has been updated to reflect relevant advances in exercise physiology and clinical applications of exercise testing, and the compendium of clinical case examples has been supplemented with contemporary cases from our practices. The premise of the book continues to be that the most important requirement for exercise performance is transport of oxygen to support the bioenergetic processes in the involved muscle cells (including, of course, the heart) and elimination of the carbon dioxide and protons formed as metabolic byproducts. Thus, appropriate cardiovascular and ventilatory responses are required to match those of muscle respiration in meeting the energy demands of exercise. This is depicted by the iconic “gears” logo which has graced the book cover of each edition of Principles of Exercise Testing and Interpretation, illustrating that normal exercise performance entails an efficient coupling of external to internal (cellular) respiration. Any defect in the systems between the muscle cell and the environment—whether in the lungs, heart, peripheral, or pulmonary circulations, the muscles themselves, or some combination of these—can result in a reduction in the capacity of the system as a whole or in the efficiency of its component parts, that is, exercise intolerance. Thus, we can quantify exercise capacity or, conversely, exercise impairment, in terms of the capacity for gas transport and exchange. Furthermore, we can describe pathophysiology in terms of how it affects the responses of individual components of the systems coupling internal to external gas exchange. The symptoms of exercise intolerance, most commonly dyspnea and/or fatigue at inappropriately low levels of exercise, can often be traced to the effects of disease on the response patterns of these component systems. And this, fortunately, can often be identified from noninvasive measures. As Karl has so often avowed, it is likely that no test in medicine is as informative and cost-effective as cardiopulmonary exercise testing for distinguishing among the broad spectrum of disorders causing symptoms of exercise intolerance. Without it, the evaluation of patients with exercise intolerance may be too narrowly focused by the physician working within the diagnostic spectrum of his or her particular subspecialty. Increasingly, cardiopulmonary exercise testing is used for quantifying impairment and/or risk in patients with known diagnoses. In these contexts, the multiplicity of variables resulting from a cardiopulmonary exercise test could seem excessive or unnecessarily complicated. However, it is precisely the breadth of information provided by such testing that allows the examiner to confirm whether the patient’s limitation is in fact attributable to the clinical condition of interest rather than to a different or coexisting disorder.

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