Research ArticleOriginal Article
Open Access

Revisiting the clinical utilization of cardiopulmonary exercise testing in Saudi Arabia after 2 decades

A cross-sectional study

Monira I. Aldhahi, Abdulfattah S. Alqahtani and Hazzaa M. AL-Hazzaa
Saudi Medical Journal February 2024, 45 (2) 154-162; DOI: https://doi.org/10.15537/smj.2024.45.2.20230713

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Tables

  • Table 1

    - Implementation of cardiopulmonary exercise testing in Saudi Arabia (N=52).

    Variablesn (%)
    Availability of CPET
    Yes15 (28.8)
    No37 (71.1)
    Apply CPET in hospital or medical Center (n=15)
    Regularly11 (73.3)
    Not regular4 (26.7)
    Department applying the CPET testing (n=11)
    Adult cardiology6 (54.5)
    Exercise physiology2 (18.2)
    Physical therapy1 (9.1)
    Research center1 (9.1)
    Respiratory therapy1 (9.1)
    Healthcare provider supervises the exercise testing(n=11)
    Cardiologist6 (54.5)
    Exercise physiologist4 (36.4)
    Pulmonologist1 (9.1)
    Number of technicians being involved in CPET in the unit (n=11)
    One technician3 (27.3)
    2 technicians4 (36.4)
    3 or more technicians4 (36.4)
    Frequency of test per week for assessment3 (1-10)

    Values are presented as numbers and precentages (%) or median and interquartile range (IQR). CPET: cardiopulmonary exercise testing

    • Table 2

      - Description of the cardiopulmonary exercise testing and referred clinical cases (n=11).

      Characteristicsn (%)
      Exercise mode
      Treadmill10 (90.9)
      Leg ergometer2 (18.2)
      Arm ergometer1 (9.1)
      CPET protocol
      Modified Bruce protocol10 (90.9)
      Balke protocol2 (18.2)
      Naughton protocol1 (9.1)
      Type of the workload
      Ramp protocol3 (27.3)
      Standard incremental protocol8 (72.8)
      Use of sensory scale for measuring exercise intensity
      Yes6 (54.5)
      No5 (45.4)
      Type of sensory scale used
      Rate of perceived exertion scale (RPE)3 (50.0)
      Parameters usually used as the main predictor of the outcome during CPET
      Peak VO22 (18.2)
      Anaerobic threshold4 (36.4)
      Heart rate threshold2 (18.2)
      All3 (27.3)
      Referred cases
      Metabolic2 (18.2)
      Cardiac7 (63.6)
      Pulmonary3 (27.3)
      Cardiorespiratory fitness3 (27.3)
      Most common cases
      Asymptomatic people4 (36.4)
      Symptomatic people2 (18.2)
      Both5 (45.4)

      Values are presented as numbers and precentages (%).

      CPET: cardiopulmonary exercise testing, VO2: maximal oxygen uptake

      • Table 3

        - Comparison between the cardiology and exercise physiology in the utilization of the cardiopulmonary exercise testing.

        CharacteristicsHealthcare providersX2 testP-values
        Cardiologist (n=6)Exercise physiologist (n=4)
        Mode
        Treadmill6 (100)2 (50.0)3.750.15
        Leg ergometer0 (0.0)1 (25.0)
        Arm ergometer0 (0.0)1 (25.0)
        Workload
        Ramp protocol0 (0.0)2 (50.0)3.750.05
        Standard incremental protocol6 (100)2 (50.0)
        Cases
        Metabolic0 (0.0)1 (25.0)7.910.04
        Cardiac5 (83.3)0 (0.0)
        Pulmonary1 (16.7)1 (25.0)
        Cardiopulmonary fitness0 (0.0)2 (50.0)
        Stress electrocardiogram testing5 (83.3)1 (25.0)6.4280.011

        Values are presented as numbers and precentages (%).

        • Table 4

          - Physiological parameters assessed most in cardiopulmonary exercise testing.

          Parametersn (%)
          Heart rate10 (90.9)
          O2 pulse9 (81.8)
          Blood pressure8 (72.7)
          Respiratory frequency6 (54.5)
          Tidal volume5 (45.4)
          O2 uptake5 (45.4)
          Cardiac output5 (45.4)
          Minute ventilation4 (36.3)
          CO2 production4 (36.3)
          Anaerobic threshold3 (27.2)
          Blood lactate3 (27.2)
          Respiratory quotient3 (27.2)
          VE/VCO2 or VE/VO23 (27.2)
          Others1 (9.0)

          Values are presented as numbers and precentages (%).

          VE/VCO2: ventilatory equivalent of carbon dioxide,

          VE/VO2: ventilatory equivalent of oxygen

          • Table 5

            - Normative data, for the types of populations and gender (n=15).

            ConditionsMaleFemale
            Pediatric (6-17 years)5 (33.3)5 (33.3)
            Young adult (18-39 years)4 (26.6)1 (6.6)
            Middle age (40-59 years)7 (46.6)6 (40.0)
            Older people (≥60 years)1 (6.6)1 (6.6)

            Values are presented as numbers and precentages (%).

            • Table 6

              - Comparison of cardiopulmonary exercise testing findings reported by the current study and a previous survey carried out 2 decades ago.

              VariablesAl-Hazzaa et al8 (N=34)Current study (N=52)
              Availability of CPET
              Yes5 (14.7)15 (28.8)
              No29 (85.4)37 (71.1)
              Mode
              Treadmill4 (80.0)10 (90.9)
              Leg ergometer3 (60.0)2 (18.2)
              Arm ergometer2 (40.0)1 (9.1)
              Type of barriers
              Lack of trained technicians10 (34.5)31 (83.7)
              Lack of equipment12 (41.4)34 (91.8)
              Lack of training in interpreting the results9 (31.0)15 (40.5)
              Time consuming1 (3.4)1 (2.7)
              No cardiologist available0 (0.0)1 (2.7)
              Not totally convinced of its diagnostic value1 (3.4)1 (2.7)
              Healthcare provider supervising the exercise testing
              Cardiologist3 (60.0)6 (54.5)
              Exercise physiologist2 (40.0)4 (36.4)
              Pulmonologist0 (0.0)1 (9.1)

              Values are presented as numbers and precentages (%). CPET: cardiopulmonary exercise testing

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