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Test-Retest Reliability of Maximal and Submaximal Gas Exchange Variables in Patients With Coronary Artery Disease

Coeckelberghs, Ellen MSc; Buys, Roselien PhD; Goetschalckx, Kaatje MD; Pattyn, Nele MSc; Vanhees, Luc PhD; Cornelissen, Véronique PhD

Journal of Cardiopulmonary Rehabilitation & Prevention: July/August 2016 - Volume 36 - Issue 4 - p 263–269
doi: 10.1097/HCR.0000000000000158
Exercise Testing

PURPOSE: Gas exchange variables derived from cardiopulmonary exercise tests (CPETs) need to be reliable for evaluating interventions and clinical decision making. Whereas peak oxygen uptake (

O2) has shown to be a highly reliable parameter in patients with coronary artery disease (CAD), little is known about the reproducibility of these parameters in patients with CAD. Therefore, the purpose of this study was to confirm the reliability of peak

O2 and to investigate the reliability of submaximal CPET variables in patients with CAD.

METHODS: Eighty-five patients with CAD (57.6 ± 8.5 years; 79 males) performed 2 CPETs within 10 days before starting a rehabilitation program. Reliability of peak and submaximal exercise variables was assessed by using intraclass correlation coefficients (ICC), coefficients of variation, Pearson correlation coefficients, paired t tests, and Bland-Altman plots.

RESULTS: Maximal and submaximal exercise parameters showed adequate reliability. Overall, there was a good correlation across both testing occasions (r = 0.63-0.95; P < .05 for all). Peak

O2 (ICC, 0.95; 95% CI, 0.92-0.97) demonstrated excellent reliability. Of the submaximal exercise variables, oxygen uptake efficiency slope (OUES) was as reliable as peak

O2 (ICC, 0.97; 95% CI, 0.95-0.98). The ventilation/carbon dioxide production (


CO2) slope showed very good test-retest reliability (ICC, 0.87; 95% CI, 0.80-0.91) and the

O2/work rate slope showed good reliability (ICC, 0.76; 95% CI, 0.64-0.85).


O2 and OUES show excellent test-retest reliability. Accordingly, in the case of no or unreliable peak

O2 data, we suggest using OUES to evaluate cardiorespiratory fitness in patients with CAD.

The reliability of maximal and submaximal gas exchange variables was investigated in 85 patients with coronary artery disease. Peak oxygen uptake (O2) and oxygen uptake efficiency slope (OUES) had excellent test-retest reliability. With submaximal exercise testing data, we suggest using OUES to evaluate changes in cardiorespiratory fitness.

Department of Rehabilitation Sciences (Ms Coeckelberghs, Dr Buys, Ms Pattyn, Dr Vanhees, and Dr Cornelissen), Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium; and Department of Cardiovascular Sciences (Dr Goetschalckx), Faculty of Medicine, KU Leuven, Leuven, Belgium.

Correspondence: Véronique Cornelissen, PhD, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101 B 1501, 3001 Leuven, Belgium (

Dr Cornelissen is supported as a postdoctoral research fellow by the Research Foundation Flanders (FWO). Dr Buys is supported by a research grant from the Research Foundation Flanders (FWO).

All authors have read and approved the manuscript.

The authors declare no conflicts of interest.

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.