Physiological basis of preoperative cardiopulmonary exercise testing

The use of cardiopulmonary exercise testing (CPET) is gaining popularity as a preoperative functional assessment tool and a useful adjunct to risk stratification before surgery. Determination of the integrated response of multiple body systems (including the cardiorespiratory and peripheral oxygen delivery systems) to exercise stress, adds important prognostic value to pre-surgical assessment, shared-decision making and postoperative management of the surgical patient. Thorough CPET interpretation is complex but may be assisted by an understanding of basic exercise physiology and its application to the preoperative context.