The effects of exercise modality on maximal and submaximal exercise parameters obtained by graded maximal exercise testing

BackgroundCardiopulmonary exercise testing (CPET) has become part of screening and evaluation in cardiology. The exercise modalities most often used in CPET are the treadmill (TM) and upright bicycle (UB). Nowadays, also the supine bicycle (SB) is becoming more often used, especially when combined with cardiac imaging.ObjectivesOur aim was to examine whether a maximal CPET on a SB leads to similar results as TM and UB in terms of different CPET measures. Secondly, we explored whether peak VO2 relates to the person's preference and experience with the different exercise modalities.MethodsTwelve healthy individuals (8 male; mean age 21.6, range 21-24) participated in a randomized controlled cross-over trial and performed 3 maximal CPETs on a TM, UB and SB. Repeated measures ANOVA was performed to evaluate differences between tests. Further, Intraclass correlation coefficients (ICC) and Bland-Altman plots were obtained.ResultsThe SB CPET resulted in lower peak VO2 (2806 ± 652 ml·min− 1 (SB) vs 3329 ± 798 ml·min− 1 (UB) and 3550 ± 799 ml·min− 1 (TM); p < 0.001) and peak heart rate (179 ± 8 beats·min− 1 (SB) vs 192 ± 7 beats·min− 1 (UB) and 193 ± 11 beats·min− 1 (TM); p < 0.001). VE/VCO2-slope did not differ between the 3 modalities. Overall, ICC and Bland-Altman plots showed low agreement for SB measures. No influence of preference and experience on peak VO2 could be found.ConclusionUpcoming maximal SB exercise tests, for evaluations in clinical settings, can't be considered as an evaluation of the maximal exercise capacity when compared to golden standard TM and UB.