Cardiopulmonary exercise testing during the COVID-19 pandemic

The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has pre-sented a global public health emergency. Although predominantly a pandemic of acute respiratory disease, co-rona virus infectious disease-19 (COVID-19) results in multi-organ damage that impairs cardiopulmonary (CP) function and reduces cardiorespiratory fitness. Superimposed on the CP consequences of COVID-19 is a marked reduction in physical activity that exacerbates CP disease (CPD) risk. CP exercise testing (CPET) is routinely used in clinical practice to diagnose CPD and assess prognosis; assess cardiovascular safety for rehabilitation; and de-lineate the physiological contributors to exercise intolerance and exertional fatigue. As such, CPET plays an im-portant role in clinical assessments of convalescent COVID-19 patients as well as research aimed at understanding the long-term health effects of SARS-CoV-2 infection. However, due to the ventilatory expired gas analysis involved with CPET, the procedure is considered an aerosol generating procedure. Therefore, extra precautions should be taken by health care providers and exercise physiologists performing these tests. This paper provides recommendations for CPET testing during the COVID-19 pandemic. These recommendations in-clude indications for CPET; pre-screening assessments; precautions required for testing; and suggested decon-tamination protocols. These safety recommendations are aimed at preventing SARS-CoV-2 transmission during CPET. (c) 2021 Published by Elsevier Inc.

Automated summary

The outbreak of COVID-19 has led to multi-organ damage and reduced cardiorespiratory fitness, while decreased physical activity exacerbates the risk of cardiopulmonary disease. CP exercise testing is crucial in clinical practice and rehabilitation, but precautions need to be taken due to its aerosol generating nature. Recommendations have been provided to prevent the transmission of SARS-CoV-2 during CPET testing.