{"entity":{"id":"rejuv-measure-cardiopulmonary-exercise-testing","kind":"technology","name":"Cardiopulmonary exercise testing: the hardest number in recovery","aka":[],"tldr":"A bike or treadmill test to exhaustion with a mask measuring the air breathed in and out, giving peak oxygen uptake. It is the most objective measure of what a body can do, and in breast cancer it showed that survivors sit around a quarter below healthy women of the same age across the whole survivorship continuum.","summary":"Peak oxygen consumption, written VO2peak, is the highest rate at which a person can take up and use oxygen during a graded exercise test to volitional exhaustion. It integrates the lungs, heart, blood, circulation and muscle into one number in millilitres per kilogram per minute, and unlike every other measure on this front it cannot be influenced by how a person feels about answering.\n\nThe method was reviewed for oncology by Jones and colleagues in 2008, who set out practice recommendations for how exercise testing should be conducted and reported in cancer research, at a point when the field was using inconsistent protocols.\n\nThe finding that matters most for recovery. Jones and colleagues measured VO2peak with expired gas analysis in 248 women with breast cancer, across four cross-sectional cohorts: before, during and after adjuvant therapy for non-metastatic disease, and during therapy for metastatic disease. \"Mean VO2peak was 17.8 plus or minus a standard deviation of 4.3 mL per kg per min, the equivalent of 27% plus or minus 17% below age-matched healthy sedentary women.\" The comparison group there is sedentary women of the same age, not athletes. And: \"For the entire cohort, 32% had a VO2peak less than 15.4 mL per kg per min, the VO2peak required for functional independence.\" That is the measurement behind the ordinary complaint that stairs are harder than they were. In the metastatic cohort VO2peak was an independent predictor of survival.\n\nWhat it is used for. Risk assessment before major cancer surgery, where anaerobic threshold and VO2peak predict postoperative complications and inform prehabilitation; cardio-oncology, where a fall in exercise capacity can precede a fall in ejection fraction; and as the endpoint for exercise trials where a questionnaire would be too blunt.\n\nWhat it misses and why it is not routine. It needs a laboratory, a metabolic cart, a physiologist and medical cover for a maximal test, so it is unavailable to most people. It is maximal and effort-dependent, so a person who stops early for pain or fear gives a falsely low value, which is why submaximal measures such as the anaerobic threshold and the six-minute walk are often used instead. It is a measure of capacity, not of symptoms: somebody can have a normal VO2peak and be exhausted, because cancer-related fatigue is not a cardiorespiratory limitation. And the normative data used to compute the percentage below expected come from reference populations that are not well matched to many cancer populations.","status":"established","asOf":"2026-10-02","wikipedia":"https://en.wikipedia.org/wiki/Cardiac_stress_test","links":[{"label":"Jones et al., Cardiorespiratory exercise testing in clinical oncology research: systematic review and practice recommendations (Lancet Oncol 2008)","url":"https://doi.org/10.1016/S1470-2045(08)70195-5"},{"label":"Jones et al., Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum (JCO 2012)","url":"https://doi.org/10.1200/JCO.2011.39.9014"}],"tags":["rejuvenation","survivorship","measurement","objective"],"related":["rejuv-measure-body-composition","rejuv-access-exercise-programmes"],"cancers":["breast-hr-positive","esophageal","colorectal","nsclc"],"sections":["rejuvenation","supportive-care"],"technologies":["prehabilitation","exercise-oncology","cardio-oncology","cardiotoxicity-surveillance-recovery","rejuv-measure-functional-tests","exercise-prescription-after-cancer"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["cancer-related-fatigue","late-effects"],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Graded exercise to volitional exhaustion with breath-by-breath gas exchange measures the integrated maximal oxygen flux through lungs, heart, blood and skeletal muscle. Because oxygen uptake at the limit is set by whichever link is weakest, a reduced VO2peak localises nothing but quantifies everything, which is why it is used as a global index of physiological reserve.","strengths":["The most objective measure of physiological reserve available, in units that cannot be gamed","Quantified the size of the deficit after breast cancer treatment against healthy sedentary controls","Predicts postoperative complications and, in metastatic breast cancer, survival","Sensitive enough to detect change from an exercise programme"],"limitations":["Needs a laboratory, equipment, trained staff and medical cover, so very few survivors ever have one","Maximal and effort-dependent, so early stopping gives a falsely low result","A normal result does not exclude cancer-related fatigue","Reference populations for the expected value are imperfectly matched"],"since":2008},"route":"/technologies/rejuv-measure-cardiopulmonary-exercise-testing/","neighbours":{"technology":[{"id":"cardio-oncology","kind":"technology","name":"Cardio-oncology","route":"/technologies/cardio-oncology/"},{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"rejuv-access-exercise-programmes","kind":"technology","name":"Exercise is the best-evidenced thing on this front, and most survivors are not doing it","route":"/technologies/rejuv-access-exercise-programmes/"},{"id":"cardiotoxicity-surveillance-recovery","kind":"technology","name":"Heart function after anthracyclines, trastuzumab and chest radiotherapy","route":"/technologies/cardiotoxicity-surveillance-recovery/"},{"id":"rejuv-measure-body-composition","kind":"technology","name":"Measuring muscle and fat on scans the patient already had","route":"/technologies/rejuv-measure-body-composition/"},{"id":"prehabilitation","kind":"technology","name":"Prehabilitation before cancer surgery","route":"/technologies/prehabilitation/"},{"id":"exercise-prescription-after-cancer","kind":"technology","name":"The exercise prescription after cancer: the dose the guidelines state","route":"/technologies/exercise-prescription-after-cancer/"},{"id":"rejuv-measure-functional-tests","kind":"technology","name":"Walking, gripping and standing up: the tests that take five minutes","route":"/technologies/rejuv-measure-functional-tests/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"esophageal","kind":"cancer","name":"Oesophageal cancer","route":"/cancers/esophageal/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"term":[{"id":"cancer-related-fatigue","kind":"term","name":"Cancer-related fatigue (tiredness)","route":"/terms/cancer-related-fatigue/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}