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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.
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.
The 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.
The 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.
What 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.
What 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.
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.
Query for this technology: (TITLE:"Cardiopulmonary exercise testing: the hardest number in recovery" OR ABSTRACT:"Cardiopulmonary exercise testing: the hardest number in recovery") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Cardiopulmonary exercise testing: the hardest number in recovery, not a curated reading list.
Shares Walking, gripping and standing up: the tests that take five minutes, The exercise prescription after cancer: the dose the guidelines state, Survivorship and late effects are neglected, HR-positive / HER2-negative breast cancer and the tags rejuvenation, survivorship, measurement, objective.
Shares Exercise is the best-evidenced thing on this front, and most survivors are not doing it, Walking, gripping and standing up: the tests that take five minutes, The exercise prescription after cancer: the dose the guidelines state, Prehabilitation before cancer surgery and the tags rejuvenation, survivorship, measurement.
Shares Measuring muscle and fat on scans the patient already had, Walking, gripping and standing up: the tests that take five minutes, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, objective.
Shares Walking, gripping and standing up: the tests that take five minutes, Cancer-related fatigue (tiredness), Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement.
Shares Exercise is the best-evidenced thing on this front, and most survivors are not doing it, Exercise & lifestyle oncology, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement.
Shares Measuring muscle and fat on scans the patient already had, Walking, gripping and standing up: the tests that take five minutes, The exercise prescription after cancer: the dose the guidelines state, Prehabilitation before cancer surgery and the tags rejuvenation, survivorship.
Shares Cancer-related fatigue (tiredness), Survivorship and late effects are neglected, HR-positive / HER2-negative breast cancer, Colorectal cancer and the tags rejuvenation, survivorship, measurement.
Shares Cancer-related fatigue (tiredness), The exercise prescription after cancer: the dose the guidelines state, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.