Cardiopulmonary exercise testing in the COVID-19 endemic phase

The COVID-19 pandemic has presented significant challenges to healthcare systems across the world. The substantial need to provide acute COVID-19-related care resulted in non-COVID-19 care being immediately curtailed, with significant implications for the provision of normal or ‘routine’ healthcare. As the pressure from acute COVID-19 care begins to regress, it is timely to consider how certain services, including those undertaking physiological measurements, will re-open and how they will function within the constraints dictated by a COVID-19 endemic working environment. Over the past decade, there has been evolving recognition of the importance and value of clinical cardiopulmonary exercise testing (CPET) within healthcare settings.1 Primarily, CPET is used to evaluate the integrative response to incremental exercise, enabling clinicians to characterise cardiorespiratory fitness and reasons for physical impairment. 2 It is recognised that CPET plays an important role in clinical arenas including determining surgical operability and evaluating the risk of perioperative death and postoperative complications.3 It also has a function in supporting pre-operative planning algorithms,4 as well as developing management strategies for pathological conditions (e.g. heart failure)5 and in disease prognostication (e.g. pulmonary hypertension).6 Whilst there is considerable uncertainty regarding the ability to safely undertake CPET at the current time, it remains an integral investigative tool in clinical practice and urgent consideration needs to be given to determine how best to deliver CPET services in the COVID-19 endemic phase.

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