Introduction

This chapter provides six carefully selected cases which are used to integrate the concepts of test purpose, instrumentation, testing methods, physiological responses, and interpretation of test results that have been developed in Chapters 1–5. These examples are not meant to represent an exhaustive examination of every set of responses that may be seen in clinical or performance exercise testing. Rather, these commonly encountered cases allow the reader to envisage the process of exercise testing leading to its natural conclusion – an interpretation of exercise performance based upon a systematic process of carefully applied methodologies and accurate collection of key response variables. Each case concludes with a brief statement about the outcome following exercise testing.

Case 1: Declining exercise capacity with a history of asthma (CXT: diagnostic)

Purpose

This 51-year-old male complained of declining exercise capacity. He had a history of asthma but normal pulmonary function tests. He used a salmeterol metered-dose inhaler (MDI: 2 puffs twice daily) and fluticasone MDI (2 puffs twice daily). He had never smoked. He was accustomed to running 2–3 miles, 4–5 days per week. A clinical exercise test (CXT) was requested to define his exercise limitations.

Method

A diagnostic exercise test was chosen utilizing a ramp work rate protocol on a cycle ergometer. Based on the initial physical assessment and reported exercise habits, a ramp rate of 30 W·min−1 was chosen. Expired ventilation was measured using a two-way breathing valve and hot wire flow transducer. Therefore, flow–volume loops could not be obtained.