Cardiopulmonary Exercise Testing under the Guidance of New Theory of Holistic Integrative Physiology and Medicine (HIPM)

Abstract

BackgroundCardiopulmonary exercise testing (CPET), is guided by holism, a comprehensive evaluation of the overall functional status of the subject's gender, age, body mass, resting lung function, daily activities, etc. It gives specific load power, makes subjects do maximum limitation movement on exercise load equipment, closely monitors the exercise ECG, blood pressure, oxygen saturation and other cycle indicators during the exercise, and measures the gas exchange index such as the oxygen uptake and carbon dioxide output, to reflect the functional status of multiple system organs such as circulation, respiration, and metabolism.METHODSHuman beings are an inseparable whole. The systems and organs such as breathing, circulation and metabolism are interrelated and mutually influential. The O2 and CO2 produced by each inhalation and exhalation are exchanged in the lungs to form the up‐down “W” waveform information, which enters the pulmonary veins, the left atrium, and the left ventricle with the blood of the pulmonary capillaries, and reaches the arterial system through non‐100% cardiac ejection. It acts on peripheral chemoreceptors to switch respiration and acts on the central chemoreceptor after about 30 seconds to maintain the stability of the breath. The regulation of respiration requires the participation of circulation. The substances in the circulating blood (nutrients, metabolites, etc.) and hemodynamic indicators affect the breathing. Similarly, the gas signal molecules generated by respiration also affect certain circulation indicators such as strokes, output, heart rate, blood pressure, autonomic variability, and thus affect circulation. On this basis, digestion and absorption, urinary excretion, neurohumoral, skin, metabolism, and even mental and psychological factors are involved in the integration of the body, so that the whole person is in a dynamic balance.RESULTSCPET is to put the subject under extreme exercise state. At this time, the whole body is in a state of stress. The whole system and organs cooperate to maintain the metabolism of the body, which is actually to meet the needs of the cells for O2 and energy substances. When there is a lesion in the heart, lungs or other organs and systems, the O2 and energy substances required for the exercise muscle cells cannot be supplied in time, and the subject exhibits a decrease in exercise endurance. According to the electrocardiogram, gas exchange, and blood flow during CPET, we can comprehensively assess the subject's overall functional status and the degree of grading function limitation, and provide a basis for clinical decision‐making.CONCLUSIONCPET is an example for a human HIPM. CPET is the only method for objective, quantitative and accurate assessment of the overall functional status of human. It has important for disease prevention, diagnosis, treatment and prognosis. Only be guidanced by HIPM, we can correctly use CPET and interpret the data.Support or Funding InformationNational Natural Science Foundation of China (81470204);Fuwai Hospital, National Cardiovascular Institute of Chinese Academy of Medical Sciences (2012‐YJR02);Research on Clinical Characteristics of the Capital (Z141107002514084);Research and Outcome Promotion of Clinical Characteristics in the Capital (Project No. Z161100000516127)