Peak Ventilation Reference Standards from Exercise Testing: From the FRIEND Registry

Abstract

Cardiopulmonary exercise testing (CPX) provides valuable clinical information, including peak ventilation (V˙Epeak), which has been shown to have diagnostic and prognostic value in the assessment of patients with underlying pulmonary disease. This report provides reference standards for V˙Epeak derived from CPX on treadmills in apparently healthy individuals. Nine laboratories in the United States experienced in CPX administration with established quality control procedures contributed to the Fitness Registry and the Importance of Exercise National Database from 2014 to 2017. Data from 5232 maximal exercise tests from men and women without cardiovascular or pulmonary disease were used to create percentiles of V˙Epeak for both men and women by decade between 20 and 79 yr. Additionally, prediction equations were developed for V˙Epeak using descriptive information. V˙Epeak was found to be significantly different between men and women and across age groups (P < 0.05). The rate of decline in V˙Epeak was 8.0% per decade for both men and women. A stepwise regression model of 70% of the sample revealed that sex, age, and height were significant predictors of V˙Epeak. The equation was cross-validated with data from the remaining 30% of the sample with a final equation developed from the full sample (r = 0.73). Additionally, a linear regression model revealed forced expiratory volume in 1 s significantly predicted V˙Epeak (r = 0.73). Reference standards were developed for V˙Epeak for the United States population. Cardiopulmonary exercise testing laboratories will be able to provide interpretation of V˙Epeak from these age and sex-specific percentile reference values or alternatively can use these nonexercise prediction equations incorporating sex, age, and height or with a single predictor of forced expiratory volume in 1 s.