Ramp exercise protocols for clinical and cardiopulmonary exercise testing

Historically, the protocol used for exercise testing has been based on trad ition, convenience or both. In the 1990s, a considerable amount of research has focused on the effect of the exercise protocol on test performance, in cluding exercise tolerance, diagnostic accuracy, gas exchange patterns and the accuracy with which oxygen uptake (V)over dot O-2 is predicted from the work rate. Studies have suggested that protocols which contain large and/o r unequal increments in work cause a disruption in the normal linear relati on between (V)over dot O-2 and work rate, leading to an overprediction of m etabolic equivalents. Other studies have demonstrated that such protocols c an mask the salutary effects of an intervention, and some have suggested th at the protocol design can influence the diagnostic performance of the test . Guidelines published by major organisations have therefore suggested that the protocol be individualised based on the patient being tested and the p urpose of the test. The ramp approach to exercise testing has recently been advocated because it facilitates recommendations made in these guidelines. This article reviews these issues and discusses the evolution of ramp test ing which has occurred in the 1990s.