WHO CAN BE TESTED?
Cardiopulmonary Exercise & Metabolic Testing offers a host of benefits to many people.
For people with shortness of breath, Cardiopulmonary Exercise Testing can indicate whether a problem is psychological or physiological. It can determine whether the cause of the shortness of breath is cardiac or pulmonary in nature or whether it is secondary to muscle disease or deconditioning.
For athletes, Metabolic Testing can determine peak performance and guide training programs. This type of testing is utilized by many professional and Olympic athletic teams.
For people who wish to gain or lose weight, Metabolic Testing can give your physician the information necessary to prescribe a safe and healthy weight control program.
In the following passages, you will see in detail, many of the benefits that Cardiopulmonary Exercise & Metabolic Testing can offer you.
Many people who suffer from exercise intolerance, may notice little decrement in their normal daily activities. Tests on a patient at rest may not indicate the severity of the loss in their abilities. There is a strong relationship between loss of reserve energy and symptoms of exercise intolerance.
When an individual limits his activity, so that he slows down or stops before the onset of symptoms, there is a progressive loss of physiological capacity. In time, even normal, daily activities will elicit symptoms of exertion intolerance.
With Metabolic Testing, we can carefully and systematically increase a patient's level of exertion while monitoring both physiological parameters and symptoms. In this manner, we may be able to detect loss of reserve energy or decreases in physiological capacity early on.
Metabolic tests may also help to distinguish between shortness of breath which is caused by psychological factors, as opposed to problems caused by cardiac disease, pulmonary disease or muscle and vascular problems.
The use of exercise testing is also used for disability evaluation. The test is done in an attempt to simulate work requirements, in a controlled and safe situation. In this manner we can determine how a person may respond physiologically in the actual work setting.
Some of the questions the test will answer are:
Is the impairment sufficient to prevent the worker from meeting the demands of the job?
Does it warrant compensation, retirement or transfer?
Do work related symptoms or allergies exist?
When is the patient ready to return to the job following an acute cardiorespiratory problem?
DIETARY GOALS & INDIRECT CALORIMETRY
Patients who are trying to lose or gain weight, are greatly assisted by the precise knowledge of how much energy they expend while resting.
A major impediment to continued weight loss is the decrease in energy utilization that occurs with dieting. This makes it even more difficult to lose weight. By following total caloric utilization throughout the dietary program, diet and exercise suggestions can be constantly adjusted and refined.
By considering a patient's energy needs and accounting for activity, specific caloric intake can be advised so they can reach their weight goal.
Metabolic Testing is well suited for evaluating athletes and assessing methods of improvement. For example, the U.S. Olympic Committee utilizes Metabolic Testing to assess athletes ranging from weight lifters to table tennis players to swimmers and runners.
Each group of athletes has different types of training and physical requirements, and evaluations should be made frequently at each stage of their progression. In some Olympic sports (particularly cycling and rowing), selection of team members may be based on exercise test results.
PULMONARY & CARDIAC REHABILITATION
Metabolic Testing can help distinguish between pulmonary and cardiac disease, so it is useful when considering a patient's exercise rehabilitation prescription. This prescription is developed from direct measurement of oxygen uptake, heart rate, anaerobic threshold.
Metabolic Testing is valuable in directing the physician's attention toward the physiological mechanisms that require care. In this way, the rehabilitation program can be better tailored for the individual patient. It also helps to identify the mechanisms responsible for the improvement.
A BRIEF HISTORY...
Metabolic Testing has been performed for over fifteen years, and has been improved upon during the last ten years. We can now provide a patient with the most precise method of testing available.
Formerly, the test was performed by analyzing how much expired and inspired gas a patient used over a period of time. This analysis would take days to complete, even after the testing was performed, and it only provided a general view of his exercise capacity.
Today, each breath is measured independently and instantaneously. It is a highly accurate test that can apprise the patient and doctor about exercise capacity at various levels of difficulty, and warn of possible limitations.
WHAT ARE THE ADVANTAGES?
The advantages of Metabolic Testing over conventional stress tests are that Metabolic Testing measures several parameters during exercise including: the electrocardiogram, the amount of oxygen consumed, and the amount of carbon dioxide produced.
It can evaluate a defect in the pulmonary system, the cardiovascular system or a defect simply secondary to obesity or deconditioning, and it can "pinpoint" the weak link in the chain of exercise intolerance.
Conventional stress tests only look at a patient's electrocardiogram during exercise.
The results of Metabolic analysis are highly accurate. Metabolic testing has been in use for 10 years at centers throughout the country, and accurately determines the source of exercise limitation in most patients.
HOW ARE THE CARDIOPULMONARY STRESS TESTS PERFORMED?
The Cardiopulmonary exercise test is performed by pedaling a bicycle against an increasing resistance. This exercise is similar to riding up a hill, with the hill gradually becoming steeper as you progress.
While the testing is performed, the patient is breathing into and outof tubing which is connected to extremely sensitive analyzers. At this time, several things are monitored and analyzed:
The amount of air the patient breathesin and blowsout (expires) is measured breath by breath. This gas is also instantly analyzed to determine the amount of oxygen consumed, and carbon dioxide produced.
The patient's arterial blood is analyzed for oxygen and carbon dioxide content.
The patient's heart rate, electrocardiogram and blood pressure are continuously monitored throughout the test.
The patient is exercised to their limit, as long as they do not develop a danger signal such as a severe drop in blood pressure, a change in the electrocardiogram, or chest pain.
Indirect Calorimetry is performed by breathing into and out of a "bubble." The patient rests in a reclining chair and can read, sleep or listen to music. The apparatus is comfortable and completely nonconfining.
WHERE IS THE CARDIOPULMONARY EXERCISE & METABOLIC TEST PERFORMED?
If you are interested in the potential benefits offered by Metabolic Testing, your testing can be performed at the Staten Island University Hospital. The Hospital is a "state of the art" modern facility, and is a major teaching affiliate of the State University of New York Health Science Center. University Hospital offers full support services to all patients on an equitable basis.
If you have any questions about Metabolic Testing, or would like information regarding a consultation, call 718-226-9488.
We will be happy to answer all of your questions.
The department heads are Dr. Michael Castellano, Director of Pulmonary Medicine Staten Island University Hospital North, and Dr. Theodore Maniatis, Director of Pulmonary Medicine Staten Island University Hospital South, Director of the Metabolic Exercise Laboratory.
Others involved in the testing procedure include registered Respiratory Therapists who have been specifically trained in exercise physiology.