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Exercise Testing and Interpretation: A Practical Approach FREE TO VIEW

Srinivasan Devanathan, MD
Chest. 2002;122(1):388-389. doi:10.1378/chest.122.1.388-a
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By Christopher B. Cooper and Thomas W. Storer. Cambridge, UK: Cambridge University Press, 2001; 278 pp; $44.95

Exercise is the essence of human livelihood, representing the physical labor required to get things done. Given the centrality of exercise in human endeavors, it is not surprising that modern exercise testing has become a versatile tool with applications to the diagnosis of disease, risk stratification for surgery, identification of disability, and quantifying and evaluating responses to physical training, therapeutic intervention, and rehabilitation. Seemingly a simple procedure (“put someone on a stationary bicycle or treadmill and record what happens”), exercise testing in actuality requires a thorough knowledge of patient selection, test protocols, instrumentation, and the complex relationships among various physiologic variables. It is only with an adequate command of this knowledge that meaningful interpretation of exercise testing is made possible.

As complex a topic as exercise testing can be, the authors have maintained a straightforward style of presenting the necessary information. The text is structured around six cardinal chapters, the first of which outlines the purpose of exercise testing. In this chapter, the authors address fundamental exercise physiology, differential diagnosis of disease states, and specific applications of exercise testing, and they include a concise treatment of exercise prescriptions and therapeutic interventions. The focus then shifts to a review of exercise testing equipment and measurement techniques, including tables enumerating the advantages and disadvantages of various modalities of testing. The ancillary respiratory and cardiac equipment needed for each variety of testing is clearly specified for those just embarking on this endeavor. A strong foundation thus having been established, the next chapter explains the various forms of exercise testing, rules on subject preparation, and selection of appropriate testing protocols. Included is a wonderfully precise flow chart diagramming the general sequence of events to be followed in any sort of exercise testing, which I considered a major highlight. Of course, no procedure is devoid of special circumstances, safety precautions, or contraindications, and these are well covered.

Exercise testing generates a broad array of data, each quantified by a unit that needs international standardization, wherever possible, in order to avoid confusion. The authors have devoted considerable attention to the use of symbols that are acceptable to the international community. US readers may miss the traditional units in some situations, despite ongoing efforts to bring everyone into concordance with the metric system. However, there is a useful table in the appendices that outlines any necessary conversions. The interpretation and integration of these data are presented in a systematic and understandable fashion that facilitates the reader’s learning of the material. The emphasis is on a stepwise approach that allows the reader to build confidence in exercise testing interpretation. To facilitate this, the authors have provided real-life case scenarios that enable the application of the principles expounded in this and previous sections.

Finally, the text is very well supplemented by appendices that are designed to be a valuable ongoing resource. These include a glossary of accepted terms and symbols, algorithms for the explanation of derived secondary variables, predicted normal values, and a unique section on frequently asked questions. A detailed and useful index completes the volume.

Overall, this book is a practical, portable, and readable guide to a useful diagnostic tool. It contains a wealth of material, reflecting the authors’ expertise and experience, and is a balanced review of a complex subject that serves to complement more detailed books on this topic. As such, it is worth possessing by all allied health professionals with involvement in exercise testing.




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