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Clinical Exercise Testing FREE TO VIEW

Albert Miller
Chest. 2003;123(5):1777. doi:10.1378/chest.123.5.1777
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By I. M. Weisman and R. J. Zeballos, eds; C. T. Bollinger, series ed. Vol 32: Progress in Respiratory Research. Basel, Switzerland: Karger, 2002; 329 pp; $192.25

Clinical Exercise Testing is remarkable in that it accomplishes seemingly conflicting, yet equally important, goals. It is both an authoritative resource on a number of important subjects, and yet it is eminently readable. It is authoritative, because each chapter stands alone as a comprehensive reference on its own particular subject, written by seminal investigators in the field; at the same time, it never departs from an integrated presentation of the entire discipline. Its readability was apparent when, despite my inclination to skip over certain chapters of less apparent interest to me, I found them too engrossing to do so. The book is additionally remarkable in providing state-of-the-art information on clinical aspects of exercise testing that hold great promise, such as the use of tidal flow-volume loops to evaluate limitations of ventilatory capacity, and exercise testing in evaluation and follow-up of heart and lung transplants and lung resection. Moreover, this information is presented in a clear, practical manner.

Inevitably, many important concepts and guidelines are addressed in more than one chapter. On the whole, the information is complementary and contributes to fuller understanding, reflecting on the attentiveness of the editors. I found these chapters to be particularly scholarly, informative, and authoritative: “Cardiovascular and Respiratory System Responses and Limitations to Exercise” (Rodman, Haverkamp, Gordon, and Dempsey); “Modalities of Clinical Exercise Testing” (Zeballos and Weisman); “Deconditioning and Principles of Training” (Troosters, Gosselink, and Decramer); “Methods for Cardiopulmonary Exercise Testing” (Beck and Weisman); “Exercise Limitation and Clinical Exercise Testing in COPD” (O’Donnell); and “Asthma and Exercise” (Tan and Spector). The physical arrangement and appearance of the book are attractive and effective. The subsections are clearly indicated by headings, and the figures and tables are clear and informative (not always the case when relationships between so many variables must be shown, as may be appreciated from review of the original research papers). The comprehensive and up-to-date listing of references after each chapter is an independent justification for the purchase of this book.

In view of the many concepts and procedures that are clearly described and definitively documented, it is perhaps understandable that I was unable to fill certain gaps in my own understanding of exercise testing. These included the following:

  1. The important distinction between psychogenic hyperventilation and physiologic increased ventilation. Brief mention of Vd/Vt was made, but this distinction requires a more definitive discussion.

  2. The separation of metabolic myopathy from cardiovascular etiologies.

  3. Definition of the “theoretical maximum ventilatory capacity” based on maximal inspiratory and expiratory flows.

In addition, there are occasional inconsistencies of abbreviations that prove distracting: V̇i vs V̇e vs VE, MVV vs MVC (thus V̇i/MVV in the chapter on ILD, V̇e/MVC in the chapter on COPD), and TL vs DL. A few unfortunately placed typographical errors are disconcerting (eg, “desaturation defined as ΔSpo2 ≥ 5 mm Hg”).

In summary, Clinical Exercise Testing is a beautifully presented, eminently readable, and authoritative state-of-the-art text suited to be used both as a learning tool and as a reference resource.




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