Normative peak cardiopulmonary exercise test responses in Canadian adults aged ≥40 years.

Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings.This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations by Jones et al. (1985) and Hansen et al. (1984) for predicting peak CPET responses.Participants were healthy adults aged ≥40 years from the Canadian Cohort Obstructive Lung Disease study who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) using quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters (i) measured and (ii) predicted in the validation cohort were assessed for equivalence (two one-sided test of equivalence for paired-samples [TOST-P]) and level of agreement (Bland-Altman analyses). TOST-P assessed differences between measured and predicted responses in the derivation cohort using reference equations by Jones et al. and Hansen et al. RESULTS: Normative reference ranges (5th to 95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) aged 64±10 years. In the validation cohort (n=84), peak CPET responses predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by Jones et al. and Hansen et al. were significantly higher than the value measured in the CanCOLD cohort.This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange and symptom responses to incremental CPET, presenting the most comprehensive reference set to date in Canadian adults aged ≥40 years identified with population-based sampling.

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