CPET Feedback Generator

Instructions: Please review the concerns documented in the Safety Concerns Checklist and select the applicable concerns.

Note: All checklist items are listed below. However, some concerns (such as Moderate-to-severe angina) may have resulted in test termination but are not considered as “abnormal findings” for reporting purposes. Therefore, certain items will not trigger a corresponding “abnormal” mark in summary of finding table.

Absolute indications for test termination (Select all that apply):

ST-segment elevation (>1.0 mm) in leads without preexisting Q waves because of prior MI (other than aVR, aVL, and V1).

Drop in systolic blood pressure >10 mm Hg, despite an increase in workload, when accompanied by any other evidence of ischemia.

Moderate-to-severe angina.

Central nervous system symptoms (e.g., ataxia, dizziness, near syncope).

Sustained (defined as >30 consecutive seconds or unstable) ventricular tachycardia (VT) or other arrhythmia, including second- or third-degree atrioventricular (AV) block, that interferes with normal maintenance of cardiac output during exercise.

Technical difficulties in monitoring the ECG or systolic blood pressure that may interfere with safety monitoring.

Relative indications for test termination (Select all that apply):

Marked ST displacement (horizontal or downsloping of >2 mm, measured 60 to 80 ms after the J point [the end of the QRS complex]) in a patient with suspected ischemia (in the absence of baseline ECG findings that interfere with repolarization such as a bundle branch block or LVH).

Drop in systolic blood pressure >10 mm Hg (persistently below baseline) despite an increase in workload, in the absence of other evidence of ischemia.

Increasing chest pain.

Fatigue, shortness of breath, wheezing, leg cramps, or claudication.

Arrhythmias other than sustained VT, including multifocal ectopy, ventricular triplets, supraventricular tachycardia, and bradyarrhythmias that have the potential to become more complex or to interfere with hemodynamic stability.

Exaggerated hypertensive response (systolic blood pressure >250 mm Hg or diastolic blood pressure >115 mm Hg).

Development of bundle-branch block that cannot immediately be distinguished from VT.

If there is affirmative confirmation of high-quality pulse oximeter plethysmography tracing, hypoxemia with oxygen saturation of <85%.

Other safety concerns:

Musculoskeletal injury

Psychological or emotional event

Other(s)

Summary of Findings:

✓	Blood pressure changes with exercise	✓	Blood oxygen saturation changes with exercise
✓	Heart muscle getting enough blood and oxygen	✓	Heart rhythm during exercise
✓ = We did not see anything abnormal		✗ = An abnormal finding was observed

Age	Very Low	Low	Fair	Good	Excellent	Superior
13-19	<25.0	25.0 - 30.9	31.0 - 34.9	35.0 - 38.9	39.0 - 41.9	>41.9
20-29	<23.6	23.6 - 28.9	29.0 - 32.9	33.0 - 36.9	37.0 - 41.0	>41.0
30-39	<22.8	22.8 - 26.9	27.0 - 31.4	31.5 - 35.6	35.7 - 40.0	>40.0
40-49	<21.0	21.0 - 24.4	24.5 - 28.9	29.0 - 32.8	32.9 - 36.9	>36.9

Age	Very Low	Low	Fair	Good	Excellent	Superior
13-19	<35.0	35.0 - 38.3	38.4 - 45.1	45.2 - 50.9	51.0 - 55.9	>55.9
20-29	<33.0	33.0 - 36.4	36.5 - 42.4	42.5 - 46.4	46.5 - 52.4	>52.4
30-39	<31.5	31.5 - 35.4	35.5 - 40.9	41.0 - 44.9	45.0 - 49.4	>49.4
40-49	<30.2	30.2 - 33.5	33.6 - 38.9	39.0 - 43.7	43.8 - 48.0	>48.0

📋 Instructions

CPET Feedback Generator

SAFETY CONCERNS (Select all that apply)

Absolute indications for test termination (Select all that apply):

Relative indications for test termination (Select all that apply):

Other safety concerns:

Summary of Findings:

VO2 Max Reference Values

FEMALES (values in ml/kg/min)

MALES (values in ml/kg/min)