Article Text

Download PDFPDF
Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease
  1. Flavio D'Ascenzi1,2,
  2. Luna Cavigli1,
  3. Antonio Pagliaro1,
  4. Marta Focardi1,
  5. Serafina Valente1,
  6. Matteo Cameli1,
  7. Giulia Elena Mandoli1,
  8. Stephan Mueller3,
  9. Paul Dendale4,
  10. Massimo Piepoli5,
  11. Matthias Wilhelm6,
  12. Martin Halle3,7,
  13. Marco Bonifazi8,
  14. Dominique Hansen9
  1. 1 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
  2. 2 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3 Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
  4. 4 Jessa Hospital, Hasselt, Belgium
  5. 5 Cardiology, G da Saliceto Hospital, Piacenza, Italy
  6. 6 Department of Cardiology, University of Bern, Bern, Switzerland
  7. 7 DZHK (German Center for Cardiovascular Research), Munich, Germany
  8. 8 Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
  9. 9 Hasselt University, Diepenbeek, Belgium
  1. Correspondence to Professor Flavio D'Ascenzi, Department of Medical Biotechnologies, University of Siena, Siena, Italy; flavio.dascenzi{at}


Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a powerful medicine and critical component of the management plan for patients at risk for or diagnosed with CVD. A tailored approach based on the patient’s personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. In this regard, the use of cardiopulmonary exercise testing is well-established for risk stratification, quantification of cardiorespiratory fitness and ventilatory thresholds for a tailored, personalised exercise prescription. The aim of this paper is to provide a practical guidance to clinicians on how to use data from cardiopulmonary exercise testing towards personalised exercise prescriptions for patients at risk of or with CVD.

  • exercise
  • exercise therapy
  • exercise training
  • sports medicine
  • preventive medicine

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @FlavioDascenzi, @CavigliLuna

  • Contributors All authors contributed to writing and reviewing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.