"I used to think that if my physical examination results were normal, everything would be fine. I never expected that high-intensity exercise could pose a 'hidden danger' to my heart. Fortunately, I underwent a cardiopulmonary exercise test in time, which not only avoided health risks but also made my training more scientific and efficient," said Mr. Zhao, a 60-year-old sports enthusiast.
Nowadays, activities such as running and marathons have become increasingly popular, and the number of participants in extreme sports is also on the rise. However, sudden cardiac deaths after exercise still occur occasionally, which is heart-wrenching. Many people are puzzled: why do they still encounter accidents despite years of regular exercise and normal physical examinations?
How to accurately screen for cardiac risks and scientifically assess physical condition? Dong Wen, Vice President and Director of Respiratory Medicine at Hainan Cancer Hospital, will introduce you to a professional medical examination that safeguards sports safety - Cardiopulmonary Exercise Testing (CPET).
Why can't routine physical examinations detect problems?
Mr. Zhao, a sports enthusiast, has been running and swimming for many years and has participated in several half-marathons. His routine physical examination results were all normal. However, after increasing his exercise intensity recently, he frequently experienced discomfort such as chest tightness and shortness of breath. Therefore, upon the advice of his friends, he went to Hainan Cancer Hospital for a cardiopulmonary exercise test.
The test revealed that when the exercise load reached 70% and the heart rate exceeded 110 beats per minute, there were early onset of anaerobic threshold and changes in the ST segment of the electrocardiogram during exercise, indicating a risk of myocardial ischemia, coronary artery stenosis, or spasm during exercise. High-intensity exercise is highly prone to induce angina pectoris and myocardial infarction. Based on the test results, the doctor provided reasonable exercise recommendations to help him scientifically adjust his exercise mode, intensity, distance, and pace.
Mr. Zhao raised a question: "Why can't such heart problems be detected through routine physical examinations?" Dong Wen explained that this is closely related to the heart's tolerance to exercise. The heart's ability to withstand exercise load often determines whether risks will occur during exercise.
The routine electrocardiogram and cardiac color Doppler ultrasound examinations previously conducted by Mr. Zhao can only reflect the condition of the heart at rest. Once the exercise load is increased, the heart rate accelerates, the heart burden increases sharply, and hidden problems such as myocardial ischemia and arrhythmia will be exposed.
This is like a car that is parked in the garage for routine checks, with all indicators appearing normal. However, once it is driven on the highway or accelerated on a slope, the potential hidden dangers of the engine will become apparent.
What is cardiopulmonary exercise testing?
Cardiopulmonary exercise testing is currently the only non-invasive detection technology capable of simultaneously assessing the coupled function and reserve capacity of the heart and lungs during exercise, and is considered the "gold standard" for cardiopulmonary function reserve testing. It is not a simple physical fitness test, but a deep stress test and comprehensive evaluation of the body's "power system". In layman's terms, it can accurately measure the upper limit of cardiac exercise tolerance.
According to Dong Wen, this examination involves gradually increasing the exercise load while having the subject perform treadmill exercise, with simultaneous monitoring of dozens of physiological indicators such as heart rate, blood pressure, electrocardiogram, and blood oxygen saturation throughout the process. It simulates the true performance of the heart and lungs under high-load conditions, comprehensively evaluates the overall function and reserve capacity of multiple organ systems including the heart, lungs, blood, skeletal muscles, and nerves, and accurately captures latent abnormalities in the heart and lungs that are difficult to detect in a resting state.
It is particularly noteworthy that this examination holds significant importance for risk assessment in extreme sports like marathons. During such extreme sports competitions, the body is in a highly stressed state, with heart rate and blood pressure significantly elevated, and the blood volume and oxygen required by the cardiac circulatory system suddenly increased. Once the tolerance limit of the human body is exceeded, acute myocardial ischemia may occur, triggering malignant arrhythmias such as ventricular tachycardia and ventricular fibrillation, which in severe cases can even lead to sudden cardiac death.
Who is suitable for cardiopulmonary exercise testing?
Many people often have a misconception that "sudden death equals heart disease". However, in reality, many young, physically active, and self-proclaimed healthy individuals are precisely the potentially high-risk groups. The following groups should pay special attention to heart health, and it is recommended to undergo cardiopulmonary exercise testing when necessary?
01 Sports enthusiasts and extreme sports participants
1. People who engage in sports such as running, cycling, and swimming all year round, and plan to increase their exercise intensity or prepare for extreme events such as marathons;
2. Exercise participants who experience discomfort symptoms such as chest tightness, shortness of breath, dizziness, and palpitations during exercise, but have no abnormalities found in routine physical examinations;
3. People who have been exercising for a long time but wish to scientifically assess their cardiorespiratory endurance and develop a personalized exercise program.
02 High-risk and suspected cardiovascular disease population
1. People with cardiovascular disease risk factors such as hypertension, hyperlipidemia, diabetes, and obesity;
2. Individuals experiencing unexplained chest tightness, chest pain, palpitations, and dyspnea after physical activity, with no clear abnormalities detected in routine electrocardiogram and echocardiogram examinations;
3. People with a family history of cardiovascular diseases such as coronary heart disease and cardiomyopathy who need to be screened for latent heart problems.
03 Cardiovascular and pulmonary disease patients and postoperative rehabilitation population
Patients with cardiopulmonary diseases such as coronary heart disease, heart failure, cardiomyopathy, chronic obstructive pulmonary disease, and asthma, who require assessment of disease severity, cardiopulmonary functional reserve, and treatment efficacy;
After undergoing cardiopulmonary surgeries such as stent implantation, coronary artery bypass grafting, and pulmonary lobectomy, patients need to undergo scientific assessments of their recovery status and develop postoperative exercise rehabilitation plans.
04 Health assessment of special populations
Individuals aged 40 and above, particularly those who are obese, sedentary, and plan to start regular exercise, need to assess their cardiorespiratory endurance in advance;
People engaged in high-intensity physical labor or special occupations who need to confirm whether their bodies can withstand the corresponding workload;
Individuals who have been prompted by routine physical examination to undergo further precise assessment of overall function due to abnormal cardiopulmonary indicators.
Cardiopulmonary exercise testing is like giving the heart a "sports-oriented physical examination". May we all exercise rationally and scientifically, so that our passion for sports can last long and our health can be maintained forever!