Role of Cardiopulmonary Exercise Testing in the Monitoring of Cardiovascular Risk Factors in Athletes – State-of-the-Art Review

Abstract: Although physical activity has beneficial effects for health, athletes also suffer from cardiovascular diseases (CVD). The type and prevalence of CVD in athletes depend on their age, but typically include hypertrophic cardiomyopathy, arrhythmias, and valve diseases. In pediatric athletes < 18 years old, congenital heart diseases (CHD) are prevalent, while in master athletes > 35 years old, coronary artery disease (CAD) is the most common. Cardiopulmonary exercise testing (CPET) is a gold standard to evaluate cardiorespiratory fitness (CRF). Although CRF is most often identified as peak oxygen uptake (O 2peak ), CPET provides a multidimensional assessment through several other cardiorespiratory variables. CVD aggravates CRF and reduces O 2peak . While there is no universal pattern of alteration in the remaining CPET parameters, the specific deviations depend on the type of CVD. Therefore, precise monitoring of changes in CPET scores is crucial for risk stratification, adjusting exercise intensity, enabling safe sports participation, and authorizing return to sport after treatment. Among athletes, CPET plays a pivotal role across all fields. Therefore, this review aimed to evaluate the value of CPET in 1) identification of risk factors of CVD among athletes, considered as changes in CRF, 2) monitoring of treatment, and 3) making shared decisions on returning to sport. A special focus was placed on the needs of emerging age groups – pediatric and master athletes. Additionally, evidence gaps and directions for future research were discussed. Keywords: CPET, athlete, cardiovascular disease, cardiopulmonary exercise testing, risk factor