Exercise Testing

Hello all, wondering how many other stress labs are still requiring use of a mask during exercise testing. Once we got back up and running at full schedules in May/June of 2020 we were mandated to have patients wear masks during exercise testing (except for cardiopulmonary exercise testing, but we do that in a negative pressure room). I feel in some cases it may have causes a less than ideal effort, but overall with some adjustments to protocols we could still routinely get double products of 25k or better and even 20k or better on many of our elderly patients. Of course do not know ultimately if we may have missed some anginal/ischemic thresholds, but we seem to have done well to date. Thoughts???

Hi Mark! I work in an academic setting where we test both health adults and those with chronic health conditions. We are still required to wear masks and will likely have to continue for a while. While less than ideal, we haven't had too many complaints (thankfully) from clients. We feel the same in regards to the results are most likely slightly lower than if the tests were performed without the masks.

Mark- We never required patients to wear masks during an exercise test. Staff wear masks. We require our patients in cardiac rehab to wear masks. We use a filter during CPX. Patients are not required to wear masks during exercise ECG only, exercise echo, or exercise nuclear.

Hi Clinton, that is what I have been pushing for here. During CPX we use a filter during baseline spirometry, but I have always done that, so was not a change, but just the Hans Rudolph mask and sensor during exercise. Again, we constructed a negative pressure room that we do the tests in now, but not sure how much that helps anyway during peak efforts. Will hopefully get to where we are the only ones wearing masks in the somewhat near future, if for no other reason than reducing the number of grumpy patients.

Clinton, can you explain more about the location of the filter you are using? Is is proximal to the patient or to the cart? Have you found the filter reduces ventilatory responses? We use a ParvoMedics cart and have been using a standard bacterial filter near the mixing chamber, but have been trying to find a way to locate a filter closer to the patient.

Carol- We use MGC Diagnostics metabolic carts. The filter is placed between the mouthpiece/mask and the flow sensor. The filters were intended for use during spirometry. Part of the reason they had not been used during exercise testing is because of the anticipated increase work of breathing through the filter. About 40% of our tests are in patients with heart failure. We have seen many patients who were tested pre-pandemic (without filter) and now with the filter. I've not heard of any of these patients commenting on the test being more difficult. To be clear, I do not think the filter is blocking 99% of organisms (https://mgcdiagnostics.com/company/news/pft-covid-19-filter-numbers-only-tell-part-of-the-story), but if it is blocking 50% of droplets that is helpful.

Hi Mark,

Unfortunately we still require our patients to use masks for all stress testing. I do feel that this inhibits the patients’ exercise capabilities, unfortunately I see no signs of our institution dropping the mask mandate any time soon.

Hi Mark we require patients to wear a surgical mask except during CPX. All personnel wear N95 and face shields. We have added FDA approved HEPA filters to our lab. This is pretty much the requirements for other labs in the columbia system. One lab I know of doing CPX was required to install a dental type filter and allows patients to go without masks something like this https://www.airsystems-inc.com/product/extract-all-987-dca1-dental-clean-air/

Here is a good article on face masks during exercise

https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.202008-990CME