Role of cardiopulmonary exercise testing in today's cardiovascular prevention and rehabilitation.

In daily clinical practice when decisions are made about the value of exercise testing in patients with cardiovascular disease, the focus is inevitably on measures that reflect the state of the coronary arterial circulation, owing to the potential requirement for coronary angiography and revascularization. Hence, exercise capacity is typically brought into play in the context in which ischemic responses are interpreted: ischemia in the setting of poor exercise capacity means high risk, whereas in the setting of good exercise capacity it has little prognostic impact [1]. Conversely, although clinicians have long been aware that high levels of exercise capacity are associated with a better prognosis [2], the widespread tendency to ignore exercise capacity in clinical management seems to be linked to a general uncertainty about the therapeutic implications of exercise capacity.