Question
Are there any hospitals or private clinics in the UK who understand ME/CFS and are able to carry out a two-day cardio-pulmonary exercise test (CPET) – similar to the one performed at the Workwell Foundation in the US – and properly interpret the results?
Answer
For people who are not aware, a cardiopulmonary exercise test (CPET) shows how your lungs, heart and muscles are all working together when you exercise.
During the test, you will be asked to exercise on an upright bicycle or on a treadmill. Each breath you take in will provide a measurement of various aspects of lung function and the results are compared to normal values. In technical terms, this involves measuring oxygen consumption during exercise and what is called the anaerobic threshold – the physiological point during exercise at which lactic acid starts to accumulate in the muscles.
Measurements are also recorded on how fast your heart is beating when you exercise.
In relation to ME/CFS, there is now robust evidence from research carried out in America by the Workwell Foundation, and here in the UK, that people with ME/CFS have an abnormal physiological response to exercise.
The CPET studies from the Workwell Foundation have shown that people with ME/CFS have an abnormal aerobic metabolism (problems converting food into energy using oxygen) when at maximum exercise capacity.
They also found low levels of VO2 (oxygen uptake in the body) and greater levels of lactic acid during exercise when performed on an exercise bike under laboratory conditions.
People with ME/CFS may also tend to perform perfectly adequately on the day of the first test but have a significant reduction in cardiopulmonary function when the test is repeated the day after.
Having this type of abnormal exercise result test provides objective evidence of post-exertional malaise/symptom exacerbation and can help to confirm a diagnosis of ME/CFS. However, the use of CPET is not recommended by NICE as a part of the normal diagnostic assessment for ME/CFS.
The simple answer to your question is that there are plenty of hospitals that can carry out a CPET test. However, I am not aware of any ME/CFS hospital-based referral centres that perform CPET tests as part of their routine clinical assessment procedures.
Other ways to get a CPET test if you have ME/CFS are to:
- Be part of a research study. Please note that the UK research group (Physios 4 ME) who use CPET does not require any more volunteers at present.
- Get one done privately. There are private hospitals such as Spire who carry out private tests but this may not be carried out by someone who understands ME/CFS.
I would also point out that there are risks in having a CPET in that it can exacerbate ME/CFS symptoms, or even cause a relapse. A recent research paper reported that, on average, it took two weeks to recover from a CPET.
Please let us know if you have had a CPET at one of the ME/CFS referral centres.
Further information
- Research studies from VanNess, Snell, Keller and others into the use of the two-day CPET in ME/CFS are summarised and referenced in the Investigations section of the ME Association ME/CFS/PVFS Clinical & Research Guide (MEA purple book)
- Research into the use of CPET in ME/CFS that is being funded by the MEA
- NHS information on having a CPET
SEE MORE: Cardiopulmonary Exercise Testing (CPET)
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MEDICAL DISCLAIMER
We recommend that the medical information is discussed with your doctor. It is not intended to be a substitute for personalised medical advice or treatment. You should consult your doctor whenever a new symptom arises, or an existing symptom worsens. It is important to obtain medical advice that considers other causes and possible treatments. Do not assume that new or worsened symptoms are solely because of ME/CFS or Long Covid.