Controversies in the physiological basis of the ‘anaerobic threshold’ and their implications for clinical cardiopulmonary exercise testing

• Published in: Anaesthesia 2011-02, Vol.66 (2), p.111-123
• Main Authors: Hopker, J. G., Jobson, S. A., Pandit, J. J.
• Format: Article
• Language: English
• Subjects: Anaerobic threshold; Anaerobic Threshold - physiology; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiovascular system; Carotid Body - physiology; Exercise; Exercise - physiology; Exercise Test - methods; Failure; Humans; Hyperventilation - physiopathology; Lactic acid; Lactic Acid - metabolism; Medical sciences; Medical tests; Motor performance tests; Patients; Physiology; Risk factors; Surgery; Terminology as Topic
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/j.1365-2044.2010.06604.x

Summary This article reviews the notion of the ‘anaerobic threshold’ in the context of cardiopulmonary exercise testing. Primarily, this is a review of the proposed mechanisms underlying the ventilatory and lactate response to incremental exercise, which is important to the clinical interpretation of an exercise test. Since such tests are often conducted for risk stratification before major surgery, a failure to locate or justify the existence of an anaerobic threshold will have some implications for clinical practice. We also consider alternative endpoints within the exercise response that might be better used to indicate a patient’s capacity to cope with the metabolic demands encountered both during and following major surgery.