Spiroergometry Execution and evaluation

A spiroergometry is an endurance performance test, which is preferably performed on an ergometer or treadmill. The test person wears a breathing mask through which his exhaled gases are analyzed.

 

Application of Spiroergometry in Sports


The main areas of application are:

  • cardiology
  • pneumology
  • Performance diagnostics

Accordingly, this method has a broad field of application, ranging from patients with heart failure or lung diseases to high-performance athletes. In addition to determining performance, training plans for sports activities can also be created and the progress of physical training can be monitored and evaluated.

 

The procedure of a spiroergometry


TreadmillThe test for an athlete should be sport specific: A runner should be tested with a treadmill, a cyclist with an ergometer. Depending on the question, a step or ramp protocol on the treadmill (walking or running load) or bicycle ergometer is selected as the ergometric load form. Initial performance and steps of increase are determined under individual aspects.

During the test, the test person wears a tight breathing mask with a so-called flowmeter. This is used in a respiratory gas measuring device (spiroergometry device) to determine the respiratory volumes and to take gas samples to measure the O2– and CO2– concentration. At the same time, the heart rate is registered via a stress ECG. If required, the blood pressure can be measured and the blood lactate values and blood gas values from the small capillary blood sample taken at each step on the earlobe (or finger). The duration of the examination itself is approx. 15 minutes, depending on the question and endurance of the test person. At the end of the test, all data is compiled and evaluated in a computer.

The test collects a great deal of data that far exceeds the meaningfulness of a conventional lactate level test. The amount and complexity of the data collected in a spiroergometry test make such a test exaggerated for a hobby athlete, as he cannot significantly implement the data of the test. A lactate level test (which also provides a lot of relevant data and is also used by professional athletes) is completely sufficient here.

 

What is examined in spiroergometry


Spiroergometry is used to determine and evaluate circulation and respiration (ventilation) at rest and under stress.

Circuit

  • blood pressure
  • Pulse
  • EKG (including heart rate)
  • Circuit adaptation
  • blood gases
  • blood lactate

Breathing (Ventilation):

  • breathing minute volume (VE)
  • oxygen absorption (VO2)
  • Carbon dioxide release (VCO2)
  • breathing frequency (AF)
  • Breath depth (VT)

Therefrom further parameters are calculated:

  • Respiratory quotient (RQ = VCO2 / VO2)
  • breath equivalent for O2 (AÄO2 = VE / VO2)
  • Breath equivalent for CO2 (AÄCO2 = VE / VCO2)
  • Breath volume (AZV = VE / AF)

This allows conclusions to be drawn about the actual performance of the heart, lungs and circulatory system. In addition, it can be distinguished quite reliably whether a restriction in performance is caused by the heart or the lungs. Spiroergometry is also used to check the exchange of respiratory gases (absorption of O2, the release of CO2).

 

Evaluation of a Spiroergometry


Today, gas analyzers with an analysis time of 90 milliseconds are available. These provide the tester untiringly, accurately and reproducibly in quasi-real time with measured values. This makes it possible to record physiological data breath by breath.

ECG Diagram
The analysis is similar to an ECG

Together with the data from circulation (pulse, ECG, blood pressure), ventilation (respiratory minute volume [AMV], respiratory depth [VT] and respiratory frequency [AF]), a very large amount of data is collected over 12-15 minutes.

This data cannot be grasped and evaluated without meaningful and graphical processing. This is only made possible by the availability of fast computers with fast color printers.

The 9-FG (a sheet with a 9-field graphic) is an internationally accepted standard for the documentation and analysis of the multitude of physiological values collected over a load duration of approx. 15 minutes. Breath by breath collected parameters for circulatory and respiratory regulation are recorded here – nowadays with fast computers and color printers – not only in tabular form but above all graphically, similar to what we know from ECGs.

 

The spiroergometry from its origin until today


1896 to 1924

  • Bis 1896: multiple attempts by scientists to measure respiratory gases during physical activity.
  • 1896: The first bicycle ergometer in the world was probably developed by the Frenchman Bouny 1896 in Paris.
  • 1912: Development of respiratory gas analysis. John Scott Haldane (1860 – 1936) develops an analytical technique for measuring gases in the air. The analysis is very precise but required large sample quantities, a highly qualified laboratory team and plenty of time.
  • 1924: Hugo Wilhelm Knipping (1895 – 1984) develops a spirograph for basal metabolic rate determination.

1924 to 1949

  • 1924 – 1929: At about this time, clinicians and physiologists were increasingly concerned with gas metabolism at rest and under stress, whereby a hand crank ergometer together with a spirograph made the first measurements in the sense of a spiroergometry possible. The technical development runs parallel to the physiological findings. The following elaborated and coined (historical) terms are less familiar to us, but still contain highly relevant and decisive physiological cornerstones:
    • “Vita Maxima” today: maximum O2absorption (VO2max respectively VO2peak)
    • “Vita Minima” today: O2absorption at complete rest (basal metabolic rate)
    • Power test according to the “principle of small wattage levels” today: most likely ramp protocol
    • “respiratory limit value” today: MVV (maximum voluntary ventilation).
  • Concepts, which are still used today – but mostly with Anglo-Saxon nomenclature – were also developed in the 1930s:
    • Respiratory reserve (1929)
    • breath equivalent (1932)
    • Respiratory resting insufficiency and exercise insufficiency (1937)
    • Spirographic O2-Deficit (1937)
  • 1947: Improvement of respiratory gas analysis. Per Fredrik Scholander (1905 – 1980) published an improvement in analytics by Scott Haldane (see 1912). In a short time (5 – 10 minutes) gas analysis can now be performed on small samples.

1950 to 1979

  • Ab 1950: During this time the technical cooperation of clinicians and physiologists with the Hamburg company A. Dargatz intensifies. The ergometer technology is optimized and measuring systems for the recording of high performances (3 L, later 5 L VO2) are installed in the German Sports University in Cologne. The knowledge thus gained from sports medicine leads to a description of the relationship between ventilation and O2 intake and lactate metabolism.
  • A term that is the focus of our attention today is coined as “PoW” = point of optimal efficiency of respiration; today we speak of the AT (anaerobic threshold).
  • 1965: Karlman Wasserman develops the well-known concept of the three meshing gears as a metaphor for the interaction of ventilation, circulation, and metabolism.
  • 1973: Working on the breath-by-breath method by Karlman Wasserman and William L. Beaver
  • 1978: Development of the 9-Field-Graphic (9-FG) by Karlman Wasserman.
  • 1986: Description of the V-slope method by Karlman Wasserman and William L. Beaver

1980 until today

  • 1980 – today: Spiroergometry with all its scientific and technical facets has – as shown – also German roots. In particular, sports medicine (W. Hollmann and his school in Cologne, based on the specifications of H. W. Knipping) made a decisive contribution to this. A standardization of spiroergometry was developed at international symposia of the RWTH Aachen (Meyer-Erkelenz) and published in 1980.
  • At the initiative of Karlman Wasserman, an international working group called ISEIRE (International Society of Exercise Intolerance Research and Education) is currently being established. The spiroergometry working group with integration into the German Society of Pneumology (DGP) and the German Society of Cardiology (DGK) will participate as a “German Chapter”.

You can find the complete article with historical photographs under:
http://www.ag-spiroergometrie.de/fileadmin/AG_Spiroergometrie/History_of_Spiroergometrie.pdf

This post is also available in: German

William C. Hilberg
As an author, Mr. Hilberg has published several papers on health issues that have gained international recognition. He is close to nature and loves the seclusion and activity as a freelance journalist. In his function as editor William C. Hilberg manages the entire content of PENP. Our team greatly appreciates his expertise and is proud to have him on board.