1. Guest, the 'News In Brief' post for w/c 17th September is available here.
    Dismiss Notice

UK: Locations that offer CPET/VO2max testing

Discussion in 'Laboratory and Genetic Testing' started by Andy, Jul 13, 2018.

  1. Andy

    Andy Senior Member (Voting Rights)

    Messages:
    3,562
    Likes Received:
    27,006
    Location:
    Hampshire, UK
    The idea of this thread is, as the thread title says, to list those places in the UK that offer this type of testing. Our familiarity is with the term CPET (2 day or otherwise), it may be better known by sports scientists as VO2 max.

    So to start, @chicaguapa said
    in this thread, https://www.s4me.info/threads/conce...nagement-of-cfs-me-davenport-et-al-2010.4937/
     
    ahimsa, alktipping, Cinders66 and 4 others like this.
  2. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

    Messages:
    1,000
    Likes Received:
    6,827
  3. arewenearlythereyet

    arewenearlythereyet Senior Member (Voting Rights)

    Messages:
    1,445
    Likes Received:
    10,027
    Location:
    UK
  4. arewenearlythereyet

    arewenearlythereyet Senior Member (Voting Rights)

    Messages:
    1,445
    Likes Received:
    10,027
    Location:
    UK
    Also these are the top sports science unis in the uk according to this site


    Where can I study Sports Science in the UK?
    To learn more about the best Sports Science courses in the UK, find details on the top ten ranking Sports Science universities in the Guardian University Guide 2019 below:

    1. University of Leeds
    2. University of Bath
    3. Loughborough University
    4. University of Birmingham
    5. Kingston University
    6. University of Aberdeen
    7. Durham University
    8. Bangor University
    9. University of Glasgow
    10. Staffordshire University
    http://www.studyin-uk.com/studyuk/sports-science/
     
  5. Ryan31337

    Ryan31337 Senior Member (Voting Rights)

    Messages:
    125
    Likes Received:
    835
  6. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

    Messages:
    394
    Likes Received:
    2,465
    One key aspect to note is that the CPET protocol for healthy people can differ from that used in ME/CFS studies, specifically the rate at which the power is increased. This can lead to less time on the bike, but also less precision of the data.

    Solent Sports Science Lab (mentioned above) says:

    When I did the first CPET test I had 23 "stages" before exhaustion, which suggests smaller increases in power for each stage. So I suggest taking them up on the offer to "tailor" the protocol to match ME/CFS studies. Having said that though, I don't really recommend doing the test at all unless you are forced to for insurance reasons or whatever. I found it quite hard, though it was not a permanent set back.
     
    Judee, TrixieStix, alktipping and 6 others like this.
  7. Sbag

    Sbag Senior Member (Voting Rights)

    Messages:
    222
    Likes Received:
    1,615
    I know Northampton hospital does it but don't know how much.
     
    alktipping likes this.
  8. Ryan31337

    Ryan31337 Senior Member (Voting Rights)

    Messages:
    125
    Likes Received:
    835
    This is a good point. The incremental work ramp rate is usually given in watts, I think I did 15W though can't be sure.

    Not sure if your CPET was done in a sports centre @Snow Leopard, but the 3x I did were in a clinical setting and sounded a little different. The power ramp was constant with no discernible stages and the clinical protocol aimed for the test to be finished (i.e. you should be at your VO2max) in 8-12 minutes.
     
    alktipping, Andy and adambeyoncelowe like this.
  9. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

    Messages:
    1,000
    Likes Received:
    6,827
  10. Cinders66

    Cinders66 Senior Member (Voting Rights)

    Messages:
    379
    Likes Received:
    2,420
    I'm not remotely capable of doing this, but if it's so widely available and not hugely expensive it's sad no one in the uk has had the interest or been persuaded to undertake a study. At £300/pp , 50 tests would cost £15 000, then the scientific analysis paper writing costs. Could those who're contacting or attending raise the issue to see if anyone might be interested?
     
  11. Ryan31337

    Ryan31337 Senior Member (Voting Rights)

    Messages:
    125
    Likes Received:
    835
    CPET abnormalities in our patient group are usually quite non-specific.

    The CPET can give some indication of where the limitation lies but no distinct cause in most cases. For me it was concluded that there was likely no respiratory limitation but moderate functional impairment from cardiovascular limitation. They couldn't say much more than that. You can drill down a little further with the sort of invasive CPET protocol that Systrom uses, looking at filling pressures & oxygen extraction to better identify the limitation - but its still not going to give you a cause.

    I imagine where it has a bit more use is in providing objective results from drug trials, which I understand is exactly what Systrom is doing with upcoming Mestinon trials.
     
  12. Cinders66

    Cinders66 Senior Member (Voting Rights)

    Messages:
    379
    Likes Received:
    2,420
    It's less about cause than about establishing our abnormal PEM weakness on exertion, through 2 day testing. The research contrasting us with MS has been interesting, larger studies establishing the abnormal response which IOM considered very important hence SEID and then, for uk benefits, contrasting with depression, IBS, pots , auto immune illness and heart and liver disease would imo be worthwhile.
    The MS /ME testing also added in gene expression measuring and immune measures which I'm guessing are expensive.

    I'm interested in what you say about mrstonin trials, I wasn't aware of this, It's CFS?
     
    alktipping and adambeyoncelowe like this.
  13. Ryan31337

    Ryan31337 Senior Member (Voting Rights)

    Messages:
    125
    Likes Received:
    835
    Hi @Cinders66,

    Check out these threads & videos:
    https://www.s4me.info/threads/dr-david-m-systrom-at-bwh-has-evidence-of-sfpn-in-some-patients.4855/
    https://www.s4me.info/threads/webin...-international-tuesday-jan-16-7-8pm-est.1917/
    https://www.s4me.info/threads/dr-oaklander-sfnp-video-small-fibers-big-pain.4890/

    These guys are seeing similar results in a good subset of their syndromic patients: CFS, Fibro, POTS etc.

    They are also seeing day 1 abnormalities in CPET results, so establishing a worsening from PEM is a secondary concern really. My expectation is that many of those that take 2 days to show abnormality probably just have less autonomic dysfunction at baseline compared to the day 1 patients like myself.

    Ryan
     
  14. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

    Messages:
    394
    Likes Received:
    2,465
    My test was done in a university clinic.
    It depends on the setup, some recent equipment may automatically ramp the power up in almost continuous steps. Some equipment require the power to be ramped up manually in steps, 10-15w is common. However the protocol/rate of increase for athletes can be at a faster rate or use larger steps.

    Indeed. The equipment is often just sitting there unused, it ultimately just requires the time of a PhD student/postdoc and a supervisor and it can be done very cheaply.

    I have not seen any highly specific and replicated findings on 1 day CPET. Many patients have VO2Peak in the normal range (despite many people suggesting patients are severely deconditioned). VO2Peak numbers are easily biased from study to study as some patients are not encouraged enough to reach a true VO2Max (hint, if you weren't about to pass out, you hadn't reached maximal exertion).

    The single replicated finding (across all studies that have tested this) is the reduction in performance at the ventilatory threshold on the 2 day CPET.
     
    Last edited: Jul 14, 2018
    Pechius, Andy, alktipping and 2 others like this.
  15. chicaguapa

    chicaguapa Established Member (Voting Rights)

    Messages:
    69
    Likes Received:
    665
    Solent priced the 2-day CPET using the CFS protocol at the cost of a returning lactate test, so it may be that contacting the relevant university will yield a different price to what's shown on their websites.
     
    Andy, adambeyoncelowe and alktipping like this.
  16. chicaguapa

    chicaguapa Established Member (Voting Rights)

    Messages:
    69
    Likes Received:
    665
    I had a long conversation today with the guys at Solent who did the tests. Their view is that it's not necessary to exercise to exhaustion on day 2 and that you just have to exercise to gas exchange threshold and then you can stop. This is if you just want to show that that the threshold has decreased on the second day. This may help if anyone is thinking of doing it there, or somewhere else, and isn't comfortable with the idea of pushing too far twice.
     
    Judee, Skycloud, ukxmrv and 13 others like this.
  17. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

    Messages:
    1,000
    Likes Received:
    6,827
    I've just completed my two-day CPET at Salford. It was daunting on the first day but less so on the second day.

    We did the 10-minute thing with slowly increasing difficulty, rather than the constant stopping and starting. She said it was exactly the way described in the paper I sent over, so there may be a couple of different protocols used? We used the Stevens Protocol. She also took some bloods on both days to see what that might yield in terms of answers.

    I provided them with a PowerPoint on CPET that Stevens presented too. I'm not sure what different info that had, but it did break down how to read the results (into mild, major, severe, etc).

    It was definitely hard, and I had to stop 45 seconds before the end of the second test, but she said my effort was very good and my power was higher than some people's. That means I'm definitely not deconditioned. 10 minutes was about the right time for this. Longer would be too difficult.

    I know that I can often do short bursts of exertion when I have to, so I wasn't worried about that. Mostly I did the test to show, objectively, that just because I can do it on day one, it doesn't mean I can do it on day two! Cycling is easier than a treadmill, and we did some warmdowns to limit OI, which did really help. I had the option of stopping if it got too much at any time.

    I don't have the results yet, but I could see from the bike that on the first day my O2 and CO2 were pretty close until the end. On the second day, the CO2 overtook the O2 levels really quite quickly. My breathing was very steady on both days. I don't know if what I was seeing was my anaerobic threshold at work, but it seemed to chime with the feeling in my legs. Does anyone who knows about this know if that's what I was seeing?

    It was a really positive experience, despite being exhausting, and it helped me feel at ease that Clare who did the test has a brother with ME. She had a previous ME patient who had a slightly different test, which looked at lactate, but I think I was her first two-day CPET for ME.

    My head hurts and my glands are swollen, but my OI is much better than yesterday. My muscles have started to hurt but I still don't think I've been hit with full PEM yet. I wonder how much that will show up on the test. Clare did take details of my symptoms, though, which was helpful.
     
    MarcNotMark, ArtStu, Judee and 14 others like this.
  18. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

    Messages:
    394
    Likes Received:
    2,465

    Thanks for sharing your experiences. The blood tests will hopefully be interesting. There is no stopping and starting, I'm not sure where you got that idea. The only difference between tests (in different venues) is the power level of warmup, the length of the warmup and the rate at which the power is increased during the test.

    The key finding is lowered performance/efficiency on the second day at the ventilatory threshold suggesting the muscles are not using oxygen efficiently eg they're fatigued!
     
    Hutan, It's M.E. Linda, Andy and 2 others like this.
  19. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    1,014
    Likes Received:
    6,080
    Robert Gordon University in Aberdeen will do VO2 / returning lactate testing - await details of cost.
    They would require letter/ authorisation from GP - i think they recognise the risks of doing the exercise.
    Will update when received
    Waiting for response from Stirling/ edinburgh ( edinburgh and napier)/ glasgow / UWS
     
  20. Pechius

    Pechius Senior Member (Voting Rights)

    Messages:
    138
    Likes Received:
    784
    Could you tell me which paper you sent her? I'm going to approach a local sports university for a 2-day CPET. Hopefully it will work out..
    Also, where does the Steven protocol come from?
    Could you point me to that as well?
     
    It's M.E. Linda likes this.

Share This Page