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Global lung function initiative reference values for cardiopulmonary exercise testing

Global lung function initiative reference values for cardiopulmonary exercise testing
Global lung function initiative reference values for cardiopulmonary exercise testing
Background: cardiopulmonary exercise testing (CPET) is used to assess individuals' physiological responses to exercise and to identify potential causes of exercise limitation.

Aims and objectives: this study aimed to derive Global Lung Function Initiative (GLI) reference equations for peak oxygen uptake (V'O2peak) and peak work rate (Wpeak) in healthy individuals.

Methods: CPET data were retrospectively collected from sites and underwent checks for consistency and quality. Generalised additive models of location, shape and scale (GAMLSS) were used to develop reference ranges, including age, sex, height, and weight as explanatory variables. The influence of geographic region, equipment, testing protocols and averaging methods for peak exercise data on the derived reference ranges was also examined.

Results: data from 6047 healthy individuals between 6 and 83 years across 17 sites in Europe, North and South America, and Asia were analysed. The final models explained 68.9% and 67.5% of the variability in V'O2peak and Wpeak, respectively. Variations persisted by site despite adjusting for key demographic factors. Geographic region, metabolic cart type, and averaging methods of peak exercise values improved model fit but were impractical as predictors for developing reference ranges.

Conclusion: significant heterogeneity in CPET testing methodology and outcomes between sites precluded the development of generalised reference ranges for V'O2peak and Wpeak. Further prospective studies with standardised CPET protocols and analytical methods are needed to reduce variability and establish robust, clinically meaningful interpretation strategies.
0903-1936
Radtke, Thomas
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Chavez, Luiz
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Duggan, Lauren
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Stanojevic, Sanja
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Agostini, Piergiuseppe
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Burns, Paul
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Button, Brenda
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Cooper, Christopher
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De Brandt, Jana
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Degani-Costa, Luiza Helena
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Franczuk, Monika
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Mcgowan, Aisling
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Kivastik, Jana
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Laveneziana, Pierantonio
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Saynor, Zoe L.
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Steenbruggen, Irene
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Hebestreit, Helge
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Sylvester, Karl P.
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Radtke, Thomas
f79ede09-9f79-4322-828a-58604c31db14
Chavez, Luiz
6f3bc86d-bf20-4bbe-99b1-8789e48b319a
Duggan, Lauren
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Stanojevic, Sanja
36c16e7a-3c72-44d7-8eb4-f113e6403af0
Agostini, Piergiuseppe
0fa3f0bf-82ca-4ec2-8f06-2427f490249c
Burns, Paul
fadd7339-4b6f-4abd-b74e-8fa53ecbf5ea
Button, Brenda
301f9a8f-9385-4d4d-b589-fdac19fe22f2
Cooper, Christopher
0a59c425-4ae3-4670-aa39-3fa025e5a64e
De Brandt, Jana
d7094140-69cb-43d6-bd35-fb45181b5e81
Degani-Costa, Luiza Helena
aec2c4ae-8aa6-42a8-a5e4-73eb64279187
Franczuk, Monika
637e2624-2354-4c6f-b636-c9f5ffed4456
Mcgowan, Aisling
e19c317f-fa93-47ce-9331-e0d19fc445f4
Kivastik, Jana
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Laveneziana, Pierantonio
0c85c94c-fbe6-419e-9580-19ca29b4c65b
Saynor, Zoe L.
a4357c7d-db59-4fa5-b24f-58d2f7e74e39
Steenbruggen, Irene
7023d31f-420f-4717-92b9-385505f70e58
Hebestreit, Helge
0355cb3a-0cf8-4b94-a97d-d15fd42c4639
Sylvester, Karl P.
cb51eb4d-3f9b-4450-b3bd-056a268d9474

Radtke, Thomas, Chavez, Luiz, Duggan, Lauren, Stanojevic, Sanja, Agostini, Piergiuseppe, Burns, Paul, Button, Brenda, Cooper, Christopher, De Brandt, Jana, Degani-Costa, Luiza Helena, Franczuk, Monika, Mcgowan, Aisling, Kivastik, Jana, Laveneziana, Pierantonio, Saynor, Zoe L., Steenbruggen, Irene, Hebestreit, Helge and Sylvester, Karl P. (2025) Global lung function initiative reference values for cardiopulmonary exercise testing. European Respiratory Journal, 66 (Suppl. 69), [OA5395]. (doi:10.1183/13993003.congress-2025.OA5395).

Record type: Meeting abstract

Abstract

Background: cardiopulmonary exercise testing (CPET) is used to assess individuals' physiological responses to exercise and to identify potential causes of exercise limitation.

Aims and objectives: this study aimed to derive Global Lung Function Initiative (GLI) reference equations for peak oxygen uptake (V'O2peak) and peak work rate (Wpeak) in healthy individuals.

Methods: CPET data were retrospectively collected from sites and underwent checks for consistency and quality. Generalised additive models of location, shape and scale (GAMLSS) were used to develop reference ranges, including age, sex, height, and weight as explanatory variables. The influence of geographic region, equipment, testing protocols and averaging methods for peak exercise data on the derived reference ranges was also examined.

Results: data from 6047 healthy individuals between 6 and 83 years across 17 sites in Europe, North and South America, and Asia were analysed. The final models explained 68.9% and 67.5% of the variability in V'O2peak and Wpeak, respectively. Variations persisted by site despite adjusting for key demographic factors. Geographic region, metabolic cart type, and averaging methods of peak exercise values improved model fit but were impractical as predictors for developing reference ranges.

Conclusion: significant heterogeneity in CPET testing methodology and outcomes between sites precluded the development of generalised reference ranges for V'O2peak and Wpeak. Further prospective studies with standardised CPET protocols and analytical methods are needed to reduce variability and establish robust, clinically meaningful interpretation strategies.

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More information

Published date: 18 November 2025

Identifiers

Local EPrints ID: 508503
URI: http://eprints.soton.ac.uk/id/eprint/508503
ISSN: 0903-1936
PURE UUID: bacb1235-d81f-4c32-ab0e-16ea6fcd0e81
ORCID for Zoe L. Saynor: ORCID iD orcid.org/0000-0003-0674-8477

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Date deposited: 23 Jan 2026 17:52
Last modified: 24 Jan 2026 03:22

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Contributors

Author: Thomas Radtke
Author: Luiz Chavez
Author: Lauren Duggan
Author: Sanja Stanojevic
Author: Piergiuseppe Agostini
Author: Paul Burns
Author: Brenda Button
Author: Christopher Cooper
Author: Jana De Brandt
Author: Luiza Helena Degani-Costa
Author: Monika Franczuk
Author: Aisling Mcgowan
Author: Jana Kivastik
Author: Pierantonio Laveneziana
Author: Zoe L. Saynor ORCID iD
Author: Irene Steenbruggen
Author: Helge Hebestreit
Author: Karl P. Sylvester

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