# Technological and Biological Reliability, and Validity of Five Different CPET Systems During Simulated and Human Exercise

## TL;DR

This study compares five CPET systems to assess their accuracy and reliability in measuring respiratory and energy variables during simulated and human exercise.

## Contribution

The study provides a comprehensive evaluation of technological and biological reliability of five CPET systems using both simulation and human trials.

## Key findings

- The Vyntus CPX and Oxycon Pro showed the lowest percentage errors in measuring V̇O2 and V̇CO2 during simulations.
- Biological variability accounted for ~60%–70% of repeated human testing variability in V̇O2 and V̇CO2.
- The Calibre system had the highest error in carbohydrate energy estimation during simulations.

## Abstract

The validity and between‐day reliability of cardiopulmonary exercise testing (CPET) systems remain largely unexplored. We therefore evaluate the validity and between‐day technological and biological reliability of five popular CPET systems for assessing respiratory variables, substrate use, and energy expenditure during simulated and real human exercise. The following systems were assessed: Vyntus CPX, Oxycon Pro, VO2 Master, KORR, and Calibre. A metabolic simulator was used to simulate breath‐by‐breath gas exchange. The values measured by each system (minute ventilation (V̇E), breathing frequency (BF), oxygen uptake (V̇O2), carbon dioxide production (V̇CO2), respiratory exchange ratio (RER), energy from carbohydrates and fats, and total energy expenditure) were compared to the simulated values to assess the validity. Six well‐trained participants cycled 5% below their first ventilatory threshold on 2 days to verify the validity in human exercise. Between‐session reliability was assessed in both the simulation and human experiments to determine technological and biological variability. Absolute percentage errors during the simulations ranged from 0.69% to 5.56% for V̇E, 0.92% to 1.44% for BF, 3.12% to 7.86% for V̇O2, 4.07% to 12.1% for V̇CO2, 1.21% to 6.94% for RER, 2.83% to 48.8% for Kcal from carbohydrates, 14.1% to 50.3% for Kcal from fats, and 4.21% to 6.98% for total energy expenditure. Between‐session variability during simulation (i.e., technological variability) ranged from 0.46% to 3.15% for V̇O2 and 0.71% to 4.99% for V̇CO2. The error and between‐day variability of the error for respiratory gas variables, substrate, and energy use differed substantially between systems. Biological and technological V̇O2 and V̇CO2 variability, respectively, accounted for ~60%–70% and 40%–30% of the variability in repeated human testing.