CPET – Cardiopulmonary Exercise Test

Logo workwell foundation


Recovery time after 2-day cardiopulmonary exercise testing at Workwell Foundation

Man sitting down


If you have myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), you’ve probably
heard of the 2-day cardiopulmonary exercise test (CPET) protocol pioneered by Workwell Foundation. CPET is an objective tool that can document functional capacity and impairment for disability purposes and provides valuable information to guide pacing and energy conservation strategies.

CPET measures how well your heart, lungs, and muscles work during exercise. Workwell’s 2-day CPET protocol requires two tests separated by 24 hours to evaluate how your body responds to physical exertion. It can also support a diagnosis of ME/CFS by showing the abnormal physiological responses to exercise characteristic of the disease.   But if you’ve already struggling with day-to-day activities, is putting your body through the strain worth it? This blog explores recent CPET studies that examine recovery in ME/CFS patients.

Why Schedule a 2-Day CPET?

A 2-day CPET can help to better understand and manage ME/CFS. It evaluates how your body responds to physical stress, one of the primary triggers of post-exertional malaise (PEM). PEM is a worsening of symptoms after exertion, including fatigue, cognitive dysfunction, pain, sleep disturbances, and flu-like symptoms that can last for days, weeks, or even months.

The Test

A two-day CPET entails pedaling on a stationary cycle ergometer (i.e., bike) for approximately 8-10 minutes until you reach maximum effort. Effort criteria are primarily based on perceived exertion and the respiratory exchange ratio (RER), which examines the relationship between carbon dioxide production and oxygen consumption. During the test, patients wear a face mask that samples oxygen and carbon dioxide, electrodes that measure the heart’s rhythm and electrical activity, a blood pressure cuff, and a pulse oximeter.  Patients record symptoms before, during, and after each test. CPET can be challenging for people with ME/CFS due to exercise intolerance and PEM. Following the test, you may feel tired, sore, and unwell. You might also experience moderate to severe PEM, including fatigue, cognitive dysfunction, pain, sleep disturbances, and flu-like symptoms.

Recovery after CPET – what the data say

Symptoms during recovery

Recovery means that physical and cognitive abilities return to your pre-CPET baseline. Some recover within a few days, while others take weeks or longer. Some experience mild symptoms, and others report moderate to severe symptoms that negatively affect activities of daily living (ADLs). Our 2019 study measured the symptoms of 49 ME/CFS patients and ten healthy sedentary controls after a 2-day CPET. The study found that ME/CFS patients had significantly more and worse symptoms than controls during and after testing. ME/CFS patients reported an average of 14 symptoms immediately after the second CPET, whereas controls reported four. Seven days post-CPET, ME/CFS patients had four persistent symptoms, while control subjects had none. ME/CFS participants reported fatigue, cognitive dysfunction, and sleep problems most frequently. Half of the patients in this study took a week or less to recover.

Recovery Time After CPET

Another Workwell study found that the majority of patients with ME/CFS quickly recovered to baseline after a 2-day CPET despite having a prolonged recovery response compared to sedentary controls. Overall, 92% of patients recovered relatively quickly. On average, it took ME/CFS subjects approximately two weeks to recover, compared to two days for control subjects. Less than 10% of the ME/CFS patients took longer than three weeks to recover. While it is hard to predict recovery time for individuals, people with ME/CFS should know if it will take days, weeks, or months to recover based on their patterns when they overdo activities. It’s important to note that many external and internal stressors can impact the severity of the ME/CFS and recovery from exercise. Our FAQ page contains helpful suggestions for preparation and recovery from CPET.

Should you do a 2-day CPET?

Each person’s recovery from exercise in ME/CFS is unique.  Should you schedule a 2-day CPET?  Scheduling a 2-day CPET is a personal choice with pros and cons that should be weighed. But knowing what to expect during recovery can help to make an informed decision that’s right for you. The 2-day CPET can provide valuable insights into your condition and help with decisions about activity. It can also provide objective data in support of disability benefits. Without objective data on functional capacity, the likelihood of a denial is higher when applying for disability. Workwell provides tips to reduce and manage symptoms of PEM and speed up recovery.

Visit our website or call (661) 466-2545 for additional information about 2-day CPET or recovery.