Table 3.

Summary of Guidelines for Exercise Testing in the Preoperative Evaluation for Lung Cancer Resection Surgery

Clinical Question	ACCP Guideline32	BTS Guideline34	ERS/ESTS Guideline33
Whom to test/which test	ppoFEV1 or ppoDLCO 30%–60% SCT or SWT ppoFEV1 or ppoDLCO < 30%: CPET	ppoFEV1 or ppoDLCO ≤ 40%: SWT or CPET	FEV1 or DLCO < 80% predicted: CPET
Functional cutoff indicating elevated risk	SCT height < 22 m, or SWT distance < 400 m, and/or ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ < 20 mL/kg/min (75% predicted)	SWT distance < 400 m, or ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ < 15 mL/kg/min	${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ < 20 mL/kg/min (75% predicted)
Anatomic resection generally not recommended (i.e., “prohibitive risk”)	${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ < 10 mL/kg/min (35% predicted)	SWT distance < 400 m, or ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ < 15 mL/kg/min	${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ < 10 mL/kg/min (35% predicted)

ACCP, American College of Chest Physicians; BTS, British Thoracic Society; CPET, cardiopulmonary exercise testing; D_LCO, diffusion capacity of the lung for carbon monoxide; ERS/ESTS, European Respiratory Society/European Society of Thoracic Surgery; FEV₁, forced expiratory volume in one second; ppo, predicted postoperative; SCT, stair-climbing test; SWT, shuttle walk test; ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$, peak oxygen consumption.