Cardiopulmonary Exercise Testing in Australia and New Zealand: a survey of current clinical practice

Background: Cardiopulmonary exercise testing (CPX) provides objective assessment of integrative physiological function and is recommended in international guidelines for the investigation of unexplained dyspnea and exercise intolerance. Despite its clinical value, the implementation of CPX is variable worldwide. No previous studies have described CPX practices in Australia and New Zealand. Methods: A cross-sectional online survey of health professionals involved in CPX delivery was conducted between May 2023 and September 2024. Laboratories were identified using professional society lists and hospital websites. The 29-question survey explored staffing, training, protocols, and test application. Descriptive analyses were used to summarize closed- and open-ended responses. Results: Fifty-five laboratories completed the survey, of 71 approached. Most services were based in public hospital respiratory departments and used cycle ergometry with individualized ramp protocols. Cardiopulmonary exercise testing was most commonly used for unexplained breathlessness, perioperative assessment, and functional evaluation. One-third of services used fixed work rate protocols, and 62% of respondents reported no formal CPX training. Multiple step and ramp protocols were identified across sites, with substantial variation in incremental work rates. The most frequently reported barriers to CPX delivery were inadequate staffing, lack of training, and limited space. Conclusion: This is the first survey of CPX practice in Australia and New Zealand. Results highlight substantial variation in training, protocols, and resourcing. These findings can inform professional development strategies and support the generation of standardized practice guidelines. Addressing training gaps, enhancing workforce capacity, and expanding clinical use may increase the quality, consistency, and impact of CPX across the region.