Clinicians who support the evaluation claim that a simple test called the cardiorespiratory optimal point (COP) may forecast a person's lifespan or the severity of their heart failure. This article discusses the applications of COP.

Cardiorespiratory Optimal Point (COP)

Advocates assert that the COP is a simpler way to measure than cardiorespiratory parameters that call for participants to exert themselves to the maximum; rather than sprinting at top speed, a participant may stroll or gently jog on a treadmill and simply measure the COP.

However, some other clinicians believe that maximal exercise tests offer several prognostic advantages and that doctors should exert every effort to encourage patients to exercise as hard as they can.

The gold standard for testing cardiovascular endurance is the VO2 max test, which measures the highest quantity of oxygen a person utilises when exercising to their limit.

The least amount of air needed to carry one litre of oxygen through the bloodstream when breathing is indicated by the COP. The minimal ventilatory equivalent for oxygen is known as the COP and is calculated as the ratio of ventilation to oxygen absorption (VE/V O2) at any given minute during an incremental exercise test.

The lower the COP, the better since it indicates that a person's heart and lungs are communicating more effectively and that they are using less energy to move the same quantity of oxygen.

The protagonist asserts: "Max VO2 is crucial, there is no disputing that. But when do you use your maximum VO2 in everyday life? Hardly. However, virtually anybody can produce a COP.

The COP's potential applications

1. The COP may be obtained after 3 or 4 minutes of having someone on a bike or treadmill. It is similar to walking speed. Nevertheless, the readings were reached with about half as much effort as VO2 max.
2. Others claim that pushing one's physical limitations while doing therapeutic tasks provides novel clinical insights.
3. The COP was initially established in a 2012 research. It is computed by monitoring the amount of expelled gasses individuals make while lightly exercising, maybe until they start to perspire, and then dividing that amount by their minute oxygen intake. The COP is the lowest value attained throughout any workout session.
4. According to several studies, greater COP readings are linked to poorer prognoses in patients with heart failure, higher death rates in men who seem to be in good condition, and more severe cardiac lesions in individuals with congenital heart disease. All of this research has only recently been published.
5. More than 3000 men and women who participated in an activity test between 1973 and 2018 and were followed for an average of 23 years were compared for COP.
6. Although COP was first used as an evaluation in 2012, it was able to calculate the figure from tests conducted before that time since those tests had recorded the pertinent oxygen uptake and breathing rate.
7. A poorer COP was substantially linked to a higher chance of dying sooner among men 18 to 85 years old. The author stated that further study is required to fully explain why this conclusion did not hold for females and the disparity in COP's predictive value by sex.
8. Every participant in the heart failure study experienced heart failure and had a COP test. The worst COPs were seen among those who also had the greatest heart failure symptoms, but after completing an activity rehabilitation program, the COPs improved when the researchers remeasured them.
9. COP has the potential to be a unique clinical care metric. For patients with severe heart failure, assessing a person's breathing patterns for their ability to efficiently exhale carbon dioxide has predictive significance.
10. This may be done without requiring them to exert themselves fully. However, some professionals advise doing maximum-effort testing wherever feasible.

Vital view

What are the potential implications for practice and/or research?

1. These results demonstrate that COP measurements in individuals who seem to be in good health might be useful for prognostication.
2. Because COP may be determined from a submaximal exercise test, it is possible to evaluate COP in men when a maximal activity test is not practical or suitable.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.