Mets and power (watts) are measured but are not “hard breaks” in terms of pass/fail. CPET directly measures peak VO2 with maximal exertion. Expressing peak VO2 as percent (%) predicted based on age, sex, height, weight refines risk stratification based on fitness. For example, a smaller stature individual may achieve 100% of his/her predicted VO2 and have absolute peak VO2 < 42 ml/kg/min or 12 Mets. If there is no underlying cardiac dysfunction, normal % predicted peak VO2 individuals are low risk for CV events regardless of not being able to achieve 12 Mets. Likewise, larger individuals that can exceed 12 Mets on the Gerkin TMST may have reduced % predicted peak VO2 due to unknown congenital causes or acquired heart disease in need of more aggressive risk-factor modification.
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