Determination of the anaerobic threshold in the pre-operative assessment clinic: inter-observer measurement error

The variability between observers in the interpretation of cardiopulmonary exercise tests may impact upon clinical decision making and affect the risk stratification and peri-operative management of a patient. The purpose of this study was to quantify the inter-reader variability in the determination of the anaerobic threshold (V-slope method). A series of 21 cardiopulmonary exercise tests from patients attending a surgical pre-operative assessment clinic were read independently by nine experienced clinicians regularly involved in clinical decision making. The grand mean for the anaerobic threshold was 10.5 ml O2.kg body mass−1.min−1. The technical error of measurement was 8.1% (circa 0.9 ml.kg−1.min−1; 90% confidence interval, 7.4–8.9%). The mean absolute difference between readers was 4.5% with a typical random error of 6.5% (6.0–7.2%). We conclude that the inter-observer variability for experienced clinicians determining the anaerobic threshold from cardiopulmonary exercise tests is acceptable.