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Figure 3: VE versus VCO~2~ during the first minute of room exercise.

Figure 4: VE versus VCO~2~ during the first minute of high intensity exercise.

Discussion
==========

The main findings of this study were that the new breath-by-breath method of measuring VE/VCO~2~ during cycling exercise accurately reflects HR and, therefore, is a valid measure of respiratory factors during cycling exercise. The Fick principle, which is generally used to assess relationships between gas exchanges and systemic O~2~ consumption, is applied to the cycle ergometer because patients are maximally exercising during the exercise test. The six-minute walk test as a standard test for evaluation of the cardiorespiratory and the functional capacity of patients with chronic respiratory diseases has been shown to be limited when compared with more specific and functional exercise protocols, such as the modified Borg scale and the oxygen uptake curve ([@B13]). The ability of the measured VE/VCO~2~ to monitor and track changes in respiratory factors during high intensity cycling exercise for chronic obstructive pulmonary disease (COPD) patients was evaluated to assess their exercise tolerance. To the best of our knowledge, this is the first study to employ the breath-by-breath method of measuring VE/VCO~2~ to assess the cardiorespiratory response during exercise in COPD patients.

A key finding was the correlation (correlation coefficient \> 0.8) between VE/VCO~2~ and ΔVO~2~ in the first minute of exercise. The correlation between VE/VCO~2~ and ΔVO~2~ is likely due to the changes in VE/VCO~2~ occurring before changes in VO~2~ during both types of exercise. The increased alve

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