Sounds and Sights of Motivation: Using Digital Encouragement and Dissociation Strategies during Cardiopulmonary Exercise Testing To Improve Patient Engagement and Diagnostic Quality

Abstract The cardiopulmonary exercise test (CPET) stands as a fundamental assessment in sports and health science as it is crucial for evaluating physical fitness, tailoring training regimens, and diagnosing health conditions. An essential aspect of this test is that participants exert maximal effort, as insufficient effort can compromise the validity of the results. While reliable results are seen in physically active individuals, reliability may not be guaranteed in exercise-naïve, less fit, and clinical populations lacking experience to exhaust themselves. This can result in inaccurate assessments, misdiagnoses, misinterpretation of intervention results, and unsuitable exercise recommendations. Various strategies, including verbal, audio, and video stimuli, are used to elicit maximal effort in exercise. While music and verbal encouragement are well-studied, non-musical sound, video, virtual reality, and augmented reality remain underexplored, with inconsistent or absent CPET-specific guidelines. Surprisingly, innovative approaches combining multisensory digital methods are notably lacking. Future research should systematically evaluate these strategies to create more immersive and engaging experiences, increasing effort and standardizing encouragement. Adaptive audio-visual methods could improve test reliability, validity, and workflows while enhancing participant enjoyment. Realizing this potential requires interdisciplinary collaboration among sound, graphic, and video designers, exercise physiologists, and psychologists. By moving beyond conventional approaches, CPET could be transformed into a more engaging and effective tool for diverse populations.