Inclusion Criteria:  Age 18 and older Able to speak English Ambulatory [assistive devices ok] Able to provide informed consent  Exclusion Criteria:  Any exclusion criteria listed in table 8 American Thoracic Society /American College of Chest Physicians Statement on CPET Inmate of correctional facility (i.e. prisoner) Diagnosed history of dementia Inability to ambulate independently Considered inappropriate to participate by Principal Investigator