# Impact of Music Selection on Motivation and Performance during Cardiopulmonary Exercise Testing
## 1 Introduction  
Cardiopulmonary exercise testing (CPET) is the most widely used assessment to examine the dynamic relationship between exercise and integrated physiological systems. The information from CPET can be applied across the spectrum of sport performance, occupational safety screening, research, and clinical diagnostics [1]. Exercise testing in medicine is used to examine the hemodynamic status of an individual, as well as the tolerance to effort, i.e., aerobic capacity, and to diagnose and assess the severity of ischemic heart disease [2]. Aerobic capacity, aerobic endurance, aerobic fitness, or cardiorespiratory endurance endurance are synonyms for the same component of physical fitness [3], which representsthe ability of the respiratory and cardiovascular system to deliver oxygen to the muscles and to utilize this oxygen to generate energy during exercises involving large muscles and the entire body at a moderate to high intensity for a prolonged period [4; 5]. The best measure, or \"gold standard\", of aerobic capacity is maximal oxygen consumption (VO\({}_{2}\)max), the upper limit of the body's aerobic functioning, the most widely used parameter characterizing the effective integration of the central nervous, cardiopulmonary, and metabolic systems [6]. VO\({}_{2}\)max is achieved during large muscle mass exercise and represents the integrative ability of the heart to generate a high cardiac output, total body hemoglobin, high muscle blood flow, and muscle oxygen extraction, and in some cases, the ability of the lungs to oxygenate the blood [7]. Although the difference exists between VO\({}_{2}\)max and peak VO\({}_{2}\) and these terms are often used interchangeably in the literature [1], the peak VO\({}_{2}\) attained on a maximum-effort incremental test is likely to be a valid index of VO\({}_{2}\)max [6]. Peak VO\({}_{2}\), the highest rate at which an individual can consume oxygen during exercise, was used in this study. During testing, to measure peak VO\({}_{2}\), a second ventilatory threshold (VT2) was also determined. In a three-zone model of the exercise [8], the training zones (low, medium, and high intensity) are separated by thresholds, which can be either determined through the ventilatory exchange--ventilatory thresholds (VT1, VT2) [9]--or the lactate concentration--lactate thresholds (LT1, LT2) [10]. VT2 was initially determined in order to dose the exercise intensity of cardiac patients [11], but today it is widely used to determine intensity zones in endurance sports. VT2 is a marker of higher exercise intensity, when lactate builds up in the bloodstream faster than the body can remove it, the exerciser breathes very heavily and can no longer speak [12]. VT2 is often called the anaerobic threshold (AnT)--usually estimated to be around 85-90% of the HRmax [13]. In addition to muscle strength, aerobic capacity is one of the most important capacities of an individual from a fitness perspective but also from a medical standpoint, as this parameter is directly related to health and longevity [14]. Promoting health-related fitness--particularly cardiovascular and muscular fitness--are the primary focus of the latest Guidelines of U.S. Department of Health and Human Services. For substantial health benefits, adults should perform at least 150 min to 300 min a week of moderate-intensity--or 75 min to 150 min a week of vigorous-intensity--aerobic physical activity and muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week [15]. Oxygen consumption increases with aerobic physical activity, which helps in combating chronic non-communicable diseases by preventing them or alleviating symptoms through immune system enhancement [14; 16], and subsequently contributes to improving the quality of life in older age by increasing physical and mental well-being [16; 17].