PURPOSE: To investigate the accuracy and repeatability of the Q-NRG Max® metabolic system against a VacuMed metabolic simulator using a wide range of metabolic rates. METHODS: Sixteen metabolic rates (oxygen consumption 0.9-6 L/min), with different combinations of minute ventilation, oxygen consumption, and carbon dioxide production, were measured for 5 minutes, two times by a single Q-NRG Max® unit over the course of one week. Recordings were performed early in the morning, by the same trained technician, in a ventilated laboratory under the same atmospheric conditions. Accuracy was assessed by ordinary least products (OLP) regression analysis, Bland-Altman plots, intraclass correlation coefficients (ICC), mean percentage differences, technical errors (TE) and minimum detectable change (MDC) for all three variables. This analysis was performed using 10 metabolic rates (oxygen consumption 0.9-4 L/min) and 16 metabolic rates (oxygen consumption 0.9-6 L/min) to allow comparisons with previous research. Intra-device repeatability was performed by absolute percentage differences between measurements (MAPE), ICC, TE, and MDC for the same variables. Repeatability was investigated using 16 metabolic rates. RESULTS: High agreement and excellent ICCs (>
0.998) were observed for all variables when considering both 10 and 16 metabolic rates. The mean percentage difference, TE and MDC were 0.87%-1.01%, 0.67%-1.07%, 1.55%-2.49%, respectively for the first 10 metabolic rates, and -0.39%-0.65%, 0.58%-1.63%, 1.35%-3.81%, respectively for the 16 metabolic rates. The intra-device repeatability results showed an excellent ICCs (=1.000), MAPE <
0.5%, TE <
1%, and MDC ≤ 2%. CONCLUSION: The Q-NRG Max® is a valid and reliable mobile metabolic system for the measurement of ventilation, oxygen consumption, and carbon dioxide production. Measurements were below the 5% TE and MDC, and 2% MAPE recommended thresholds across a wide range of metabolic rates up to 6 L/min oxygen consumption.