A comparison of the shuttle and 6 minute walking tests with measured peak oxygen consumption in patients with heart failure

doi:10.1016/S1440-2440(01)80038-4

Journal of Science and Medicine in Sport

Volume 4, Issue 3, September 2001, Pages 292-300

https://doi.org/10.1016/S1440-2440(01)80038-4 Get rights and content

This study investigated the use of an incremental, externally-paced 10m shuttle walk test (SWT) as an objective, reliable and predictive test of functional capacity in patients with heart failure (CHF). The SWT was compared to a 6 minute walk test (6WT) and a maximal symptom-limited treadmill peak oxygen consumption (V̇O₂peak) test. Experiment 1 examined the reproducibility of the SWT. Two SWT trials were performed and distance ambulated (DA), heart rate (HR) and rate of perceived exertion (RPE) results compared. In experiment 2, SWT, 6WT, and V̇O₂peak tests were performed and HR, RPE and ambulatory V̇O₂ compared. The SWT demonstrated strong test/retest reliability for DA (r = 0.98), HR (r = 0.96) and RPE (r = 0.89). Treadmill V̇O₂peak was significantly correlated with DA during the SWT (r = 0.83, P < 0.05), but not the 6WT. SWT peak V̇O₂ (18.5±1.8 ml.kg⁻¹.min⁻¹) and treadmill V̇O₂peak (18.3±2.0 ml.kg⁻¹.min⁻¹) were also highly correlated (r = 0.78, P < 0.05). Conversely, 6WT peak V̇O₂ and treadmill V̇O₂peak were not significantly correlated. This study suggests the SWT is a reliable, objective test, highly predictive of V̇O₂peak which may be a more optimal field exercise test than the self paced 6WT.

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Cited by (63)

Effects of Aerobic Training Versus Breathing Exercises on Asthma Control: A Randomized Trial
2020, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
Second, ISWT is not the gold standard to assess exercise capacity and has never been demonstrated to be sensitive in evaluating exercise training in subjects with asthma. However, this maximal incremental and standardized test was developed for patients with obstructive lung diseases, and the walked distance during the test has a good linear correlation with peak VO2.45 Third, the conclusions of this study seem to be useful only for subjects with moderate-to-severe asthma without other comorbidities.
Aerobic training and breathing exercises are interventions that improve asthma control. However, the outcomes of these 2 interventions have not been compared.
To compare the effects of aerobic training versus breathing exercises on clinical control (primary outcome), quality of life, exercise capacity, and airway inflammation in outpatients with moderate-to-severe asthma.
Fifty-four asthmatics were randomized into either the aerobic training group (AG, n = 29) or the breathing exercise group (BG, n = 25). Both interventions lasted for 24 sessions (2/week, 40 minutes/session). Asthma clinical control (Asthma Control Questionnaire [ACQ]), quality of life (Asthma Quality of Life Questionnaire), asthma symptom-free days (ASFD), airway inflammation, exercise capacity, psychological distress (Hospital Anxiety and Depression Scale), daily-life physical activity (DLPA), and pulmonary function were evaluated before, immediately after, and 3 months after the intervention.
Both interventions presented similar results regarding the ACQ score, psychological distress, ASFD, DLPA, and airway inflammation (P > .05). However, participants in the AG were 2.6 times more likely to experience clinical improvement at the 3-month follow-up than participants in the BG (P = .02). A greater proportion of participants in the AG also presented a reduction in the number of days without rescue medication use compared with BG (34% vs 8%; P = .04).
Outpatients with moderate-to-severe asthma who participated in aerobic training or breathing exercise programs presented similar results in asthma control, quality of life, asthma symptoms, psychological distress, physical activity, and airway inflammation. However, a greater proportion of participants in the AG presented improvement in asthma control and reduced use of rescue medication.
Interpreting Meaningful Change in the Distance Walked in the 10-Metre ISWT in Cardiac Rehabilitation
2019, Heart Lung and Circulation
Citation Excerpt :
The 10-metre incremental shuttle walk test (ISWT) is a commonly used externally paced and incremental field exercise test in cardiac rehabilitation [9]. Previous research has supported both the retest reliability of this test when either one or two tests were performed on admission to cardiac rehabilitation [10–15] and criterion validity when either one or two tests were performed [10,11,14–17]. An important aspect of measurement properties is the interpretability of the change scores.
The interpretability of change in exercise test scores is an important measurement property. This study aimed to provide a framework for the interpretation of individual change scores of the 10 metre incremental shuttle walk test (ISWT) in cardiac rehabilitation.
In a quantitative pre-post design study, 52 patients who were referred to a hospital outpatient department for cardiac rehabilitation participated in this study. Participants completed two ISWTs prior to cardiac rehabilitation. Post cardiac rehabilitation, participants completed a global rating of change score and two ISWTs. Change scores were analysed for smallest detectable change (SDC) and minimum important change (MIC).
The SDC for an individual was 47 metres. The predicted MIC for participants to report an improvement ranged from 70 to 92 metres. The predicted MIC for participants who did not report a deterioration in the global rating of change (i.e., those who reported unchanged or improved) ranged from 16 to 42 metres.
The MIC for patients who report any improvement in physical fitness and functional capacity is 70 metres. These results suggest that over an 8-week program, patients would need to improve by at least seven shuttles to perceive an improvement in their physical fitness and functional capacity. Patients with small increases in the 10-metre ISWT distance may still report deterioration in their physical fitness and functional capacity.
Association between Modified Shuttle Walk Test and cardiorespiratory fitness in overweight/obese adults with primary hypertension: EXERDIET-HTA study
2017, Journal of the American Society of Hypertension
The aims of the study were to evaluate the relationship between Modified Shuttle Walk Test (MSWT) with peak oxygen uptake ( $\dot{V}$ O_2peak) in overweight/obese people with primary hypertension (HTN) and to develop an equation for the MSWT to predict $\dot{V}$ O_2peak. Participants (N = 256, 53.9 ± 8.1 years old) with HTN and overweight/obesity performed a cardiorespiratory exercise test to peak exertion on an upright bicycle ergometer using an incremental ramp protocol and the 15-level MSWT. The formula of Singh et al was used as a template to predict $\dot{V}$ O_2peak, and a new equation was generated from the measured $\dot{V}$ O_2peak-MSWT relationship in this investigation.
The correlation between measured and predicted $\dot{V}$ O_2peak for Singh et al equation was moderate (r = 0.60, P < .001) with a standard error of the estimate (SEE) of 4.92 mL·kg⁻¹ minute⁻¹, SEE% = 21%. The correlation between MSWT and measured $\dot{V}$ O_2peak as well as for the new equation was strong (r = 0.72, P < .001) with a SEE of 4.35 mL·kg⁻¹ minute⁻¹, SEE% = 19%. These results indicate that MSWT does not accurately predict functional capacity in overweight/obese people with HTN and questions the validity of using this test to evaluate exercise intolerance. A more accurate determination from a new equation in the current study incorporating more variables from MSWT to estimate $\dot{V}$ O_2peak has been performed but still results in substantial error.
The 10 m incremental shuttle walk test is a highly reliable field exercise test for patients referred to cardiac rehabilitation: A retest reliability study
2016, Physiotherapy (United Kingdom)
To determine the retest reliability of the 10 m incremental shuttle walk test (ISWT) in a mixed cardiac rehabilitation population.
Participants completed two 10 m ISWTs in a single session in a repeated measures study. Ten participants completed a third 10 m ISWT as part of a pilot study.
Hospital physiotherapy department.
62 adults aged a mean of 68 years (SD 10) referred to a cardiac rehabilitation program.
Retest reliability of the 10 m ISWT expressed as relative reliability and measurement error. Relative reliability was expressed in a ratio in the form of an intraclass correlation coefficient (ICC) and measurement error in the form of the standard error of measurement (SEM) and 95% confidence intervals for the group and individual.
There was a high level of relative reliability over the two walks with an ICC of .99. The SEM_agreement was 17 m, and a change of at least 23 m for the group and 54 m for the individual would be required to be 95% confident of exceeding measurement error.
The 10 m ISWT demonstrated good retest reliability and is sufficiently reliable to be applied in practice in this population without the use of a practice test.
Do field walking tests produce similar cardiopulmonary demands to an incremental treadmill test in obese individuals with treated OSA?
2014, Chest
Citation Excerpt :
The ISWT is an externally paced, symptom-limited test conducted along a 10-m course. It is reproducible after one practice test in patients with chronic cardiac and respiratory disease.13,17 The modified ISWT was used, which has an additional four levels (ie, speeds).25
Cardiorespiratory fitness, assessed during cardiopulmonary exercise tests by peak oxygen uptake ( $\dot{V}$ o₂pk), is an independent predictor of mortality in obesity. We investigated whether $\dot{V}$ o₂pk and systemic responses measured during field walking tests were similar to those measured during an incremental treadmill test (ITMT) in obese individuals with treated OSA.
Individuals with treated OSA and a BMI > 30 kg/m² were recruited. Participants completed an ITMT, two 6-min walk tests (6MWTs), and two incremental shuttle walk tests (ISWTs) on three separate days in a randomized order. Expired gas analysis was performed during all tests.
The study was completed by 16 patients (nine men) (mean [SD] age, 58 [12] y; BMI, 36.1 [7.6] kg/m²). There was no difference (P = .27) in $\dot{V}$ o₂pk assessed by the ITMT and the ISWT (2,266 [478] and 2,017 [561] mL/min, respectively). The $\dot{V}$ o₂pk measured by the 6MWT (1,778 [360] mL/min) was lower than that measured by the ITMT (P < .01). The limits of agreement for $\dot{V}$ o₂pk between the ISWT and the ITM were ± 730 mL/min. Cardiorespiratory responses during the ISWT and the ITMT reflected a graded response to a peak, whereas the 6MWT demonstrated a rapid rise to a plateau.
The ISWT can be used instead of an ITMT and in preference to the 6MWT to assess cardiorespiratory fitness for a cohort of obese people with treated OSA. However, the imprecision of the agreement in $\dot{V}$ o₂pk between the ITMT and ISWT means they cannot be used interchangeably in an individual.
ClinicalTrials.gov; No.: NCT01930513; www.clinicaltrials.gov
Measurement of energy expenditure in submaximal functional assessment tests through accelerometry
2018, Rehabilitacion
La valoración funcional del paciente es un elemento relevante en la práctica clínica prestando atención a la desadaptación al ejercicio como consecuencia del proceso patológico. El grado de desadaptación podemos valorarlo mediante pruebas de campo, como las pruebas ISWT y 6 MWT. La acelerometría puede ser una herramienta de utilidad para valorar la actividad física y el consumo energético. El objetivo de este estudio es determinar el gasto energético entre las pruebas de valoración funcional ISWT y 6 MWT; analizar las diferencias y el grado de correlación existente entre ellas, teniendo en cuenta el nivel de actividad física de los sujetos.
Veintiséis sujetos jóvenes sanos realizaron las pruebas ISWT y 6 MWT con la colocación de un acelerómetro triaxial en la muñeca que registraba el movimiento.
Las pruebas ISWT y 6 MWT mostraron un consumo distinto para todos los sujetos (p < 0,001) y un alto grado de correlación entre ellas (p< 0,001) basado en el coeficiente tanto de Pearson como de Spearman.
La acelerometría es útil para la medición del gasto energético en pruebas submáximas de valoración funcional, permitiéndonos así relacionar el consumo energético con el nivel de actividad física.
Functional assessment of patients is a key element of clinical practice because it focuses on impaired adjustment to exercise as a consequence of the pathological process. The degree of impairment can be assessed by field tests such as the incremental shuttle walk test (ISWT) and the 6 minute walk test (6 MWT). Accelerometry might be a useful tool to evaluate physical activity and energy expenditure. The aim of this study was to determine energy expenditure through the use of ISWT and 6 MWT and to analyse the differences and correlation between them, bearing in mind the participants’ level of physical activity.
A total of 26 healthy young participants performed the ISWT and 6 MWT functional assessment tests while wearing a triaxial accelerometer on their wrists that recorded their movements.
The ISWT and 6 MWT showed different expenditure levels for each participant (P<.001) and a high correlation between them (P<.001) based on both Pearson and Spearman coefficients.
Accelerometry is useful for measuring energy expenditure in submaximal functional assessment tests, allowing us to relate energy consumption to physical activity.

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A comparison of the shuttle and 6 minute walking tests with measured peak oxygen consumption in patients with heart failure

Chest

Am. Heart J.

Lancet

J. Sci. Med. Sports

J. Am. Coll. Cardiol.

Randomised, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life, and clinical outcome

Circulation

Two-, six-, and 12-minute walking tests in respiratory disease

B.M.J.