Search

AbstractPurposeMaterials and MethodsResultsConclusionAmidst the global diabetes crisis, Europe faces mortality and prevalence rates of 10-12%, as reported by the World Health Organisation. The COVID-19 pandemic worsened metabolic concerns, particularly in India. This study delves into the unexplored impact of type 2 diabetes on individuals with a normal BMI, examining the efficacy of supervised nordic walking in improving glycemic control and aerobic capacity compared to standard activity and diet control.A parallel arm superiority randomised controlled trial enrolled 70 participants (aged 40–65) with type 2 diabetes and BMI <25 kg/m2. The intervention group (n = 35) received 4 weeks of Nordic walking alongside conventional treatment, while the control group (n = 35) received only conventional treatment. Key outcomes included glycated haemoglobin levels, maximum oxygen uptake, and rate of perceived exertion.The intervention group exhibited a substantial decrease in glycated haemoglobin (mean difference: 0.58, p < 0.001) compared to the control group, which showed minimal changes (mean difference: 0.09, p > 0.05). Additionally, the intervention group demonstrated significant enhancements in maximal oxygen uptake (p < 0.001) and distance walked (mean difference: 56.74, p < 0.001), whereas the control group experienced minimal alterations. Rate of perceived exertion showed no significant changes in either group.Supervised Nordic walking demonstrated notable enhancements in glycemic control and aerobic capacity in individuals with type 2 diabetes and a normal BMI. [ABSTRACT FROM AUTHOR]

BACKGROUND: Field-based walk tests conducted remotely may provide an alternative method to a facility-based assessment of exercise capacity for people with advanced lung disease. This prospective study evaluated the level of agreement in the distance walked between a 6-min walk test (6MWT) and an incremental shuttle walk test performed by using standard in-person procedures and test variations and settings. METHODS: Adults with advanced lung disease underwent 4 study visits: (i) one in-person standard 6MWT (30-m corridor) and one in-person treadmill 6MWT, (ii) a remote 6MWT in a home setting (10-m corridor), (iii) 2 in-person standard incremental shuttle walk tests (10-m corridor), and (iv) a remote incremental shuttle walk test in a home setting (10-m corridor). A medical-grade oximeter measured heart rate and oxygen saturation before, during, and for 2 min after the tests. RESULTS: Twenty-eight participants were included (23 men [82%]; 64 (57--67) y old; 19 with interstitial lung disease [68%] and 9 with COPD [32%]; and 26 used supplemental oxygen (93%) [exertional Embedded Image of 0.46 ± 0.1]). There was no agreement between the tests. Greater walking distances were achieved with standard testing procedures: in-person 6MWT versus treadmill 6MWT (355 ± 68 vs 296 ± 97; P = .001; n = 28), in-person 6MWT versus remote 6MWT (349 ± 68 vs 293 ± 84; P = .001; n = 24), and in-person incremental shuttle walk test versus remote incremental shuttle walk test (216 ± 62 vs 195 ± 63; P = .03; n = 22). CONCLUSIONS: Differences in the distance walked may have resulted from different track lengths, widths, and walking surfaces. This should be considered in test interpretation if tests are repeated under different conditions. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodsResultsConclusionMaximal treadmill cardiopulmonary exercise testing is the gold standard for assessing functional capacity in patients with idiopathic pulmonary fibrosis (IPF).Primarily to investigate the concurrent validity between three field tests and cardiopulmonary exercise testing in these patients.Patients performed the cardiopulmonary exercise testing, a six-minute walk test, an incremental shuttle walk test, and, the Glittre–ADL test. For cardiopulmonary exercise testing, the ten seconds with the higher average of the peak oxygen uptake obtained within the last 30 seconds were considered; for six-minute walk test and incremental shuttle walk test, the longer distance; and for the Glittre-ADL test, the shorter time spent. Concurrent validity was assessed using different regression models based on the best adjustment of the data.Twenty-two patients with IPF were assessed, aged: 68 ± 8.1 years, 13 male. Patients presented a peak oxygen uptake of 16.5 ± 3.6 mL.kg−1.min1, achieving a distance of 512.6 ± 102.8 meters in the six-minute walk test and 415.7 ± 125.1 meters in incremental shuttle walk test. The walking distance in the six-minute walk test and the incremental shuttle walk test explained, respectively, 64% and 56% peak oxygen uptake variance observed in the cardiopulmonary exercise testing (R2 = 0.64,p < .001; R2 = 0.56,p < .001). The time spent in the Glittre-ADL test was 233.4 ± 88.7 seconds and explained 47% of the peak oxygen uptake variance observed in cardiopulmonary exercise testing (R2 = 0.47,p = .001).The six-minute walk test, incremental shuttle walk test, and Glittre-ADL test were considered valid tests to explain the peak oxygen uptake variance obtained by the cardiopulmonary exercise testing in patients with IPF. [ABSTRACT FROM AUTHOR]

The article discusses research which evaluated incremental shuttle walk test procedures for a 69-year old totally blind person. The study made modifications to the floor setup and used a taped-down rope for directional cues during mobility cane walking and tactile change to carpet tiles as the cue for turning. It suggests further consideration for people with low vision or for those with dual-sensory impairment.

Objective Methods Results Conclusion This study aimed to measure the functional exercise capacity of patients with ankylosing spondylitis (AS) with the incremental shuttle walk test (ISWT), and to determine the factors associated with this test.This cross-sectional study included 54 patients with AS (29 males, 25 females). The ISWT was performed to determine functional exercise capacity. The number of completed shuttles was recorded, and the total incremental shuttle walk distance (ISWD) was calculated. Disease activity was assessed with the Bath AS Disease Activity Index (BASDAI), physical functioning was assessed with the Bath AS Functional Index (BASFI), and spinal mobility was assessed with the Bath AS Mobility Index (BASMI). Upper body and core endurance were assessed by sit-up and push-up tests. Tests were performed in a single session in the order listed.The mean ISWD of the patients was 462.41 ± 97.96 m, and the subjects reached 50.48% of the predicted ISWD. The ISWD of male subjects was significantly higher than that of females (p < .05). At the end of the test, male subjects reached 60.87% of the age-predicted maximal heart rate, and female subjects reached 55.25%. There was a significant positive moderate correlation between ISWD and height (r = 0.535, p < .01), sit-up test (r = 0.617, p < .01), and push-up test (r = 0.495, p < .01), while there was a negative weak correlation between BASFI (r = -0.344, p = .011) and BASMI (r = -0.280, p = .040).The study showed that functional exercise capacity as assessed by the ISWT decreased in patients with AS. ISWT performance was associated with sex, height, functionality, spinal mobility, and muscular endurance. [ABSTRACT FROM AUTHOR]

• Six minute walk test (6MWT) and incremental shuttle walk test (ISWT) caused remarkable changes in heart rate, oxygen saturation, dyspnea, and leg fatigue in patients after the Fontan procedure compared to healthy subjects. • ISWT lead to the more pronounced exercise-induced responses, especially in oxygen desaturation. • With similar safety to the 6MWT, the ISWT can also be performed as a field test to evaluate exercise capacity and as an outcome measure in some clinical settings in patients with Fontan procedure. Despite the frequent use of the 6-minute walk test (6MWT), exercise capacity has not been assessed with the incremental shuttle walk test (ISWT) in patients who have undergone the Fontan procedure. It is unclear whether these tests cause clinically relevant cardiorespiratory responses in these patients. We aimed to assess cardiorespiratory responses to the 6MWT and ISWT in Fontan patients, compare the responses with those in the controls, and examine the agreement between the two field tests. Submaximal exercise capacity was assessed using the 6MWT, maximal exercise capacity using the ISWT, quadriceps isometric muscle strength with a hand dynamometer, and body composition using a bioelectrical impedance device. Twenty-one Fontan patients (16.42±6.63 years, 5F/16M) and 21 controls (16.57±4.30 years, 7F/14M) were included. While body composition was similar between the groups (p>0.05), quadriceps isometric muscle strength and 6MWT and ISWT distance were lower in the Fontan patients than in the controls (p<0.05). In both the 6MWT and ISWT, pre- and post-test heart rate (HR), oxygen saturation (SpO 2), dyspnea, and leg fatigue differed significantly between the Fontan patients and the controls (p<0.05). In addition, the ISWT resulted in a more significant change in HR, SpO 2 , and leg fatigue than the 6MWT in the Fontan patients (p<0.05). Bland–Altman plots for the 6MWT vs. the ISWT indicated agreement between the two tests. There were remarkable changes in HR, SpO 2 , dyspnea, and leg fatigue in both tests. With similar safety to the 6MWT but with more caution applied for adverse events, the ISWT can also be performed as a field test to evaluate exercise capacity and identify more pronounced exercise-induced responses (especially oxygen desaturation) in Fontan patients. [ABSTRACT FROM AUTHOR]

Background/Purpose: To date, there are no published validated Chinese versions of the incremental shuttle walk test (ISWT) instructions despite its wide clinical applications. Translation of the Chinese ISWT instruction is done in an ad-hoc manner within the Chinese-speaking populations, affecting the test’s reliability and validity since translation can differ significantly between individuals. This warrants the need for psychometric testing of such translation. Objectives: To develop a Chinese (Mandarin) version of the ISWT instructions (ISWT-CHN) that is conceptually equivalent to the original English version (ISWT-ENG) and establish its reliability and validity. Methods: Forward and backward translations from the ISWT-ENG were done to generate the ISWT-CHN. Face and content validity was determined during the translation process. Intra-rater and inter-rater reliability of the ISWT-CHN, construct and criterion validity were established by analysing the ISWT and the gold standard cardiopulmonary exercise test results. Results: The Item-Content validity index (I-CVI), Scale-level-Content validity index (S-CVI), and content validity ratio (CVR) of the ISWT-CHN were 1.0. Intra-class Correlation Coefficient (ICC) for inter-rater reliability between two raters were excellent ([Formula: see text], 95% CI 0.97–1.0, [Formula: see text]; [Formula: see text][Formula: see text]m, [Formula: see text][Formula: see text]m). The intra-rater reliability of both Raters A ([Formula: see text], 95% CI 0.53–0.98, [Formula: see text]; [Formula: see text][Formula: see text]m, [Formula: see text][Formula: see text]m) and B ([Formula: see text], 95% CI 0.76–0.96, [Formula: see text]; [Formula: see text][Formula: see text]m, [Formula: see text][Formula: see text]m) were good. In a sample of 32 healthy participants, both ISWT-CHN and ISWT-ENG instruction results showed low-positive correlations with the VO[Formula: see text] determined from the cardiopulmonary exercise test ([Formula: see text] = 0.439, [Formula: see text]; [Formula: see text], [Formula: see text]). There is a very high correlation between ISWT-ENG and ISWT-CHN results with no statistically significant differences ([Formula: see text], [Formula: see text]). The construct and criterion validity of the ISWT-CHN were established. Conclusion: This study developed the ISWT-CHN and showed that it is a valid and reliable measure conceptually comparable to the ISWT-ENG. It will benefit the determination of functional exercise capacity in Chinese-speaking populations. Key messages •This study is aimed to develop a Chinese (Mandarin) version of the ISWT instructions. •The ISWT Chinese translation is valid and reliable that is conceptually comparable to the original English instruction. •The translated ISWT-Chinese instruction will enable the use of ISWT among the Chinese-speaking populations.

Background: Aging is associated with structural degeneration and functional limitations in the respiratory system, reducing exercise capacity. Respiratory muscle stretch gymnastics (RMSG) is used to improve the function of lungs and respiratory muscles with some success in various populations. Materials and Methods: Eighty-four individuals in the age group of 60–70 years were randomly allocated to the experimental and control group. Individuals in the experimental group were put on a 4-week RMSG supervised program. Distance covered in incremental shuttle walk test (ISWT), maximal inspiratory pressure (MIP), and quality of life (QoL) were the outcome measures for the study. Results: There was an improvement in distance covered in ISWT, MIP, and scores of World Health Organization QoL-BREF (WHO QoL-BREF) questionnaire of subjects in the experimental group (P = 0.000) as compared to the control group. Conclusion: Prescription of RMSG for 4 weeks was beneficial in improving exercise performance, maximal inspiratory muscle strength, and QoL in elderly individuals.

None of the spironolactone trials in heart failure (HF) assessed the blood pressure (BP) responses to exercise, while conflicting results were reported for exercise capacity. In the HOMAGE trial, 527 patients at increased HF risk were randomized to usual treatment with or without spironolactone (25-50 mg/day). The current substudy included 113 controls and 114 patients assigned spironolactone, who all completed the incremental shuttle walk test at baseline and months 1 and 9. Quality of life (QoL) was assessed by EQ5D questionnaire. Between-group differences (spironolactone minus control [Δs]) were analyzed by repeated measures ANOVA with adjustment for baseline and, if appropriate, additionally for sex, age and body mass index. Δs in the pre-exercise systolic/diastolic BP were -8.00 mm Hg (95% CI, -11.6 to -4.43)/-0.85 mm Hg (-2.96 to 1.26) at month 1 and -9.58 mm Hg (-14.0 to -5.19)/-3.84 mm Hg (-6.22 to -1.47) at month 9. Δs in the post-exercise systolic/diastolic BP were -8.08 mm Hg (-14.2 to -2.01)/-2.07 mm Hg (-5.79 to 1.65) and -13.3 mm Hg (-19.9 to -6.75)/-4.62 mm Hg (-8.07 to -1.17), respectively. For completed shuttles, Δs at months 1 and 9 were 2.15 (-0.10 to 4.40) and 2.49 (-0.79 to 5.67), respectively. Δs in QoL were not significant. The correlations between the exercise-induced BP increases and the number of completed shuttles were similar in both groups. In conclusion, in patients at increased risk of developing HF, spironolactone reduced the pre- and post-exercise BP, but did not improve exercise capacity or QoL., (© 2024. The Author(s).)

Aims: Few randomized trials assessed the changes over time in the chronotropic heart rate (HR) reactivity (CHR), HR recovery (HRR) and exercise endurance (EE) in response to the incremental shuttle walk test (ISWT). We addressed this issue by analysing the open HOMAGE (Heart OMics in Aging) trial., Methods: In HOMAGE, 527 patients prone to heart failure were randomized to usual treatment with or without spironolactone (25-50 mg/day). The current sub-study included 113 controls and 114 patients assigned spironolactone (~70% on beta-blockers), who all completed the ISWT at baseline and at Months 1 and 9. Within-group changes over time (follow-up minus baseline) and between-group differences at each time point (spironolactone minus control) were analysed by repeated measures ANOVA, unadjusted or adjusted for sex, age and body mass index, and additionally for baseline for testing 1 and 9 month data., Results: Irrespective of randomization, the resting HR and CHR did not change from baseline to follow-up, with the exception of a small decrease in the HR immediately post-exercise (-3.11 b.p.m.) in controls at Month 9. In within-group analyses, HR decline over the 5 min post-exercise followed a slightly lower course at the 1 month visit in controls and at the 9 month visits in both groups, but not at the 1 month visit in the spironolactone group. Compared with baseline, EE increased by two to three shuttles at Months 1 and 9 in the spironolactone group but remained unchanged in the control group. In the between-group analyses, irrespective of adjustment, there were no HR differences at any time point from rest up to 5 min post-exercise or in EE. Subgroup analyses by sex or categorized by the medians of age, left ventricular ejection fraction or glomerular filtration rate were confirmatory. Combining baseline and Months 1 and 9 data in both treatment groups, the resting HR, CHR and HRR at 1 and 5 min averaged 61.5, 20.0, 9.07 and 13.8 b.p.m. and EE 48.3 shuttles., Conclusions: Spironolactone on top of usual treatment compared with usual treatment alone did not change resting HR, CHR, HRR and EE in response to ISWT. Beta-blockade might have concealed the effects of spironolactone. The current findings demonstrate that the ISWT, already used in a wide variety of pathological conditions, is a practical instrument to measure symptom-limited exercise capacity in patients prone to developing heart failure because of coronary heart disease., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: Current guidelines for the treatment of noncystic fibrosis bronchiectasis (NCFB) recommend pulmonary rehabilitation (PR), but to date, there are few studies that have proven its effectiveness. Objective: The main objective of this study was to examine the effect of PR on pulmonary function tests and exercise capacity. Method: The aim of this study was to systematically review the effects of PR in NCFB on (1) forced expiratory volume in the first second (FEV1) and (2) exercise capacity evaluated by the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT). This meta-analysis was undertaken according to PRISMA recommendations. Results: This pair-wise meta-analysis included data obtained from studies that enrolled 529 NCFB patients. The FEV1 assessment after PR between the active and control group did not show any significant increase (FEV1 difference 0.084 mL; CI: −0.064, +0.233; p = 0.264), and there was an increasing trend (188 mL; CI: −0 to 0.009, +0.384) at the limits of statistical significance (p = 0.061). Walked distance showed a significant increase in the PR group compared to the control group (ISWT distance difference 070.0 m; CI: 55.2, 84.8; p < 0.001), and this finding was confirmed before and after PR both by the ISWT (68.85 m greater than baseline; CI: 40.52, 97.18; p < 0.001) and by the 6MWT (37.7 m greater than baseline; CI: 20.22, 55.25; p < 0.001). Conclusions: PR improves exercise tolerance in NCFB patients, but it has a modest impact on respiratory function. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine if the Incremental Shuttle Walk Test (ISWT) can elicit similar patient responses as a treadmill stress test in patients with coronary artery disease (CAD). Methods: Both the stress test and the ISWT were performed by 172 participants, aged 60.67±10.23 years. We screened participants for unstable angina, severe aortic stenosis, uncontrolled hypertension, and excluded if unable to walk on a treadmill. Outcome measures (signs and symptoms) included: i) patient-reported chest pain; ii) patient-reported breathlessness/exhaustion and not being able to keep up with test protocol; and iii) able to reach target HRmax. Additionally, EKG changes during the stress test were monitored for ST changes or arrhythmias. Results: During the stress test, 15 participants reported chest pain, 23 participants reached target HRmax. No participants reported chest pain and 2 participants reached target HRmax during the ISWT. Participants reporting chest pain had a higher mean BMI and significant difference in METS (p

Aims: This study aims to investigate the demographic, clinical and service level factors determining change in walking fitness in cardiac rehabilitation (CR) patients with a history of depression following the CR programme., Methods and Results: National Audit of Cardiac Rehabilitation (NACR) clinical data were used to identify 1476 patients with a history of depression who had their pre and post incremental shuttle walk test (ISWT) recorded between 1st Jan 2016 and 31st Jan 2020. A multiple linear regression was conducted to examine the determinants of change in walking fitness (m) following CR. Mean age was 61 (SD 10.45) and mean ISWT distance at baseline and outcome were 352.06m (SD 169.48) and 463.43m (SD 197.65), respectively. Multivariate analysis revealed that change in walking distance reduced by 1.6m for each year increase in age at baseline (P < 0.001). Females and unemployed patients had less improvement in walking fitness (23.1m and 21.5m, respectively). Having a body mass index >30 was associated with lower improvement (24.2m, p < 0.001), while physically active patients had 14.6m higher change. Higher baseline ISWT quintiles were associated with less improvement, and increased waiting time to start CR was associated with reduced change in walking fitness following CR., Conclusion: Older age, female gender, unemployment, higher baseline BMI, longer waiting time, and lower physical activity were associated with reduced walking fitness improvement in patients with a history of depression. Targeted intervention and prompt access to CR can optimize outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Self-reported measures of decreased aerobic fitness and low physical activity are criteria of frailty. However, research assessing aerobic fitness and physical activity levels associated with frailty is limited. Therefore, the aims of this study were to objectively assess the aerobic fitness and the physical activity level of frail and nonfrail elderly, and to examine the association between frailty, aerobic fitness and habitual physical activity. Methods: This study included 26 elderly (66 to 86 years), randomly selected. The groups (frail/nonfrail) were age and sex paired. Peak oxygen consumption, maximal walking distance and speed were assessed during the incremental shuttle walk test (ISWT). Average daily time spent in sedentary, light, moderate and hard activity, counts, number of steps and energy expenditure were measured by accelerometry. Results: All variables measured by the ISWT and accelerometer differed significantly between the groups (P < .02). All aerobic fitness and physical activity variables were significantly associated with frailty, independent of the number of chronic health conditions (P < .05). Conclusions: Frailty is associated with low peak oxygen consumption and low physical activity level. These findings could guide future clinical trials designed to evaluate the efficacy of aerobic exercises in the prevention and treatment of frailty. [ABSTRACT FROM AUTHOR]

Background: 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 10metre incremental shuttle walk test (ISWT) in cardiac rehabilitation.Methods: 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).Results: 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.Conclusions: 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. [ABSTRACT FROM AUTHOR]

Background and objective: We investigated the repeatability and validity of the incremental shuttle walk test (ISWT) distance compared to peak oxygen uptake (VO2pk) during maximal incremental cycle ergometer (ICE) and treadmill (ITM) tests in adults with severe asthma. Methods: Adults with severe asthma, Medical Research Council (MRC) dyspnoea ≥2, were recruited from specialists caring for patients with severe asthma. All participants performed three ISWT (familiarization and two subsequent tests on the same day), an ICE and an ITM in a randomized order, on separate days, to intolerance with expiratory gas analysis. Results: A total of 50 patients (32 females, mean (SD), age: 54 (13) years, forced expiratory volume in 1 s (FEV1): 1.9 (0.8) L and body mass index (BMI): 32 (6) kg/m2) completed all five tests. The mean (SD) ISWT distance for each test was 400 (156), 418 (142) and 438 (157) m (P = 0.001), respectively. There was a strong correlation between the ISWT distance with VO2pk derived from ITM (r = 0.74, P < 0.001) and ICE (r = 0.75, P < 0.001). Conclusion: There was a small increase in the mean ISWT distance on sequential testing. In clinical practice, the coefficient of repeatability and heteroscedasticity need to be considered when assessing whether a true change has occurred within an individual patient. The ISWT has validity compared to VO2pk on both ICE and ITM, but they are not interchangeable. The measurement properties of the incremental shuttle walk test (ISWT) are unknown in patients with severe asthma. The study results show ISWT can be used to assess exercise capacity in patients with severe asthma. However, the small increase in distance on repeated testing would need to be considered in non‐randomized trials. See relatedEditorial [ABSTRACT FROM AUTHOR]

Background: A validated clinical end point is needed to assess response to therapies in bronchiectasis.Objectives: The goal of this study was to assess the reliability, validity, and responsiveness of the incremental shuttle walk test (ISWT) as a clinical end point in bronchiectasis.Methods: In clinically stable patients (n = 30), the ISWT was performed twice, 6 months apart. Correlation between the St. George's Respiratory Questionnaire (SGRQ) and the ISWT (n = 94) was performed. The 1-year gentamicin study was reanalyzed to assess the area under the curve (percent change of ISWT with a ≥ 4 unit improvement in total SGRQ). ISWT was performed prior to and following 14 days of antibiotics for an exacerbation (94 oral courses and 30 IV courses, n = 124) and reanalysis of the 1-year gentamicin study (n = 57).Results: The ISWT did not significantly change over 6 months while clinically stable. The ISWT correlated inversely with the SGRQ (rs = -0.60; P < .0001), Bronchiectasis Severity Index score (rs = -0.44; P < .0001), and sedentary time (rs = -0.48; P = .0007) but correlated with physical activity (rs = 0.42; P = .004). The area under the curve for percent change in ISWT with ≥ 4 unit improvement in SGRQ was 0.79 (95% CI, 0.66-0.91; P = .001). A threshold of 5% improvement in the ISWT had a 92% sensitivity but 50% specificity, and from the responsiveness studies would capture 73% of all patients.Conclusions: This study confirmed the ISWT to be reliable, valid, and responsive to change in patients with bronchiectasis. The authors propose that a minimum clinically important difference of 5% improvement in the ISWT would be a useful objective end point to assess therapies in bronchiectasis. [ABSTRACT FROM AUTHOR]

Aerobic capacity is essential for physical function. The aims of this study were to identify the peak oxygen consumption (... peak) and the incremental shuttle walk test (ISWT) distance associated with disability and to develop an equation to predict ... peak, based on the ISWT distance. Fifteen disabled and 13 nondisabled older adults performed the ISWT using a portable telemetric gas analyzer. The ... peak and the distance associated with disability were 15.8 mL/kg/min or less and 230 m or less, respectively. The coefficient of determination from the predictive model was 0.54. The ISWT might be considered to assess aerobic capacity in older adults. [ABSTRACT FROM AUTHOR]

Purpose: Physical inactivity in Indians is leading to an increase in noncommunicable disorders at an early age in life. Early identification and quantification of the lack of physical activity using simple and reliable exercise testing is the need of the hour. The incremental shuttle walk test (ISWT) is an externally paced walk test widely used for the evaluation of exercise capacity. Currently the normative values available for clinical reference are generated from Western populations. Hence, the study was conducted to find normative values for the ISWT in healthy Indian adults (17-75 years). Materials and Methods: A convenience sample of 862 subjects was recruited after ethical approval was obtained. All subjects were divided into groups as per age and gender. For age, the grouping was as follows: Group 1: Young adulthood (17-40 years), group 2: Middle adulthood (40-65 years), and group 3: Old adulthood (>65 years). The ISWT was performed as per standard protocol by Sally Singh. Results: The average distance walked were 709.2m,556.4m and 441.3m in females and 807.9 m, 639.6 m and 478.2 m in males in the three respective age groups. Stepwise regression analysis revealed age and gender as key variables correlating with incremental shuttle walk distance (ISWD). The derived predictive equations for males and females may be given as follows: 740.351 - (5.676 × age) + (99.007 × gender). Conclusion: Reference values were generated for healthy Indian adults. Physiological response to the ISWT was shown to be affected by gender and increasing age. Easily measurable variables explained 68% of the variance seen in the test, making the reference equation a relevant part of the evaluation of the ISWT.

Background: There is increasing interest in screening for and diagnosing pulmonary hypertension earlier in the course of disease. However, there is limited data on cardiopulmonary abnormalities in patients with pulmonary hypertension newly diagnosed in World Health Organization Function Class (WHO FC) I.Methods: Data were retrieved from the ASPIRE registry (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral center) for consecutive treatment naïve patients diagnosed with pulmonary hypertension by cardiac catheterization between 2001 and 2010 who underwent incremental shuttle walk exercise testing.Results: Eight hundred and ninety-five patients were diagnosed with Group 1-5 pulmonary hypertension. Despite the absence of symptoms, patients in WHO FC I (n = 9) had a significant reduction in exercise capacity (Incremental shuttle walk distance percent predicted (ISWD%pred) 65 ± 13%, Z score −1.77 ± 1.05), and modest pulmonary hypertension with a median (interquartile range) pulmonary artery pressure 31(20) mmHg and pulmonary vascular resistance 2.1(8.2) Wood Units, despite a normal diffusion of carbon monoxide adjusted for age and sex (DLco)%pred 99 ± 40%. Compared to patients in WHO FC I, patients in WHO FC II (n = 162) had a lower ISWD%pred 43 ± 22 and lower DLco%pred 65 ± 21%.Conclusion: Our results demonstrate that patients with newly diagnosed pulmonary hypertension with no or minimal symptomatic limitation have a significant reduction of exercise capacity.

Background: The cardiopulmonary exercise test (CPET) is considered to be the gold standard to evaluate functional capacity (FC) in patients with heart failure. However, field tests such as the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT) are simple and effective in evaluating the same. Despite the increasing use of ISWT, no studies that used the test in patients with Chagas heart disease (CHD) were found and only few studies have evaluated the health-related quality-of-life (HRQoL) in this population. The objective of this study was to correlate the distance walked in the ISWT with distance walked by 6MWT and peak oxygen uptake (VO 2peak ) by CPET and HRQoL in patients with CHD. Methods: A total of 35 patients with CHD were evaluated according to the FC and HRQoL. The FC was assessed by CPET, 6MWT and ISWT. HRQoL was assessed by the generic short-form health survey (SF-36) and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Descriptive data were shown as mean and standard deviation or median and interquartile range. The correlation was carried out with Pearson or Spearman correlation test. A receiver operating characteristic (ROC) curve was constructed to investigate the accuracy of ISWT for predicting low values of VO 2peak . Results: The distance walked in ISWT correlated with VO 2peak (r = 0.587; P < 0.001), distance walked in 6MWT (r = 0.484; P = 0.003), MLWHFQ scores (r = −0.460; P = 0.006) and physical functioning and role physical domains of the SF-36 scores (r = 0.435, P = 0.009; r = 0.477, P = 0.008, respectively). There was no significant difference between the distances walked in field tests (P = 0.694). The area under the ROC curve was 0.871 for ISWT in predicts a VO 2peak value of, at least, 25 mL/kg/min. Conclusions: The ISWT showed to be effective in evaluating the FC in CHD and in demonstrate the impact of disease on some aspects of the HRQoL of these patients.

Background To ensure effective monitoring of pulmonary arterial hypertension (PAH), a simple, reliable assessment of exercise capacity applicable over a range of disease severity is needed. The aim of this study was to assess the ability of the incremental shuttle walk test (ISWT) to correlate with disease severity, measure sensitivity to change, and predict survival in PAH. Methods We enrolled 418 treatment-naïve patients with PAH with baseline ISWT within 3 months of cardiac catheterization. Clinical validity and prognostic value of ISWT distance were assessed at baseline and 1 year. Results ISWT distance was found to correlate at baseline with World Health Organization functional class, Borg score, and hemodynamics without a ceiling effect (all p < 0.001). Walking distance at baseline and after treatment predicted survival; the area under the receiver operating characteristic curve for ability of ISWT distance to predict mortality was 0.655 (95% confidence interval 0.553–0.757; p = 0.004) at baseline and 0.737 (95% confidence interval 0.643–0.827; p < 0.001) at 1 year after initiation of treatment. Change in ISWT distance also predicted survival ( p = 0.04). Heart rate (HR) and systolic blood pressure (SBP) parameters reflecting autonomic response to exercise (highest HR, change in HR, HR recovery at 1 minute >18 beats/min, highest SBP, change in SBP, and 3-minute SBP ratio) were significant predictors of survival (all p < 0.05). Conclusions In patients with PAH, the ISWT is simple to perform, allows assessment of maximal exercise capacity, is sensitive to treatment effect, predicts outcome, and has no ceiling effect. Also, measures of autonomic function made post-exercise predict survival in PAH. [ABSTRACT FROM AUTHOR]

Obesity is a chronic disease with a multifaceted treatment approach that includes nutritional counseling, structured exercise training, and increased daily physical activity. Increased body mass elicits higher cardiovascular, ventilatory and metabolic demands to varying degrees during exercise. With functional capacity assessment, this variability can be evaluated so individualized guidance for exercise training and daily physical activity can be provided. The aim of the present study was to compare cardiovascular, ventilatory and metabolic responses obtained during a symptom-limited cardiopulmonary exercise test (CPX) on a treadmill to responses obtained by the incremental shuttle walk test (ISWT) in obese women and to propose a peak oxygen consumption (VO2) prediction equation through variables obtained during the ISWT. Forty obese women (BMI ≥30 kg/m2) performed one treadmill CPX and two ISWTs. Heart rate (HR), arterial blood pressure (ABP) and perceived exertion by the Borg scale were measured at rest, during each stage of the exercise protocol, and throughout the recovery period. The predicted maximal heart rate (HRmax) was calculated (210 – age in years) (16) and compared to the HR response during the CPX. Peak VO2 obtained during CPX correlated significantly (P

Purpose: Physical inactivity in Indians is leading to an increase in noncommunicable disorders at an early age in life. Early identification and quantification of the lack of physical activity using simple and reliable exercise testing is the need of the hour. The incremental shuttle walk test (ISWT) is an externally paced walk test widely used for the evaluation of exercise capacity. Currently the normative values available for clinical reference are generated from Western populations. Hence, the study was conducted to find normative values for the ISWT in healthy Indian adults (17‑75 years). Materials and Methods: A convenience sample of 862 subjects was recruited after ethical approval was obtained. All subjects were divided into groups as per age and gender. For age, the grouping was as follows: Group 1: Young adulthood (17‑40 years), group 2: Middle adulthood (40‑65 years), and group 3: Old adulthood (>65 years). The ISWT was performed as per standard protocol by Sally Singh. Results: The average distance walked were 709.2m,556.4m and 441.3m in females and 807.9 m, 639.6 m and 478.2 m in males in the three respective age groups. Stepwise regression analysis revealed age and gender as key variables correlating with incremental shuttle walk distance (ISWD). The derived predictive equations for males and females may be given as follows: 740.351 ‑ (5.676 × age) + (99.007 × gender). Conclusion: Reference values were generated for healthy Indian adults. Physiological response to the ISWT was shown to be affected by gender and increasing age. Easily measurable variables explained 68% of the variance seen in the test, making the reference equation a relevant part of the evaluation of the ISWT. [ABSTRACT FROM AUTHOR]

The incremental shuttle walk (ISW) is well validated in COPD but limited psychometric data restrict its use in idiopathic pulmonary fibrosis (IPF). Study 1: 50 patients performed the ISW and 6 min walk test (6MWT). Study 2: 72 patients completed the ISW before and after pulmonary rehabilitation (PR). The ISW correlated strongly with 6MWT distance (r=0.81,p<0.0001). Mean (95% confidence interval) improvement in ISW with PR was 54 (38 to 70) m with an effect size of 0.29. Distribution-based and anchor-based minimum clinically important difference (MCID) estimates ranged from 31 to 46 m. The ISW is valid and responsive in IPF, with an anchor-based MCID estimate similar to that observed in chronic obstructive pulmonary disease.Trial Registration Number: Pre-results; NCT02530736, NCT02436278. [ABSTRACT FROM AUTHOR]

Background: Dietary nitrate supplementation has been shown to decrease the oxygen cost of exercise and prolong exercise tolerance, as measured by sub-maximal exercise endurance distance and time at 85% VO2max, in both elite athletes and normal healthy subjects. Patients with chronic obstructive pulmonary disease (COPD) have reduced quality of life and ability to perform activities of daily living attributable to diminished exercise tolerance, and dietary nitrate may be able to ameliorate this. Methods: We performed a double-blind, computer-randomized placebo control crossover trial at a tertiary Australian hospital to investigate whether dietary nitrate supplementation as beetroot juice (BR) would augment submaximal exercise endurance in individuals with spirometrically confirmed stable moderate COPD. Volunteers underwent an incremental shuttle walk test to determine VO2max followed by a test dose of BR to establish safety in the study population. Participants performed an endurance shuttle walk test (ESWT) at 85%VO2max after randomization to either a 3 day wash-in of BR (4.8 mmol twice a day) or placebo (nitrate deplete BR), with a final dose on the morning of testing. They then crossed over after 4 day washout. Repeated measures two sided paired t-tests were employed. Results: 35 participants were recruited with 19 completing the trial. In the initial safety phase, we measured systolic blood pressure over four hours post first dose of BR, and found a mean 10 mmHg decrement maximal at 1 hour. One individual developed symptomatic postural hypotension and was excluded. The primary outcomes of ESWT distance and time to fatigue improved by 11% and 6% respectively; however these differences did not achieve statistical significance (p = 0.494 and 0.693 respectively). Conclusions: Our study does not support a role for routine dietary nitrate supplementation for enhancement of exercise endurance in COPD. [ABSTRACT FROM AUTHOR]