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Field Exercise Testing: 6-Minute Walk and Shuttle Walk Tests

  • Annemarie L. Lee
  • Theresa Harvey-Dunstan
  • Sally Singh
  • Anne E. Holland
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

In people with chronic lung disease, the assessment of exercise capacity gives important information that can assist with staging disease, assessing prognosis, and evaluating effects of therapy. Field walking tests are a useful alternative to laboratory-based exercise tests as they require minimal equipment and can be performed across many settings where people with chronic respiratory disease receive their care. The 6-minute walk test is a self-paced test of functional exercise capacity that is widely used across many disease groups. The 6-minute walk test is reliable and valid; however, it is sensitive to small changes in methodology, and therefore standardization is required. The incremental shuttle walk test is a measure of peak exercise capacity. It is externally paced according to auditory cues, allowing very good standardization. The endurance shuttle walk test is a constant speed test that is particularly sensitive for detecting changes following interventions. This chapter details the measurement properties of each field walking test, protocols to ensure standardized conduct, strategies to interpret results, and clinical examples of their application.

Keywords

Exercise testing 6-minute walk test Incremental shuttle walk test Endurance shuttle walk test Standardization 

Selected References

  1. American Thoracic S, American College of Chest P. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–77.CrossRefGoogle Scholar
  2. Bolton CE, Bevan-Smith EF, Blakey JD, Crowe P, Elkin SL, Garrod R, Greening NJ, Heslop K, Hull JH, Man WD, Morgan MD, Proud D, Roberts CM, Sewell L, Singh SJ, Walker PP, Walmsley S. British Thoracic Society pulmonary rehabilitation guideline development G, British Thoracic Society standards of care C. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax. 2013;68(Suppl 2):ii1–30.CrossRefGoogle Scholar
  3. Borel B, Pepin V, Mahler DA, Nadreau E, Maltais F. Prospective validation of the endurance shuttle walking test in the context of bronchodilation in COPD. Eur Respir J. 2014;44(5):1166–76.  https://doi.org/10.1183/09031936.00024314.CrossRefPubMedGoogle Scholar
  4. Celli B, Cote C, Lareau S, Meek P. Predictors of survival in COPD: more than just the FEV1. Respir Med. 2008;102(Suppl 1):S27–35.CrossRefGoogle Scholar
  5. Chandra D, Wise R, Hrishikesh S, et al. Optimising the 6-min walk test as a measure of exercise capacity in COPD. Chest. 2012;142:1545–52.CrossRefGoogle Scholar
  6. Dyer CA, Singh SJ, Stockley RA, Sinclair AJ, Hill SL. The incremental shuttle walking test in elderly people with chronic airflow limitation. Thorax. 2002;57(1):34–8.CrossRefGoogle Scholar
  7. Eaton T, Young P, Milne D. Six-minute walk, maximal exercise tests: reproducibility in fibrotic interstitial pneumonia. Am J Respir Crit Care Med. 2005;171:1150–7.CrossRefGoogle Scholar
  8. Granger C, denehy L, Parry S, Martin J, Dimitriadis T, Sorohan M, Irving L. Which field walking test should be used to assess functional exercise capacity in lung cancer? An observational study. BMC Pulm Med. 2015;15:89.CrossRefGoogle Scholar
  9. Harrison SL, Greening NJ, Houchen-Wolloff L, Bankart J, Morgan MD, Steiner MC, Singh SJ. Age-specific normal values for the incremental shuttle walk test in a healthy British population. J Cardiopulm Rehabil Prev. 2013;33(5):309–13.CrossRefGoogle Scholar
  10. Hernandes N, Wouters E, Meijer K, et al. Reproducibility of 6-minute walking test in patients with COPD. Eur Respir J. 2011;38:261–7.CrossRefGoogle Scholar
  11. Hill K, Dolmage TE, Woon L, Coutts D, Goldstein R, Brooks D. Comparing peak and submaximal cardiorespiratory responses during field walking tests with incremental cycle ergometry in COPD. Respirology (Carlton, Vic). 2012;17(2):278–84.CrossRefGoogle Scholar
  12. Holland A, Spruit M, Singh S. How to carry out a field walking test in chronic respiratory disease. Breathe. 2015;11(2):129–39.CrossRefGoogle Scholar
  13. Holland A, Spruit M, Troosters T, Puhan M, Pepin V, Saey D, MCCormack M, Carlin B, Sciurba F, pitta F, Wanger J, MacIntyre N, Kaminsky D, Culver B, Revill S, Hernandres N, Andrianopoulos V, Camillo C, Mitchell K, Lee A, Hill C, Singh S. An official European Respiratory Society / American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428–46.CrossRefGoogle Scholar
  14. Leger LA, Lambert J. A maximal multistage 20-m shuttle run test to predict VO2 max. Eur J Appl Physiol Occup Physiol. 1982;49(1):1–12.CrossRefGoogle Scholar
  15. Mador MJ, Modi K. Comparing various exercise tests for assessing the response to pulmonary rehabilitation in patients with COPD. J Cardiopulm Rehabil Prev. 2016;36(2):132–9.CrossRefGoogle Scholar
  16. McKeough ZJ, Leung RW, Alison JA. Shuttle walk tests as outcome measures: are two incremental shuttle walk tests and two endurance shuttle walk tests necessary? Am J Phys Med Rehabil. 2011;90(1):35–9.CrossRefGoogle Scholar
  17. Pepin V, Laviolette L, Brouillard C, Sewell L, Singh SJ, Revill SM, Lacasse Y, Maltais F. Significance of changes in endurance shuttle walking performance. Thorax. 2011;66(2):115–20.CrossRefGoogle Scholar
  18. Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Goncalves CG, Hayashi D, Singh S, Pitta F. Reference values for the incremental shuttle walking test. Respir Med. 2012;106(2):243–8.CrossRefGoogle Scholar
  19. Puente-Maestu L, Palange P, Casaburi R, Laveneziana P, Maltais F, Neder JA, O'Donnell DE, Onorati P, Porszasz J, Rabinovich R, Rossiter HB, Singh S, Troosters T, Ward S. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J. 2016. doi: ERJ-00745-2015 [pii];47:429.CrossRefGoogle Scholar
  20. Revill SM, Noor MZ, Butcher G, Ward MJ. The endurance shuttle walk test: an alternative to the six-minute walk test for the assessment of ambulatory oxygen. Chron Respir Dis. 2010;7(4):239–45.CrossRefGoogle Scholar
  21. Sandland CJ, Morgan MD, Singh SJ. Detecting oxygen desaturation in patients with COPD: incremental versus endurance shuttle walking. Respir Med. 2008;102(8):1148–52.CrossRefGoogle Scholar
  22. Singh S, Puhan M, Andrianopoulos V, Hernandes N, Mitchell K, Hill C, Lee A, Camillo C, Troosters T, Spruit M, Carlin B, Wanger J, Pepin V, Saey D, Pitta F, Kaminsky D, MCCormack M, MacIntyre N, Culver B, Sciurba F, REvill S, Delafosse V, Holland A. An official systematic review of the European Respiratory Society / American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1447–78.CrossRefGoogle Scholar
  23. Singh SJ, Jones PW, Evans R, Morgan MD. Minimum clinically important improvement for the incremental shuttle walking test. Thorax. 2008;63(9):775–7.CrossRefGoogle Scholar
  24. Singh SJ, Morgan MD, Hardman AE, Rowe C, Bardsley PA. Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Eur Respir J. 1994;7(11):2016–20.PubMedGoogle Scholar
  25. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019–24.CrossRefGoogle Scholar
  26. Spruit M, Polkey M, Celli B, Edwards L, Watkins M, Pinto-Plata V, Vestbo J, Calverley P, Tal-Singer R, Agusti A, Coxson H, Lomas D, MacNee W, Rennard S, Silverman E, Crim C, Yates J, Wouters E, investigators EoCltipseEs. Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease. J Am Med Dir Assoc. 2012;13(3):291–7.CrossRefGoogle Scholar
  27. Van Gestel A, Clarenbach C, Stowhas A, et al. Prevalence and prediction of exercise-induced oxygen desaturation in patients with chronic obstructive pulmonary disease. Respiration. 2012;84:353–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Annemarie L. Lee
    • 1
    • 2
    • 3
  • Theresa Harvey-Dunstan
    • 4
    • 5
  • Sally Singh
    • 4
    • 5
  • Anne E. Holland
    • 3
    • 6
    • 7
  1. 1.Faculty of Medicine, Nursing and Health Sciences, Monash UniversityFrankstonAustralia
  2. 2.Rehabilitation, Nutrition and Sport, La Trobe UniversityBundooraAustralia
  3. 3.Institute for Breathing and Sleep, Austin HealthHeidelbergAustralia
  4. 4.Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre – Respiratory, Glenfield HospitalLeicesterUK
  5. 5.Faculty of the College of Medicine, Biological Sciences and Psychology, University of LeicesterLeicesterUK
  6. 6.Alfred HealthMelbourneAustralia
  7. 7.Department of Rehabilitation, Nutrition and Sport, La Trobe UniversityBundooraAustralia

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