Development of a 10 metre shuttle walking test to access patients with chronic airways limitation
The purpose of this study was to develop an incremental field exercise test of disability to use in the assessment of functional capacity in patients with chronic airways limitation (CAL). The test was modified from the 20m shuttle running test, employed to predict the maximal oxygen uptake of sporting individuals. The protocol devised for the patients was adapted from the running speeds proposed by Leger and Lambert (1982). The shuttle walking test requires patients to walk up and down a 10m course at speeds dictated by a series of audio signals played from a tape cassette, increasing each minute to a symptom limited maximum performance. Examination of the reproducibility of the test revealed strong test/retest reliability, after just one practice walk. The mean between trial difference (test 2 vs test 3) was -2m,(n=10), (95% CI -21.9 to 17.9m). The shuttle walking test was validated against the traditional measurement of peak oxygen uptake (Vo2pmk) measured conventionally during an incremental maximal treadmill test with Douglas bags (n=19). The results from this exercise test were compared against the patients' performance (distance achieved) on the shuttle walking test (after one practice walk) and revealed a strong relationship between the two variables (r=0.88). The validity and the resistance to breathing, of a portable oxygen consumption meter was examined. Validation, again in comparison to Douglas bag measurements, involved four cohorts (two healthy and two patient groups). After some modifications to the equipment, measurements of lib2 by the two different methods were not significantly different. The patients' response to the shuttle walking test was examined (n=10). The heart rate, ventilation and 7Orck2 increased gradually in response to the increasing intensity of the shuttle walking test. Again Vo 2wa measurements related strongly to the patients performance (r=0.81). A further study employing a treadmill test and shuttle walking test confirmed that the latter provided a comparable metabolic and physiological challenge to the patients as the conventional treadmill test. Comparison with the 6 minute walking test (6MWT), one of the most commonly employed field exercise tests in this patient population) revealed that the heart rate response was significantly higher in the shuttle walking test than the 6 MWT and graded, a response not observed in the 6MWT. The shuttle test reflected the true extent of the patients disability more accurately than the 6MWT. The shuttle walking test provides a simple, reproducible exercise test of disability in patients with CAL that relates well to Vb2puk . The external pacing of the test allows more valid intra- and inter- subject comparison than has previously been possible with field tests alone.