Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients
Introduction
Functional capacity is an important predictor of mortality and morbidity in patients with cardiovascular disease (CVD). One aim of cardiac rehabilitation should be to increase functional capacity. However, to verify such changes objectively, there is a need for reliable functional capacity tests that can be carried out by nurses and physiotherapists.
Graded exercise tests aim to provoke a physiological response to continuously increasing incremental exercise levels [1], [2]. The requirements of the cardiorespiratory system are challenged as the intensity increases, and the body's ability to cope with these demands can be investigated to provide an insight into aerobic capacity.
Several cardiorespiratory assessment tests and functional measurements have been developed to determine prognosis, prescribe exercise and assess the efficacy of cardiac rehabilitation. Several walk tests based either on a specific time (2-minute, 5-minute, 6-minute, 9-minute and 12-minute walk test), distance (100 m, half mile, 2 km walk test) or walking speed [self-paced, 6-minute and controlled-paced incremental shuttle walking test (ISWT)] are used to assess the functional capacity of cardiac patients, the effectiveness of a cardiac rehabilitation programme and the prognosis of CVD [3].
The British Association for Cardiac Rehabilitation (BACR) recommends use of the ISWT to assess and monitor functional capacity in patients with chronic heart failure, patients who have experienced a myocardial infarction, and patients who have undergone cardiovascular surgery or pacemaker insertion [4], [5], [6], [7], [8].
The ISWT has been used to track changes in functional capacity during cardiac rehabilitation programmes [8], [9], [10], [11]. These studies typically use a single test at the beginning of rehabilitation and compare the distances walked with a post-rehabilitation test. While the ISWT appears to be able to assess changes in functional capacity in patients with CVD, only short-term (up to 7 days) test–retest reliability of the test has been assessed [9], [12], [13]. Given that cardiac rehabilitation programmes typically last for 6 to 12 weeks, long-term reliability is clearly of great importance.
If the ISWT is to be used to assess changes in functional capacity during cardiac rehabilitation, it is necessary to evaluate its long-term reliability. The primary aim of this study was to assess the test–retest reliability of a modified version of the ISWT over 8 weeks in clinically stable CVD patients.
Section snippets
Methods
Thirty CVD patients (15 males and 15 females; age 55 to 80 years) volunteered to participate in this study. Patients were verbally recruited by instructors prior to two consecutive exercise classes. All patients were defined as clinically stable, according to the BACR criteria [14].
All participants were attending a community-based phase IV cardiac rehabilitation programme at the University of Essex. The programme provides additional phase IV cardiac rehabilitation capacity in the local area,
Results
The mean age of participants was 67 ± 8 years. Most participants (60%) were elective post-revascularisation patients (coronary artery bypass graft or percutaneous transluminal coronary angioplasty), 17% were post-myocardial-infarction patients, and the other patients had stable angina or heart failure. Fifty-three percent of patients were β-blocked, but none of the participants changed their medication from pre-test to post-test (Table 1). Paired-samples t-tests showed that body mass remained
Discussion
Functional capacity patterns of CVD patients are usually established by the end of hospital outpatient (phase III) cardiac rehabilitation, and remain stable during community-based phase IV cardiac rehabilitation [8]. Assessment of functional capacity in CVD patients is important for assessing the effectiveness of exercise interventions and in exercise prescription. The ISWT is an affordable alternative to treadmill testing, but its reliability has only been tested over short test–retest
References (23)
- et al.
A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain
Chest
(2001) - et al.
The 10 m Shuttle Walk Test with Holter Monitoring: an objective outcome measure for cardiac rehabilitation
Coronary Health Care
(1999) Low-cost shuttle walk test for assessing exercise capacity in chronic heart failure
Int J Cardiol
(2000)- et al.
Reproducibility and validity of the incremental shuttle walking test in patients following coronary artery bypass surgery
Physiotherapy
(2005) - et al.
Validity and reliability of the modified shuttle walk test in patients with chronic obstructive pulmonary disease
Arch Phys Med Rehab
(2006) - et al.
Reproducibility and safety of the incremental shuttle walking test for cardiac rehabilitation
Int J Cardiol
(2008) Assessment of functional capacity in cardiac rehabilitation
Coronary Health Care
(1997)- et al.
Reliability, repeatability, and sensitivity of the modified shuttle test in adult cystic fibrosis
Chest
(2000) - et al.
Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study
JAMA
(2003) - et al.
Heart-rate profile during exercise as a predictor of sudden death
N Engl J Med
(2005)
Shuttle walking test: a new approach for evaluating patients with pacemakers
Heart
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Interpreting Meaningful Change in the Distance Walked in the 10-Metre ISWT in Cardiac Rehabilitation
2019, Heart Lung and CirculationWhat factors are associated with patients walking fitness when starting cardiac rehabilitation?
2019, IJC Heart and VasculatureCitation Excerpt :It is reliable and strongly correlated with CPET results validated in cardiac and pulmonary populations undergoing rehabilitation programmes [12–15]. Some studies have used the ISWT to investigate potential determinants of walking fitness in conventional cardiac populations [16,17] identifying several personal characteristics as significant predictors of fitness, including gender, age, body mass index, physical activity status, employment and marital status [15,17,19]. The impact of comorbidities, which often occur together with the diagnosis of HF, particularly in elderly patients, have not yet been investigated for their impact in determining walking fitness in terms of distance achieved using the ISWT.
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)Citation Excerpt :Measurement error can be estimated for an individual score or around a change score for either a group, such as a cardiac rehabilitation group or for an individual within a program. Previous research has demonstrated that for change scores within a group the minimum amount of change required to be interpreted as real change over and above measurement error after the completion of one 10 m ISWT ranged from 36 m in a mixed cardiac rehabilitation group in a single session [2], to 44 m in a group who were attending a community based maintenance cardiac rehabilitation program and completed the testing over a minimum of eight weeks [3] to 56 m for a group of patients following coronary artery bypass surgery who completed the tests within one week [4]. For an individual, after one test an improvement in test score required to be interpreted as more than measurement error ranged from 53 m in individuals with heart failure in a single session [7] to 122 m [4] to 203 m [3].
Does the Incremental Shuttle Walking Test require maximal effort in healthy subjects of different ages?
2015, Physiotherapy (United Kingdom)Citation Excerpt :It was also shown in COPD that two ISWTs are needed to assess exercise capacity during a maintenance exercise program [13]. van Bloemendaal et al. found that the ISWT is a valid and reliable measure of functional walking capacity in patients after stroke [6], whilst Pepera et al. found that there appears to be no learning effect in the ISWT over long test–retest durations in patients with cardiovascular disease [9]. Despite the widespread use of the ISWT in diseased and/or functionally limited subjects, its use in subjects without any important disease/limitation or healthy subjects is less common [14–17].