The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method Relationship between field walking tests and incremental cycle ergometry in COPD. Shuttle Walking Test and 6-Minute Walking Test Induce a Similar Cardiorespiratory Performance in Patients Recovering from an Acute Exacerbation of Chronic Obstructive Pulmonary Disease The influence of alternative instruction on 6-min walk test distance. Validity and reliability of the modified shuttle walk test in patients with chronic obstructive pulmonary disease. Repeat six-minute walk tests in patients with chronic heart failure: are they clinically necessary? Submaximal exercise testing in the assessment of interstitial lung disease secondary to systemic sclerosis: reproducibility and correlations of the 6-min walk test Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Detecting oxygen desaturation in patients with COPD: incremental versus endurance shuttle walking. Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease. Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Comparison of hallway and treadmill six-minute walk tests. Endurance shuttle walking test: responsiveness to salmeterol in COPD Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease
UK guidelines for domiciliary oxygen have suggested the six-minute walk test or shuttle walk tests as suitable functional measures for the clinical assessment of ambulatory oxygen ( AO ) . To date , there is limited evidence that would support the use of shuttle walk tests as assessment tools for AO . The endurance shuttle walk test ( ESWT ) is used increasingly as an assessment tool within pulmonary rehabilitation ( PR ) but its potential as an investigative test for AO has not been explored . Using the same test for both PR and AO assessment is appealing since it would improve efficiency and act to st and ardise outcome measures in this patient population . The aim of this study was to examine the responsiveness and repeatability of the ESWT to AO and to compare the response with that of the six-minute walk test ( 6MWT ) .  Twenty-three patients with chronic obstructive pulmonary disease ( COPD ) performed , in r and om order , the ESWT and the 6MWT on air and whilst breathing AO . Oxygen saturation and Borg ratings of breathlessness and perceived exertion were recorded . On a third day , eleven patients repeated the ESWT with AO in order to measure repeatability . There was a significantly greater change in the ESWT with oxygen than the change recorded from the 6MWT ( 66 [ 91 ] vs 6 [ 28 ] m respectively ; P < .05 ) . When repeated on a separate day , the mean difference ( 95 % CI ) between distances walked on the ESWT with AO was 0.91 ( -47 , 49 ) m. The ESWT was more responsive than the 6MWT for detecting improvements in walking endurance whilst breathing AO Background There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer ( NSCLC ) .  Cardiopulmonary exercise testing ( CPET ) is the gold st and ard measure of exercise capacity ; however this laboratory test has limitations for use in research and clinical practice . Alternative field walking tests are the six-minute walk test ( 6MWT ) , incremental-shuttle walk test ( ISWT ) and endurance-shuttle walk test ( ESWT ) ; however there is limited information about their clinimetric properties in NSCLC . Aims : In NSCLC to determine the 1 ) criterion validity of the 6MWT , ISWT and ESWT against CPET ; 2 ) construct validity of the 6MWT , ISWT and ESWT against measures of function , strength , respiratory function and health-related quality of life ( HRQoL ) ; and 3 ) clinical applicability of the tests . Methods Twenty participants ( 40 % male , mean ± SD age 66.1 ± 6.5 years ) with stage I-IIIb NSCLC completed the 6MWT , ISWT , ESWT and CPET within six months of treatment . Testing order was r and omised . Additional measures included Eastern Cooperative Oncology Group Performance-Status ( ECOG-PS , function ) , respiratory function , h and -grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships . Results The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption ( r = 0.61 , p = 0.007 ) . Relationships between CPET and six minute walk distance ( 6MWD ) ( r = 0.24 , p = 0.329 ) or ESWT time ( r = 0.02 , p = 0.942 ) were poor . Moderate construct validity existed for the 6MWD and respiratory function ( forced vital capacity % predicted r = 0.53 , p = 0.019 ; forced expiratory volume in the first second % predicted r = 0.55 , p = 0.015 ) . There were no relationships between the walking tests and measures of function , strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time . No floor effects were seen in the tests . The mean ± SD time required to perform the individual 6MWT , ISWT and ESWT was 12.8 ± 2.5 , 14.7 ± 3.7 and 16.3 ± 5.0 min respectively ; in comparison to CPET which was 51.2 ± 12.7 min . Only one assessor was required to perform all field walking tests and no adverse events occurred . Conclusions The ISWT is a promising measure of functional exercise capacity in lung cancer . Findings need to be confirmed in a larger sample prior to translation into practice Background Although the endurance shuttle walk test ( ESWT ) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation ( PR ) for COPD , the minimally important difference ( MID ) has not yet been established . We aim ed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR . Methods Data were derived from a r and omized controlled trial , investigating the value of noninvasive positive pressure ventilation added to PR . Fifty-five patients with stable COPD , GOLD stage IV , with chronic respiratory failure were included ( mean ( SD ) FEV1 31.1 ( 12.0 ) % pred , age 62 ( 9 ) y ) . MID estimates of the ESWT in seconds , percentage and meters change were calculated with anchor based and distribution based methods .  Six minute walking distance ( 6MWD ) , peak work rate on bicycle ergometry ( Wpeak ) and Chronic Respiratory Question naire ( CRQ ) were used as anchors and Cohen ’s effect size was used as distribution based method . Results The estimated MID of the ESWT with the different anchors ranged from 186–199 s , 76–82 % and 154–164 m. Using the distribution based method the MID was 144 s , 61 % and 137 m. Conclusions Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure . Therefore we recommend using a range of 186–199 s , 76–82 % or 154–164 m as MID of the ESWT in COPD patients with chronic respiratory failure . Further research in larger population s should eluci date whether this cut-off value is also valid in other COPD population s and with other interventions .Trial registration Clinical Trials . Gov ( ID NCT00135538 ) BACKGROUND AND OBJECTIVE Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients Background : The incremental shuttle walking test ( SWT ) has recently been proposed as a more valid and reproducible alternative to the conventional 6-min walking test ( 6MWT ) in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease ( COPD ) . Objective : To compare the cardiorespiratory performance obtained during two sessions of SWT with that obtained during two sessions of 6MWT . Methods : We examined 18 patients ( forced expiratory volume in 1 s : 48 ± 14 % ) recovering from an acute exacerbation of COPD that had required hospitalization . In the same afternoon , each patient performed two SWT and two 6MWT , with an interval of at least 30 min between each test ; the sequence of the tests was r and omized . Results : Mean walking distance was greater in the second SWT test than in the first SWT . The changes from baseline in systolic blood pressure , heart rate , respiratory rate , oxygen saturation and dyspnea Borg index at the end of the test were similar between the two 6MWT and the two SWT . There was a highly significant correlation between walking distances measured during SWT and during 6MWT ( ρ : 0.85 , p < 0.0005 ) . Neither SWT nor 6MWT correlated with functional data of COPD . Conclusions : SWT , though being considered to be closer to a submaximal exercise test than 6MWT , does not induce a greater cardiorespiratory performance  than 6MWT in patients recovering from acute exacerbation of COPD BACKGROUND The goal of the 6-min walk test ( 6MWT ) is to enable patients to walk " as far as possible " as a measure of their functional ability . The impact of the specific walk instructions on patient 6MWT performance is unknown . METHODS Patients with pulmonary arterial hypertension ( PAH ) , idiopathic pulmonary fibrosis ( IPF ) , and other forms of interstitial lung disease ( ILD ) were recruited to perform four identical 6MWTs with one differing instructional phrase . The st and ard instruction to walk " as far as possible " was substituted in r and om order with " as fast as possible , " " at your normal pace , " or " at a leisurely pace . " RESULTS Twenty-four patients ( 10 with PAH , eight with IPF , six with other ILD ) were enrolled and completed all four 6MWTs . Patients attained the greatest distance with the fast instruction , exceeding the st and ard instruction distance by a mean of 52.7 m ( P < .001 ) . The mean difference between the fast and st and ard walks was 41.5 m in the PAH group , 66.5 m in the IPF group , and 53 m in the other ILD group . CONCLUSIONS Patients do not walk as far as they are able with the st and ard American Thoracic Society instruction for 6MWT . Changing the wording from " far " to " fast " may facilitate a better effort and greater distance during the test . It is possible that this modified 6MWT instruction may result in improved accuracy and reproducibility , thereby enhancing its clinical and research trial usefulness OBJECTIVES ( 1 ) To examine the concurrent criterion validity of the modified shuttle walk test ( MSWT ) by using the 6- ( 6MWT ) and 12-minute walk test ( 12MWT ) , ( 2 ) to examine the concurrent criterion validity of the estimated maximum oxygen uptake ( Vo2max ) of the MSWT with actual Vo2max , and ( 3 ) to determine test-retest reliability of the MSWT in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Validation study . SETTING Outpatient pulmonary rehabilitation program . PARTICIPANTS Thirty clinical ly stable adults with COPD . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Subjects were r and omly assigned to receive either the 6MWT and 12MWT or the MSWT first . The MSWT was repeated 1 week later ( N = 30 ) . Estimated Vo2max was calculated , and actual Vo2max was conducted by using the Jones test . Validity of the MSWT was assessed by comparing endurance scores and Vo2max with results from the 6MWT and 12MWT and Jones test , respectively . RESULTS There was a moderately high correlation between the  MSWT  and the 6MWT and 12MWT at initial testing ( .82 and .74 , respectively ) . Correlation between estimated and actual Vo2max was r equal to .68 . Test-retest reliability for the entire sample was high ( intraclass correlation coefficient , .88 ) . Results remained quite stable across severity , age , and sex subgroups . CONCLUSIONS The MSWT is a st and ardized externally paced submaximal endurance walking test . The results indicate that the MSWT has high concurrent validity and test-retest reliability for patients with COPD Background : Owing to a reported learning effect in patients with chronic cardiopulmonary disease , performance of at least two six-minute walk tests ( 6MWT ) are recommended as st and ard practice . Patients with chronic heart failure ( CHF ) are typically elderly and frail and it is unknown whether current guidelines are practical in a clinical setting . Aims : The aim of this study was to determine whether repeat performance of 6MWTs in patients with CHF is related to between-test interval or baseline performance . Methods : This was a multisite observational study enrolling participants entering into heart failure rehabilitation programmes . Participants performed two 6MWTs with r and omly allocated inter-test intervals between 15 and 90 minutes . Distance walked in the second test was compared with the first test using a paired t test . Results : Eighty-eight participants ( 45 females , age 65 ± 14 years ) with stable CHF were enrolled . Mean distance walked increased from 301 metres in test 1 to 313 metres in test 2 ( p < 0.001 ) . No significant change was recorded between test 1 and test 2 for those whose baseline distance was < 300 metres . The interval between tests had no significant effect on the distance walked . Conclusion : The change in 6MWT distance was significantly associated with better baseline performance but not with the interval between tests Background : The 6-min walk test ( 6MWT ) is increasingly used as an outcome measure in interstitial lung disease ( ILD ) . Aim : To evaluate the usefulness of the 6MWT in a cohort of patients with ILD secondary to systemic sclerosis ( SSc ) and to correlate with established physiological parameters . Methods : 163 patients with SSc-ILD were recruited for a multicentre , r and omised , double-blind clinical trial . Available data at protocol screening included repeated 6MWTs , pulmonary function testing with diffusing capacity , Doppler echocardiography and high-resolution computed tomography of the thorax . Borg Dyspnoea Index was evaluated before and after 6MWT . Results : Mean ( st and ard deviation ( SD ) ) distance walked during walk test 1 was 396.6 ( 84.55 ) m compared with 399.5 ( 86.28 ) m at walk test 2 . The within-subject , intertest correlation as determined by Pearson ’s correlation coefficient testing was 0.95 ( p<0.001 ) . However , only weak correlations of 6MWT with percentage forced vital capacity and the Borg Dyspnoea Index were observed , and no correlation was observed with percentage diffusing capacity . Conclusion : These data confirm the high reproducibility of the  6MWT in patients with SSc-ILD and therefore the validity of the test in this cohort . The lack of correlation of 6MWT with st and ard physiological parameters of ILD suggests a multifactorial basis for limited exercise capacity in patients with SSc and calls into question the utility of the 6MWT as a measure of outcome in future studies on SSc-ILD OBJECTIVE To estimate the minimal clinical ly important difference ( MCID ) for the 6-minute walk test ( 6MWT ) and the 200-m fast-walk test ( FWT ) in patients with coronary artery disease ( CAD ) during a cardiac rehabilitation program . DESIGN Prospect i ve study using distribution- and anchor-based methods . SETTING Out patients from a cardiac rehabilitation unit . PARTICIPANTS Stable patients with CAD ( N=81 ; 77 men ; mean±SD age , 58.1±8.7y ) enrolled 31±12.1 days after an acute coronary syndrome ( ACS ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  6MWT and 200-m FWT results before and after an 8-week cardiac rehabilitation program and at the 6th and 12th sessions . Patients and physiotherapists who supervised the training were asked to provide a global rating of perceived change in walking ability while blinded to changes in walk test performances . RESULTS Mean change in 6MWT distance ( 6MWD ) in patients who reported no change was -6.5 m versus 23.3 m in those who believed their performance had improved ( P<.001 ) . This result was consistent with the MCID determined by using the distribution method ( 23 m ) . Considering a 25-m cutoff , positive and negative predictive values were 0.9 and .63 , respectively . Conversely , there was no difference in 200-m FWT performance between these 2 groups ( 0.1 vs -1.4s , respectively ) . There was poor agreement with the physiotherapist 's perceived change . CONCLUSIONS The MCID for 6MWD in patients with CAD after ACS was 25 m . This result will help physicians interpret 6MWD change and help research ers estimate sample sizes in further studies using 6MWD as an endpoint BACKGROUND There has been no direct comparison between an incremental and endurance walking test to detect the relative oxygen desaturation in patients with chronic obstructive pulmonary disease ( COPD ) . This is of some importance as current guidelines have suggested that ambulatory oxygen should only be prescribed after a st and ard assessment and desaturation documented . No clear advice about the nature of the required exercise task is given . This study therefore compared the relative desaturation between the incremental shuttle walking test ( ISWT ) and the constant speed walking test ( ESWT ) and response to ambulatory oxygen . METHODS Forty-one patients ( 29 male ) , mean ( SD ) , age 71.18 ( 7.48 ) yrs , FEV(1 ) 0.85 ( 0.29 ) l with stable COPD were recruited after completion of a 7-week pulmonary rehabilitation programme . Patients completed a baseline ( without carrying a cylinder ) ISWT and ESWT and then , in r and om order in double blind fashion , completed the walk tests with a cylinder of air or a cylinder of oxygen . Measurements included distance walked , oxygen saturation , heart rate , perceived breathlessness and exertion ( Borg scale ) . RESULTS All patients desaturated ( < 4 % below 90 % ) . There was no significant difference in desaturation between the ISWT and the ESWT . There was a significant improvement in performance with supplementary oxygen compared to cylinder air ( p<0.05 ) for both tests . However , compared to the baseline walk , supplementary oxygen did not enhance the distance walked for either test . There was a significant decrease in walking performance on both the ISWT and the ESWT when carrying an air cylinder compared with the control walk . When comparing the percentage difference between oxygen and air for responders ( i.e. those that achieve a 10 % or more increase ) , the ESWT showed a greater percentage change 42.1 % compared to 26.1 % for the ISWT . CONCLUSIONS This study identifies that incremental and endurance walking provokes significant desaturation and that there is a short-term benefit of oxygen versus air in enhancing exercise performance . There was no significant difference in the level of desaturation between tests . Therefore the ISWT is a suitable exercise test that can be used to evaluate desaturation and is practically more realistic OBJECTIVES To investigate the feasibility of an outdoor 6-minute walk test ( 6MWT ) as a measure of functional status among individuals with chronic obstructive pulmonary disease ( COPD ) , and to examine the relationship between performance on an indoor and an outdoor 6MWT . DESIGN An experimental , repeated- measures crossover design . Subjects were studied on 2 separate days in the same week . Two 6MWTs-one indoors and the other outdoors-were performed on each study day , with a rest in between . The test order was r and omly selected on the first day and reversed on the second day . Outdoor tests were performed on days of moderate weather conditions ( mean temperature + /- st and ard deviation , 21 degrees + /-3 degrees C ; mean wind speed , 15+/-7 km/h ; no precipitation ) and on a flat surface ( sidewalk ) . SETTING  Outpatient rehabilitation program in Ontario . PARTICIPANTS Eighteen subjects with COPD ( 10 men , 8 women ; age , 70+/-8y ) , 5 using supplemental oxygen at rest ( forced expiratory volume in 1s , 1.0+/-0.3L ; 42%+/-8 % of predicted ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Distance walked in 6 minutes ( in meters ) , duration of rest ( in seconds ) , and change in rate of perceived dyspnea . RESULTS There was no significant effect of setting ( indoors vs outdoors ) on distance walked ( 394+/-86 m vs 398+/-84 m , P=0.4 ) , duration of rest ( 13+/-28s vs 9+/-20s , P=0.4 ) , or change in rate of perceived dyspnea ( 2.3+/-1.7 vs 2.3+/-2.0 , P=0.8 ) . Testing day had no significant effect on walk test performance ( all P>0.1 ) . CONCLUSIONS The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors QUESTIONS Does an eight-week program of walk training improve endurance walking capacity in people with COPD compared to cycle training ? Does walk training improve peak walking capacity , cycle capacity , and quality of life compared to cycle training ? Is the endurance shuttle walk test ( ESWT ) responsive to change in walking capacity elicited by exercise training ? DESIGN R and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 36 people with stable COPD recruited with four dropouts . INTERVENTION Participants were r and omised into either a walk or cycle training group . Both groups trained indoors for 30 to 45 minutes per session , three times weekly over eight weeks at Concord Hospital . Training intensities were based on baseline peak exercise tests and progressed as able . OUTCOME MEASURES The primary outcome was endurance walking capacity measured by the ESWT . Secondary outcomes included peak walking capacity , peak and endurance cycle capacity , and health-related quality of life . Measures were taken at baseline ( Week 0 ) and following training ( Week 8) . RESULTS The walk training group increased their endurance walking time by 279 seconds ( 95 % CI 70 to 483 ) more than the cycle training group . No significant differences between the groups were found for any other outcome . CONCLUSION Ground walk training increased endurance walking capacity more than cycle training and was similar to cycle training in improving peak walking capacity , peak and endurance cycle capacity and quality of life . This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs RATIONALE The 6-minute-walk test ( 6MWT ) is a practical and clinical ly meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases . Performance characteristics in patients with idiopathic pulmonary fibrosis ( IPF ) have not been systematic ally evaluated . OBJECTIVES To assess the reliability , validity , and responsiveness of the 6MWT and estimate the minimal clinical ly important difference ( MCID ) in patients with IPF . METHODS The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b ( n = 822 ) .  Six-minute walk distance ( 6MWD )  and other parameters were measured at baseline and at 24-week intervals using a st and ardized protocol . Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function , dyspnea , and health-related quality of life . Both distribution-based and anchor-based methods were used to estimate the MCID . MEASUREMENTS AND MAIN RESULTS Comparison of two proximal measures of 6MWD ( mean interval , 24 d ) demonstrated good reliability ( coefficient = 0.83 ; P < 0.001 ) . 6MWD was weakly correlated with measures of physiologic function and health-related quality of life ; however , values were consistently and significantly lower for patients with the poorest functional status , suggesting good construct validity . Importantly , change in 6MWD was highly predictive of mortality ; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year ( hazard ratio , 4.27 ; 95 % confidence interval , 2.57- 7.10 ; P < 0.001 ) . The estimated MCID was 24 - 45 m. CONCLUSIONS The 6MWT is a reliable , valid , and responsive measure of disease status and a valid endpoint for clinical trials in IPF The 6-min walk test ( SMWT ) performed in the hallway ( HW ) is used as a clinical indicator of functional capacity in patients with lung disease . A 6-min walk test utilizing a treadmill ( TM ) is easier to perform and allows easier patient monitoring . Therefore , we formulated a st and ardized TM SMWT protocol and compared the results with those of a HW SMWT .  All patients were enrolled in a pulmonary rehabilitation program . Patients with current infection , recent change in inhaled medications or oral steroid use , and significant cardiovascular disease were excluded . Each subject performed three HW SMWTs and three TM SMWTs assigned r and omly on subsequent days . There was a 30-min rest between each walk and at least a 48-h rest between each test day . All patients completed both HW and TM SMWT within 7 d. Supplemental oxygen was utilized or increased if the saturation fell below 88 % . The best of the three tests was used for data analysis . Twenty-one subjects completed the protocol . The mean age was 65 + /- 10.9 yr ( range , 35 to 79 yr ) . Ten subjects were receiving supplemental oxygen . The mean FEV(1 ) was 1.07 + /- 0.53 L. The mean HW SMWT distance was 1,228 + /- 255 ft ( range , 612 to 1,679 ft ) and the mean TM SMWT distance was 1,060 + /- 389 ft ( range , 475 to 1,819 ft ) , which were statistically different ( p = 0.01 ) . The mean difference was 168 + /- 280 ft ( range , -326 to 743 ft ) . Oxygen saturation and supplemental oxygen requirements did not differ significantly . The intra-test variability of the three HW SMWTs was similar to the three TM SMWTs and no significant difference in the coefficient of variation was found . A st and ardized TM SMWT is feasible and allows easier patient monitoring , but there is a statistically significant difference between the HW and TM SMWT distance and therefore they are not interchangeable . However , the intratest reproducibility of the TM and HW SMWTs are similar when three walks are performed in a single test session . The role of the TM SMWT in pulmonary rehabilitation requires further exploration Few studies have shown that the endurance shuttle walking test ( ESWT ) is responsive to treatment in patients with chronic obstructive pulmonary disease ( COPD ) . This exercise test needs to be further investigated because of its relevance for activity of daily living . The aim of the present study was to evaluate , in patients with COPD , the responsiveness of the ESWT in detecting improvement in walking performance after a single dose of salmeterol . In a r and omised , double-blind , placebo-controlled crossover trial , 20 patients with COPD performed two ESWT at 80 % of peak capacity 2.5 h after inhaling either a placebo or 50 µg of salmeterol  . Cardiorespiratory parameters were monitored during each walking test . Inspiratory capacities and Borg ratings for dyspnoea were obtained every other minute throughout the tests . Compared with placebo , salmeterol produced a significant change in lung function and a significant improvement in walking performance ( mean±sd difference in time : 117±20 s ; difference in distance : 160±277 m ) . At isotime ( the latest exercise time that was reached on both ESWT ) , a significant reduction in dyspnoea was observed after bronchodilation . Bronchodilation with salmeterol reduced dyspnoea during walking and improved walking capacity in patients with chronic obstructive pulmonary disease . These findings provide further support for the use of the endurance shuttle walking test as an evaluative tool in chronic obstructive pulmonary disease The 6-min walking test ( 6MWT ) is frequently used to assess functional capacity in chronic cardiopulmonary disorders because of its simplicity . The study examines the physiological responses during encouraged 6MWT in patients with chronic obstructive pulmonary disease . Pulmonary oxygen ( O2 ) uptake ( V′O2 ) was measured in 20 male patients ( age 66±6 yrs , forced expiratory volume in one second 45±14 % predicted ) during 6MWT and incremental cycling  , in r and om order  . O2 tension in arterial blood , carbon dioxide tension in arterial blood and arterial lactate concentration ( [La]art ) were obtained in the last 10 patients . During the 6MWT  , V′O2 showed a plateau after the 3rd min ( 1.39±0.28 , 1.42±0.31 , and 1.40±0.30 L·min−1 , 4th , 5th and 6th min , respectively ) , and minute ventilation ( V′E ) ( 42±8 L·min−1 ) was 91 % maximal voluntary ventilation . No differences were shown between 6MWT ( 6th min ) and peak cycling exercise in V′O2 ( 1.40±0.30 versus 1.41±0.28 L·min−1 , respectively ) , cardiac frequency ( 126±13 versus 130±12 beats·min−1 ) , or arterial respiratory blood gases . The two tests were significantly different in V′E ( 42±8 versus 47±8 L·min−1 , 6MWT versus cycling , respectively ) , carbon dioxide production ( 1.30±0.31 versus 1.45±0.18 L·min−1 ) and [La]art ( 2.9±1.99 versus 5.9±1.51 M ) . The study demonstrates that an encouraged 6-min walking test  generates a high but sustainable oxygen uptake . Since the oxygen uptake plateau reflects the integrated response of the system , it may explain the high prognostic value of the 6-min walking test
Current data confirm that the 6MWT , ISWT and ESWT are valid , reliable and responsive to change with some interventions .
However , results are sensitive to small changes in methodology .
Field walking tests are commonly employed to evaluate exercise capacity , assess prognosis and evaluate treatment response in chronic respiratory diseases .
In recent years , there has been a wealth of new literature pertinent to the conduct of the 6-min walk test ( 6MWT ) , and a growing evidence base describing the incremental and endurance shuttle walk tests ( ISWT and ESWT , respectively ) .
The aim of this document is to describe the st and ard operating procedures for the 6MWT , ISWT and ESWT , which can be consistently employed by clinicians and research ers .