A Comparative Assessment of Measurements Made in an Incremental Shuttle Walk Test and Incremental Cycle Ergometry Test in Patients With Idiopathic Pulmonary Fibrosis
Conditions: Idiopathic Pulmonary Fibrosis
Sponsor: University Hospitals Coventry and Warwickshire NHS Trust

 
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ISWT vs CPET 
A comparative assessment of the relationship between the measurements made in 
an incremental shuttle walk test and an incremental cycle ergometry test in patients 
with idiopathic pulmonary fibrosis 
 
PROTOCOL 
 
IRAS number 
222072 
Sponsor 
University Hospitals Coventry & Warwickshire NHS Trust 
Sponsor reference 
DP206517 
REC reference  
17/LO/1953 
REC approval date 
<insert> 
HRA approval date 
<insert> 
Version number 
2.0 
Date 
16th November 2017 
Start date 
1st December 2017 
End date 
31st March 2018 
 
 
 
Confidentiality statement 
All information contained within this document is regarded as, and must be kept, confidential. No part of 
this document may be disclosed to any Third Party without the written permission of the Chief Investigator 
and/or Sponsor. 
 

 
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SIGNATURE PAGE 
The undersigned confirm that the following protocol has been agreed and accepted and that the Chief 
Investigator agrees to conduct the trial in compliance with the approved protocol and will adhere to the 
principles outlined in the Research Governance Framework, the ICH Good Clinical Practice guidelines and 
the Sponsor’s SOPs. 
 
I agree to ensure that the confidential information contained in this document will not be used for any other 
purpose other than the evaluation or conduct of the clinical investigation without the prior written consent 
of the Sponsor. 
 
I also confirm that I will make the findings of the study publically available through publication or 
other dissemination tools without any unnecessary delay and that an honest accurate and 
transparent account of the study will be given; and that any discrepancies from the study as planned 
in this protocol will be explained. 
 
For and on behalf of the Study Sponsor: 
Signature:  
 
...................................................................................................... 
 
Date:  
 
......../…..../…..... 
Name (please print): 
 
...................................................................................................... 
 
 
Position:  
 
...................................................................................................... 
 
 
 
 
Chief Investigator: 
Signature:  
 
...................................................................................................... 
 
Date:  
 
…...../......../........ 
Name: (please print): 
 
...................................................................................................... 
Position:  
 
...................................................................................................... 
 
 

 
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KEY TRIAL CONTACTS 
Chief Investigator 
Name: Professor David Parr 
Address: University Hospital, Coventry, CV2 2DX 
Contact no: 02476 967697 
Student Researcher  
Name: Miss Elizabeth Dobson 
Address: Respiratory Physiology and Sleep Department, University 
Hospital, Coventry, CV2 2DX 
Contact no: 02476 966734 
Sponsor 
Name: Mrs. Ceri Jones 
Address: Research and Development, University Hospital, Coventry, CV2 
2DX 
Contact no: 02476 965031  
Academic Supervisor  
Name: Mrs. Joanna Shakespeare 
Address: Respiratory Physiology and Sleep Department, University 
Hospital, Coventry, CV2 2DX 
Contact no: 02476 966734 
Academic Institution  
Name: Dr. Martin Stout 
Address: Manchester Metropolitan University, John Dalton Building, 
Chester Street, Manchester, M1 5GD 
Contact no: 01612 471183 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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STUDY SUMMARY 
Full study title 
A comparative assessment of the relationship between the 
measurements made in an incremental shuttle walk test and 
an incremental cycle ergometry test in patients with idiopathic 
pulmonary fibrosis 
Short study title 
ISWT vs CPET 
Study aim 
1. To test the relationship between VO2 peak in a CPET and 
the distance walked in an ISWT 
2. To test the hypothesis that PO2 is the same at the end of 
an ISWT and a CPET. 
 
Study design  
Single centre  
Study participants 
Patients over the age of 16 with a confirmed diagnosis of IPF  
Study arms 
Not applicable 
Sample size  
43 
Planned study period  
 4 months 
Planned recruitment start date 
 1st December 2017 
Planned recruitment end date  
 1st March 2018 
Planned study end date 
 31st March 2018 
 
Objectives 
Outcome Measures 
Primary 
 
To test the relationship 
between distance walked in 
an ISWT and VO2 peak 
measured in a CPET. 
VO2 peak 
 
Key Words: Idiopathic pulmonary fibrosis, cardiopulmonary exercise test, incremental shuttle walk test, 
VO2 peak 
 
 
 
 
 

 
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STUDY FLOW CHART 
Figure 1: Flow of participants through the study 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Letter of invitation to take part in this study sent to patient. They are asked to contact the 
research team if they are interested in taking part. 
After 48 hours or more: Potential participant receives phone call to further discuss study and 
decides whether or not to take part 
Potential participants choosing to take part in the study visit University Hospital and sign the 
Participant Consent Form 
Participant makes Study Visit One 
Participant undertakes either a cardiopulmonary exercise test or an incremental shuttle walk 
test with a member of the research team. At the end of the test a capillary blood sample is taken 
and analysed for oxygen pressure. 
Approximately two weeks later participant makes Study Visit Two: 
Participant undertakes either a cardiopulmonary exercise test or an incremental shuttle walk 
test, whichever they do not do at Study Visit One. At the end of the test a capillary blood sample 
is taken and analysed for oxygen pressure. 
Study 
Recruitment 
Potential participant told about the present study and receives Participant Information Sheet 

 
Version 2.0 16.11.17 
 
 
SCHEDULE OF OBSERVATIONS 
Table 1: Schedule of measures:  
 Schedule of events  
Procedure 
First 
meeting 
Phone 
conversation 
Second 
meeting 
Visit one 
Visit two 
Eligibility Check 
X 
 
 
 
 
Decision to take part in study or not to take 
part in study 
 
X 
 
 
 
Informed consent 
 
 
X 
 
 
Participant questionnaire  
 
 
X 
 
 
Incremental shuttle walk test 
 
 
 
XA 
XB 
Cardiopulmonary exercise test 
 
 
 
XB 
XA 
Capillary blood gas 
 
 
 
X 
X 
 
 
X – applies to all patients, whether in group A or group B. 
XA – patient randomly assigned to group A. These patients complete the ISWT at visit one and CPET at 
visit two. 
XB – patient randomly assigned to group B. These patients undertake CPET at visit one and ISWT at visit 
two.  
 
 
 
 
 
 
 
 
 

 
Version 2.0 16.11.17 
 
 
LIST of CONTENTS 
GENERAL INFORMATION 
Page No. 
TITLE PAGE  
1 
RESEARCH REFERENCE NUMBERS 
 
1 
SIGNATURE PAGE 
2 
KEY TRIAL CONTACTS 
 
3 
TRIAL SUMMARY 
 
4 
TRIAL FLOW CHART 
5 
SCHEDULE OF OBSERVATIONS 
6 
LIST OF CONTENTS  
7 
LIST OF ABBREVIATIONS 
8 
 
 
SECTION 
1. INTRODUCTION  
9 
2. TRIAL DESIGN 
13 
3. STUDY SETTING 
13 
4. ELIGIBILITY CRITERIA 
14 
5. TRIAL PROCEDURES 
15 
6. STATISTICS AND DATA ANALYSIS 
16 
7. DATA HANDLING 
17 
8. TRIAL OVERSIGHT 
18 
9. MONITORING, AUDIT & INSPECTION 
18 
10. ETHICAL AND REGULATORY CONSIDERATIONS 
18 
11. DISSEMINATION POLICY 
19 
12. REFERENCES 
19 
 

 
 
 
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LIST OF ABBREVIATIONS  
 
 
 
 
 
 
 
 
 
 
 
LIST OF ABBREVIATIONS 
CI 
Chief Investigator 
GCP 
Good Clinical Practice 
HRA 
Health Research Authority 
ICH 
International Conference on Harmonisation 
of technical requirements for registration of 
pharmaceuticals for human use. 
NICE 
National Institute for Health and Care 
Excellence 
SOP 
Standard Operating Procedure  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
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STUDY PROTOCOL 
A comparative assessment of the relationship between the measurements made in an incremental 
shuttle walk test and an incremental cycle ergometry test in patients with idiopathic pulmonary fibrosis 
 
 
 
 
1. 
INTRODUCTION 
Idiopathic pulmonary fibrosis (IPF) is a chronic and fatal lung disease. As IPF progresses, patients 
become increasingly breathless with reduced exercise capacity and quality of life. Average life 
expectancy is three years from diagnosis but IPF progresses at different rates in different people. In 2012 
the British Lung Foundation estimated that 32,500 in the UK had IPF. 
 
An accurate prognosis can help determine the most appropriate treatment option and allow patients and 
their families to make suitable plans. Currently, measurements made during resting lung function tests 
are used to predict prognosis. However, evidence suggests that measurements made during a 
cardiopulmonary exercise test (CPET), particularly peak oxygen consumption (VO2 peak) are more 
sensitive predictors of survival. CPET is the gold standard for assessing IPF but has not been adopted in 
clinical practice. 
 
The incremental shuttle walk test (ISWT) is quicker, cheaper and more widely available than CPET. This 
study builds on previous research from our department which showed a relationship between the 
distance walked in an ISWT and VO2 peak during a CPET. We will identify any relationship between 
ISWT distance and VO2 peak in a new cohort of patients and compare this with the relationship of the 
previous study. Patients will undertake both ISWT and CPET and the results will be compared. This 
study paves the way for a simple, standardised test to more accurately predict prognosis in IPF. 
 
1.1 Background 
IPF is a chronic, progressive lung disease of unknown cause characterised by uncontrolled fibrosis of the 
lung interstitium. IPF causes progressive lung function decline, exercise limitation, reduced quality of life 
and ultimately death (NICE, 2013b; Miki et al., 2003). Life expectancy is approximately three to four years 
from the time of diagnosis though there is much variation between individuals (King et al., 2001; 
Navaratnam et al., 2011; Gribbin et al., 2006). Over 5000 people are diagnosed with IPF each year in the 
UK with an estimated 5% increase in incidence year-on-year since 1968 (Navaratnam et al., 2011). 
 

 
 
 
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Patients with IPF may be referred for lung transplantation. Alternatively, disease management options 
focus on slowing progression and maintaining quality of life. These include symptom relief, management 
of comorbidities, withdrawal of ineffective or harmful therapies and palliative care (NICE, 2013b). Two 
pharmacological therapies, Pirfenidone and Nintedanib, are licensed for the treatment of IPF for the 
purpose of slowing disease progression (NICE, 2013a; NICE, 2016). 
 
IPF progresses at different rates in different individuals (Travis et al., 2013). This has led to calls for a 
validated scoring system to predict a patient’s likely prognosis using clinical tests (Swigris et al., 2005; 
Ley et al., 2011). Similar scoring systems are already recommended for patients with chronic obstructive 
pulmonary disease (NICE, 2010). An accurate prognosis informs selection of the most suitable treatment 
and allows patients, their families and their care providers to make appropriate plans (Raghu et al., 2011; 
Swigris et al., 2005). Prognostic models are also useful in therapeutic trials for making baseline 
comparisons between individuals assigned to different treatment groups and including prognostic 
variables in analyses (Swigris et al., 2005).  
 
Current NICE guidelines (2013b) for IPF management recommend using resting measurements of 
spirometry and gas transfer to assess disease severity and likely prognosis. However, patients with IPF 
demonstrate significant exercise limitation due to impaired gas exchange and ventilation (Miki et al., 
2003). Measurements made during exercise have been shown to be more sensitive to the changes in 
oxygen transfer associated with IPF than those made at rest (Ley et al. 2011). CPET is recognised as a 
gold standard test for IPF assessment but has not been routinely adopted in practice (Bonini and 
Fiorenzano, 2017). 
 
A study of IPF by Kawut et al. (2005) showed that VO2 peak in a maximal CPET was inversely 
proportional to a patient’s risk of death. Similarly, Fell et al. (2009) found that a VO2 peak of < 8.3 
ml/kg/min in a CPET was associated with an increased risk of death in patients with IPF. Oxygen 
consumption during an incremental treadmill test and an ISWT increases similarly (Singh et al., 1994) 
and, because an ISWT is cheaper, quicker and easier to perform, the usefulness of measurements made 
during an ISWT should be evaluated in more detail. 
 
Moloney et al. (2003) demonstrated a significant correlation between total distance walked in a corridor 
ISWT by patients with IPF and the VO2 max measured during a shuttle walk test on a treadmill. In a 
previous study in our department the distance walked in an ISWT by patients diagnosed with IPF 

 
 
 
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correlated with the individual’s VO2 peak during an incremental cycle ergometry test (ICET) (Fielding et 
al., 2015). Linear regression was used to derive a formula which predicted VO2 peak using ISWT 
distance. The present study looks to test this formula in a new cohort of patients with IPF. 
 
Arterial oxygen pressure (PaO2) at the end of a maximal CPET has also been shown to be a significant 
predictor of survival in patients with IPF (King et al., 2001). This study also investigates the relationship 
between blood oxygen pressure (PO2) at the end of a CPET and the end of an ISWT.  
 
1.2 Proposed study 
Patients at University Hospital, Coventry and St Cross Hospital, Rugby will be invited to take part in a 
letter. Those who express an interest in taking part will be given more information about the study 
including a written document and then at least 48 hours to decide whether or not to take part in the study. 
Should they decide to take part, each participant will be asked to make two visits to University Hospital 
Respiratory Physiology and Sleep Department.  
At one visit participants will be asked to undertake an ISWT; walking 10 m between cones at an 
increasing speed dictated by a standardised audiotape. The ISWT will be performed according to the 
standardised protocol set out by Singh et al. (1992) and our department protocol. At the other visit 
participants will undertake an ICET. The ICET will be performed on a static exercise bike following the 
department protocol. The order in which these two tests are done will be randomly assigned to each 
participant. 
After both the ISWT and the ICET, an earlobe capillary blood sample will be taken by a trained member 
of staff and the sample analysed for blood oxygen pressure. Each participant will also fill in a 
questionnaire about their experience of the test. 
The relationship between ISWT distance and VO2 peak will be analysed and the oxygen pressure of 
capillary blood gas after each test will be compared. 
 
1.3 Study population 
This is a prospective study of patients with a diagnosis of IPF confirmed by a multi-disciplinary team. We 
aim to recruit a minimum of 43 patients to this study, all of whom will already be under the care of a 
Respiratory Consultant at University Hospitals Coventry and Warwickshire NHS Trust. 
  
 

 
 
 
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1 RATIONALE  
2.1 Aims and hypothesis 
 
To test the relationship between VO2 peak and the distance walked in an ISWT 
 
To test the hypothesis that PO2 is the same at the end of an ISWT and a CPET. 
 
2.2 Justification 
This project tests a formula proposed by Fielding et al. (2015) to predict VO2 peak during an ICET using 
distance walked in an ISWT. It will compare predicted VO2 peak value with the actual value in a new 
cohort of patients with IPF. In addition, this study will test the relationship between PO2 at the end of an 
ICET and at the end of an ISWT. 
NICE recognises the importance of providing patients and their families with information when IPF is 
diagnosed and as the disease progresses (NICE, 2013b). Patients can be better informed about 
expectations of future symptoms and management, their treatment options and their life expectancy if 
more accurate prognostic tests are available. 
This study paves the way for a relatively cheap and widely available incremental exercise test to be used 
to gather helpful information about a patient’s prognosis. In the future, such a test could be 
recommended for making prognostic predictions in IPF. 
 
2.3 
Assessment and management of risk 
The ISWT and CPET require physical effort and exertion. In rare cases these tests can cause myocardial 
infarction, cardiac arrhythmia, orthopaedic injury or, in exceptional circumstances, death. A specialist 
physiologist will assess each participant’s fitness to carry out these tests beforehand. If a participant 
reports any chest pain or severe discomfort then the test will be stopped. 
 
3 
OBJECTIVES AND OUTCOME MEASURES/ENDPOINTS 
3.1 Primary objective 
To assess the relationship between VO2 peak and ISWT distance and to determine how similar it is to a 
linear relationship from other data collected in a previous study with the following relationship: 
VO2 peak = 10.02 + (0.01575 x ISWT distance) 

 
 
 
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3.2 Primary endpoint/outcome 
VO2 peak 
 
 
4 
TRIAL DESIGN 
This is a basic science study involving procedures with human participants 
 
5 
STUDY SETTING 
This study will be conducted at University Hospital, Coventry. All visits will take place in the Respiratory 
Physiology and Sleep Department, located within the Outpatients area of the hospital. 
 
 
6 
ELIGIBILITY CRITERIA 
We will recruit a minimum of 43 participants to this study. In each case, the following inclusion and 
exclusion criteria will apply. 
 
6.1 
Inclusion criteria 
 
A diagnosis of IPF confirmed by a multidisciplinary team 
 
Over 16 years of age 
 
6.2 
Exclusion criteria 
 
Patients absolutely contraindicated for ISWT or ICET. Contraindications are summarised in table 
one. Where a patient has a relative contraindication, the test will be discussed with their medical 
team and a decision made as to whether or not to proceed. 
 
Inability to undertake ISWT or CPET 
 
Inability to walk without a walking aid such as a stick or frame 
 
Inability to give informed consent for testing 
 

 
 
 
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Absolute contraindications 
 
Relative contraindications 
Acute myocardial infarction (3–5 days) 
Unstable angina 
Uncontrolled arrhythmias causing 
symptoms or haemodynamic 
compromise 
Syncope 
Active endocarditis 
Acute myocarditis or pericarditis 
Symptomatic severe aortic stenosis 
Uncontrolled heart failure 
Acute pulmonary embolus or pulmonary 
infarction 
Thrombosis of lower extremities 
Suspected dissecting aneurysm 
Uncontrolled asthma 
Pulmonary oedema 
Room air SpO2 at rest ≤ 85% 
Acute respiratory failure 
Acute non-cardiopulmonary disorder that 
may affect exercise performance or be 
aggravated by exercise (i.e. infection, 
renal failure, thyrotoxicosis) 
Mental impairment leading to inability to 
cooperate 
Left main coronary stenosis or its 
equivalent 
Moderate stenotic valvular heart disease 
Severe untreated arterial hypertension at 
rest 
(200 mmHg systolic, 120 mmHg 
diastolic) 
Tachyarrhythmias or bradyarrhythmias 
High-degree atrioventricular block 
Hypertrophic cardiomyopathy 
Significant pulmonary hypertension 
Advanced or complicated pregnancy 
Electrolyte abnormalities 
Orthopaedic impairment that prevents 
walking 
 
 
 
 
7 
TRIAL PROCEDURES  
7.1 Recruitment 
 
7.1.1 Patient identification 
Patients known to have IPF and included in departmental IPF database will be sent a letter inviting them 
to take part in this research project. The letter will include a description of the study and will ask anybody 

 
 
 
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who is interested in taking part to contact Lizzie Dobson by phone, email or letter. Potential participants 
who are interested in taking part will be given information about the study including a written document 
and then at least 48 hours to decide whether or not to take part.  
 
7.1.2 
Screening 
Only patients with a confirmed diagnosis of IPF will be asked to take part in the study. All participants will 
then be asked to fill in a participant questionnaire which will ask participants if they are taking part in any 
other research trials at the moment, about any other medical conditions which could contraindicate their 
taking part and whether or not they require a walking aid. 
 
7.2 Consent  
This study will obtain consent from adult participants only. Only patients deemed fit to give informed 
consent will be included in the study. All patients will be given a verbal outline of the study, given an 
information sheet to read and time to ask any questions that they might have about the research and 
their involvement. Potential participants still interested in taking part will be given a minimum of two days 
to decide whether or not they would like to take part. After this time a member of the research team will 
call the patient. There will be time for questions to be answered. If they would like to take part then they 
will be invited into University Hospital to give their informed consent by signing the consent form. 
 
7.3 Baseline data 
Any comorbidities will be asked for on the participant information sheet. No other baseline data will be 
required before visit one. 
 
7.4 Trial assessments 
At one visit participants will be asked to undertake an ISWT; walking 10 m between cones at an 
increasing speed dictated by a standardised audiotape. The ISWT will be performed according to the 
standardised protocol set out by Singh et al. (1992) and our department protocol. At the other visit 
participants will undertake an Incremental Cycle Ergometry Test (ICET). The ICET will be performed on a 
static exercise bike following the department protocol. After each of these exercise tests a capillary blood 
sample will be taken from the participant’s earlobe by a trained member of staff following department 
protocol. The blood sample will be analysed and oxygen pressure will be recorded. Both visits will be in 
the Respiratory Physiology and Sleep Department at University Hospital, Coventry. 

 
 
 
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7.5 Statistical analysis  
The data collected in this study will be combined with data from the previous study in our department and 
distinguished by a study indicator. The similarity between the two datasets will be tested using a series of 
linear regression models. The value of PO2, measured in capillary blood, after ISWT and after CPET will 
be compared using a paired t-test. All analyses will be performed in SPSS statistical software. We do not 
anticipate missing data. Should a participant withdraw from the study then none of the identifiable data 
that they generated will be used. 
 
7.6 
End of study definition 
The end of the study will be defined when the last participant has completed the last study visit.  
 
8 
DATA HANDLING 
 
8.1 
Data collection tools and source document identification 
Identifiable information will be saved in one database for this study. Each participant will be assigned a 
research number for this study which will be linked to their personal information only in this one database. 
All other project files and data collection sheets will be anonymised; the participant will only be identified 
by their research number. 
All members of the Respiratory Physiology and Sleep team who have access to the office undertake 
annual information governance training and work within the guidelines of the Data Protection Act 1998. 
 
8.2 Data handling and record keeping 
Screening and recruitment logs of all participants approached to take part in the study and enrolled in the 
study will be kept for the study. Participants that agree to participate in the study will be assigned a 
unique identifier, which will be used to identify all documents associated with that participant for the 
duration of the study. All data generated in the study will be kept on site at UHCW.  Participant consent 
will be recorded, in triplicate, on an informed consent form and stored securely at UHCW. 
 
8.3 Access to Data 
Access to study data will be restricted to members of the study team and patient identifiable data will be 
restricted to those members of staff that require it for the performance of their role. Direct access to data 

 
 
 
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will be granted to authorised representatives of the Sponsor, host institution and the regulatory authorities 
for the purposes of trial-related monitoring, audits and inspections.  
 
8.4 Archiving 
Following the resolution of queries and confirmation of study close-out by the CI, all essential 
documentation will transferred to a third party archiving service, which provides suitable fire and water-
resistant facilities. Study files will be archived for a period of 25 years. Access to the study documentation 
will be restricted to named individuals within the study team with express permission from the CI.   
 
 
 
 
9. TRIAL OVERSIGHT 
 
9.1 Role and responsibilities of the Sponsor 
 
UHCW has agreed to act as sponsor for this trial and will undertake the responsibilities of sponsor as 
defined by the Research Governance Framework and ICH Good Clinical Practice. An authorised 
representative of the Sponsor has approved the final version of this protocol with respect to the trial 
design, conduct, data analysis and interpretation and plans for publication and dissemination of results. 
As sponsor, UHCW provides indemnity for this trial and, as such, will be responsible for claims for any 
non-negligent harm suffered by anyone as a result of participating in this trial. The indemnity is renewed 
on an annual basis and will continue for the duration of this trial. 
 
10. MONITORING, AUDIT & INSPECTION 
 
The study may be monitored by the Research & Development Department at UHCW as representatives 
of the Sponsor, to ensure that the study is being conducted as per protocol, adhering to Research 
Governance and GCP. The approach to, and extent of, monitoring will be specified in a trial monitoring 
plan determined by the risk assessment undertaken prior to the start of the study. 
 
11. 
ETHICAL AND REGULATORY CONSIDERATIONS 
 

 
 
 
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11.1   Ethical approval and research governance 
The study will be conducted in compliance the principles of the ICH GCP guidelines and in accordance 
with all applicable regulatory guidance, including, but not limited to, the Research Governance 
Framework. Ethical approval for this study will be sought from the Research Ethics Committee combined 
with HRA approval. No study activities will commence until favourable ethical opinion and HRA approval 
has been obtained. Progress reports and a final report at the conclusion of the trial will be submitted to 
the approving REC within the timelines defined by the committee. Confirmation of capacity and capability 
will be obtained from the R&D department prior to commencement of the study at all participating sites.  
 
11.2  Data protection and patient confidentiality 
 
The study will comply with the Data Protection Act 1998 and regular checks and monitoring will be 
undertaken by the Trial Manger to ensure compliance. Participants will be assigned a unique identifier 
upon enrolment in to the study to allow link-anonymisation of patient-identifiable data. Access to patient 
identifiable data will be restricted to members of the study co-ordination team who require it for the 
performance of their role.  Electronic data will be stored on password protected encrypted drives and 
hard copies of study documents will be stored in locked filing cabinets in secure entry-card protected 
sites..  
 
12  
DISSEMINATION POLICY 
The results of this study will be written up as a report. This report will be given to all Respiratory 
Consultants and patients will be able to discuss the results with their consultant. The results will also be 
written up as a research project which will be handed in as part of a Clinical Science Masters programme 
at Manchester Metropolitan University. If accepted for presentation, the results will be presented to 
members of the Association of Respiratory Physiology and Technology at their annual conference. 
 
13 
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Bonini, M. and Fiorenzano, G. (2017) 'Exertional dyspnoea in interstitial lung diseases: the clinical utility of 
cardiopulmonary exercise testing.' European Respiratory Review, 26(143) p. 160099. 
 
Fell, C. D., Liu, L. X., Motika, C., Kazerooni, E. A., Gross, B. H., Travis, W. D., Colby, T. V., Murray, S., 
Toews, G. B., Martinez, F. J. and Flaherty, K. R. (2009) 'The prognostic value of cardiopulmonary exercise 
testing in idiopathic pulmonary fibrosis.' American journal of respiratory and critical care medicine 179(5) p. 
402. 
 
Fielding, R., Shakespeare, J., Woodhead, F., Hughes, R. and Parr, D. (2015) 'The relationship between 
the incremental shuttle walk test and the incremental cycle ergometry test in interstitial pulmonary fibrosis.'  
 
Gribbin, J., Hubbard, R. B., Le Jeune, I., Smith, C. J. P., West, J. and Tata, L. J. (2006) 'Incidence and 
mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK.' Thorax, 61(11) pp. 980-985. 

 
 
 
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Holland, A. E., Spruit, M. A., Troosters, T., Puhan, M. A., Pepin, V., Saey, D., McCormack, M. C., Carlin, 
B. W., Sciurba, F. C., Pitta, F., Wanger, J., MacIntyre, N., Kaminsky, D. A., Culver, B. H., Revill, S. M., 
Hernandes, N. A., Andrianopoulos, V., Camillo, C. A., Mitchell, K. E., Lee, A. L., Hill, C. J. and Singh, S. J. 
(2014) 'An official European Respiratory Society/American Thoracic Society technical standard: field 
walking tests in chronic respiratory disease.' The European respiratory journal 44(6) p. 1428. 
 
Kawut, S. M., O’Shea, M. K., Bartels, M. N., Wilt, J. S., Sonett, J. R. and Arcasoy, S. M. (2005) 'Exercise 
testing determines survival in patients with diffuse parenchymal lung disease evaluated for lung 
transplantation.' Respiratory Medicine, 99(11) pp. 1431-1439. 
 
King, J. T. E., Tooze, J. A., Schwarz, M. I., Brown, K. R. and Cherniack, R. M. (2001) 'Predicting survival in 
idiopathic pulmonary fibrosis: scoring system and survival model.' American journal of respiratory and 
critical care medicine, 164(7) p. 1171. 
 
Ley, B., Collard, H. R. and King Jr, T. E. (2011) 'Clinical course and prediction of survival in idiopathic 
pulmonary fibrosis.' American journal of respiratory and critical care medicine, 183(4) pp. 431-440. 
 
Miki, K., Maekura, R., Hiraga, T., Okuda, Y., Okamoto, T., Hirotani, A. and Ogura, T. (2003) 'Impairments 
and prognostic factors for survival in patients with idiopathic pulmonary fibrosis.' Respiratory Medicine, 
97(5) pp. 482-490. 
 
Moloney, E. D., Clayton, N., Mukherjee, D. K., Gallagher, C. G. and Egan, J. J. (2003) 'The shuttle walk 
exercise test in idiopathic pulmonary fibrosis.' Respiratory Medicine, 97(6) pp. 682-687. 
 
Navaratnam, V., Fleming, K. M., West, J., Smith, C. J. P., Jenkins, R. G., Fogarty, A. and Hubbard, R. B. 
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ISWT vs CPET 
 
20                                         Version 2.0 16.11.17 
 
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