Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study Detecting oxygen desaturation in patients with COPD: incremental versus endurance shuttle walking. The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen Relationship between field walking tests and incremental cycle ergometry in COPD. Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease Prescription of Walking Exercise Intensity from the Incremental Shuttle Walk Test in People with Chronic Obstructive Pulmonary Disease 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 Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. Endurance shuttle walking test: responsiveness to salmeterol in COPD Pulmonary rehabilitation for chronic obstructive pulmonary disease: a pilot study evaluating a once-weekly versus twice-weekly supervised programme. Validity and reliability of the modified shuttle walk test in patients with chronic obstructive pulmonary disease. Peak exercise capacity estimated from incremental shuttle walking test in patients with COPD: a methodological study Do patients with lung cancer benefit from physical exercise? Generic, symptom based, exercise rehabilitation; integrating patients with COPD and heart failure. High intensity physical group training in water--an effective training modality for patients with COPD. 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 A comparison of twice- versus once-weekly supervision during pulmonary rehabilitation in chronic obstructive pulmonary disease. Relationship between daily physical activity and exercise capacity in patients with COPD. Comparison of the effects of neuromuscular electrical stimulation and endurance training in patients with severe chronic obstructive pulmonary disease. Effect of 12 weeks of once-daily tiotropium/olodaterol on exercise endurance during constant work-rate cycling and endurance shuttle walking in chronic obstructive pulmonary disease Randomized controlled trial of ambulatory oxygen and an ambulatory ventilator on endurance exercise in COPD. Feasibility and impact of a structured, exercise-based rehabilitation programme for intensive care survivors An evaluation of the acute impact of pursed lips breathing on walking distance in nonspontaneous pursed lips breathing chronic obstructive pulmonary disease patients
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 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 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 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 responsiveness of the endurance shuttle walk to functional changes following bronchodilation has recently been reported . The current literature suggests that the 6 min walking test ( 6MWT ) is less responsive to bronchodilation than the endurance shuttle walk . Aim : To compare bronchodilator-induced changes in exercise performance with the 6MWT and the endurance shuttle walk . Methods : In a r and omised , double-blind , placebo-controlled , crossover trial , 14 patients with chronic obstructive pulmonary disease ( forced expiratory volume in 1 s ( FEV1 ) 50 (8)% predicted ) completed two 6MWTs and two endurance shuttle walks , each preceded by nebulised placebo or 500 μg ipratropium bromide .  Cardiorespiratory parameters were monitored during each walking test with a portable telemetric gas analyser . Quadriceps twitch force was measured by magnetic stimulation of the femoral nerve before and after each walking test . Results : The 6 min walking distance did not change significantly after bronchodilation despite a significant increase in FEV1 of 0.18 ( 0.09 ) litres ( p<0.001 ) . A similar change in FEV1 ( 0.18 ( 0.12 ) litres , p<0.001 ) was associated with a significant improvement in the distance walked on the endurance shuttle walk ( Δdistance ipratropium bromide – placebo = 144 ( 219 ) m , p = 0.03 ) . Quadriceps muscle fatigue was infrequent ( < 15 % of patients ) after both walking tests . Conclusion : The endurance shuttle walk is more responsive than the 6MWT for detecting changes in exercise performance following bronchodilation Objective This study determined the intensity of walking exercise prescribed from 70 % of peak speed achieved during the incremental shuttle walk test ( ISWT ) in people with chronic obstructive pulmonary disease and whether a steady-state response was achieved when exercising at this intensity . Design Each participant performed lung function tests , an incremental cycle test , two ISWTs , and a 10-min continuous walking exercise at 70 % peak ISWT speed . Oxygen consumption ( V˙O2 ) was collected using a portable system ( Cosmed K4b2 , Rome , Italy ) . The V˙O2 from the 10-min walking exercise was compared with V˙O2peak from the better ISWT as a measure of walking exercise intensity . Results Thirty-four participants completed the study .  The mean intensity achieved during the 10-min walking exercise was 76 % ( 11 % ) V˙O2peak . Steady-state V˙O2 was achieved by minute 5 in the 10-min walking exercise . Conclusions Prescription of walking exercise at 70 % of the peak ISWT speed provided an intensity appropriate for achieving physiologic training responses 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 OBJECTIVES To investigate cardiorespiratory and dyspnea responses to incremental and self-paced exercise tests in patients with COPD . DESIGN A prospect i ve within-subject design was used . PATIENTS Twenty stable subjects ( 15 men ) , with a mean ( + /- SD ) age of 64.0 + /- 7.5 years and moderate-to-severe COPD ( ie , mean FEV(1 ) , 0.8 + /- 0.3 L and 28.9 + /- 7.9 % predicted ) were studied . METHODS Each subject completed a 6-min walk test ( 6MWT ) , an incremental shuttle walking test ( ISWT ) , and a cycle ergometer test ( CET ) , within a 2-week period . The tests were performed at least 24 h apart . St and ardized encouragement was utilized in each test with the aim of maximizing performance . Heart rate ( HR ) and dyspnea were measured each minute throughout the tests , and pulse oximetric saturation ( Spo(2 ) ) was measured before and immediately after each test . The distances walked in the 6MWT and ISWT were compared to peak oxygen uptake ( Vo(2 ) ) values from the CET . RESULTS HR increased linearly with increasing workload during the CET and ISWT , but increased alinearly with a disproportionate increase early in the 6MWT . In contrast , dyspnea scores increased linearly during the 6MWT , but increased alinearly with a disproportionate increase late during the CET and ISWT . Peak HR and dyspnea were not significantly different between tests . Spo(2 ) was significantly lower at the end of both walking tests compared to that at the end of the CET ( p < 0.001 ) . The distance walked in both the ISWT and 6MWT were related to peak Vo(2 ) values on the CET ( for both tests , r = 0.73 ; p < 0.001 ) . CONCLUSIONS The patterns of response in HR and dyspnea seen during the 6MWT suggest that patients with COPD titrate exertion against dyspnea to achieve a peak tolerable intensity . This strategy is not possible in an externally paced ISWT or CET . However , it is a limited strategy , with performance converging at higher workloads . Similar peak exercise responses were achieved in the 6MWT , ISWT , and CET . Greater oxygen desaturation was observed during the field walking tests , suggesting that both the ISWT and 6MWT are more sensitive than the CET in detecting exercise-induced hypoxemia and in assessing ambulatory oxygen therapy needs 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 OBJECTIVES To compare the effectiveness of a once-weekly supervised pulmonary rehabilitation programme with a st and ard twice-weekly format . DESIGN R and omised trial of equivalency . SETTING Pulmonary rehabilitation service of a primary care trust delivered at two physiotherapy outpatient departments . PARTICIPANTS Thirty patients with chronic obstructive pulmonary disease . OUTCOME MEASURES Primary outcomes were the Incremental Shuttle Walking Test ( ISWT ) , Endurance Shuttle Walking Test ( ESWT ) and St George 's Respiratory Question naire ( SGRQ ) , assessed at baseline and at completion of the supervised programme . Secondary outcomes were home-exercise activity , attendance levels and patient satisfaction with the programme . INTERVENTIONS The once-weekly group ( n=15 ) received one supervised rehabilitation session per week , and the twice-weekly group ( n=15 ) received two sessions per week , both for 8 weeks , together with a home-exercise plan . RESULTS After pulmonary rehabilitation , the groups showed similar improvements in exercise tolerance ( median values : ISWT once-weekly 60metres , twice-weekly 50metres ; ESWT once-weekly 226seconds , twice-weekly 109seconds ) . However , for health-related quality -of-life , the once-weekly group 's score did not change ( SGRQ 0 ) , whereas an improvement was seen for the twice-weekly group ( SGRQ 3.7 ) . The number of home-exercise sessions and attendance levels were similar between the groups . Patient satisfaction with both formats was high and almost identical between the groups . CONCLUSIONS This pilot provides data to inform a larger study and shows that the methodology is feasible . The findings suggest that once-weekly supervision may be capable of producing equivalent improvements in exercise tolerance as a twice-weekly programme , but the health-related quality -of-life outcome appeared to be poorer for once-weekly supervision 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 In patients with COPD , both laboratory exercise tests and field walking tests are used to assess physical performance . In laboratory tests , peak exercise capacity in watts ( W peak ) and /or peak oxygen uptake ( VO2 peak ) are assessed , whereas the performance on walking tests usually is expressed as distance walked . The aim of the study was to investigate the relationship between an incremental shuttle walking test ( ISWT ) and two laboratory cycle tests in order to assess whether W peak could be estimated from an ISWT . Methods Ninety-three patients with moderate or severe COPD performed an ISWT , an incremental cycle test ( ICT ) to measure W peak and a semi-steady-state cycle test with breath-by-breath gas exchange analysis ( CPET ) to measure VO2 peak . Routine equations for conversion between cycle tests were used to estimate W peak from measured VO2 peak ( CPET ) . Conversion equation for estimation of W peak from ISWT was found by univariate regression . Results There was a significant correlation between W peak and distance walked on ISWT × body weight ( r = 0.88 , p < 0.0001 ) . The agreement between W peak measured by ICT and estimated from ISWT was similar to the agreement between measured W peak ( ICT ) and W peak estimated from measured VO2 peak by CPET . Conclusion Peak exercise capacity measured by an incremental cycle test could be estimated from an ISWT with similar accuracy as when estimated from peak oxygen uptake in patients with COPD Abstract Background . Patients with lung cancer are often burdened by dyspnoea , fatigue , decreased physical ability and loss of weight . Earlier studies of physical exercise of patients with COPD have shown promising results . The aim of this study was to investigate , if a well-documented COPD rehabilitation protocol can improve physical fitness and quality of life ( QoL ) in patients with lung cancer . Material and methods . Forty-five patients , with a minimum walking distance of 50 meters , absence of cognitive deficits or severe heart disease and motivated for physical training were invited to an exercise intervention .  The intervention consisted of seven weeks of twice weekly training , focusing on walking training , circuit training , h and ling of dyspnoea and instructions in daily diary-based training at home . Prior to , and after the intervention , Incremental- and Endurance Shuttle Walk Test ( ISWT and ESWT ) were performed , and pulmonary function as well as self-reported QoL ( EORTC-QLQ-C30 and LC13 ) were measured . Results . Fourteen subjects dropped out before commencement of the intervention . Seven were excluded after physiotherapeutic evaluation . Of the remaining 24 , three were excluded because of insufficient attendance ( < 65 % of scheduled exercise sessions ) thus 21 patients completed the intervention . For 17 patients with complete pre- and post intervention data , ISWT increased 9 % ( −77 to 39 % ) ( median and range ) ( p = 0.021 ) , while ESWT increased 109 % ( −70 to 432 % ) ( p = 0.002 ) . Twelve of 17 improved in ISWT , while 15 improved in ESWT . No changes in pulmonary function and improvements in QoL were observed . Conclusion . Patients with pulmonary cancer can achieve significant improvements in physical fitness measured with ISWT and ESWT after completion of the intervention program . No changes in pulmonary function and QoL were observed . In addition , we found that a large number of patients dropped out before intervention and that the patients , who succeeded , often discontinued training at home BACKGROUND Patients with Chronic Heart Failure ( CHF ) develop similar symptoms of exertional breathlessness and fatigue as patients with COPD . Although pulmonary ( exercise based ) rehabilitation ( PR ) is an integral part of the management of COPD , the potential for exercise rehabilitation ( ER ) to assist patients with CHF may not be as readily appreciated . We investigated whether combined ER for patients with CHF and COPD was feasible and effective using the model of PR . METHODS 57 patients with CHF were r and omized 2:1 to 7 weeks ER ( CHF-ER ) or 7 weeks of usual care ( CHF-UC )  . As a comparator 55 patients with COPD were simultaneously recruited to the same ER program ( COPD -ER ) . The primary outcome measure was the Incremental Shuttle Walk Test ( ISWT ) and the secondary outcome measures were the Endurance Shuttle Walk Test ( ESWT ) , isometric quadriceps strength and health status . RESULTS 27 CHF and 44 COPD patients completed ER and 17 patients with CHF completed UC . The CHF-ER group made significant improvements , compared to CHF-UC , in the mean ( 95%CI ) ISWT distance ; 62(35 - 89)m vs -6(-11 to 33)m p < 0.001 . The CHF-ER group also made statistically significant improvements in health status . The improvements in exercise performance and health status were similar between patients with CHF and COPD , treated with ER . CONCLUSION Patients with CHF who undergo ER improve similarly in their exercise performance and health status to COPD . Combined training programs for COPD and CHF are effective and feasible , such that service provision could be targeted around common disability rather than the primary organ disease The aim of this study was to examine the effect of high intensity physical group training in water and on l and for patients with COPD with regard to physical capacity and health related quality of life ( HRQoL ) . A controlled , semi-r and omised study was conducted where 30 patients were r and omised to training either in water or on l and . Thirteen patients constituted a control group . Forty-three out patients , with moderate to severe COPD ( 27w/16 m ) , from two local hospitals in northern Sweden , were included in the study . High intensity physical group training in water ( water group ) or on l and ( l and group ) was performed for 12weeks , three times per week , 45min per session . The control group received no intervention . Pre- and post-intervention , all patients performed incremental and endurance shuttle walking tests ( ISWT and ESWT ) ,  cycle ergometer tests  and  responded question naires about HRQoL ( St. Georges Respiratory Question naire -- SGRQ and SF-36 ) . The patients trained with a mean heart rate of 80 - 90 % of peak heart rate . Both training groups increased the distance walked , i.e. l and group in ISWT ( 25 m ) and water group in ESWT ( 179 m ) . The water group increased the distance in ESWT significantly more that both the l and and the control groups . Both training groups increased the time cycled ( 40 - 85s ) and work load ( 10 - 20W ) in the cycle ergometer test . The control group deteriorated in HRQoL according to total score in SGRQ while the training groups remained constant . The water group improved their activity score in SGRQ and their physical health score in SF-36 and those improvements were significant as compared to the l and and the control groups . In conclusion , high intensity physical group training in water is of benefit for patients with COPD . It was in some areas found to be even more effective regarding improvements in physical capacity and experienced physical health compared to the same kind of training on l and 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 ) OBJECTIVE To compare the effects of twice- versus once-weekly supervised pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Prospect i ve , r and omized , parallel-group study . SETTING Hospital outpatient physiotherapy department . PARTICIPANTS Patients with COPD . INTERVENTION Group 1 ( n=46 ) received 1 supervised exercise session a week and 2 unsupervised sessions ; group 2 ( n= 45 ) received 2 supervised exercise sessions a week and 1 unsupervised session for 6 weeks . Patients were assessed at baseline and at 6 weeks , 2 months , and 6 months . MAIN OUTCOME MEASURES Incremental ( ISWT ) and endurance ( ESWT ) shuttle walk tests and Chronic Respiratory Disease Question naire ( CRDQ ) . RESULTS Sixty-six of 91 patients ( group 1 , n=34 ; group 2 , n=32 ) completed the 6-week program . There was no significant difference in key outcome measures between the 2 groups ( ISWT , 13.50 m ; 95 % confidence interval [ CI ] , -10.06 to 37.15 m ; ESWT , 72.64s ; 95 % CI , -96.01 to 241.29s ; CRDQ total score , 2.54 ; 95 % CI , -3.16 to 8.24 ) . The results of the ESWTs suggest there may be an interaction between baseline exercise capacity and benefit of pulmonary rehabilitation , with more disabled patients achieving greater benefit if they are supervised twice weekly . Irrespective of group , allocation benefits after pulmonary rehabilitation had almost dissipated by 6 months . CONCLUSIONS There was no difference in the effectiveness of twice- versus once-weekly supervised pulmonary rehabilitation . This study highlights the need for development of strategies that will maintain the improvement achieved by the initial pulmonary rehabilitation program BACKGROUND Exercise training programmes for patients with COPD are effective in improving exercise capacity . The few trials that have investigated the effects of exercise programmes on daily physical activity show contradictory results . AIM To investigate the relation between daily physical activity level and exercise capacity in patients with COPD using data of a r and omised controlled trial in which the exercise intervention was aim ed at improvement of both physical activity and exercise capacity ( the COPE-II study ) . METHODS These are secondary analyses of the COPE-II study , a r and omised controlled trial in which a community-based physiotherapeutic exercise programme was evaluated .  Daily physical activity  was measured with a pedometer ( steps/day ) . Exercise capacity  was measured with an incremental maximal cycle ergometer test , the incremental ( ISWT ) and endurance shuttle walk test ( ESWT ) . Pearson correlation coefficients were calculated . RESULTS At baseline , correlations between steps/day and VO(2peak ) , ISWT ( m ) , ESWT ( m ) and ESWT ( s ) were 0.54 , 0.59 , 0.44 , and 0.34 , respectively ( all p < 0.01 ) . In the  intervention group , correlations between change in steps/day over 7 months and change in ISWT ( m ) , ESWT ( m ) and ESWT ( s ) were 0.47 , 0.41 , and 0.38 , respectively ( all p < 0.01 ) . In the  control group , these same correlations were weak to non-existent . CONCLUSIONS A moderate to weak relationship was found between daily physical activity and exercise capacity . These results strengthen our beliefs that exercise interventions need to target not only exercise capacity but also behaviour change with regard to daily physical activity to achieve improvements in both parameters INTRODUCTION In severely disabled patients who are not capable of following formal pulmonary rehabilitation ( PR ) and /or tolerating higher training intensities , neuromuscular electrical stimulation ( NMES ) has been successfully utilized as a localized training method . MATERIAL S AND METHODS In this non-r and omized controlled observational study 50 patients with severe chronic obstructive pulmonary disease ( COPD ) , who were allocated into two groups . Endurance training group ( ET ) ( n= 27 ) and NMES group ( n= 23 ) . To compare the effects of NMES and ET on health-related quality of life ( HRQOL ) , exercise capacity , muscle strength , dyspnea , psychological status , and body composition in patients with severe COPD . Before and after PR program , the study parameters were assessed using the Medical Research Council ( MRC ) scale , incremental and endurance shuttle walking tests ( ISWT , ESWT ) , manual muscle testing ( MMT ) , the St. George 's Respiratory Question naire ( SGRQ ) , bioelectrical impedance analysis , and the Hospital Anxiety and Depression Scale ( HADS ) . RESULTS After the PR program , walking distance and endurance time significantly increased in both groups ( p < 0.001 for each ) , whereas the MRC scores of both groups significantly decreased ( p < 0.001 for each ) . In the ET group , significant decreases were noted in all domains of SGRQ and HADS . In the NMES group , significant improvements were observed in the HADS scores and in all SGRQ domain except symptom domain . No significant differences were observed between the NMES and ET groups regarding the changes from baseline to after PR program in walking distance ( p= 0.140 ) , endurance time ( p= 0.376 ) , the MRC ( p= 0.540 ) , HRQOL ( p > 0.05 ) and HADS ( p > 0.05 ) scores , body-mass index ( BMI ) ( p= 0.49 ) , fat-free mass ( FFM ) ( p= 0.50 ) and fat-free mass index ( FFMI ) ( p= 0.94 ) . CONCLUSION NMES can be used as an effective treatment strategy in PR programs for peripheral muscle training in patients with severe COPD Background : The TORRACTO ® study evaluated the effects of tiotropium/olo date rol versus placebo on endurance time during constant work-rate cycling and constant speed shuttle walking in patients with chronic obstructive pulmonary disease ( COPD ) after 12 weeks of treatment . Methods : The effects of once-daily tiotropium/olo date rol ( 2.5/5 and 5/5 μg ) on endurance time during constant work-rate cycle ergometry ( CWRCE ) after 6 and 12 weeks of treatment were compared with placebo in patients with COPD in a r and omized , double-blind , placebo-controlled , parallel-group clinical trial . Endurance time during the endurance shuttle walk test ( ESWT ) after 6 and 12 weeks of treatment was also evaluated in a subset of patients . Results : A total of 404 patients received treatment , with 165 participating in the ESWT sub study . A statistically significant improvement in endurance time during CWRCE was observed after 12 weeks ( primary endpoint ) with tiotropium/olo date rol 5/5 µg [ 14 % ( p = 0.02 ) ] but not with tiotropium/olo date rol 2.5/5 µg [ 9 % ( p = 0.14 ) ] versus placebo . In the ESWT sub study , a trend to improvement in endurance time during ESWT after 12 weeks ( key secondary endpoint ) was observed with tiotropium/olo date rol 5/5 µg [ 21 % ( p = 0.055 ) ] and tiotropium/olo date rol 2.5/5 µg [ 21 % ( p = 0.056 ) ] versus placebo . Conclusion : Tiotropium/olo date rol 5/5 µg improved endurance time during cycle ergometry versus placebo , with a strong tendency to also improve walking endurance time . [ Clinical Trials.gov identifier : NCT01525615 . In a prospect i ve , r and omized study we examined the effect of ( i ) ambulatory oxygen and ( ii ) a portable , inspiratory pressure support ( IPS ) device on the endurance shuttle walk test ( ESWT ) in patients with severe chronic obstructive pulmonary disease ( COPD ) . Ten out patients [ median ( range ) FEV1 0.60 l(0.35 , 1.45 ) ] performed the ESWT under five test conditions : baseline walk ( no assistance ) , IPS at 14 cmH2O from a portable ventilator ( the HIPPY , Friday Medical , U.K. ) , sham IPS ( < 8 cmH2O ) , ambulatory oxygen at 2 l min(-1 ) , and sham oxygen ( carrying the portable oxygen cylinder and breathing air ) . There were significant improvements in the ESWT with  ambulatory oxygen  , but a negative effect with the HIPPY device [ mean ( SD ) time : baseline 172 ( 48 ) sec ; oxygen 242 ( 62 ) sec ; HIPPY 84 ( 35 ) sec ] . The ESWT appeared sensitive to the effect of cylinder weight although differences in endurance capacity were not significant [ sham oxygen 151 ( 45 ) sec ] . The ESWT was sensitive to the acute application of oxygen , demonstrating a beneficial effect on endurance performance in patients with severe COPD . The ESWT could form the basis of a st and ardized assessment for ambulatory oxygen Our objective was to assess the impact of an outpatient physiotherapy-led rehabilitation programme on exercise capacity and anxiety and depression scores in a cohort of adult intensive care survivors . In a prospect i ve study in a teaching hospital , 38 general intensive care survivors following hospital discharge underwent an established physiotherapy-led outpatient rehabilitation programme . The programme involved 2 hours of supervised exercise and education sessions each week and two unsupervised exercise sessions each week for 6 weeks . Assessment s took place 1 week before and 1 week after completing the programme . Primary outcome measures were changes in exercise capacity measured using the 6-minute walk test ( 6MWT ) and incremental shuttle walk test ( ISWT ) . Secondary outcome measures were changes in anxiety and depression scores using the Hospital Anxiety and Depression Scale ( HADS ) . Median distance covered in the 6MWT improved by 160 metres ( p<0.001 ) , and median distance covered in the ISWT also improved by 160 metres ( p < 0.001 ) . Significant improvement in anxiety ( p = 0.001 ) and depression ( p = 0.001 ) scores were also seen . Outpatient , physiotherapy-lead rehabilitation appears to improve both exercise capacity and anxiety and depression scores in a cohort of intensive care survivors . A similar programme should be tested in a r and omised controlled trial This study was design ed to test the effects of pursed lips breathing ( PLB ) during exercise in patients with chronic obstructive pulmonary disease ( COPD ) who did not spontaneously perform PLB . Sixtynine COPD patients , mean FEV , ( SD ) 1.09 ( 0.5 ) , age 68 ( 51 - 83 ) were recruited to the study . They performed three incremental shuttle walk tests ( ISWT ) . The first walk was design ed to identify natural PLBs and the next two walks were performed in a r and om order ; ISWT + PLB or ISWT whilst breathing normally . Measures of respiratory rate ( RR ) , breathlessness and oxygen saturation were taken before and after walks . Data was analysed using the t-test . Fifteen patients demonstrated PLB on baseline ISWT and were therefore excluded from further walking tests although baseline data was included in the analysis . There was no significant difference between walks , mean ( SD ) , 298.5 (173.7)PLB and non-PLB ; 292.5 ( 161.9 ) nor any difference in dyspnoea . There was a significant reduction in end exercise RR and recovery time with PLB , mean difference ( 95 % CI ) ; 6.2 ( 4.5 - 7.9 ) and 24.9 ( 2.8 - 47.0 ) seconds , respectively . Patients who showed a good response with the PLB walk ( 41 % ) had significantly higher baseline breathlessness , Borg score , mean ( SD ) , 1.5 ( 1.0 ) versus 0.74 (0.96)(P = 0.02 ) . Natural PLB patients demonstrated lower exercise tolerance on the baseline walk(P = 0.01 ) and a trend towards greater resting breathlessness than those who did not . This study shows PLB during exercise and recovery results in lower post exercise RR and speeds return to pre exercise breathlessness , compared with exercise and non-PLB . Reductions in RR appear to be greatest in those patients with resting breathlessness
Method ological factors affecting 6MWD include track length , encouragement , supplemental oxygen and walking aids .
Supplemental oxygen also affects ISWT and ESWT performance .
Responsiveness was moderate to high for all tests , with greater responsiveness to interventions that included exercise training .
The findings of this review demonstrate that the 6MWT , ISWT and ESWT are robust tests of functional exercise capacity in adults with chronic respiratory disease
This systematic review examined the measurement properties of the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and endurance shuttle walk test ( ESWT ) in adults with chronic respiratory disease .