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Original Research: Pulmonary Physiology |

Measurement Properties of the Incremental Shuttle Walk TestProperties of the Incremental Shuttle Walk Test: A Systematic Review FREE TO VIEW

Verônica F. Parreira, PhD; Tania Janaudis-Ferreira, PhD; Rachel A. Evans, PhD; Sunita Mathur, PhD; Roger S. Goldstein, PhD, FCCP; Dina Brooks, PhD
Author and Funding Information

From the Department of Physical Therapy (Dr Parreira), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; CAPES Brazil (Dr Parreira), West Park Healthcare Centre (Respiratory Medicine), and Department of Physical Therapy (Dr Parreira), University of Toronto, Toronto, ON, Canada; Department of Respiratory Medicine (Drs Parreira, Janaudis-Ferreira, Mathur, Goldstein, and Brooks), West Park Healthcare Centre, Toronto, ON, Canada; Sunnybrook Health Sciences Centre (Dr Janaudis-Ferreira), St. John’s Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Physical Therapy (Drs Janaudis-Ferreira, Mathur, Goldstein, and Brooks), University of Toronto, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation (Dr Evans), School of Medicine, University of Leicester, Leicester, England; and Department of Medicine (Dr Goldstein), University of Toronto, Toronto, ON, Canada.

Correspondence to: Dina Brooks, PhD, Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada; e-mail: dina.brooks@utoronto.ca


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(6):1357-1369. doi:10.1378/chest.13-2071
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Background:  The incremental shuttle walk test (ISWT) was developed > 20 years ago and has been used to assess peak exercise capacity in a variety of chronic diseases. The aim of this systematic review is to describe the measurement properties of the ISWT in a clinical population.

Methods:  Of 800 articles identified by electronic and hand searches, 35 were included. Twenty-one articles included data on the validity of the ISWT, 18 on the reliability, four on the responsiveness, and four on the interpretability.

Results:  Most of the studies were conducted in patients with COPD (n = 13) or cardiac disease (n = 8). For criterion validity, comparisons between distance covered during the ISWT and peak oxygen consumption reported correlations ranging from 0.67 to 0.95 (P < .01). Intraclass correlation coefficients for test-retest reliability ranged from 0.76 to 0.99. The ISWT was shown to be responsive to pulmonary rehabilitation and bronchodilator administration. The minimal clinically important difference (MCID) in patients with COPD was 48 m. Predictive equations for the distance in the ISWT are available for healthy individuals.

Conclusions:  The ISWT can be considered a valid and reliable test to assess maximal exercise capacity in individuals with chronic respiratory diseases. The ISWT has been shown to be responsive to pulmonary rehabilitation and bronchodilator use in individuals with COPD, cystic fibrosis, and asthma. Further studies examining responsiveness and the MCID of the ISWT in patients with conditions other than lung diseases are required for the interpretation of interventions in other populations.

Figures in this Article

The incremental shuttle walk test (ISWT) was developed by Singh and colleagues1 (based on a shuttle run test of 20 m originally described by Léger and Lambert2) to measure disability in patients with COPD. It is an inexpensive tool and has been used to assess exercise capacity in the pulmonary rehabilitation (PR) setting for patients with COPD38 as well as for patients with other conditions, such as cardiac disease,9,10 obesity,11 cancer,12 peripheral arterial disease,13 intermittent claudication,14 bronchiectasis,15 pulmonary hypertension,16 and critical illness.17 The ISWT was developed using an incremental format as a possible surrogate for laboratory-based symptom-limited maximal exercise tests.1,18

The ISWT is a 12-level test (1 min in each level) imposing an incremental acceleration as the subject walks up and down a 10-m course. In brief, two cones are set apart to provide a between-cone distance of 9 m.1 The walking speed is dictated by an audio signal. The speed starts at 0.50 m/s and is increased each minute by 0.17 m/s until a final speed (level 12) of 2.37 m/s. The test is finished when the subject is limited by dyspnea or a heart rate (HR) > 85% predicted maximum1 or when the subject is unable to maintain the required speed and fails to complete a shuttle for a second consecutive time.19 The primary outcome is the distance covered calculated from the completed number of shuttles.

Understanding the measurement properties of an instrument helps with the selection of a specific instrument and facilitates the interpretation of the results in the clinical or research setting. Thus, the aim of this systematic review is to describe the measurement properties of the ISWT in a clinical population.

Literature Search

The literature search was performed through the following electronic databases: PubMed, MEDLINE, EMBASE, LILACS, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence-Based Database), and Cochrane Library. The dates were January 1992 to April 2012, and key terms used were “incremental shuttle walk test,” “incremental shuttle walking test,” and “ISWT.” Hand searches of the references of all identified studies were also performed.

Selection of Articles

The title and abstract of all articles were reviewed. Articles were considered relevant if reliability, validity, responsiveness, or interpretability of ISWT in any population was assessed. Articles not written in English, French, or Portuguese were excluded. One reviewer (V. F. P.) reviewed all the titles and abstracts to identify the relevant studies for which the full manuscripts were retrieved. In case of doubt, a second reviewer (T. J.-F.) was consulted.

Measurement Properties

Validity was defined as the extent to which an instrument measures what it is to intended to measure.20 In this systematic review, criterion validity (when one test is compared with a gold standard) and construct validity (when two measures reflect the same phenomenon) were considered. Reliability was defined as the degree to which the measure is consistent and free of random error.20 Studies of test-retest reliability or of measurement error were considered. Responsiveness is defined as the ability of an instrument to detect minimal change over time20; thus, in this review, changes in the incremental shuttle walk distance (ISWD) are compared with changes in other outcomes. Interpretability was also considered and defined as the degree of change (ie, minimal important change, norm scores, floor-ceiling effects).21

Quality Assessment

Studies describing the measurement properties of the ISWT were assessed for study quality using the Consensus-Based Standards for the Selection of Health Status Measurements Instruments (COSMIN).21 Each article was reviewed and assessed by two independent investigators (V. F. P. and T. J.-F. or V. F. P. and S. M.). Discordances in scoring between the two reviewers were resolved by consensus. The assessment was based on a rating score system of four points,22 classifying the quality of the study as excellent, good, fair, or poor.21 Some studies analyzed more than one measurement property; in these cases, quality assessment and data extraction were performed separately for each property.

COSMIN provides a set of items for analysis of each measurement property (criterion validity, seven items; construct validity [hypotheses testing], 10 items; reliability, 14 items; responsiveness, seven items). On the basis of the COSMIN recommendations, the total score for the methodologic quality of each study was obtained from the worst score counts of each set of items. In accordance with recommendations by Terwee et al,21 we established two scoring definitions. Sample size (item 3 of each property), the first criterion, was considered poor for n < 10, fair for n = 10 to 19, good for n = 20 to 29, and excellent for n > 30. The second criterion was established for appropriate time interval for reliability studies. The time interval was considered not appropriate if the ISWTs were conducted on the same day.

In COSMIN, a no scoring system is available for interpretability or generalizability. Therefore, we extracted information on norm scores and minimal important change (interpretability) or data on the characteristics of the sample (generalizability).

Data Extraction and Synthesis

Data extraction was performed and verified by two reviewers (V. F. P. and R. A. E.). Data regarding source, sample size, measurement property, and main observed findings were retrieved. The PRISMA (Parameters of the Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement was applied.23 We did not perform a meta-analysis because this was beyond the scope of this review. To obtain additional data, corresponding authors of two articles were contacted and responded. Ethics approval was not necessary because this is a systematic review.

Literature Search

Figure 1 shows the flowchart of studies included in this systematic review. Of 800 articles identified by electronic and hand searches, 35 met the inclusion criteria (all of them were written in English), with some reporting on more than one property. Twenty-one articles included data on the validity of the ISWT, 18 on reliability, four on responsiveness, and four on interpretability.

Figure Jump LinkFigure 1. Flowchart of the study. ISWT = incremental shuttle walk test.Grahic Jump Location
Validity

Table 1 shows the details of the 21 studies that assessed validity of the ISWT in patients with COPD (n = 10); cardiac disease, including coronary artery bypass graft, chronic heart failure, and cardiac transplantation (n = 6); idiopathic pulmonary fibrosis (n = 1); operable lung cancer (n = 1); cystic fibrosis (n = 1); thermal injury (n = 1); and general surgery (n = 1). Seventeen studies evaluated criterion validity; of those, six also evaluated construct validity, and four exclusively evaluated construct validity.

Table Graphic Jump Location
Table 1 —Studies That Assessed Validity of the ISWT

6MWT = 6-min walk test; AUC = area under the curve; DEE = daily energy expenditure; Dlco = diffusing capacity of the lung for carbon monoxide; GOLD = Global Initiative for Chronic Obstructive Lung Disease; HR = heart rate; ISWT = incremental shuttle walk test; ROC = receiver operating characteristic; RPE = rating of perceived exertion; V˙ co2 = CO2 output; V˙ co2peak = peak CO2 output; V˙ o2 = oxygen consumption; V˙ o2max = maximum oxygen consumption; V˙ o2peak = peak oxygen consumption.

For criterion validity, most studies performed comparisons between ISWD and peak oxygen consumption (V˙ o2peak) during a treadmill or cycle ergometer test. Correlations ranged from 0.67 (P < .001)38 to 0.95 (P < .01).26 Regression equations for V˙ o2peak were reported for patients with various diseases, including cardiac disease,27,29,36 COPD,24,33,35 and cystic fibrosis,26 and for individuals who underwent vascular or abdominal surgery39 (Table 1).

Most of the studies that examined construct validity of the ISWT compared the ISWT with the 6-min walk test (6MWT) (n = 8). Correlations of the distance in the ISWT compared with the 6MWT ranged from 0.68 to 0.91.1,3235,37V˙ o2peak28,32,33,41 and HR1,27,33,41 were higher or similar during the ISWT compared with the 6MWT. Borg scale and BP were higher during the ISWT.27 One study performed comparisons between the ISWT and the 10-min walk test and showed that HR and peak relative cardiac outputs were significantly higher during the ISWT.25 One study compared ISWT to daily energy expenditure and reported a moderate association (r = 0.52, P < .007).42

Reliability

Table 2 shows the details of the studies that assessed reliability of the ISWT in patients with cardiac disease (coronary artery bypass graft, chronic heart failure, screening for cardiac transplantation, use of pacemakers, and cardiovascular diseases) (n = 7), COPD (n = 5), peripheral obstructive arterial disease (n = 2), advanced cancer (n = 1), cystic fibrosis (n = 1), lumbar spinal stenosis (n = 1), and asthma (n = 1). All 18 studies evaluated test-retest reliability, and six also evaluated repeatability.

Table Graphic Jump Location
Table 2 —Studies That Assessed Reliability of the ISWT

ICC = intraclass correlation coefficient; LOA = limit of agreement. See Table 1 legend for expansion of other abbreviations.

Intraclass correlation coefficients (ICCs) to verify agreement between test and retest in ISWD ranged from 0.76 to 0.99 in five studies13,36,37,50,51(Table 2). Pearson correlations of ISWD between test and retest were very high (r ≥ 0.90) in the other six studies.1,2729,45,48 Coefficients of repeatability ranged from 21 to 76 m36,4548 for distance covered and 414 mL/min and 329 mL/min for V˙ o2peak and CO2 output, respectively.41 The coefficient of variation ranged from 6.9% to 16.4%13,28,50 in three studies. The lowest coefficient was observed in the study where a practice test was performed,28 and the highest coefficient was observed in the study where the practice test was not performed.13

Responsiveness

Table 3 shows the details of the four studies that assessed responsiveness of the ISWT. Two studies compared the changes in ISWT distances with changes in lung function tests either following hospital admission for a disease exacerbation or following optimization of bronchodilation. Sensitivity indexes (ratio of mean change and SD of change) were 0.76 (moderate) in the changes in number of shuttles in patients with COPD49 and 1.18 in the ISWD in patients with cystic fibrosis.45 Correlations between changes in distance during the ISWT and lung function were weak and inconsistent.45,47 Calvert et al52 reported a weak correlation between changes in ISWD and peak workload (r = 0.44, P = .03) after PR and no significant correlation between change in distance and V˙ o2peak (P = .44).

Table Graphic Jump Location
Table 3 —Studies That Assessed Responsiveness of the ISWT

See Table 1 legend for expansion of abbreviations.

Interpretability

Table 4 shows the details of the four studies that assessed interpretability of the ISWT. One study aimed to find the minimal clinically important difference (MCID) in patients with COPD and described it as being 48 m (95% CI, 38.6-56.5 m).18 The three other studies described predictive equations for the distance in the ISWT in healthy individuals.19,53,54

Table Graphic Jump Location
Table 4 —Studies That Assessed Interpretability of the ISWT

Male sex = 1; female sex = 0. GS = grip strength; ISWD = incremental shuttle walk distance; MCID = minimal clinically important difference; PR = pulmonary rehabilitation; SEE = standardized error of the estimate. See Table 1 legend for expansion of other abbreviations.

Generalizability

All articles met the COSMIN criteria for generalizability.22 These criteria were mean age, distribution of sex, disease characteristics, description of treatment, settings in which the study was conducted, language, country, method to select the patients, and percentage of missing responses. The only criterion that was not met by all the studies was countries in which the study was conducted, which was not included in two articles.31,41

Quality Assessment

Table 5 shows the results of the quality assessment of the included studies. The three investigators responsible for quality assessment (V. F. P., T. J. F., and S. M.) agreed on every box of the COSMIN checklist to be chosen.22 They independently scored each article and reached consensus on inconsistencies found in any item of the checklist or in the final score.

Table Graphic Jump Location
Table 5 —Methodologic Quality of Each Study That Assessed Measurement Property of the ISWT

Numbers in parentheses indicate the items that justify the score according to Consensus-Based Standards for the Selection of Health Status Measurements Instruments criteria.22 See Table 1 legend for expansion of abbreviation.

This systematic review identified articles that evaluated the measurement properties of the ISWT. The findings indicate that the ISWT is a valid and reliable test to assess maximal exercise capacity in individuals with chronic diseases. Responsiveness and interpretability are reported only in patients with chronic lung disease and should be used to evaluate response to treatments and monitor progress in this population.

Validity

The ISWT was proposed as a symptom-limited maximal performance test.1 In the 17 studies that assessed criterion validity, the most frequent gold standard used was the V˙ o2peak performed either on a treadmill24,26,28,29,31,36,38 or cycle ergometer27,32,33,35,37,39,41,43 or simultaneously during the ISWT24,32,40 (Table 1). Most studies observed strong correlations between distance walked and V˙ o2peak (r ≥ 0.70). Macsween et al30 reported weak, nonsignificant correlations between number of shuttles of the ISWT and extrapolated maximal rate of oxygen uptake (calculated from an HR/V˙ o2 plot) during the ISWT in 10 patients with rheumatoid arthritis and 10 patients with cardiac disease (Table 1). One possible explanation for the discrepancy with other studies is the use of an indirect measure.

Regression equations based on comparisons between ISWD and V˙ o2peak were reported in several studies.24,26,27,29,33,35,36,39 These studies included patients with various diseases, such as COPD, chronic heart failure or cardiomyopathy, and cystic fibrosis, and individuals who underwent vascular or abdominal surgery. In COPD, several equations were proposed24,33,35; the differences observed in the predicted values are probably related to the disease severity of the included patients, which ranged from moderate to very severe. Although seven studies presented regression equations, only three had coefficients of determination showing the percentage of V˙ o2peak explained by the ISWD. Reported coefficients of determination were R2 = 0.5335 to 0.7233 in patients with COPD and R2 = 0.57 for patients who underwent vascular and abdominal surgery.39 The differences in the coefficients of determination in patients with COPD may also be related to the differences in disease severity of the included patients. The higher coefficient was observed in patients with moderate COPD33 and the lower in patients with moderate to very severe COPD35 (Table 1).

The ISWT and 6MWT are two common tests used to assess exercise capacity in individuals with chronic lung and heart diseases.1,27,35,41 Besides the known differences in cardiorespiratory responses during these two tests,28,41 several studies showed that the distance covered in the two tests is strongly correlated, demonstrating a good association between the constructs measured1,3235,37 (Table 1).

Reliability

All studies using ICC to evaluate test-retest reliability between days found values > 0.75, which is considered good reliability for distances covered between test repetitions. The ICC is considered a good index of reliability because it is calculated by variance estimates from analysis of variance and, thus, reflects the correlation and agreement between two measures.20 When the repeatability of distance covered was evaluated using the coefficient of repeatability, there were inconsistencies among the studies (range, 20.8-76 m) (Table 2).36,4548 Thus, when a postintervention change is being evaluated, it is important to consider whether the change is within the measurement error observed in that specific population.20 Despite the small number of studies reporting the coefficient of variation, it was systematically lower during the ISWT than during the 6MWT50 or the submaximal constant-power treadmill test.13

Another factor that may affect the reliability is the number of tests performed. In the studies where three tests were performed (one for practice), significant increases in distance were demonstrated from test 1 to test 2, without further changes from tests 2 to test 3 in most of the studies.1,27,46,49 All these studies were performed in individuals with COPD except for one study, which was performed in patients with advanced cancer (Table 2). Studies that performed only two tests did not demonstrate significant differences between tests among patients with diseases other than COPD.28,29,45,47,48,50,51 One possible explanation for these findings may be that the learning effect is specific to the patient population. For example, even though the ISWT is externally paced, patients with COPD may decide to finish the test earlier when performing it for the first time because of fear of becoming too dyspneic.

Responsiveness

The ISWT was shown to be responsive to PR in patients with COPD (effect size, 0.72)52 and to medical and pharmacologic treatment during hospitalization in patients with cystic fibrosis (effect size, 0.60),45 both considered a moderate effect.55 The ISWT was also shown to be sensitive to bronchodilator use in a short-term (same-day) study in elderly patients with asthma47 (effect size, 1.18) as well as in patients with COPD49 (effect size, 0.76).55 In chronic lung diseases, the ISWT, therefore, should be used to evaluate treatments and monitor progress.

Interpretability and Generalizability

There is limited information about interpretability and generalizability of the ISWT in clinical populations. The MCID for the ISWT has been assessed in only one study, which included patients with COPD18 (Table 4). There are no data on interpretability of the ISWT in other populations.

Predictive equations are available19,53,54 but were developed with data from Brazilian individuals, which limits their generalizability. Moreover, the predictive values that can be obtained from the equation proposed by Probst et al19 differ significantly from the values from the other two studies.53,54 It is possible that this discrepancy was due to the modified protocol that Probst et al19 used, which allowed the individuals to stop only when they reached their maximal effort, whereas the other two studies stop the test if the individual had reached the 15th level.53,54 Another aspect that influenced the generalizability of the findings of this review is that most of the studies included patients with COPD or cardiac conditions.

Quality Assessment

Although few studies received good and excellent scores in the COSMIN checklist, it is worth noting that the COSMIN checklist22 uses a conservative criterion but permits some flexibility in its interpretation. This makes the results of the quality assessment of the studies not absolute.

Conclusions

The ISWT can be considered a valid and reliable test to assess maximal exercise capacity in individuals with chronic respiratory diseases. The ISWT has been shown to be responsive to PR and bronchodilator use in individuals with COPD, cystic fibrosis, and asthma. Further studies examining responsiveness and the MCID of the ISWT in patients with conditions other than lung disease are required for the interpretation of interventions in other populations.

Author contributions: Dr Brooks had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Parreira: contributed to the study concept and design, literature search, data extraction and interpretation, writing and approval of the manuscript, and approval of the final version of the manuscript.

Dr Janaudis-Ferreira: contributed to the literature search, data extraction and interpretation, writing of the manuscript, and approval of the final version of the manuscript.

Dr Evans: contributed to the data extraction, critical revision of the manuscript for important intellectual content, and approval of the final version of the manuscript.

Dr Mathur: contributed to the data extraction, critical revision of the manuscript for important intellectual content, and approval of the final version of the manuscript.

Dr Goldstein: contributed to the data interpretation, critical revision of the manuscript for important intellectual content, and approval of the final version of the manuscript.

Dr Brooks: contributed to the study concept and design, data interpretation, critical revision of the manuscript for important intellectual content, and approval of the final version of the manuscript.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: This work was performed at the Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.

6MWT

6-min walk test

COSMIN

Consensus-Based Standards for the Selection of Health Status Measurements Instruments

HR

heart rate

ICC

intraclass correlation coefficient

ISWD

incremental shuttle walk distance

ISWT

incremental shuttle walk test

MCID

minimal clinically important difference

PR

pulmonary rehabilitation

V˙ o2peak

peak oxygen consumption

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Benzo RP, Sciurba FC. Oxygen consumption, shuttle walking test and the evaluation of lung resection. Respiration. 2010;80(1):19-23.
 
Hill K, Dolmage TE, Woon L, Coutts D, Goldstein R, Brooks D. Comparing peak and submaximal cardiorespiratory responses during field walking tests with incremental cycle ergometry in COPD. Respirology. 2012;17(2):278-284.
 
Hill K, Dolmage TE, Woon L, Coutts D, Goldstein R, Brooks D. Defining the relationship between average daily energy expenditure and field-based walking tests and aerobic reserve in COPD. Chest. 2012;141(2):406-412.
 
Stockton KA, Davis MJ, Brown MG, Boots R, Paratz JD. Physiological responses to maximal exercise testing and the modified incremental shuttle walk test in adults after thermal injury: a pilot study. J Burn Care Res. 2012;33(2):252-258.
 
Arnott AS. Assessment of functional capacity in cardiac rehabilitation: reproducibility of a 10-m shuttle walk test. Coron Health Care. 1997;1(1):30-36.
 
Bradley J, Howard J, Wallace E, Elborn S. Reliability, repeatability, and sensitivity of the modified shuttle test in adult cystic fibrosis. Chest. 2000;117(6):1666-1671.
 
Booth S, Adams L. The shuttle walking test: a reproducible method for evaluating the impact of shortness of breath on functional capacity in patients with advanced cancer. Thorax. 2001;56(2):146-150.
 
Dyer CA, Singh SJ, Stockley RA, Sinclair AJ, Hill SL. The incremental shuttle walking test in elderly people with chronic airflow limitation. Thorax. 2002;57(1):34-38.
 
Pratt RK, Fairbank JC, Virr A. The reliability of the shuttle walking test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2002;27(1):84-91.
 
Eiser N, Willsher D, Doré CJ. Reliability, repeatability and sensitivity to change of externally and self-paced walking tests in COPD patients. Respir Med. 2003;97(4):407-414.
 
da Cunha-Filho IT, Pereira DAG, de Carvalho AMB, Campedeli L, Soares M, de Sousa Freitas J. The reliability of walking tests in people with claudication. Am J Phys Med Rehabil. 2007;86(7):574-582.
 
Pepera G, McAllister J, Sandercock G. Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients. Physiotherapy. 2010;96(3):222-227.
 
Calvert LD, Singh SJ, Morgan MD, Steiner MC. Exercise induced skeletal muscle metabolic stress is reduced after pulmonary rehabilitation in COPD. Respir Med. 2011;105(3):363-370.
 
Dourado VZ, Vidotto MC, Guerra RL. Reference equations for the performance of healthy adults on field walking tests. J Bras Pneumol. 2011;37(5):607-614.
 
Jürgensen SP, Antunes LCO, Tanni SE, et al. The incremental shuttle walk test in older Brazilian adults. Respiration. 2011;81(3):223-228.
 
Portney GL, Watkins PM. Statistical Measures Of Validity. Foundations of Clinical Research. Applications to Practice. Upper Saddle River, NJ: Pearson Prentice Hall; 2008:619-658.
 

Figures

Figure Jump LinkFigure 1. Flowchart of the study. ISWT = incremental shuttle walk test.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 —Studies That Assessed Validity of the ISWT

6MWT = 6-min walk test; AUC = area under the curve; DEE = daily energy expenditure; Dlco = diffusing capacity of the lung for carbon monoxide; GOLD = Global Initiative for Chronic Obstructive Lung Disease; HR = heart rate; ISWT = incremental shuttle walk test; ROC = receiver operating characteristic; RPE = rating of perceived exertion; V˙ co2 = CO2 output; V˙ co2peak = peak CO2 output; V˙ o2 = oxygen consumption; V˙ o2max = maximum oxygen consumption; V˙ o2peak = peak oxygen consumption.

Table Graphic Jump Location
Table 2 —Studies That Assessed Reliability of the ISWT

ICC = intraclass correlation coefficient; LOA = limit of agreement. See Table 1 legend for expansion of other abbreviations.

Table Graphic Jump Location
Table 3 —Studies That Assessed Responsiveness of the ISWT

See Table 1 legend for expansion of abbreviations.

Table Graphic Jump Location
Table 4 —Studies That Assessed Interpretability of the ISWT

Male sex = 1; female sex = 0. GS = grip strength; ISWD = incremental shuttle walk distance; MCID = minimal clinically important difference; PR = pulmonary rehabilitation; SEE = standardized error of the estimate. See Table 1 legend for expansion of other abbreviations.

Table Graphic Jump Location
Table 5 —Methodologic Quality of Each Study That Assessed Measurement Property of the ISWT

Numbers in parentheses indicate the items that justify the score according to Consensus-Based Standards for the Selection of Health Status Measurements Instruments criteria.22 See Table 1 legend for expansion of abbreviation.

References

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Morales FJ, Martínez A, Méndez M, et al. A shuttle walk test for assessment of functional capacity in chronic heart failure. Am Heart J. 1999;138(2):291-298.
 
Green DJ, Watts K, Rankin S, Wong P, O’Driscoll JG. A comparison of the shuttle and 6 minute walking tests with measured peak oxygen consumption in patients with heart failure. J Sci Med Sport. 2001;4(3):292-300.
 
Lewis ME, Newall C, Townend JN, Hill SL, Bonser RS. Incremental shuttle walk test in the assessment of patients for heart transplantation. Heart. 2001;86(2):183-187.
 
Macsween A, Johnson NJ, Armstrong G, Bonn J. A validation of the 10-meter incremental shuttle walk test as a measure of aerobic power in cardiac and rheumatoid arthritis patients. Arch Phys Med Rehabil. 2001;82(6):807-810.
 
Moloney ED, Clayton N, Mukherjee DK, Gallagher CG, Egan JJ. The shuttle walk exercise test in idiopathic pulmonary fibrosis. Respir Med. 2003;97(6):682-687.
 
Onorati P, Antonucci R, Valli G, et al. Non-invasive evaluation of gas exchange during a shuttle walking test vs. a 6-min walking test to assess exercise tolerance in COPD patients. Eur J Appl Physiol. 2003;89(3-4):331-336.
 
Satake M, Shioya T, Takahashi H, Kawatani M. Ventilatory responses to six-minute walk test, incremental walking test, and cycle ergometer test in patients with chronic obstructive pulmonary disease. Biomed Res. 2003;24(6):306-316.
 
Vagaggini B, Taccola M, Severino S, et al. 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. Respiration. 2003;70(6):579-584.
 
Turner SE, Eastwood PR, Cecins NM, Hillman DR, Jenkins SC. Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. Chest. 2004;126(3):766-773.
 
Fowler SJ, Singh SJ, Revill S. Reproducibility and validity of the incremental shuttle walking test in patients following coronary artery bypass surgery. Physiotherapy. 2005;91(1):22-27.
 
Campo LA, Chilingaryan G, Berg K, Paradis B, Mazer B. Validity and reliability of the modified shuttle walk test in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2006;87(7):918-922.
 
Win T, Jackson A, Groves AM, Sharples LD, Charman SC, Laroche CM. Comparison of shuttle walk with measured peak oxygen consumption in patients with operable lung cancer. Thorax. 2006;61(1):57-60.
 
Struthers R, Erasmus P, Holmes K, Warman P, Collingwood A, Sneyd JR. Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients. Br J Anaesth. 2008;101(6):774-780.
 
Benzo RP, Sciurba FC. Oxygen consumption, shuttle walking test and the evaluation of lung resection. Respiration. 2010;80(1):19-23.
 
Hill K, Dolmage TE, Woon L, Coutts D, Goldstein R, Brooks D. Comparing peak and submaximal cardiorespiratory responses during field walking tests with incremental cycle ergometry in COPD. Respirology. 2012;17(2):278-284.
 
Hill K, Dolmage TE, Woon L, Coutts D, Goldstein R, Brooks D. Defining the relationship between average daily energy expenditure and field-based walking tests and aerobic reserve in COPD. Chest. 2012;141(2):406-412.
 
Stockton KA, Davis MJ, Brown MG, Boots R, Paratz JD. Physiological responses to maximal exercise testing and the modified incremental shuttle walk test in adults after thermal injury: a pilot study. J Burn Care Res. 2012;33(2):252-258.
 
Arnott AS. Assessment of functional capacity in cardiac rehabilitation: reproducibility of a 10-m shuttle walk test. Coron Health Care. 1997;1(1):30-36.
 
Bradley J, Howard J, Wallace E, Elborn S. Reliability, repeatability, and sensitivity of the modified shuttle test in adult cystic fibrosis. Chest. 2000;117(6):1666-1671.
 
Booth S, Adams L. The shuttle walking test: a reproducible method for evaluating the impact of shortness of breath on functional capacity in patients with advanced cancer. Thorax. 2001;56(2):146-150.
 
Dyer CA, Singh SJ, Stockley RA, Sinclair AJ, Hill SL. The incremental shuttle walking test in elderly people with chronic airflow limitation. Thorax. 2002;57(1):34-38.
 
Pratt RK, Fairbank JC, Virr A. The reliability of the shuttle walking test, the Swiss Spinal Stenosis Questionnaire, the Oxford Spinal Stenosis Score, and the Oswestry Disability Index in the assessment of patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2002;27(1):84-91.
 
Eiser N, Willsher D, Doré CJ. Reliability, repeatability and sensitivity to change of externally and self-paced walking tests in COPD patients. Respir Med. 2003;97(4):407-414.
 
da Cunha-Filho IT, Pereira DAG, de Carvalho AMB, Campedeli L, Soares M, de Sousa Freitas J. The reliability of walking tests in people with claudication. Am J Phys Med Rehabil. 2007;86(7):574-582.
 
Pepera G, McAllister J, Sandercock G. Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients. Physiotherapy. 2010;96(3):222-227.
 
Calvert LD, Singh SJ, Morgan MD, Steiner MC. Exercise induced skeletal muscle metabolic stress is reduced after pulmonary rehabilitation in COPD. Respir Med. 2011;105(3):363-370.
 
Dourado VZ, Vidotto MC, Guerra RL. Reference equations for the performance of healthy adults on field walking tests. J Bras Pneumol. 2011;37(5):607-614.
 
Jürgensen SP, Antunes LCO, Tanni SE, et al. The incremental shuttle walk test in older Brazilian adults. Respiration. 2011;81(3):223-228.
 
Portney GL, Watkins PM. Statistical Measures Of Validity. Foundations of Clinical Research. Applications to Practice. Upper Saddle River, NJ: Pearson Prentice Hall; 2008:619-658.
 
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