Field walking tests are commonly employed to evaluate exercise capacity, assess prognosis and evaluate treatment response in chronic respiratory diseases. In recent years, there has been a wealth of new literature pertinent to the conduct of the 6-min walk test (6MWT), and a growing evidence base describing the incremental and endurance shuttle walk tests (ISWT and ESWT, respectively). The aim of this document is to describe the standard operating procedures for the 6MWT, ISWT and ESWT, which can be consistently employed by clinicians and researchers.The Technical Standard was developed by a multidisciplinary and international group of clinicians and researchers with expertise in the application of field walking tests. The procedures are underpinned by a concurrent systematic review of literature relevant to measurement properties and test conduct in adults with chronic respiratory disease.Current data confirm that the 6MWT, ISWT and ESWT are valid, reliable and responsive to change with some interventions. However, results are sensitive to small changes in methodology. It is important that two tests are conducted for the 6MWT and ISWT.This Technical Standard for field walking tests reflects current evidence regarding procedures that should be used to achieve robust results. OverviewThe aim of this Technical Standard is to document the standard operating procedures for the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease. The testing procedures were developed by a multinational and multidisciplinary group of experts in field exercise testing, informed by a systematic review of the measurement properties and interpretation of the 6MWT, ISWT and ESWT in adults with chronic respiratory disease [1].The key findings of the Technical Standard are as follows.1) The 6-min walking distance (6MWD), ISWT and ESWT demonstrate good construct validity. Strong relationships with measures of exercise performance and physical activity support their conceptualisation as tests of functional exercise performance.2) A lower 6MWD is strongly associated with increased risk of hospitalisation and mortality in people with chronic respiratory disease, with a small number of studies suggesting a similar relationship for the ISWT.3) The 6MWD, ISWT and ESWT exhibit good test-retest reliability; however, there is strong evidence of a learning effect for the 6MWT and ISWT. Two tests should be performed when the 6MWT or ISWT are used to measure change over time.4) The 6MWD, ISWT and ESWT are responsive to treatment effects in people with chronic respiratory disease; however, most studies have evaluated responsiveness to rehabilitation and fewer data are available to confirm responsiveness to other interventions.5) The 6MWD and ISWT elicit a peak oxygen uptake (V9O 2 peak) that is similar to that during a cardiopulmonary exercise test (CPET). As a result, the contraindications and precautions for field testing should be consistent with those ...

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.Studies that report the evaluation or use of the 6MWT, ISWT or ESWT were included. We searched electronic databases for studies published between January 2000 and September 2013.The 6-min walking distance (6MWD) is a reliable measure (intra-class correlation coefficients ranged from 0.82 to 0.99 in seven studies). There is a learning effect, with greater distance walked on the second test (pooled mean improvement of 26 m in 13 studies). Reliability was similar for ISWT and ESWT, with a learning effect also evident for ISWT (pooled mean improvement of 20 m in six studies). The 6MWD correlates more strongly with peak work capacity (r50.59-0.93) and physical activity (r50.40-0.85) than with respiratory function (r50.10-0.59). Methodological 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. OverviewThe aim of this systematic review was to examine the measurement properties for the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease. A companion paper describes the standard operating procedures for the tests [1]. The key findings of this systematic review are as follows.1) The 6-min walking distance (6MWD) is a valid and reliable measure of exercise capacity for people with chronic lung disease. The 6MWD correlates more strongly with measures of peak work capacity and physical activity than with respiratory function or quality of life, which supports its conceptualisation as a test of functional exercise performance.2) The ISWT offers a different protocol to the 6MWT as it is incremental and externally paced. The ISWT is a valid and reliable measure of cardiopulmonary exercise capacity in chronic obstructive pulmonary disease (COPD), where there is a strong relationship between ISWT distance and peak oxygen uptake (V9O 2 peak) or work rate on a cardiopulmonary exercise test (CPET).3) A learning effect is observed for the 6MWT and the ISWT. The second test usually is the better compared with the first, but this is inconsistent.4) The ESWT is a test of endurance capacity. It is externally paced and is performed along the same course as the ISWT. Two tests do not appear to be necessary if the second test is conducted on the same day.5) Reference equations have been proposed for the 6MWD and the ISWT. Age, height and weight are included in most equations. The influence of race and ethnicity is unclear.6) The safety profile of ...

BackgroundIt is important to include large sample sizes and different factors that influence the six-minute walking distance (6MWD) in order to propose reference equations for the six-minute walking test (6MWT). ObjectiveTo evaluate the influence of anthropometric, demographic, and physiologic variables on the 6MWD of healthy subjects from different regions of Brazil to establish a reference equation for the Brazilian population. MethodIn a multicenter study, 617 healthy subjects performed two 6MWTs and had their weight, height, and body mass index (BMI) measured, as well as their physiologic responses to the test. Delta heart rate (∆HR), perceived effort, and peripheral oxygen saturation were calculated by the difference between the respective values at the end of the test minus the baseline value. ResultsWalking distance averaged 586±106m, 54m greater in male compared to female subjects (p<0.001). No differences were observed among the 6MWD from different regions. The quadratic regression analysis considering only anthropometric and demographic data explained 46% of the variability in the 6MWT (p<0.001) and derived the equation: 6MWDpred=890.46-(6.11×age)+(0.0345×age2)+(48.87×gender)-(4.87×BMI). A second model of stepwise multiple regression including ∆HR explained 62% of the variability (p<0.0001) and derived the equation: 6MWDpred=356.658-(2.303×age)+(36.648×gender)+(1.704×height)+(1.365×∆HR). ConclusionThe equations proposed in this study, especially the second one, seem adequate to accurately predict the 6MWD for Brazilians.

The reproducibility of the 6-min walking test (6MWT) needs to be more solidly studied. This study aimed to investigate the reproducibility of two 6MWTs performed on subsequent days in a large and representative sample of patients with chronic obstructive pulmonary disease (COPD), and to quantify the learning effect between the two tests, as well as its determinants.In a retrospective observational study, 1,514 patients with COPD performed two 6MWTs on subsequent days. Other measurements included body composition (dual X-ray absorptiometry), dyspnoea (Medical Research Council scale) and comorbidity (Charlson index).Although the 6MWT was reproducible (intraclass correlation coefficient50.93), patients walked farther in the second test (391 m, 95% CI 155-585 m versus 418 m, 95% CI 185-605 m; p,0.0001). On average, the second 6MWT increased by 27 m (or 7%), and 82% of patients improved in the second test. Determinants of improvement o42 m in the second test (upper limit of the clinically important change) were as follows: first 6MWT ,350 m, Charlson index ,2 and body mass index ,30 kg?m -2 (OR 2.49, 0.76 and 0.60, respectively).The 6MWT was statistically reproducible in a representative sample of patients with COPD. However, the vast majority of patients improved significantly in the second test by an average learning effect of 27 m.KEYWORDS: Chronic obstructive pulmonary disease, 6-min walking test, reproducibility of results C hronic obstructive pulmonary disease (COPD) is a systemic disease characterised by progressive airflow limitation, exercise intolerance and physical inactivity [1,2]. Although the degree of airflow obstruction is frequently used as a marker of disease severity, it does not adequately reflect extrapulmonary manifestations of COPD [3,4]. Some modalities of field tests are available to assess these patients' exercise capacity [4], which better reflect the extrapulmonary features of the disease.The 6-min walking test (6MWT) is a simple and inexpensive test that provides a global and integrated response of both physical (pulmonary and nonpulmonary factors) and psychological factors [5,6]. The 6MWT is used to assess functional exercise capacity before and after interventions [7,8] and as a predictor of morbidity and mortality in COPD [9].In general, the 6MWT is a reliable test in COPD patients but a learning effect has been suggested [10-15], i.e. patients achieving a considerably higher walked distance when a second test is performed. Indeed, there is controversy about the size of the learning effect, which may range from 2.6% to 22% [10,11,[16][17][18][19][20]. Moreover, the external validity of the previous studies is limited due to the pre-specified inclusion criteria [10,11,13,18]. Furthermore, researchers usually used statistical analysis that did not demonstrate trends and agreement between both 6MWTs, thereby compromising the internal validity of the results [10]. Additionally, the determinants of improvement in walking distance remain unknown. Considering the importance of the 6...

In conclusion, the variability of the ISWT is explained largely by gender, age and BMI. The reference values for the ISWT can be adequately predicted using the equation proposed in this study.