The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen

Abstract

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 standardise 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 random 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.

An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease

“…2). However, the shuttle tests may be more sensitive to the effects of common interventions, including bronchodilators [106,233,234]. The externally paced nature of the ISWT and ESWT may be an advantage in circumstances where methodological variation is a concern (e.g.…”

“…Additional measures can be recorded. Three studies demonstrated the potential for the use of SpO 2 to record exertional desaturation during ESWT, either breathing air or for assessment of ambulatory oxygen [219,233,242]. One study reported greater desaturation with ESWT compared with 6MWT [233].…”

“…Both supplemental oxygen or heliox and oxygen may have an impact on ESWT performance [219,233,241,242]. The studies reflect a difference in conduct, regarding whether the cylinder was carried by the participant or the operator.…”

“…Seven studies were specifically designed to examine the responsiveness of the ESWT to bronchodilation [105][106][107], oxygen therapy [219,233] and pulmonary rehabilitation [232,234]. The responsiveness of the ESWT was moderate to high, with standardised response means (mean change/standard deviation of change) ranging from 0.52 to 1.27.…”

Prospective validation of the endurance shuttle walking test in the context of bronchodilation in COPD

“…The randomness of this variability suggests that it was not related to a learning effect, as confirmed by the Bland-Altman plot. The issue about intraindividual variability in exercise performance was previously discussed for the ESWT [12,[19][20][21], but also for constant work-rate cycling exercise [22]. REVILL et al [21] reported greater variability in ESWT performance with longer endurance time.…”