The incremental shuttle walking test in elderly people with chronic airflow limitation

Abstract

Background: There is a concern that comorbidity or frailty in older people could limit the usefulness of currently available exercise tests for chronic lung disease. This study evaluated the feasibility and reproducibility of the incremental shuttle walking test (SWT) in people aged 70 years or over, compared exercise tolerance with other disability markers, and assessed whether the SWT is responsive to change after bronchodilators. Methods: Fifty elderly patients with chronic airflow limitation (CAL) and 32 controls without airflow limitation attempted the SWT before and after combined nebulised salbutamol/ipratropium bromide. Subjects also completed the Nottingham Extended Activities of Daily Living index (NEADL) and the London Handicap score (LHS). Results: Forty four subjects with CAL (88%) and 29 controls (84%) completed the SWT, including many with co-morbidities. Two week repeatability was good and the SWT was strongly associated with EADL (r=0.51, p<0.001) and LHS (r=0.43, p<0.004), but only weakly with forced expiratory volume in 1 second (FEV 1 ) (r=0.31, p=0.05). Subjects with CAL walked a mean distance of 177.7 m compared with 243.3 m in controls (p<0.001); following bronchodilator therapy the distance walked increased in the CAL group by 13.2% (p=0.009). Conclusion: The SWT is a feasible and reproducible measure of exercise tolerance in elderly people with and without airflow obstruction and correlates with other markers of disability. It is sensitive to change following bronchodilation in subjects with CAL, although the change correlates less well with improvements in FEV 1 . Overall, these results suggest that the SWT might be an appropriate measure to assess interventions in elderly people.

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

“…This study procedure is at variance with the suggestion that two ISWTs should be performed to account for a small but significant learning effect seen with this test [31][32][33][34][35][36][37]. This proposed methodology is likely to be important to accurately determine ISWT performance.…”

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

“…ISWT is sensitive to both short-and long-acting anticholinergic and β 2 -agonist bronchodilators in COPD in most [172,177,[188][189][190], but not all [191] studies. The mechanisms of improvement have not been studied extensively, but are probably related to improvements in lung function [189,190].…”

Exercise capacity in pulmonary Tuberculosis

“…It is common practice that exercise prescription forms the basis of a management programme for patients with chronic respiratory disease (Dyer et al, 2002). Should exercise capacity be found to be reduced in patients with pulmonary tuberculosis the results of this study would imply that new treatment options might need to be considered, such as the inclusion of the patient in a pulmonary rehabilitation program.…”

“…HIV suppresses the immune system and makes its host more susceptible to opportunistic infections, of which PTB is the most common and most infectious complication (Raviglione et al, 1992;Eriki et al, 1991). It is estimated that between the years 2000 and 2020 nearly one billion people will be newly infected and 35 million as measured by maximal/peak oxygen uptake (VO 2 peak) (Dyer et al, 2002;Singh et al, 1994 and. This poor exercise capacity, and in some instances the inability to perform simple activities of daily living, may have a profound impact on the quality of life of these patients.…”