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a Department of
Respiratory Medicine, Glenfield Hospital, Leicester LE3 9QP, UK, b Department of Sports Science,
Loughborough University of Technology, UK
Correspondence to: Dr S M Revill.
Received 9 February 1998; Returned to authors 8 May 1998; Revised version received 17 September 1998; Accepted for publication 12 November 1998
BACKGROUND
The purpose
of this study was to develop an externally controlled, constant paced
field walking test to assess endurance capacity in patients with
chronic obstructive pulmonary disease (COPD). There were four
objectives: (1) to develop a protocol; (2) to compare treadmill and
shuttle walk tests of endurance capacity; (3) to examine the
repeatability of the endurance shuttle walk test; and (4) to compare
the sensitivity to pulmonary rehabilitation of endurance and
incremental shuttle walk tests.
METHODSThe test was
designed to complement the incremental shuttle walk test (ISWT) using
the same 10 m shuttle course and an audio signal to control pace. The
intensity of the field endurance test was related to a percentage of
each patient's maximum field exercise performance assessed by the
ISWT. A number of cassette tapes were pre-recorded with a range of
audio signal frequencies to dictate walking speeds between 1.80 and
6.00 km/h. In the first limb of the study 10 patients with COPD (mean
(SD) forced expiratory volume in one second (FEV1) 1.0 (0.36) l, 35% predicted) performed three endurance shuttle walk tests
(ESWTs) and three treadmill endurance tests. The walking speeds were
calculated to elicit 75%, 85%, and 95% of each patient's maximum
ISWT performance for the field tests and measured peak oxygen
consumption for the treadmill tests. In a separate group of patients
the repeatability of the ESWT at an intensity of 85% of the ISWT
performance was evaluated. Finally, the ESWT (at the 85% intensity)
and the ISWT were performed at the start of a five week control period
and at the start and end of a seven week pulmonary rehabilitation
programme in 21 patients with COPD (mean FEV1 0.80 (0.18) l).
RESULTSThe mean (SE)
times achieved during the ESWT were 13.1 (2.3), 10.2 (2.5), and 5.3 (1.7) min for the walks at 75%, 85%, and 95% intensities,
respectively. Patients tended to walk for longer on the treadmill than
during the field tests at all intensities, but there were no
significant differences between the end of test heart rates or Borg
ratings of breathlessness or perceived exertion. Following one practice
ESWT at the 85% intensity, the mean difference and limits of agreement
(2SD) between tests 2 and 3 was +15 (42) s (p>0.05). There was no
significant change in performance on either test following the five
week control period prior to rehabilitation. Following rehabilitation
the ESWT duration increased by 160 (24)% and the ISWT distance
increased by 32 (11)% (effect sizes 2.90 and 0.41, respectively).
CONCLUSIONSThe ESWT
was simple to perform, acceptable to all patients, and exhibited good
repeatability after one practice walk. The test showed major
improvement following rehabilitation and was more sensitive to change
than the field test of maximal capacity.
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