Letter to the EditorReproducibility and safety of the incremental shuttle walking test for cardiac rehabilitation☆
Introduction
The ISWT is recommended as a measure of exercise capacity in CR [1], it is considered more suitable for the elderly rehabilitation population who perform poorly on a treadmill test and is a cost-effective alternative [2]. It is important to objectively measure improvements in exercise tolerance prior to and at the completion of a CR programme. There have been reports of a good correlation between ISWT and peak VO2 in patients with heart failure [3], [4], and of its reproducibility to show differences in exercise capacity in patients with cardiac pacemakers [5] and chronic heart failure [4], but a recent review has highlighted the relative paucity of studies of the validity and reliability of the ISWT compared to the literature base for the 6- and 12-min walking tests in cardiac patients [6].
The need to undertake a practice test was identified in patients with COPD, but only two small studies (39 and 46 patients) have investigated this in cardiac patients [4], [7]. The aim of our study was to determine whether a practice ISWT is necessary and whether there are any patients in whom one test might suffice.
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Methods
Patients were taking part in the Birmingham Rehabilitation Uptake Maximisation (BRUM) trial of CR [8]. Practice and second ISWTs were assessed for the first time 6 months after recruitment into the trial, using methodology described by Singh et al. [2]. Patients undertook a practice ISWT then rested for at least 30 min before undertaking a second test. The distance achieved was recorded, together with reason for stopping the test and the peak heart rate.
Data were analysed in SPSS version 12.
Results
In the BRUM study, 1457 ISWTs were undertaken without major adverse incident. Paired ISWT data were available at 6-month follow-up for 353 participants: mean age (S.D.) 61.6 (10.2) years, 282 (79.9%) male, 165 (46.7%) post-MI, 188 (53.3%) post-revascularisation, 68 (19.3%) from a minority ethnic group.
There was a significant increase in the mean (S.D.) distance from the practice to the second walk from 385.3 m (151.8) to 414.8 m (157.5), difference 29.5 m (95% CI 23.0, 36.0) p < 0.001. The Bland
Discussion
Using guidelines for undertaking the ISWT [1], we have found it to be safe in a large cohort of patients with ischaemic heart disease. This finding is in keeping with the low level of cardiac events associated with exercise stress tests, ranging from 0% to 0.36% [13].
Whilst the distance between the first and second tests increased significantly, the RPE only increased by 0.3, which although statistically significant is not a clinically significant difference. The peak heart rate did not
Acknowledgements
The BRUM study is funded by the UK Department of Health through its HTA Programme. The opinions and conclusions expressed here are those of the authors and do not necessarily reflect those of the UK National Health Service or the Department of Health. Members of the BRUM Steering Committee are available [8].
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2014, Research in Developmental DisabilitiesCitation Excerpt :Results from the best test, defined as the test in which the participant reached the highest heart rate, were used in the analyses. Test–retest reliability was confirmed in patients with chronic airway construction (r ≥ 0.98; Singh et al., 1992) and patients attending cardiac rehabilitation (ICC = 0.94; Jolly et al., 2008). Validity has also been confirmed in patients with chronic airway construction (Singh, Morgan, Hardman, Rowe, & Bardsley, 1994).
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Conflicts of interest: Dr Sally Singh developed the ISWT and funds obtained from the sale of recordings and instructions for its use support research activities within her department.