Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study Detecting oxygen desaturation in patients with COPD: incremental versus endurance shuttle walking. Relationship between field walking tests and incremental cycle ergometry in COPD. Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen Do patients with lung cancer benefit from physical exercise? Relationship between daily physical activity and exercise capacity in patients with COPD. Pulmonary rehabilitation for chronic obstructive pulmonary disease: a pilot study evaluating a once-weekly versus twice-weekly supervised programme. Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease Prescription of Walking Exercise Intensity from the Incremental Shuttle Walk Test in People with Chronic Obstructive Pulmonary Disease Endurance shuttle walking test: responsiveness to salmeterol in COPD Peak exercise capacity estimated from incremental shuttle walking test in patients with COPD: a methodological study Generic, symptom based, exercise rehabilitation; integrating patients with COPD and heart failure. A comparison of twice- versus once-weekly supervision during pulmonary rehabilitation in chronic obstructive pulmonary disease. High intensity physical group training in water--an effective training modality for patients with COPD. Feasibility and impact of a structured, exercise-based rehabilitation programme for intensive care survivors Comparison of the effects of neuromuscular electrical stimulation and endurance training in patients with severe chronic obstructive pulmonary disease. Shuttle Walking Test and 6-Minute Walking Test Induce a Similar Cardiorespiratory Performance in Patients Recovering from an Acute Exacerbation of Chronic Obstructive Pulmonary Disease Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. Randomized controlled trial of ambulatory oxygen and an ambulatory ventilator on endurance exercise in COPD. 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Acu-TENS Reduces Breathlessness during Exercise in People with Chronic Obstructive Pulmonary Disease Reproducibility of the 6-Minute Walk Test for Ambulatory Oxygen Prescription [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.] A pilot study of pulmonary rehabilitation and chest physiotherapy versus chest physiotherapy alone in bronchiectasis. Dietary nitrate supplementation in COPD: an acute, double-blind, randomized, placebo-controlled, crossover trial. Water-based exercise in COPD with physical comorbidities: a randomised controlled trial The effects of supervised exercise training 12–24 months after bariatric surgery on physical function and body composition: a randomised controlled trial How long should outpatient pulmonary rehabilitation be? A randomised controlled trial of 4 weeks versus 7 weeks Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. The effects of oxitropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease. A comparison of three different exercise tests. A Home-Based Walking Program Improves Respiratory Endurance in Patients With Acute Myocardial Infarction: A Randomized Controlled Trial. The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD. A randomised controlled trial of supplemental oxygen versus medical air during exercise training in people with chronic obstructive pulmonary disease: supplemental oxygen in pulmonary rehabilitation trial (SuppORT) (Protocol) Effect of Bariatric Surgery on the Six-Minute Walk Test in Severe Uncomplicated Obesity
Background There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer ( NSCLC ) .  Cardiopulmonary exercise testing ( CPET ) is the gold st and ard measure of exercise capacity ; however this laboratory test has limitations for use in research and clinical practice . Alternative field walking tests are the six-minute walk test ( 6MWT ) , incremental-shuttle walk test ( ISWT ) and endurance-shuttle walk test ( ESWT ) ; however there is limited information about their clinimetric properties in NSCLC . Aims : In NSCLC to determine the 1 ) criterion validity of the 6MWT , ISWT and ESWT against CPET ; 2 ) construct validity of the 6MWT , ISWT and ESWT against measures of function , strength , respiratory function and health-related quality of life ( HRQoL ) ; and 3 ) clinical applicability of the tests . Methods Twenty participants ( 40 % male , mean ± SD age 66.1 ± 6.5 years ) with stage I-IIIb NSCLC completed the 6MWT , ISWT , ESWT and CPET within six months of treatment . Testing order was r and omised . Additional measures included Eastern Cooperative Oncology Group Performance-Status ( ECOG-PS , function ) , respiratory function , h and -grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships . Results The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption ( r = 0.61 , p = 0.007 ) . Relationships between CPET and six minute walk distance ( 6MWD ) ( r = 0.24 , p = 0.329 ) or ESWT time ( r = 0.02 , p = 0.942 ) were poor . Moderate construct validity existed for the 6MWD and respiratory function ( forced vital capacity % predicted r = 0.53 , p = 0.019 ; forced expiratory volume in the first second % predicted r = 0.55 , p = 0.015 ) . There were no relationships between the walking tests and measures of function , strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time . No floor effects were seen in the tests . The mean ± SD time required to perform the individual 6MWT , ISWT and ESWT was 12.8 ± 2.5 , 14.7 ± 3.7 and 16.3 ± 5.0 min respectively ; in comparison to CPET which was 51.2 ± 12.7 min . Only one assessor was required to perform all field walking tests and no adverse events occurred . Conclusions The ISWT is a promising measure of functional exercise capacity in lung cancer . Findings need to be confirmed in a larger sample prior to translation into practice BACKGROUND There has been no direct comparison between an incremental and endurance walking test to detect the relative oxygen desaturation in patients with chronic obstructive pulmonary disease ( COPD ) . This is of some importance as current guidelines have suggested that ambulatory oxygen should only be prescribed after a st and ard assessment and desaturation documented . No clear advice about the nature of the required exercise task is given . This study therefore compared the relative desaturation between the incremental shuttle walking test ( ISWT ) and the constant speed walking test ( ESWT ) and response to ambulatory oxygen . METHODS Forty-one patients ( 29 male ) , mean ( SD ) , age 71.18 ( 7.48 ) yrs , FEV(1 ) 0.85 ( 0.29 ) l with stable COPD were recruited after completion of a 7-week pulmonary rehabilitation programme . Patients completed a baseline ( without carrying a cylinder ) ISWT and ESWT and then , in r and om order in double blind fashion , completed the walk tests with a cylinder of air or a cylinder of oxygen . Measurements included distance walked , oxygen saturation , heart rate , perceived breathlessness and exertion ( Borg scale ) . RESULTS All patients desaturated ( < 4 % below 90 % ) . There was no significant difference in desaturation between the ISWT and the ESWT . There was a significant improvement in performance with supplementary oxygen compared to cylinder air ( p<0.05 ) for both tests . However , compared to the baseline walk , supplementary oxygen did not enhance the distance walked for either test . There was a significant decrease in walking performance on both the ISWT and the ESWT when carrying an air cylinder compared with the control walk . When comparing the percentage difference between oxygen and air for responders ( i.e. those that achieve a 10 % or more increase ) , the ESWT showed a greater percentage change 42.1 % compared to 26.1 % for the ISWT . CONCLUSIONS This study identifies that incremental and endurance walking provokes significant desaturation and that there is a short-term benefit of oxygen versus air in enhancing exercise performance . There was no significant difference in the level of desaturation between tests . Therefore the ISWT is a suitable exercise test that can be used to evaluate desaturation and is practically more realistic BACKGROUND AND OBJECTIVE Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients OBJECTIVES To investigate cardiorespiratory and dyspnea responses to incremental and self-paced exercise tests in patients with COPD . DESIGN A prospect i ve within-subject design was used . PATIENTS Twenty stable subjects ( 15 men ) , with a mean ( + /- SD ) age of 64.0 + /- 7.5 years and moderate-to-severe COPD ( ie , mean FEV(1 ) , 0.8 + /- 0.3 L and 28.9 + /- 7.9 % predicted ) were studied . METHODS Each subject completed a 6-min walk test ( 6MWT ) , an incremental shuttle walking test ( ISWT ) , and a cycle ergometer test ( CET ) , within a 2-week period . The tests were performed at least 24 h apart . St and ardized encouragement was utilized in each test with the aim of maximizing performance . Heart rate ( HR ) and dyspnea were measured each minute throughout the tests , and pulse oximetric saturation ( Spo(2 ) ) was measured before and immediately after each test . The distances walked in the 6MWT and ISWT were compared to peak oxygen uptake ( Vo(2 ) ) values from the CET . RESULTS HR increased linearly with increasing workload during the CET and ISWT , but increased alinearly with a disproportionate increase early in the 6MWT . In contrast , dyspnea scores increased linearly during the 6MWT , but increased alinearly with a disproportionate increase late during the CET and ISWT . Peak HR and dyspnea were not significantly different between tests . Spo(2 ) was significantly lower at the end of both walking tests compared to that at the end of the CET ( p < 0.001 ) . The distance walked in both the ISWT and 6MWT were related to peak Vo(2 ) values on the CET ( for both tests , r = 0.73 ; p < 0.001 ) . CONCLUSIONS The patterns of response in HR and dyspnea seen during the 6MWT suggest that patients with COPD titrate exertion against dyspnea to achieve a peak tolerable intensity . This strategy is not possible in an externally paced ISWT or CET . However , it is a limited strategy , with performance converging at higher workloads . Similar peak exercise responses were achieved in the 6MWT , ISWT , and CET . Greater oxygen desaturation was observed during the field walking tests , suggesting that both the ISWT and 6MWT are more sensitive than the CET in detecting exercise-induced hypoxemia and in assessing ambulatory oxygen therapy needs 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 st and ardise 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 r and om 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 Abstract Background . Patients with lung cancer are often burdened by dyspnoea , fatigue , decreased physical ability and loss of weight . Earlier studies of physical exercise of patients with COPD have shown promising results . The aim of this study was to investigate , if a well-documented COPD rehabilitation protocol can improve physical fitness and quality of life ( QoL ) in patients with lung cancer . Material and methods . Forty-five patients , with a minimum walking distance of 50 meters , absence of cognitive deficits or severe heart disease and motivated for physical training were invited to an exercise intervention .  The intervention consisted of seven weeks of twice weekly training , focusing on walking training , circuit training , h and ling of dyspnoea and instructions in daily diary-based training at home . Prior to , and after the intervention , Incremental- and Endurance Shuttle Walk Test ( ISWT and ESWT ) were performed , and pulmonary function as well as self-reported QoL ( EORTC-QLQ-C30 and LC13 ) were measured . Results . Fourteen subjects dropped out before commencement of the intervention . Seven were excluded after physiotherapeutic evaluation . Of the remaining 24 , three were excluded because of insufficient attendance ( < 65 % of scheduled exercise sessions ) thus 21 patients completed the intervention . For 17 patients with complete pre- and post intervention data , ISWT increased 9 % ( −77 to 39 % ) ( median and range ) ( p = 0.021 ) , while ESWT increased 109 % ( −70 to 432 % ) ( p = 0.002 ) . Twelve of 17 improved in ISWT , while 15 improved in ESWT . No changes in pulmonary function and improvements in QoL were observed . Conclusion . Patients with pulmonary cancer can achieve significant improvements in physical fitness measured with ISWT and ESWT after completion of the intervention program . No changes in pulmonary function and QoL were observed . In addition , we found that a large number of patients dropped out before intervention and that the patients , who succeeded , often discontinued training at home BACKGROUND Exercise training programmes for patients with COPD are effective in improving exercise capacity . The few trials that have investigated the effects of exercise programmes on daily physical activity show contradictory results . AIM To investigate the relation between daily physical activity level and exercise capacity in patients with COPD using data of a r and omised controlled trial in which the exercise intervention was aim ed at improvement of both physical activity and exercise capacity ( the COPE-II study ) . METHODS These are secondary analyses of the COPE-II study , a r and omised controlled trial in which a community-based physiotherapeutic exercise programme was evaluated .  Daily physical activity  was measured with a pedometer ( steps/day ) . Exercise capacity  was measured with an incremental maximal cycle ergometer test , the incremental ( ISWT ) and endurance shuttle walk test ( ESWT ) . Pearson correlation coefficients were calculated . RESULTS At baseline , correlations between steps/day and VO(2peak ) , ISWT ( m ) , ESWT ( m ) and ESWT ( s ) were 0.54 , 0.59 , 0.44 , and 0.34 , respectively ( all p < 0.01 ) . In the  intervention group , correlations between change in steps/day over 7 months and change in ISWT ( m ) , ESWT ( m ) and ESWT ( s ) were 0.47 , 0.41 , and 0.38 , respectively ( all p < 0.01 ) . In the  control group , these same correlations were weak to non-existent . CONCLUSIONS A moderate to weak relationship was found between daily physical activity and exercise capacity . These results strengthen our beliefs that exercise interventions need to target not only exercise capacity but also behaviour change with regard to daily physical activity to achieve improvements in both parameters OBJECTIVES To compare the effectiveness of a once-weekly supervised pulmonary rehabilitation programme with a st and ard twice-weekly format . DESIGN R and omised trial of equivalency . SETTING Pulmonary rehabilitation service of a primary care trust delivered at two physiotherapy outpatient departments . PARTICIPANTS Thirty patients with chronic obstructive pulmonary disease . OUTCOME MEASURES Primary outcomes were the Incremental Shuttle Walking Test ( ISWT ) , Endurance Shuttle Walking Test ( ESWT ) and St George 's Respiratory Question naire ( SGRQ ) , assessed at baseline and at completion of the supervised programme . Secondary outcomes were home-exercise activity , attendance levels and patient satisfaction with the programme . INTERVENTIONS The once-weekly group ( n=15 ) received one supervised rehabilitation session per week , and the twice-weekly group ( n=15 ) received two sessions per week , both for 8 weeks , together with a home-exercise plan . RESULTS After pulmonary rehabilitation , the groups showed similar improvements in exercise tolerance ( median values : ISWT once-weekly 60metres , twice-weekly 50metres ; ESWT once-weekly 226seconds , twice-weekly 109seconds ) . However , for health-related quality -of-life , the once-weekly group 's score did not change ( SGRQ 0 ) , whereas an improvement was seen for the twice-weekly group ( SGRQ 3.7 ) . The number of home-exercise sessions and attendance levels were similar between the groups . Patient satisfaction with both formats was high and almost identical between the groups . CONCLUSIONS This pilot provides data to inform a larger study and shows that the methodology is feasible . The findings suggest that once-weekly supervision may be capable of producing equivalent improvements in exercise tolerance as a twice-weekly programme , but the health-related quality -of-life outcome appeared to be poorer for once-weekly supervision Background : The responsiveness of the endurance shuttle walk to functional changes following bronchodilation has recently been reported . The current literature suggests that the 6 min walking test ( 6MWT ) is less responsive to bronchodilation than the endurance shuttle walk . Aim : To compare bronchodilator-induced changes in exercise performance with the 6MWT and the endurance shuttle walk . Methods : In a r and omised , double-blind , placebo-controlled , crossover trial , 14 patients with chronic obstructive pulmonary disease ( forced expiratory volume in 1 s ( FEV1 ) 50 (8)% predicted ) completed two 6MWTs and two endurance shuttle walks , each preceded by nebulised placebo or 500 μg ipratropium bromide .  Cardiorespiratory parameters were monitored during each walking test with a portable telemetric gas analyser . Quadriceps twitch force was measured by magnetic stimulation of the femoral nerve before and after each walking test . Results : The 6 min walking distance did not change significantly after bronchodilation despite a significant increase in FEV1 of 0.18 ( 0.09 ) litres ( p<0.001 ) . A similar change in FEV1 ( 0.18 ( 0.12 ) litres , p<0.001 ) was associated with a significant improvement in the distance walked on the endurance shuttle walk ( Δdistance ipratropium bromide – placebo = 144 ( 219 ) m , p = 0.03 ) . Quadriceps muscle fatigue was infrequent ( < 15 % of patients ) after both walking tests . Conclusion : The endurance shuttle walk is more responsive than the 6MWT for detecting changes in exercise performance following bronchodilation Objective This study determined the intensity of walking exercise prescribed from 70 % of peak speed achieved during the incremental shuttle walk test ( ISWT ) in people with chronic obstructive pulmonary disease and whether a steady-state response was achieved when exercising at this intensity . Design Each participant performed lung function tests , an incremental cycle test , two ISWTs , and a 10-min continuous walking exercise at 70 % peak ISWT speed . Oxygen consumption ( V˙O2 ) was collected using a portable system ( Cosmed K4b2 , Rome , Italy ) . The V˙O2 from the 10-min walking exercise was compared with V˙O2peak from the better ISWT as a measure of walking exercise intensity . Results Thirty-four participants completed the study .  The mean intensity achieved during the 10-min walking exercise was 76 % ( 11 % ) V˙O2peak . Steady-state V˙O2 was achieved by minute 5 in the 10-min walking exercise . Conclusions Prescription of walking exercise at 70 % of the peak ISWT speed provided an intensity appropriate for achieving physiologic training responses Few studies have shown that the endurance shuttle walking test ( ESWT ) is responsive to treatment in patients with chronic obstructive pulmonary disease ( COPD ) . This exercise test needs to be further investigated because of its relevance for activity of daily living . The aim of the present study was to evaluate , in patients with COPD , the responsiveness of the ESWT in detecting improvement in walking performance after a single dose of salmeterol . In a r and omised , double-blind , placebo-controlled crossover trial , 20 patients with COPD performed two ESWT at 80 % of peak capacity 2.5 h after inhaling either a placebo or 50 µg of salmeterol  . Cardiorespiratory parameters were monitored during each walking test . Inspiratory capacities and Borg ratings for dyspnoea were obtained every other minute throughout the tests . Compared with placebo , salmeterol produced a significant change in lung function and a significant improvement in walking performance ( mean±sd difference in time : 117±20 s ; difference in distance : 160±277 m ) . At isotime ( the latest exercise time that was reached on both ESWT ) , a significant reduction in dyspnoea was observed after bronchodilation . Bronchodilation with salmeterol reduced dyspnoea during walking and improved walking capacity in patients with chronic obstructive pulmonary disease . These findings provide further support for the use of the endurance shuttle walking test as an evaluative tool in chronic obstructive pulmonary disease Background In patients with COPD , both laboratory exercise tests and field walking tests are used to assess physical performance . In laboratory tests , peak exercise capacity in watts ( W peak ) and /or peak oxygen uptake ( VO2 peak ) are assessed , whereas the performance on walking tests usually is expressed as distance walked . The aim of the study was to investigate the relationship between an incremental shuttle walking test ( ISWT ) and two laboratory cycle tests in order to assess whether W peak could be estimated from an ISWT . Methods Ninety-three patients with moderate or severe COPD performed an ISWT , an incremental cycle test ( ICT ) to measure W peak and a semi-steady-state cycle test with breath-by-breath gas exchange analysis ( CPET ) to measure VO2 peak . Routine equations for conversion between cycle tests were used to estimate W peak from measured VO2 peak ( CPET ) . Conversion equation for estimation of W peak from ISWT was found by univariate regression . Results There was a significant correlation between W peak and distance walked on ISWT × body weight ( r = 0.88 , p < 0.0001 ) . The agreement between W peak measured by ICT and estimated from ISWT was similar to the agreement between measured W peak ( ICT ) and W peak estimated from measured VO2 peak by CPET . Conclusion Peak exercise capacity measured by an incremental cycle test could be estimated from an ISWT with similar accuracy as when estimated from peak oxygen uptake in patients with COPD BACKGROUND Patients with Chronic Heart Failure ( CHF ) develop similar symptoms of exertional breathlessness and fatigue as patients with COPD . Although pulmonary ( exercise based ) rehabilitation ( PR ) is an integral part of the management of COPD , the potential for exercise rehabilitation ( ER ) to assist patients with CHF may not be as readily appreciated . We investigated whether combined ER for patients with CHF and COPD was feasible and effective using the model of PR . METHODS 57 patients with CHF were r and omized 2:1 to 7 weeks ER ( CHF-ER ) or 7 weeks of usual care ( CHF-UC )  . As a comparator 55 patients with COPD were simultaneously recruited to the same ER program ( COPD -ER ) . The primary outcome measure was the Incremental Shuttle Walk Test ( ISWT ) and the secondary outcome measures were the Endurance Shuttle Walk Test ( ESWT ) , isometric quadriceps strength and health status . RESULTS 27 CHF and 44 COPD patients completed ER and 17 patients with CHF completed UC . The CHF-ER group made significant improvements , compared to CHF-UC , in the mean ( 95%CI ) ISWT distance ; 62(35 - 89)m vs -6(-11 to 33)m p < 0.001 . The CHF-ER group also made statistically significant improvements in health status . The improvements in exercise performance and health status were similar between patients with CHF and COPD , treated with ER . CONCLUSION Patients with CHF who undergo ER improve similarly in their exercise performance and health status to COPD . Combined training programs for COPD and CHF are effective and feasible , such that service provision could be targeted around common disability rather than the primary organ disease OBJECTIVE To compare the effects of twice- versus once-weekly supervised pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Prospect i ve , r and omized , parallel-group study . SETTING Hospital outpatient physiotherapy department . PARTICIPANTS Patients with COPD . INTERVENTION Group 1 ( n=46 ) received 1 supervised exercise session a week and 2 unsupervised sessions ; group 2 ( n= 45 ) received 2 supervised exercise sessions a week and 1 unsupervised session for 6 weeks . Patients were assessed at baseline and at 6 weeks , 2 months , and 6 months . MAIN OUTCOME MEASURES Incremental ( ISWT ) and endurance ( ESWT ) shuttle walk tests and Chronic Respiratory Disease Question naire ( CRDQ ) . RESULTS Sixty-six of 91 patients ( group 1 , n=34 ; group 2 , n=32 ) completed the 6-week program . There was no significant difference in key outcome measures between the 2 groups ( ISWT , 13.50 m ; 95 % confidence interval [ CI ] , -10.06 to 37.15 m ; ESWT , 72.64s ; 95 % CI , -96.01 to 241.29s ; CRDQ total score , 2.54 ; 95 % CI , -3.16 to 8.24 ) . The results of the ESWTs suggest there may be an interaction between baseline exercise capacity and benefit of pulmonary rehabilitation , with more disabled patients achieving greater benefit if they are supervised twice weekly . Irrespective of group , allocation benefits after pulmonary rehabilitation had almost dissipated by 6 months . CONCLUSIONS There was no difference in the effectiveness of twice- versus once-weekly supervised pulmonary rehabilitation . This study highlights the need for development of strategies that will maintain the improvement achieved by the initial pulmonary rehabilitation program The aim of this study was to examine the effect of high intensity physical group training in water and on l and for patients with COPD with regard to physical capacity and health related quality of life ( HRQoL ) . A controlled , semi-r and omised study was conducted where 30 patients were r and omised to training either in water or on l and . Thirteen patients constituted a control group . Forty-three out patients , with moderate to severe COPD ( 27w/16 m ) , from two local hospitals in northern Sweden , were included in the study . High intensity physical group training in water ( water group ) or on l and ( l and group ) was performed for 12weeks , three times per week , 45min per session . The control group received no intervention . Pre- and post-intervention , all patients performed incremental and endurance shuttle walking tests ( ISWT and ESWT ) ,  cycle ergometer tests  and  responded question naires about HRQoL ( St. Georges Respiratory Question naire -- SGRQ and SF-36 ) . The patients trained with a mean heart rate of 80 - 90 % of peak heart rate . Both training groups increased the distance walked , i.e. l and group in ISWT ( 25 m ) and water group in ESWT ( 179 m ) . The water group increased the distance in ESWT significantly more that both the l and and the control groups . Both training groups increased the time cycled ( 40 - 85s ) and work load ( 10 - 20W ) in the cycle ergometer test . The control group deteriorated in HRQoL according to total score in SGRQ while the training groups remained constant . The water group improved their activity score in SGRQ and their physical health score in SF-36 and those improvements were significant as compared to the l and and the control groups . In conclusion , high intensity physical group training in water is of benefit for patients with COPD . It was in some areas found to be even more effective regarding improvements in physical capacity and experienced physical health compared to the same kind of training on l and Our objective was to assess the impact of an outpatient physiotherapy-led rehabilitation programme on exercise capacity and anxiety and depression scores in a cohort of adult intensive care survivors . In a prospect i ve study in a teaching hospital , 38 general intensive care survivors following hospital discharge underwent an established physiotherapy-led outpatient rehabilitation programme . The programme involved 2 hours of supervised exercise and education sessions each week and two unsupervised exercise sessions each week for 6 weeks . Assessment s took place 1 week before and 1 week after completing the programme . Primary outcome measures were changes in exercise capacity measured using the 6-minute walk test ( 6MWT ) and incremental shuttle walk test ( ISWT ) . Secondary outcome measures were changes in anxiety and depression scores using the Hospital Anxiety and Depression Scale ( HADS ) . Median distance covered in the 6MWT improved by 160 metres ( p<0.001 ) , and median distance covered in the ISWT also improved by 160 metres ( p < 0.001 ) . Significant improvement in anxiety ( p = 0.001 ) and depression ( p = 0.001 ) scores were also seen . Outpatient , physiotherapy-lead rehabilitation appears to improve both exercise capacity and anxiety and depression scores in a cohort of intensive care survivors . A similar programme should be tested in a r and omised controlled trial INTRODUCTION In severely disabled patients who are not capable of following formal pulmonary rehabilitation ( PR ) and /or tolerating higher training intensities , neuromuscular electrical stimulation ( NMES ) has been successfully utilized as a localized training method . MATERIAL S AND METHODS In this non-r and omized controlled observational study 50 patients with severe chronic obstructive pulmonary disease ( COPD ) , who were allocated into two groups . Endurance training group ( ET ) ( n= 27 ) and NMES group ( n= 23 ) . To compare the effects of NMES and ET on health-related quality of life ( HRQOL ) , exercise capacity , muscle strength , dyspnea , psychological status , and body composition in patients with severe COPD . Before and after PR program , the study parameters were assessed using the Medical Research Council ( MRC ) scale , incremental and endurance shuttle walking tests ( ISWT , ESWT ) , manual muscle testing ( MMT ) , the St. George 's Respiratory Question naire ( SGRQ ) , bioelectrical impedance analysis , and the Hospital Anxiety and Depression Scale ( HADS ) . RESULTS After the PR program , walking distance and endurance time significantly increased in both groups ( p < 0.001 for each ) , whereas the MRC scores of both groups significantly decreased ( p < 0.001 for each ) . In the ET group , significant decreases were noted in all domains of SGRQ and HADS . In the NMES group , significant improvements were observed in the HADS scores and in all SGRQ domain except symptom domain . No significant differences were observed between the NMES and ET groups regarding the changes from baseline to after PR program in walking distance ( p= 0.140 ) , endurance time ( p= 0.376 ) , the MRC ( p= 0.540 ) , HRQOL ( p > 0.05 ) and HADS ( p > 0.05 ) scores , body-mass index ( BMI ) ( p= 0.49 ) , fat-free mass ( FFM ) ( p= 0.50 ) and fat-free mass index ( FFMI ) ( p= 0.94 ) . CONCLUSION NMES can be used as an effective treatment strategy in PR programs for peripheral muscle training in patients with severe COPD Background : The incremental shuttle walking test ( SWT ) has recently been proposed as a more valid and reproducible alternative to the conventional 6-min walking test ( 6MWT ) in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease ( COPD ) . Objective : To compare the cardiorespiratory performance obtained during two sessions of SWT with that obtained during two sessions of 6MWT . Methods : We examined 18 patients ( forced expiratory volume in 1 s : 48 ± 14 % ) recovering from an acute exacerbation of COPD that had required hospitalization . In the same afternoon , each patient performed two SWT and two 6MWT , with an interval of at least 30 min between each test ; the sequence of the tests was r and omized . Results : Mean walking distance was greater in the second SWT test than in the first SWT . The changes from baseline in systolic blood pressure , heart rate , respiratory rate , oxygen saturation and dyspnea Borg index at the end of the test were similar between the two 6MWT and the two SWT . There was a highly significant correlation between walking distances measured during SWT and during 6MWT ( ρ : 0.85 , p < 0.0005 ) . Neither SWT nor 6MWT correlated with functional data of COPD . Conclusions : SWT , though being considered to be closer to a submaximal exercise test than 6MWT , does not induce a greater cardiorespiratory performance  than 6MWT in patients recovering from acute exacerbation of COPD Background Although the endurance shuttle walk test ( ESWT ) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation ( PR ) for COPD , the minimally important difference ( MID ) has not yet been established . We aim ed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR . Methods Data were derived from a r and omized controlled trial , investigating the value of noninvasive positive pressure ventilation added to PR . Fifty-five patients with stable COPD , GOLD stage IV , with chronic respiratory failure were included ( mean ( SD ) FEV1 31.1 ( 12.0 ) % pred , age 62 ( 9 ) y ) . MID estimates of the ESWT in seconds , percentage and meters change were calculated with anchor based and distribution based methods .  Six minute walking distance ( 6MWD ) , peak work rate on bicycle ergometry ( Wpeak ) and Chronic Respiratory Question naire ( CRQ ) were used as anchors and Cohen ’s effect size was used as distribution based method . Results The estimated MID of the ESWT with the different anchors ranged from 186–199 s , 76–82 % and 154–164 m. Using the distribution based method the MID was 144 s , 61 % and 137 m. Conclusions Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure . Therefore we recommend using a range of 186–199 s , 76–82 % or 154–164 m as MID of the ESWT in COPD patients with chronic respiratory failure . Further research in larger population s should eluci date whether this cut-off value is also valid in other COPD population s and with other interventions .Trial registration Clinical Trials . Gov ( ID NCT00135538 ) QUESTIONS Does an eight-week program of walk training improve endurance walking capacity in people with COPD compared to cycle training ? Does walk training improve peak walking capacity , cycle capacity , and quality of life compared to cycle training ? Is the endurance shuttle walk test ( ESWT ) responsive to change in walking capacity elicited by exercise training ? DESIGN R and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 36 people with stable COPD recruited with four dropouts . INTERVENTION Participants were r and omised into either a walk or cycle training group . Both groups trained indoors for 30 to 45 minutes per session , three times weekly over eight weeks at Concord Hospital . Training intensities were based on baseline peak exercise tests and progressed as able . OUTCOME MEASURES The primary outcome was endurance walking capacity measured by the ESWT . Secondary outcomes included peak walking capacity , peak and endurance cycle capacity , and health-related quality of life . Measures were taken at baseline ( Week 0 ) and following training ( Week 8) . RESULTS The walk training group increased their endurance walking time by 279 seconds ( 95 % CI 70 to 483 ) more than the cycle training group . No significant differences between the groups were found for any other outcome . CONCLUSION Ground walk training increased endurance walking capacity more than cycle training and was similar to cycle training in improving peak walking capacity , peak and endurance cycle capacity and quality of life . This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs In a prospect i ve , r and omized study we examined the effect of ( i ) ambulatory oxygen and ( ii ) a portable , inspiratory pressure support ( IPS ) device on the endurance shuttle walk test ( ESWT ) in patients with severe chronic obstructive pulmonary disease ( COPD ) . Ten out patients [ median ( range ) FEV1 0.60 l(0.35 , 1.45 ) ] performed the ESWT under five test conditions : baseline walk ( no assistance ) , IPS at 14 cmH2O from a portable ventilator ( the HIPPY , Friday Medical , U.K. ) , sham IPS ( < 8 cmH2O ) , ambulatory oxygen at 2 l min(-1 ) , and sham oxygen ( carrying the portable oxygen cylinder and breathing air ) . There were significant improvements in the ESWT with  ambulatory oxygen  , but a negative effect with the HIPPY device [ mean ( SD ) time : baseline 172 ( 48 ) sec ; oxygen 242 ( 62 ) sec ; HIPPY 84 ( 35 ) sec ] . The ESWT appeared sensitive to the effect of cylinder weight although differences in endurance capacity were not significant [ sham oxygen 151 ( 45 ) sec ] . The ESWT was sensitive to the acute application of oxygen , demonstrating a beneficial effect on endurance performance in patients with severe COPD . The ESWT could form the basis of a st and ardized assessment for ambulatory oxygen This study was design ed to test the effects of pursed lips breathing ( PLB ) during exercise in patients with chronic obstructive pulmonary disease ( COPD ) who did not spontaneously perform PLB . Sixtynine COPD patients , mean FEV , ( SD ) 1.09 ( 0.5 ) , age 68 ( 51 - 83 ) were recruited to the study . They performed three incremental shuttle walk tests ( ISWT ) . The first walk was design ed to identify natural PLBs and the next two walks were performed in a r and om order ; ISWT + PLB or ISWT whilst breathing normally . Measures of respiratory rate ( RR ) , breathlessness and oxygen saturation were taken before and after walks . Data was analysed using the t-test . Fifteen patients demonstrated PLB on baseline ISWT and were therefore excluded from further walking tests although baseline data was included in the analysis . There was no significant difference between walks , mean ( SD ) , 298.5 (173.7)PLB and non-PLB ; 292.5 ( 161.9 ) nor any difference in dyspnoea . There was a significant reduction in end exercise RR and recovery time with PLB , mean difference ( 95 % CI ) ; 6.2 ( 4.5 - 7.9 ) and 24.9 ( 2.8 - 47.0 ) seconds , respectively . Patients who showed a good response with the PLB walk ( 41 % ) had significantly higher baseline breathlessness , Borg score , mean ( SD ) , 1.5 ( 1.0 ) versus 0.74 (0.96)(P = 0.02 ) . Natural PLB patients demonstrated lower exercise tolerance on the baseline walk(P = 0.01 ) and a trend towards greater resting breathlessness than those who did not . This study shows PLB during exercise and recovery results in lower post exercise RR and speeds return to pre exercise breathlessness , compared with exercise and non-PLB . Reductions in RR appear to be greatest in those patients with resting breathlessness Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease ( COPD ) desaturate during exercise . Although oxygen supplementation may ameliorate oxygen desaturation , the effects on outcomes of exercise training have not been rigorously evaluated . This study aim ed to determine whether supplemental oxygen during exercise training was more effective than medical air in improving exercise capacity and health-related quality of life ( HRQoL ) in people with COPD . People with COPD who demonstrated oxygen desaturation < 90 % during the 6-min walk test were recruited to this multicentre trial with r and omisation ( independent , concealed allocation ) to either an Oxygen group or Air group , blinding ( participants , exercise trainers and European Respiratory Journal assessors ) and intention-to-treat analysis . Both groups received the respective gas from concentrators via nasal prongs at 5 L·min−1 during exercise training consisting of treadmill and cycle exercise , three times per week for 8 weeks . Primary outcomes were the endurance shuttle walk test ( ESWT ) time and Chronic Respiratory Disease Question naire (CRQ)-Total score . 111 participants ( 60 males ) , mean±sd age 69±7 years , with moderate to severe COPD were recruited and 97 completed ( Oxygen  group n=52 ; Air group n=45 ) . At the end of the 8-week training programme there were no between-group differences in change in ESWT ( mean difference 15 s ( 95 % CI −106–136 s ) or change in CRQ-Total ( 0.0 points ( 95 % CI −0.3–0.3 points ) ) . Within-group changes at end-training were significant for ESWT and CRQ-Total ( all p<0.01 ) . Exercise capacity and HRQoL improved in both groups , with no greater benefit from training with supplemental oxygen than medical air . Exercise training improved exercise capacity and quality of life in normoxaemic COPD patients who demonstrated oxygen desaturation during exercise , with no greater improvement with supplemental oxygen during exercise training compared to air Aim : The purpose of this study was to investigate whether adding neuromuscular electrical stimulation ( NMES ) to a comprehensive pulmonary rehabilitation ( cPR ) program would have additive effects on clinical -functional outcomes . Methods : Twenty-seven chronic obstructive pulmonary disease patients participating in a 10-week cPR program were r and omly allocated to NMES + cPR ( n = 13 ) or Sham + cPR ( n = 14 ) groups . Quadriceps strength , exercise capacity , symptoms , mood , activities of daily living and quality of life were evaluated pre- and post- interventions . Results : There were no significant differences in any of the physiological and subjective improvements induced by NMES + cPR versus Sham + cPR ( p > 0.05 ) . In fact , the NMES + cPR group showed lower increases in incremental shuttle walk test ( ISWT ) distance ( 38.4 vs 69.2 m , respectively ) and % ISWT distance ( 5.1 vs 9 % , respectively ) compared with the Sham + cPR group ( p < 0.05 ) . Conclusion : The increase in exercise capacity is less important when NMES is used as an adjunct to the cPR PURPOSE : The Incremental Shuttle Walk Test ( ISWT ) is an important functional and prognostic marker in chronic disease . Aging has a detrimental effect on exercise performance . The objective of this study was to produce normal age-specific values for the ISWT in a healthy British population and to explore whether additional variables improve the accuracy of a predictive equation . METHODS : Healthy subjects ( N = 152 ) , aged 40 to 90 years , were recruited . Data collection occurred over 2 study visits . Anthropometric and demographic data were collected , and lung function and quadriceps maximal voluntary contraction were measured . An accelerometer was worn for 2 consecutive days at home . The Duke Activity Status Index was completed , and the greatest distance from 2 ISWTs was recorded . RESULTS : One hundred forty subjects ( 56 men ) with mean age ( SD ) of 59.4 ( 11.0 ) years completed 2 ISWTs . Forced expiratory volume in 1 second ( FEV1 ) was 109.1 % ( 14.56 % ) predicted and ISWT distance was 737 m ( 183 m ) . Age-specific normal values for the ISWT were observed : mean ( lower limit of normal)—40 to 49 years , 824 m ( 765 m ) ; 50 to 59 years , 788 m ( 730 m ) ; 60 to 69 years , 699 m ( 649 m ) ; and 70 years and older , 633 m ( 562 m ) . A predictive equation was developed from 114 subjects . Age , body mass index , FEV1 , quadriceps maximal voluntary contraction , and Duke Activity Status Index contributed to ISWT distance predicting 50.4 % of the variation in performance . CONCLUSION : We have developed age-specific normal values for performance on the ISWT in a healthy British population . However , even using practical , clinical ly relevant variables , it is not possible to accurately predict exercise capacity from a regression equation Abstract The use of rhythmic music is beneficial in assisting with the exercise intensity at home . This paper investigated the effects of paced walking to music at home with an 80 % VO2 peak for patients with COPD . A prospect i ve r and omized clinical trial consisting of a treatment group ( n = 20 ) assigned to a 12-week period of paced walking to music at home , while the patients in the control group ( n = 21 ) were only given educational information . The treatment response was measured based on the patient 's score in the maximal exercise capacity test using the incremental shuttle walking test ( ISWT ) , lung function , health- related quality of life ( HRQOL ) using the Saint George Respiratory Question naire ( SGRQ ) and their health care utilization during baseline , 4 , 8 , 12 and 16 weeks . The treatment group increased their distance in the ISWT from 243.5 ± 135.4 at baseline to 16 weeks ( 306.0 ± 107.3 , p < 0.001 ) , Borg RPE-D decreased from 2.2 ± 1.3 at baseline to 0.8 ± 1.1 ( p < 0.001 ) at 16 weeks , and Borg RPE-L decreased from 1.2 ± 1.4 at baseline to 0.3 ± 0.7 ( p < 0.05 ) at 16 weeks , and improved all of the domains of the SGRQ , compared to the control group . The paced walking to music at home program helps patients to achieve a higher-intensity exercise . It is easily incorporated into the care of COPD patients , providing them with a convenient , safe and enjoyable exercise Background Symptomatic relief is an important treatment goal for patients with COPD . To date , no diary for evaluating respiratory symptoms in clinical trials has been developed and scientifically-vali date d according to FDA and EMA guidelines . The EXACT – Respiratory Symptoms ( E-RS ) scale is a patient-reported outcome ( PRO ) measure design ed to address this need . The E-RS utilizes 11 respiratory symptom items from the existing and vali date d 14-item EXACT , which measures symptoms of exacerbation . The E-RS total score quantifies respiratory symptom severity , and 3 domains assess breathlessness , cough and sputum , and chest symptoms . Methods This study examined the performance of the E-RS in each of 3 controlled trials with common and unique validation variables : one 6-month ( N = 235 , US ) and two 3-month ( N = 749 ; N = 597 ; international ) . Subjects completed the E-RS as part of a daily eDiary . Tests of reliability , validity , and responsiveness were conducted in each data set . Results In each study , RS-Total score was internally consistent ( Cronbach α ) ( 0.88 , 0.92 , 0.92 ) and reproducible ( intra-class correlation ) in stable patients ( 2 days apart : 0.91 ; 7 days apart : 0.71 , 0.74 ) . RS-Total scores correlated significantly with the following criterion variables ( Spearman 's rho ; p < 0.01 , all comparisons listed here ) : FEV1 % predicted ( -0.19 , -0.14 , -0.15 ) ; St. George 's Respiratory Question naire ( SGRQ ) ( 0.65 , 0.52 , 0.51 ) ; Breathlessness , Cough , and Sputum Scale ( BCSS ) ( 0.89 , 0.89 ) ; modified Medical Research Council dyspnoea scale ( mMRC ) ( 0.40 ) ; rescue medication use ( 0.43 , 0.42 ) ; Functional Performance Inventory Short-Form ( FPI-SF ) ( 0.43 ) ; 6-minute walk distance ( 6-MWT ) ( -0.30 , -0.14 ) and incremental shuttle walk ( ISWT ) ( -0.18 ) tests . Correlations between these variables and RS-Breathlessness , RS-Cough and Sputum , RS-Chest Symptoms scores supported subscale validity . RS-Total , RS-Breathlessness , and RS-Chest Symptoms differentiated mMRC levels of breathlessness severity ( p < 0.0001 ) . RS-Total and domain scores differentiated subjects with no rescue medication use and 3 or more puffs ( p < 0.0001 ) . Sensitivity to changes in health status ( SGRQ ) , symptoms ( BCSS ) , and exercise capacity ( 6MWT , ISWT ) were also shown and responder definitions using criterion- and distribution-based methods are proposed . Conclusions Results suggest the E-RS is a reliable , valid , and responsive measure of respiratory symptoms of COPD suitable for use in natural history studies and clinical trials . Trial registration MPEX : NCT00739648 ; AZ1 : NCT00949975 ; AZ 2 : Background : The 6-min walk test ( 6MWT ) is increasingly used as an outcome measure in interstitial lung disease ( ILD ) . Aim : To evaluate the usefulness of the 6MWT in a cohort of patients with ILD secondary to systemic sclerosis ( SSc ) and to correlate with established physiological parameters . Methods : 163 patients with SSc-ILD were recruited for a multicentre , r and omised , double-blind clinical trial . Available data at protocol screening included repeated 6MWTs , pulmonary function testing with diffusing capacity , Doppler echocardiography and high-resolution computed tomography of the thorax . Borg Dyspnoea Index was evaluated before and after 6MWT . Results : Mean ( st and ard deviation ( SD ) ) distance walked during walk test 1 was 396.6 ( 84.55 ) m compared with 399.5 ( 86.28 ) m at walk test 2 . The within-subject , intertest correlation as determined by Pearson ’s correlation coefficient testing was 0.95 ( p<0.001 ) . However , only weak correlations of 6MWT with percentage forced vital capacity and the Borg Dyspnoea Index were observed , and no correlation was observed with percentage diffusing capacity . Conclusion : These data confirm the high reproducibility of the  6MWT in patients with SSc-ILD and therefore the validity of the test in this cohort . The lack of correlation of 6MWT with st and ard physiological parameters of ILD suggests a multifactorial basis for limited exercise capacity in patients with SSc and calls into question the utility of the 6MWT as a measure of outcome in future studies on SSc-ILD Study objectives Patients with chronic obstructive pulmonary disease ( COPD ) have low exercise capacity and low content of high energetic phosphates in their skeletal muscles . The aim of the present study was to investigate whether creatine supplementation together with exercise training may increase physical performance compared with exercise training in patients with COPD . Design In a r and omized , double-blind , placebo-controlled study , 23 patients with COPD ( forced expiratory volume in one second [ FEV1 ] < 70 % of predicted ) were r and omized to oral creatine ( n = 13 ) or placebo ( n = 10 ) supplementation during an 8-week rehabilitation programme including exercise training . Physical performance was assessed by Endurance Shuttle Walking Test ( ESWT ) , dyspnea and leg fatigue with Borg CR-10 , quality of life with St George ’s Respiratory Question naire ( SGRQ ) . In addition , lung function test , artery blood gases , grip strength test , muscle strength and fatigue in knee extensors were measured . Results COPD patients receiving creatine supplementation increased their average walking time by 61 % ( ESWT ) ( p < 0.05 ) after the training period compared with 48 % ( p = 0.07 ) in the placebo group . Rated dyspnea directly after the ESWT decreased significantly from 7 to 5 ( p < 0.05 ) in the creatine group . However , the difference between the groups was not statistically significant neither in walking time nor in rated dyspnea . Creatine supplementation did not increase the health related quality of life , lung function , artery blood gases , grip strength and knee extensor strength/fatigue . Conclusions Oral creatine supplementation in combination with exercise training showed no significant improvement in physical performance , measured as ESWT , in patients with COPD compared with exercise training alone Abstract Purpose : To evaluate the effectiveness of a home-based inspiratory muscle training ( IMT ) programme using multiple inspiratory muscle tests . Method : Sixty-eight patients ( 37 M ) with moderate to severe chronic obstructive pulmonary disease ( COPD ) ( Mean [ SD ] , FEV1 36.1 [13.6]% pred . ; FEV1/FVC 35.7 [11.2]% ) were r and omised into an experimental or control group and trained with a threshold loading device at intensity > 30 % maximum inspiratory pressure ( PImax ) or < 15 % PImax , respectively , for 7 weeks . Thirty-nine patients ( 23 M ) completed the study . The following measures were assessed pre- and post-IMT : PImax , sniff inspiratory nasal pressure ( SNIP ) , diaphragm contractility ( Pdi , tw ) , incremental shuttle walk test ( ISWT ) , respiratory muscle endurance ( RME ) , chronic respiratory disease question naire ( CRDQ ) , the hospital anxiety and depression scale ( HADS ) and the SF-36 . Between-group changes were assessed using one-way analysis of variance ( ANOVA ) . Results : PImax and perception of well-being improved significantly post-IMT [ p = 0.04 and < 0.05 in four domains , respectively ] . This was not reflected in SNIP [ p = 0.7 ] , Pdi , tw [ p = 0.8 ] , RME [ p = 0.9 ] or ISWT [ p = 0.5 ] . Conclusions : A seven-week , community-based IMT programme , with realistic use of health-care re sources , improves PImax and perception of well-being but a different design may be required for improvement in other measures . Multiple tests provide a more comprehensive evaluation of changes in muscle function post-IMT . Implication s for Rehabilitation A seven-week , home-based inspiratory muscle training programme improves maximal inspiratory pressure and perception of well-being in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm contractility , respiratory muscle endurance and exercise capacity . Multiple tests are recommended for a more comprehensive assessment of changes in muscle function following inspiratory muscle training programmes . Therapists need to explore different community-based inspiratory muscle training regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to improvements in diaphragm contractility and exercise capacity Background : The TORRACTO ® study evaluated the effects of tiotropium/olo date rol versus placebo on endurance time during constant work-rate cycling and constant speed shuttle walking in patients with chronic obstructive pulmonary disease ( COPD ) after 12 weeks of treatment . Methods : The effects of once-daily tiotropium/olo date rol ( 2.5/5 and 5/5 μg ) on endurance time during constant work-rate cycle ergometry ( CWRCE ) after 6 and 12 weeks of treatment were compared with placebo in patients with COPD in a r and omized , double-blind , placebo-controlled , parallel-group clinical trial . Endurance time during the endurance shuttle walk test ( ESWT ) after 6 and 12 weeks of treatment was also evaluated in a subset of patients . Results : A total of 404 patients received treatment , with 165 participating in the ESWT sub study . A statistically significant improvement in endurance time during CWRCE was observed after 12 weeks ( primary endpoint ) with tiotropium/olo date rol 5/5 µg [ 14 % ( p = 0.02 ) ] but not with tiotropium/olo date rol 2.5/5 µg [ 9 % ( p = 0.14 ) ] versus placebo . In the ESWT sub study , a trend to improvement in endurance time during ESWT after 12 weeks ( key secondary endpoint ) was observed with tiotropium/olo date rol 5/5 µg [ 21 % ( p = 0.055 ) ] and tiotropium/olo date rol 2.5/5 µg [ 21 % ( p = 0.056 ) ] versus placebo . Conclusion : Tiotropium/olo date rol 5/5 µg improved endurance time during cycle ergometry versus placebo , with a strong tendency to also improve walking endurance time . [ Clinical Trials.gov identifier : NCT01525615 . The 6-min walking test ( 6MWT ) is frequently used to assess functional capacity in chronic cardiopulmonary disorders because of its simplicity . The study examines the physiological responses during encouraged 6MWT in patients with chronic obstructive pulmonary disease . Pulmonary oxygen ( O2 ) uptake ( V′O2 ) was measured in 20 male patients ( age 66±6 yrs , forced expiratory volume in one second 45±14 % predicted ) during 6MWT and incremental cycling  , in r and om order  . O2 tension in arterial blood , carbon dioxide tension in arterial blood and arterial lactate concentration ( [La]art ) were obtained in the last 10 patients . During the 6MWT  , V′O2 showed a plateau after the 3rd min ( 1.39±0.28 , 1.42±0.31 , and 1.40±0.30 L·min−1 , 4th , 5th and 6th min , respectively ) , and minute ventilation ( V′E ) ( 42±8 L·min−1 ) was 91 % maximal voluntary ventilation . No differences were shown between 6MWT ( 6th min ) and peak cycling exercise in V′O2 ( 1.40±0.30 versus 1.41±0.28 L·min−1 , respectively ) , cardiac frequency ( 126±13 versus 130±12 beats·min−1 ) , or arterial respiratory blood gases . The two tests were significantly different in V′E ( 42±8 versus 47±8 L·min−1 , 6MWT versus cycling , respectively ) , carbon dioxide production ( 1.30±0.31 versus 1.45±0.18 L·min−1 ) and [La]art ( 2.9±1.99 versus 5.9±1.51 M ) . The study demonstrates that an encouraged 6-min walking test  generates a high but sustainable oxygen uptake . Since the oxygen uptake plateau reflects the integrated response of the system , it may explain the high prognostic value of the 6-min walking test Objectives Pulmonary rehabilitation ( PR ) provides benefit for patients with chronic obstructive pulmonary disease ( COPD ) in terms of quality of life ( QoL ) and exercise capacity ; however , the effects diminish over time . Our aim was to evaluate a maintenance programme for patients who had completed PR . Setting Primary and secondary care PR programmes in Norfolk . Participants 148 patients with COPD who had completed at least 60 % of a st and ard PR programme were r and omised and data are available for 110 patients . Patients had greater than 20 pack year smoking history and less than 80 % predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection . Interventions Patients were r and omised to receive a maintenance programme or st and ard care . The maintenance programme consisted of 2 h ( 1 h individually tailored exercise training and 1 h education programme ) every 3 months for 1 year . Primary and secondary outcome measures The Chronic Respiratory Question naire ( CRQ ) ( primary outcome ) , endurance shuttle walk test ( ESWT ) , EuroQol ( EQ5D ) , hospital anxiety and depression score ( HADS ) , body mass index ( BMI ) , body fat , activity levels ( overall score and activity diary ) and exacerbations were assessed before and after 12 months . Results There was no statistically significant difference between the groups for the change in CRQ dyspnoea score ( primary end point ) at 12 months which amounted to 0.19 ( −0.26 to 0.64 ) units or other domains of the CRQ . There was no difference in the ESWT duration ( −10.06 ( −191.16 to 171.03 ) seconds ) , BMI , body fat , EQ5D , MET-minutes , activity rating , HADS , exacerbations or admissions . Conclusions A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months . We do not recommend that our maintenance programme is adopted . Other methods of sustaining the benefits of PR are required . Trial registration number NCT00925171 OBJECTIVES ( 1 ) To examine the concurrent criterion validity of the modified shuttle walk test ( MSWT ) by using the 6- ( 6MWT ) and 12-minute walk test ( 12MWT ) , ( 2 ) to examine the concurrent criterion validity of the estimated maximum oxygen uptake ( Vo2max ) of the MSWT with actual Vo2max , and ( 3 ) to determine test-retest reliability of the MSWT in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Validation study . SETTING Outpatient pulmonary rehabilitation program . PARTICIPANTS Thirty clinical ly stable adults with COPD . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Subjects were r and omly assigned to receive either the 6MWT and 12MWT or the MSWT first . The MSWT was repeated 1 week later ( N = 30 ) . Estimated Vo2max was calculated , and actual Vo2max was conducted by using the Jones test . Validity of the MSWT was assessed by comparing endurance scores and Vo2max with results from the 6MWT and 12MWT and Jones test , respectively . RESULTS There was a moderately high correlation between the  MSWT  and the 6MWT and 12MWT at initial testing ( .82 and .74 , respectively ) . Correlation between estimated and actual Vo2max was r equal to .68 . Test-retest reliability for the entire sample was high ( intraclass correlation coefficient , .88 ) . Results remained quite stable across severity , age , and sex subgroups . CONCLUSIONS The MSWT is a st and ardized externally paced submaximal endurance walking test . The results indicate that the MSWT has high concurrent validity and test-retest reliability for patients with COPD Background . Exertional dyspnoea limits level of physical activity in people with Chronic Obstructive Pulmonary Disease ( COPD ) . This r and omized , double-blinded , crossover study evaluated the effect of Acu-TENS , application of Transcutaneous Electrical Nerve Stimulation on acupoints , on breathlessness during exercise in people with COPD . Methods . Twenty-one participants , mean% predicted FEV1 50 ± 21 % , attended assessment followed by two intervention days , one week apart . On each intervention day , participants performed two  endurance shuttle walk tests  ( ESWT ) ( Walk 1 and Walk 2 ) . Walk 1 was performed without intervention and Walk 2 was performed with either Acu-TENS or Sham-TENS , in r and om order , for 45 minutes before and during Walk 2 . Duration of each ESWT and dyspnoea score at isotime of Walk 1 and Walk 2 on each intervention day were compared . Between-group differences in ESWT duration and isotime dyspnoea were also compared . Results . At isotime of Walk 1 and Walk 2 , Acu-TENS showed significant reduction in dyspnoea of −0.8 point ( 95 % CI −0.2 to −1.4 ) but not in Sham-TENS [ 0.1 point ( 95 % CI −0.4 to 0.6 ) ] . Compared to Sham-TENS , Acu-TENS showed significant reduction in dyspnoea of −0.9 point ( 95 % CI −0.2 to −1.6 ) while no between-group significance was found in ESWT duration . Conclusion . Acu-TENS  alleviated dyspnoea during walking in people with COPD but did not increase walking duration Background : Ambulatory oxygen is frequently prescribed for patients with chronic obstructive pulmonary disease ( COPD ) who have oxygen desaturation ≤88 % during exercise . The 6-min walk test ( 6MWT ) with continuous pulse oximetry monitoring is a common method to document this oxygen desaturation , but the reproducibility of this test in determining the need for ambulatory oxygen in patients with COPD is not well documented . Objective : The aim of this study was to establish the reproducibility of the 6MWT in determining the need for ambulatory oxygen prescription in stable COPD patients using the Centers for Medicare and Medicaid ( CMS ) criteria for ambulatory oxygen prescription . Methods : The study was design ed as a prospect i ve observational study in an academic health center and associated pulmonary rehabilitation program . Eighty-eight COPD patients referred to pulmonary rehabilitation underwent continuous pulse oximetry while performing st and ard 6MWT on 3 separate days . Results : Fifty-one ( 58 % ) of these patients desaturated by continuous pulse oximetry to an SpO2 ≤88 % on a least one of the 6MWTs . Only 26 patients ( 30 % ) demonstrated consistency in meeting the criteria for ambulatory oxygen set forth by the CMS on all three 6MWT with a κ statistic of 0.62 . The percent agreement between 6MWTs for ambulatory oxygen prescription was 72 % and the paired observation was 51 % . Conclusions : The 6MWT distance is simple and widely used as a consistent measure of functional capacity in patients with COPD ; however , the 6MWT oxygen saturation has only modest reproducibility in determining the need for ambulatory oxygen in stable COPD patients undergoing pulmonary rehabilitation The six-minute walk test ( 6MWT ) has been broadly used in clinical setting s. Several reference equations for prediction of the total distance walked during the test ( 6MWD ) are available in literature . The present review aim ed to critically discuss studies , published in Portuguese and English ( LILACS , SCIELO , MEDLINE , PUBMED ) , which evaluated normal values and created reference equations for predicting 6MWD in healthy subjects , comparing them with the results that were recently obtained in Brazilian individuals . Age , sex , weight , height and body mass index were the main demographic and anthropometric features more often correlated with 6MWD . The equations derived from these characteristics were able to explain between 25 and 66 % of the total variability in the 6MWD . Unfortunately , the foreign equations were not applicable to the Brazilian population . Even when the 6MWT was performed following strict st and ardization , the difference in 6MWT performance between foreign and Brazilian individuals remains , indicating the necessity of providing specific reference equations for each population and /or ethnic group . Accordingly , these equations developed in Brazil are probably the most appropriate for interpreting 6MWT performance in Brazilian patients with chronic diseases affecting the exercise capacity . Future studies are necessary with larger sample sizes ( e.g. multicentric ones ) and r and omized design for the reference values of the 6MWD to be considered reliable AIM The aim of our study was to assess the efficacy of pulmonary rehabilitation in addition to regular chest physiotherapy in non cystic fibrosis bronchiectasis . METHODS Thirty patients with clinical ly significant bronchiectasis and limited exercise tolerance were r and omized into either the control group receiving chest physiotherapy ( 8 weeks ) or into the  intervention group , receiving pulmonary rehabilitation in addition to chest physiotherapy ( 8 weeks ) . Both groups were encouraged to maintain their exercise program and or chest physiotherapy , following completion of the study . RESULTS End of training ( 8 weeks ) No improvement in control group . In the intervention group , incremental shuttle walk test ( ISWT ) improved by 56.7 m ( p = 0.03 ) , endurance walk test ( EWT ) by 193.3 m ( p = 0.01 ) , Leicester Cough Question naire ( LCQ ) improved by 2.6 units ( p < 0.001 ) and St. George 's Respiratory Question naire ( SGRQ ) by 8 units ( p < 0.001 ) . At 20 weeks ( 12 weeks post end of training ) No improvement in control group . In the intervention group , ISWT improved by 80 m ( p = 0.04 ) and EWT by 247.5 m ( p = 0.003 ) . LCQ improved by 4.4 units ( p < 0.001 ) and SGRQ by 4 units ( p < 0.001 ) . CONCLUSION Pulmonary rehabilitation in addition to regular chest physiotherapy , improves exercise tolerance and health related quality of life  in non cystic fibrosis bronchiectasis and the benefit was sustained at 12 weeks post end of pulmonary rehabilitation . Clinical trials regn no. NCT00868075 BACKGROUND The acute consumption of dietary nitrate has been shown to improve exercise capacity in athletes , healthy adults and subjects with peripheral vascular disease . Many COPD patients have reduced exercise capacity . We hypothesized that acute nitrate consumption might increase incremental shuttle walk test ( ISWT ) distance in COPD subjects . METHODS Eleven COPD subjects were r and omly assigned to consume either a high nitrate or a matched , low nitrate beverage in a double-blind , r and omized , placebo-controlled , crossover design . ISWT distance was measured both before and 3 h after the beverage and change was recorded . After a 7-day washout , ISWT distances were re-measured before and 3 h after the alternate beverage and changes were recorded . RESULTS We observed an increase in ISWT distance after consuming the high nitrate juice ( 25 m ) compared with a reduction after the low nitrate juice ( 14 m ) ( p < 0.01 ) . This improvement in exercise capacity was associated with significant increases in serum nitrate ( p < 0.000005 ) and nitrite ( p < 0.01 ) levels and a significant lowering of resting blood pressure ( < 0.05 ) . CONCLUSIONS In patients with stable COPD , the acute consumption of dietary nitrate increased serum nitrate/nitrite levels and exercise capacity and was associated with a decrease in resting blood pressure .  Nitrate consumption might alter exercise capacity in COPD patients L and -based exercise is often difficult for people with chronic obstructive pulmonary disease ( COPD ) who have coexisting obesity or musculoskeletal or neurological conditions . This r and omised controlled trial aim ed to determine the effectiveness of water-based exercise training in improving exercise capacity and quality of life compared to l and -based exercise training and control ( no exercise ) in people with COPD and physical comorbidities . Participants referred to pulmonary rehabilitation were r and omly allocated to a water-based exercise , l and -based exercise or the control group . The two exercise groups trained for 8 weeks , completing three sessions per week . 45 out of 53 participants ( mean±sd age 72±9 years ; forced expiratory volume in 1 s 59±15 % predicted ) completed the study . Compared to controls , water-based exercise training  significantly increased 6-min walking distance , incremental and endurance shuttle walk distances , and improved Chronic Respiratory Disease Question naire ( CRDQ ) dyspnoea and fatigue . Compared to l and -based exercise training , water-based exercise training significantly increased incremental shuttle walk distance ( mean difference 39 m , 95 % CI 5–72 m ) , endurance shuttle walk distance ( mean difference 228 m , 95 % CI 19–438 m ) and improved CRDQ fatigue  . Water-based exercise training was significantly more effective than l and -based exercise training and control in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD and physical comorbidities Background : Bariatric surgery is effective for the treatment of stage II and III obesity and its related diseases , although increasing evidence is showing weight regain ~12–24 months postsurgery . Weight regain increases the risk of physical function decline , which negatively affects an individual 's ability to undertake activities of daily living . The study assessed the effects of a 12-week supervised exercise intervention on physical function and body composition in patients between 12 and 24 months post bariatric surgery . Methods : Twenty-four inactive adult bariatric surgery patients whose body mass index remained ⩾30 kg m2 12 to 24 months post surgery were r and omised to an exercise intervention ( n=12 ) or control group ( n=12 ) . Supervised exercise consisted of three 60-min gym sessions per week of moderate intensity aerobic and resistance training for 12 weeks . Control participants received usual care .  The incremental shuttle walk test ( ISWT ) was used to assess functional walking performance after the 12-week exercise intervention , and at 24 weeks follow-up . Measures of anthropometric , physical activity , cardiovascular and psychological outcomes were also examined . Using an intention-to-treat protocol , independent t-tests were used to compare outcome measures between groups . Results : Significant improvements in the exercise group were observed for the ISWT , body composition , physical function , cardiovascular and self-efficacy measures from baseline to 12 weeks . A large baseline to 12-week change was observed for the ISWT ( exercise : 325.00±117.28 m ; control : 355.00±80.62 m , P<0.001 ) . The exercise group at 24 weeks recorded an overall mean improvement of 143.3±86.6 m and the control group recorded a reduction of −32.50±75.93 m. Findings show a 5.6 kg difference between groups in body mass change from baseline to 24 weeks favouring the exercise group . Conclusions : A 12-week supervised exercise intervention led to significant improvements in body mass and functional walking ability post intervention , with further improvements at the 24-week follow-up Background : The evidence of benefit for pulmonary rehabilitation ( PR ) programmes is established . However , the optimal duration of a PR programme is not known . A r and omised controlled trial was undertaken in patients with chronic obstructive pulmonary disease ( COPD ) to assess whether a 4 week PR programme was equivalent to our conventional 7 week PR programme at equivalent time points of 7 weeks and 6 months . Methods : One hundred patients ( 56 men ) with stable COPD of mean ( SD ) age 70 ( 8) years and forced expiratory volume in 1 second ( FEV1 ) 1.13 ( 0.50 ) litres were r and omised to either a 7 week ( n = 50 ) or 4 week ( n = 50 ) supervised PR programme . Patients were assessed at baseline , at completion of the supervised PR programme , and 6 months later . Patients r and omised to the 4 week group were also assessed at the 7 week time point . Outcome measures were the Incremental Shuttle Walk Test , Endurance Shuttle Walk Test ( ESWT ) , Chronic Respiratory Question naire-Self Reported , and the Breathing Problems Question naire . Results : Forty one patients in each group completed the PR programme . Patients made significant within group improvements after supervised rehabilitation . There were no statistically significant differences between the groups for any other measure at the 7 week or 6 month time points , except that patients in the 4 week group attained higher ESWT times ( mean difference 124 seconds ( 95 % CI 17.00 to 232.16 ) , p = 0.024 ) at the 7 week time point . Conclusions : A shortened 4 week supervised PR programme is equivalent to a 7 week supervised PR programme at the comparable time points of 7 weeks and 6 months The purpose of this study was to investigate the relationship between performance on the shuttle walking test and maximal oxygen uptake ( VO2max ) during a conventional treadmill test in patients with chronic airflow limitation . Two different techniques were used to measure oxygen consumption , i.e. conventional Douglas bag techniques ( treadmill test ) and a portable oxygen consumption meter ( shuttle test ) . Initially , 19 patients performed a shuttle walking test ( after one practice walk ) and a maximal treadmill walking test , in a r and omized , balanced design . Subsequently , 10 patients , ( after one practice ) completed an unencumbered shuttle walking test and one supporting the portable oxygen consumption meter , in r and om order . The results of the first experiment revealed a strong relationship between performance during the shuttle walking test and VO2max during the treadmill walking test ( r = 0.88 ) . The results of the second experiment consistently demonstrated an incremental increase in oxygen consumption and ventilation in response to the increasing intensity of the shuttle walking test . Again , a strong relationship between VO2max and performance on the shuttle test was demonstrated ( r = 0.81 ) . We concluded that the shuttle walking test is a valid field exercise test of functional capacity . Performance on the test relates strongly to VO2max , the traditional indicator of cardiorespiratory capacity The purpose of the present study was to compare the characteristics of three different exercise tests in evaluating the effects of oxitropium bromide on exercise performance . Thirty-eight males with stable chronic obstructive pulmonary disease ( COPD ) ( FEV(1 ) = 40.8 + /- 16.5 % predicted ; mean + /- SD ) completed r and omized , double-blind , placebo-controlled , crossover studies for each exercise test . The exercise tests were performed 60 min after the inhalation of either oxitropium bromide 400 microg or placebo . The patients performed 6-min walking tests ( 6MWT ) on Days 1 and 2 , progressive cycle ergometry ( PCE ) on Days 3 and 4 , and cycle endurance tests at 80 % of the maximal workload of PCE on Days 5 and 6 . Spirometry was conducted before and at 45 and 90 min after the inhalation . Oxitropium bromide significantly increased FEV(1 ) as compared with placebo . Oxitropium bromide increased the endurance time significantly , by 19 % ( p < 0.001 ) , and caused a small but significant increase in the 6-min walking distance by 1 % ( p < 0.05 ) , but induced no significant increase in maximal oxygen consumption ( V O(2)max ) in PCE . The responses in these three exercise tests were different , and we conclude that the endurance test was the most sensitive in detecting the effects of inhaled anticholinergic agents on exercise performance in patients with stable COPD . An endurance procedure may be performed to detect clinical changes in evaluating the effects of oxitropium bromide on exercise performance BACKGROUND The purpose of this study was to evaluate respiratory muscle strength and endurance in the inpatient period in patients who recently experienced myocardial infa rct ion ( MI ) and investigate the effects of a home-based walking program on respiratory strength and endurance in low-risk patients after MI . METHODS Patients were r and omized into a usual-care group ( UCG ) entailing regular care  ( n = 23 ) and an intervention group ( IG ) entailing an outpatient home-based walking program  ( n = 31 ) . Healthy sex- and age-matched participants served as a control group for respiratory endurance variables . Respiratory muscle strength was evaluated through maximal inspiratory pressure ( MIP ) and endurance during the inpatient period , at 15 days , and at 60 days after MI . Submaximal functional capacity was determined by a 6-minute walk test ( 6MWT ) at hospital discharge and 60 days after MI . RESULTS Both groups showed impaired inspiratory muscle strength at hospital discharge . When compared with healthy individuals , after MI , patients had worse respiratory muscle endurance pressure ( PTHmax = 73.02 ± 8.40 vs 44.47 ± 16.32 ; P < 0.05 ) and time ( Tlim = 324.1 ± 12.2 vs 58.7 ± 93.3 ; P < 0.05 ) . Only the IG showed a significant improvement in MIP and PTHmax at 15 days and 60 days after MI ( P < 0.05 ) . When comparing groups , the IG achieved higher values for MIP , PTHmax , and Tlim 15 and 60 days after MI ( P < 0.01 ) . The 60-day assessment revealed that the 6MWT distance and level of physical activity was significantly higher in the IG compared with the UCG . CONCLUSIONS Low-risk patients recently experiencing MI demonstrate impaired MIP and respiratory endurance compared with healthy participants . A home-based walking program improved respiratory endurance and functional capacity STUDY OBJECTIVES This study was conducted to examine the short-term effects of using a rollator on functional exercise capacity among individuals with COPD and to characterize which individuals benefit most from its use . DESIGN Repeated- measures r and omized crossover design using the 6-min walk test ( 6MWT ) as the primary outcome measure . SETTING Respiratory rehabilitation center . PATIENTS Forty stable subjects who had received a diagnosis of COPD . INTERVENTIONS Two 6MWTs were performed on each study day . One 6MWT was performed unaided , and the other was performed with a rollator . The order was r and omized on the first day and reversed on the second day . RESULTS Use of the rollator was associated with a significant reduction in dyspnea ( p < 0.001 ) and duration of rest ( reduction for the total group , 19 s ; and reduction for those who walked < 300 m unaided , 40 s ; p = 0.001 ) during the 6MWT . For subjects who walked < 300 m unaided , there was also a significant improvement in distance walked ( p = 0.02 ) . No changes were found for the measures of cardiorespiratory function or gait ( p > 0.05 ) . The requirement to rest during an unaided 6MWT was a significant predictor of improved functional exercise capacity with the use of the rollator ( p < 0.005 ) . The majority of subjects whose unaided 6MWT distance was < 300 m preferred using the rollator to walking unaided . CONCLUSIONS Use of a rollator was effective in improving functional exercise capacity by reducing dyspnea and rest duration among stable individuals with severe COPD . Individuals who walked < 300 m and individuals who required a rest during an unaided 6MWT benefited the most from using a rollator in terms of reduced dyspnea , reduced rest time , and improved distance walked Background Oxygen desaturation during exercise is common in people with chronic obstructive pulmonary disease ( COPD ) . The aim of the study is to determine , in people with COPD who desaturate during exercise , whether supplemental oxygen during an eight-week exercise training program is more effective than medical air ( sham intervention ) in improving exercise capacity and health-related quality of life both at the completion of training and at six-month follow up . Methods / Design This is a multi-centre r and omised controlled trial with concealed allocation , blinding of participants , exercise trainers and assessors , and intention-to-treat analysis . 110 people with chronic obstructive pulmonary disease who demonstrate oxygen desaturation lower than 90 % during the six-minute walk test will be recruited from pulmonary rehabilitation programs in seven teaching hospitals in Australia . People with chronic obstructive pulmonary disease on long term oxygen therapy will be excluded . After confirmation of eligibility and baseline assessment , participants will be r and omised to receive either supplemental oxygen or medical air during an eight-week supervised treadmill and cycle exercise training program , three times per week for eight weeks , in hospital outpatient setting s. Primary outcome measures will be endurance walking capacity assessed by the endurance shuttle walk test and health-related quality of life assessed by the Chronic Respiratory Disease Question naire . Secondary outcomes will include peak walking capacity measured by the incremental shuttle walk test , dyspnoea via the Dyspnoea-12 question naire and physical activity levels measured over seven days using an activity monitor . All outcomes will be measured at baseline , completion of training and at six-month follow up . Discussion Exercise training is an essential component of pulmonary rehabilitation for people with COPD . This study will determine whether supplemental oxygen during exercise training is more effective than medical air in improving exercise capacity and health-related quality of life in people with COPD who desaturate during exercise . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12612000395831 , 5th Background : The six-minute walk test ( 6mWT ) is a simple index of functional capacity in healthy people , and it has been used to estimate exercise capacity in obese subjects . The aim of this study was to determine whether weight reduction induced by laparoscopic adjustable gastric b and ing ( LAGB ) improves the functional capacity in the severely obese on the 6mWT . Methods : A prospect i ve 1-year study was carried out at the Hospital Casoria , Naples , involving 15 consecutive severely obese patients who underwent the 6mWT before and 1 year after LAGB .  BMI , walking distance , heart rate , dyspnea , and respiratory function tests were also measured . Patients served as their own controls . Results : 15 patients ( all females ) were evaluated .  Mean BMI decreased from 42.1 ( range 39 - 49 ) before to 31.9 ( range 25 - 38 ) postoperatively . The distance walked increased from 475.7 meters ( range 380 - 580 ) before LAGB to 626.3 meters ( range 435 - 880 ) 1 year postoperatively ( P<0.0001 ) , and the dyspnea score after the 6mWT was significantly reduced postoperatively . All functional variables after the 6mWT showed improvement postoperatively at 1 year study . Conclusion : Weight reduction in the obese increases the functional capacity during walking . The improvements are refected in the patients ' own assessment
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 .
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 st and ard operating procedures for the 6MWT , ISWT and ESWT , which can be consistently employed by clinicians and research ers .