Chronic Respiratory Disease 2006; 3: 201
www.CRDjournal.com
LETTER TO THE EDITOR
In their editorial, Brooks and Solway suggest that fur-
ther research on the endurance shuttle walk test (ESWT)
is needed before the test is advocated for clinical prac-
tice and research.1 Although I agree that more research
would be welcome, the ESWT and the incremental shut-
tle walk test (ISWT) are being used increasingly within
clinical practice in the UK. Like the six-minute walk test
(6 MWT) before them, the utility of the tests will evolve
with experience and over time. Experiential reports will
usefully suggest areas for research and can inform
debate.
The number of SWTs required should not be a detri-
ment to their use. The ISWT is a useful surrogate
measure of peak exercise capacity in its own right.
Singh et al. measured a significant correlation between
distance walked and VO2peak and recorded an
incremental heart rate response2,3; such a response
would be expected of a standardized laboratory test.
Although a patient may be required to perform four
SWTs (two ISWT and two ESWT), these provide
assessments of both peak and endurance capacity. A
total of three walk tests are required for the 6 MWT
(two practice and one trial). Indeed, evaluation of the
practice and trial data of the ESWT in 44 patients has
shown that the practice walk is not necessary.4
Brookes and Solway suggest that the 20-minute ‘ceil-
ing’ effect of the ESWT may be problematic when
assessing change in high-functioning patients.1 This is
also a problem with the 6 MWT; with the much lower
© 2006 SAGE Publications
ceiling of six minutes to constrain the magnitude of
change it can be argued that this will affect a broader
range of patients. In order to achieve a test that was
acceptable for clinical practice, a 20-minute duration
was imposed on the ESWT. The test instructions state
that the patient should not be informed of the test limit.
This was a reasonable compromise because the initial
research demonstrated that the test was highly respon-
sive to pulmonary rehabilitation. Additionally, the test
has the potential for providing re-calibration and assess-
ment at the next walking intensity.
References
1. Brookes D, Solway S. Should the endurance shuttle walk test replace
the six-minute walk test in individuals with chronic obstructive pul-
monary disease? Chron Respir Dis 2006; 3: 1–2.
2. Singh SJ, Morgan MDL, Hardman AE, Rowe C, Bardsley PA.
Comparison of oxygen uptake during a conventional treadmill test and
the shuttle walking test in chronic airflow limitation. Eur Respir J
1994; 7: 2016–20.
3. Singh SJ, Morgan MDL, Scott S, Walters D, Hardman AE.
Development of a shuttle walking test of disability in patients with
chronic airways obstruction. Thorax 1992; 47: 1019–24.
4. Singh SJ, Collier R, Williams J, Mason L, Morgan MDL. Is a practice
endurance shuttle walking test necessary after performing the incre-
mental shuttle walking test? Eur Respir J 1999; 14: 422s.
SM Revill
Head of District
Pulmonary Rehabilitation Services
Sherwood Forest Hospitals
10.1177/1479972306070503
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