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How to carry out a field walking test in chronic respiratory disease

Anne E. Holland, Martijn A. Spruit, Sally J. Singh
Breathe 2015 11: 128-139; DOI: 10.1183/20734735.021314
Anne E. Holland
1Dept of Physiotherapy, La Trobe University, Melbourne, Australia
2Dept of Physiotherapy, Alfred Health, Melbourne, Australia
3Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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  • For correspondence: a.holland@alfred.org.au
Martijn A. Spruit
4Dept of Research & Education, CIRO+ centre of expertise for chronic organ failure, Horn, the Netherlands
5REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Sally J. Singh
6Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
7Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Figures

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  • Figure 1
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    Figure 1

    Course layout for the ISWT and ESWT. Cones are inset 0.5 m from either end to avoid abrupt changes in direction. Taken from the ERS/ATS Technical Standard [1].

Tables

  • Figures
  • Table 1

    Equipment required for conducting field walking tests

    At least one chair, positioned at one end of the walking course
    A validated scale to measure dyspnoea and subjective fatigue
    Sphygmomanometer for blood pressure measurement
    Pulse oximeter
    Stopwatch
    Pre-measured marks along the track/corridor
    Access to oxygen and telephone in case of an emergency
    An emergency plan
    Portable supplemental oxygen if required to perform exercise test by patient
    Clipboard with reporting sheet and pen
    • Taken from the ERS/ATS Technical Standard [1].

  • Table 2

    Absolute and relative contraindications for field walking tests

    AbsoluteRelative
    Acute myocardial infarction (3–5 days)
    Unstable angina
    Uncontrolled arrhythmias causing symptoms or hemodynamic compromise
    Syncope
    Active endocarditis
    Acute myocarditis or pericarditis
    Symptomatic severe aortic stenosis
    Uncontrolled heart failure
    Acute pulmonary embolus or pulmonary infarction
    Thrombosis of lower extremities
    Suspected dissecting aneurysm
    Uncontrolled asthma
    Pulmonary oedema
    Room air SpO2 at rest ≤85%#
    Acute respiratory failure
    Acute noncardiopulmonary disorder that may affect exercise performance or be aggravated by exercise (i.e. infection, renal failure, thyrotoxicosis)
    Mental impairment leading to inability to cooperate
    Left main coronary stenosis or its equivalent
    Moderate stenotic valvular heart disease
    Severe untreated arterial hypertension at rest (200 mmHg systolic, 120 mmHg diastolic)
    Tachyarrhythmias or bradyarrhythmias
    High-degree atrioventricular block
    Hypertrophic cardiomyopathy
    Significant pulmonary hypertension
    Advanced or complicated pregnancy
    Electrolyte abnormalities
    Orthopedic impairment that prevents walking
    • Adapted from the ATS/ACCP Statement on Cardiopulmonary Exercise Testing (2003) and taken from the ERS/ATS Technical Standard [1].#: exercise patient with supplemental oxygen.

  • Table 3

    Standardised instructions for the 6-min walk test

    “The aim of this test is to walk as far as possible for six minutes. You will walk along this hallway between the markers, as many times as you can in six minutes.”
    “I will let you know as each minute goes past and then at six minutes I will ask you to stop where you are. Six minutes is a long time to walk, so you will be exerting yourself. You are permitted to slow down, to stop, and to rest as necessary, but please resume walking as soon as you are able.”
    “Remember that the objective is to walk AS FAR AS POSSIBLE for six minutes, but don’t run or jog.”
    “Do you have any questions?”
    • Taken from the ERS/ATS Technical Standard [1].

  • Table 4

    Standardised encouragement for the 6-min walk test

    1 min: “You are doing well. You have five minutes to go.”
    2 min: “Keep up the good work. You have four minutes to go.”
    3 min: “You are doing well. You are halfway.”
    4 min: “Keep up the good work. You have only two minutes left.”
    5 min: “You are doing well. You have only one minute to go.”
    6 min: “Please stop where you are.”
    If the patient stops during the test, provide the following encouragement every 30 s once SpO2 is ≥85%: “Please resume walking whenever you feel able.”
    • Taken from the ERS/ATS Technical Standard [1].

  • Table 5

    ISWT and ESWT instructions

    Incremental shuttle walking test instructions
    The object of the progressive shuttle walking test is to walk as long as possible there and back along the 10 m course, keeping to the speed indicated by the bleeps on the audio recording. You will hear these bleeps at regular intervals.
    You should walk at a steady pace aiming to turn around the cone at one end of the course when you hear the first bleep, and at the other end when you hear the next. At first your walking speed will be very slow, but you will need to speed up at the end of each minute. Your aim should be to follow the set rhythm for as long as you can. Each single bleep signals the end of a shuttle and each triple bleep signals an increase in walking speed. You should stop walking only when you become too breathless to maintain the required speed or can no longer keep up with the set pace.
    The test is maximal and progressive. In other words, it is easier at the start and harder at the end. The walking speed for the first minute is very slow. You have 20 s to complete each 10 m shuttle, so don’t go too fast. The test will start in 15 s, so get ready at the start now. Level one starts with a triple bleep after the 4 s countdown
    Endurance shuttle walking test instructions
    Walking test level (1–16) The instructions below are repeated for all 16 levels.
    The walking speed for the first 2 min is fairly slow, so don’t go too fast. The test will start in 10 s so get ready at the start now. The test starts with a triple bleep after a 4 s countdown.
    At the next triple bleep increase your walking speed.
    • Taken from the ERS/ATS Technical Standard [1].

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How to carry out a field walking test in chronic respiratory disease
Anne E. Holland, Martijn A. Spruit, Sally J. Singh
Breathe Jun 2015, 11 (2) 128-139; DOI: 10.1183/20734735.021314

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How to carry out a field walking test in chronic respiratory disease
Anne E. Holland, Martijn A. Spruit, Sally J. Singh
Breathe Jun 2015, 11 (2) 128-139; DOI: 10.1183/20734735.021314
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  • Article
    • Abstract
    • Introduction
    • The 6-min walk test
    • The incremental and endurance shuttle walking tests
    • Preparing to conduct a field walking test
    • How to conduct a 6-min walk test
    • How to conduct an ISWT
    • How to conduct an ESWT
    • Which field walking test should I choose?
    • Acknowledgements
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