Skip to main content

Advertisement

SpringerLink
Log in

Oxygen Costs of the Incremental Shuttle Walk Test in Cardiac Rehabilitation Participants: An Historical and Contemporary Analysis

  • Original Research Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Background

The incremental shuttle walk test (ISWT) is a standardised assessment for cardiac rehabilitation. Three studies have reported oxygen costs (VO2)/metabolic equivalents (METs) of the ISWT. In spite of classic representations from these studies graphically showing curvilinear VO2 responses to incremented walking speeds, linear regression techniques (also used by the American College of Sports Medicine [ACSM]) have been used to estimate VO2.

Purpose

The two main aims of this study were to (i) resolve currently reported discrepancies in the ISWT VO2-walking speed relationship, and (ii) derive an appropriate VO2 versus walking speed regression equation.

Methods

VO2 was measured continuously during an ISWT in 32 coronary heart disease [cardiac] rehabilitation (CHD-CR) participants and 30 age-matched controls.

Results

Both CHD-CR and control group VO2 responses were curvilinear in nature. For CHD-CR VO2 = 4.4e0.23 × walkingspeed (km/h). The integrated area under the curve (iAUC) VO2 across nine ISWT stages was greater in the CHD-CR group versus the control group (p < 0.001): CHD-CR = 423 (±86) ml·kg−1·min−1·km·h−1; control = 316 (±52) ml·kg−1·min−1·km·h−1.

Conclusions

CHD-CR group vs. control VO2 was up to 30 % greater at higher ISWT stages. The curvilinear nature of VO2 responses during the ISWT concur with classic studies reported over 100 years. VO2 estimates for walking using linear regression models (including the ACSM) clearly underestimate values in healthy and CHD-CR participants, and this study provides a resolution to this when the ISWT is used for CHD-CR populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Singh SJ, et al. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Parreira VF, et al. Measurement properties of the incremental shuttle walk test. A systematic review. Chest. 2014;145(6):1357–69.

    Article  PubMed  Google Scholar 

  3. Ramsbottom R, Brewer J, Williams C. A progressive shuttle run test to estimate maximal oxygen uptake. Br J Sports Med. 1988;22(4):141–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Tobin D, Thow MK. The 10 m shuttle walk test with Holter monitoring: an objective outcome measure for cardiac rehabilitation. Coron Health Care. 1999;3:3–17.

    Article  Google Scholar 

  5. Jolly K, et al. Reproducibility and safety of the incremental shuttle walking test for cardiac rehabilitation. Int J Cardiol. 2008;125(1):144–5.

    Article  PubMed  Google Scholar 

  6. British Association for Cardiovascular Prevention and Rehabilitation. A practical approach to exercise and physical activity in the prevention and management of cardiovascular disease. London: British Association for Cardiovascular Prevention and Rehabilitation; 2014.

    Google Scholar 

  7. British Heart Foundation. National audit for cardiac rehabilitation. British Heart Foundation, York University; 2015.

  8. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation and secondary prevention programs. 5th ed. with web resource. Champaign: Human Kinetics; 2013.

  9. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. Baltimore: Lippincott, Williams and Wilkins; 2013.

    Google Scholar 

  10. Sandercock GR, Brodie DA. The use of heart rate variability measures to assess autonomic control during exercise. Scand J Med Sci Sports. 2006;16(5):302–13.

    Article  CAS  PubMed  Google Scholar 

  11. Association of Chartered Physiotherapists in Cardiac Rehabilition. Standards for physical activity and exercise in the cardiac population. London: Association of Chartered Physiotherapists in Cardiac Rehabilitation; 2015.

    Google Scholar 

  12. Almodhy M, et al. Pilot investigation of the oxygen demands and metabolic cost of incremental shuttle walking and treadmill walking in patients with cardiovascular disease. BMJ Open. 2014;4(9):e005216.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sandercock GR, et al. Cardiorespiratory fitness changes in patients receiving comprehensive outpatient cardiac rehabilitation in the UK: a multicentre study. Heart. 2013;99(11):785–90.

    Article  PubMed  Google Scholar 

  14. Woolf-May K, Ferrett D. Metabolic equivalents during the 10-m shuttle walking test for post-myocardial infarction patients. Br J Sports Med. 2008;42(1):36–41 (discussion 41).

  15. Woolf-May K, Meadows S. Exploring adaptations to the modified shuttle walking test. BMJ Open. 2013;3(5) (pii:e002821).

  16. Douglas CG, Haldane JS. The capacity of the air passages under varying physiological conditions. J Physiol. 1912;45(4):235–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Passmore R, Durnin JV. Human energy expenditure. Physiol Rev. 1955;35(4):801–40.

    CAS  PubMed  Google Scholar 

  18. Margaria R, et al. Energy cost of running. J Appl Physiol. 1963;18:367–70.

    CAS  PubMed  Google Scholar 

  19. Menier DR, Pugh LG. The relation of oxygen intake and velocity of walking and running, in competition walkers. J Physiol. 1968;197(3):717–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Falls HB, Humphrey LD. Energy cost of running and walking in young women. Med Sci Sports. 1976;8(1):9–13.

    CAS  PubMed  Google Scholar 

  21. Dill DB. Oxygen used in horizontal and grade walking and running on the treadmill. J Appl Physiol. 1965;20:19–22.

    CAS  PubMed  Google Scholar 

  22. Naughton J, Nagle F. Peak oxygen intake during physical fitness program for middle-aged men: measurement of changes by laboratory and field testing. JAMA. 1965;191:899–901.

    Article  CAS  PubMed  Google Scholar 

  23. McArdle DW, Katch FI, Katch VL. Exercise physiology: nutrition, energy, and human performance. 8th ed. Baltimore: Lippincott Williams and Wilkins; 2014.

    Google Scholar 

  24. Su SW, et al. Oxygen uptake estimation in humans during exercise using a Hammerstein model. Ann Biomed Eng. 2007;35(11):1898–906.

    Article  PubMed  Google Scholar 

  25. Buckley JP, Furze G, Doherty P, Speck L, Connolly S, Hinton S, British Association for Cardiovascular Prevention and Rehabilitation, et al. BACPR scientific statement: British standards and core components for cardiovascular disease prevention and rehabilitation. Heart. 2013;99(15):1069–71.

    Article  PubMed  Google Scholar 

  26. National Institute for Health and Care Excellence. MI—secondary prevention: secondary prevention in primary and secondary care for patients following a myocardial infarction. NICE guidelines CG172. London: National Institute for Health and Care Excellence; 2013.

  27. British Association for Cardiovascular Prevention and Rehabilitation. Standards and core components of cardiovascular disease prevention and rehabilitation. 2nd ed. London: British Association for Cardiovascular Prevention and Rehabilitation; 2012.

    Google Scholar 

  28. Leger L, Mercier D. Gross energy cost of horizontal treadmill and track running. Sports Med. 1984;1(4):270–7.

    Article  CAS  PubMed  Google Scholar 

  29. Borg G. Borg’s perceived exertion and pain scales. Champaign: Human Kinetics; 1998.

    Google Scholar 

  30. Ainsworth BE, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81.

    Article  PubMed  Google Scholar 

  31. Buckley JP, et al. Standing-based office work shows encouraging signs of attenuating post-prandial glycaemic excursion. Occup Environ Med. 2014;71(2):109–11.

    Article  PubMed  Google Scholar 

  32. Levine JA. Non-exercise activity thermogenesis (NEAT). Best Pract Res Clin Endocrinol Metab. 2002;16(4):679–702.

    Article  PubMed  Google Scholar 

  33. Savage PD, Toth MJ, Ades PA. A re-examination of the metabolic equivalent concept in individuals with coronary heart disease. J Cardiopulm Rehabil Prev. 2007;27(3):143–8.

    Article  PubMed  Google Scholar 

  34. Pepera G, et al. Predictors of shuttle walking test performance in patients with cardiovascular disease. Physiotherapy. 2013;99(4):317–22.

    Article  CAS  PubMed  Google Scholar 

  35. Koike A, Hiroe M, Marumo F. Delayed kinetics of oxygen uptake during recovery after exercise in cardiac patients. Med Sci Sports Exerc. 1998;30(2):185–9.

    Article  CAS  PubMed  Google Scholar 

  36. Tajima A, et al. Oxygen uptake kinetics during and after exercise are useful markers of coronary artery disease in patients with exercise electrocardiography suggesting myocardial ischemia. Circ J. 2009;73(10):1864–70.

    Article  PubMed  Google Scholar 

  37. Dodd S, et al. Effects of beta-adrenergic blockade on ventilation and gas exchange during the rest to work transition. Aviat Space Environ Med. 1988;59(3):255–8.

    CAS  PubMed  Google Scholar 

  38. Kowalchuk JM, Hughson RL. Effect of beta-adrenergic blockade on VO2 kinetics during pseudorandom binary sequence exercise. Eur J Appl Physiol Occup Physiol. 1990;60(5):365–9.

    Article  CAS  PubMed  Google Scholar 

  39. Poole DC, Jones AM. Oxygen uptake kinetics. Compr Physiol. 2012;2(2):933–96.

    PubMed  Google Scholar 

  40. Eynon N, et al. The effect of long-term beta-adrenergic receptor blockade on the oxygen delivery and extraction relationship in patients with coronary artery disease. J Cardiopulm Rehabil Prev. 2008;28(3):189–94.

    Article  PubMed  Google Scholar 

  41. Head A, Maxwell S, Kendall MJ. Exercise metabolism in healthy volunteers taking celiprolol, atenolol, and placebo. Br J Sports Med. 1997;31(2):120–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Gullestad L, et al. The effect of acute vs chronic treatment with beta-adrenoceptor blockade on exercise performance, haemodynamic and metabolic parameters in healthy men and women. Br J Clin Pharmacol. 1996;41(1):57–67.

    Article  CAS  PubMed  Google Scholar 

  43. Juhlin-Dannfelt A. Beta-adrenoceptor blockade and exercise: effects on endurance and physical training. Acta Med Scand Suppl. 1983;672:49–54.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to all patients who have volunteered for this study (at Colchester and Liverpool) and for the invaluable assistance of the cardiac rehabilitation professionals involved (Liverpool: Elaine Gossage, Zoe Evans and Adrian Roose).

Author information

Authors and Affiliations

  1. Institute of Medicine, University Centre Shrewsbury/University of Chester, The Guildhall, Frankwell Quay, Shrewsbury, UK

    John P. Buckley

  2. Centre for Sports and Exercise Sciences, School of Biological Sciences, University of Essex, Colchester, UK

    Fernando M. F. Cardoso & Gavin R. H. Sandercock

  3. Department of Sport, Health and Exercise Science, University of Hull, Cottingham Road, Kingston Upon Hull, UK

    Stefan T. Birkett

Authors
  1. John P. Buckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando M. F. Cardoso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan T. Birkett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gavin R. H. Sandercock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John P. Buckley.

Ethics declarations

Funding

The authors are also grateful for the financial support of the Foundation for Science and Technology to Fernando M.F. Cardoso on this study, under Project No. SFRH/BD/86769/2012.

Conflict of interest

John P. Buckley, Fernando Cardoso, Stefan T. Birkett and Gavin G.R. Sandercock declare no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buckley, J.P., Cardoso, F.M.F., Birkett, S.T. et al. Oxygen Costs of the Incremental Shuttle Walk Test in Cardiac Rehabilitation Participants: An Historical and Contemporary Analysis. Sports Med 46, 1953–1962 (2016). https://doi.org/10.1007/s40279-016-0521-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-016-0521-1

Keywords

Search

Navigation