title: Relationship between field walking tests and incremental cycle ergometry in COPD. Modifying track layout from straight to circular has a modest effect on the 6-min walk distance. Generic, symptom based, exercise rehabilitation; integrating patients with COPD and heart failure. Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. The effect of walking aids on exercise capacity and oxygenation in elderly patients with chronic obstructive pulmonary disease. Training with supplemental oxygen in patients with COPD and hypoxaemia at peak exercise. Repeatability of the 6-minute walk test in adolescents and adults with cystic fibrosis. Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length. The timed walk test as a measure of severity and survival in idiopathic pulmonary fibrosis 6-minute walk work for assessment of functional capacity in patients with COPD. Effect of a walking aid on disability, oxygenation, and breathlessness in patients with chronic airflow limitation. Prescription of Walking Exercise Intensity from the Incremental Shuttle Walk Test in People with Chronic Obstructive Pulmonary Disease Effect of encouragement on walking test performance. Distance saturation product predicts health–related quality of life among sarcoidosis patients Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease Energy Expenditure at Rest and during Walking in Patients with Chronic Respiratory Failure: A Prospective Two-Phase Case-Control Study The Combination of Tiotropium and Budesonide in the Treatment of Chronic Obstructive Pulmonary Disease Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Water-based exercise in COPD with physical comorbidities: a randomised controlled trial The minimal important difference of exercise tests in severe COPD Endurance shuttle walking test: responsiveness to salmeterol in COPD The acute effects of a rollator in individuals with COPD. OXYGEN RELIEVES BREATHLESSNESS IN "PINK PUFFERS" Walking versus cycling: sensitivity to bronchodilation in chronic obstructive pulmonary disease. Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease. Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. The incremental shuttle walking test in elderly people with chronic airflow limitation Six-Minute Walk Test as an Outcome Measure: Are Two Six-Minute Walk Tests Necessary Immediately After Pulmonary Rehabilitation and at Three-Month Follow-up? Validity and reliability of the modified shuttle walk test in patients with chronic obstructive pulmonary disease. Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. The effects of oxitropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease. A comparison of three different exercise tests. Effects of supplemental oxygen during activity in patients with advanced COPD without severe resting hypoxemia. Comparison of hallway and treadmill six-minute walk tests. Exertional oxygen of limited benefit in patients with chronic obstructive pulmonary disease and mild hypoxemia. The influence of alternative instruction on 6-min walk test distance. Detecting oxygen desaturation in patients with COPD: incremental versus endurance shuttle walking. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. The Incremental Shuttle Walk Test in Older Brazilian Adults Shuttle versus six-minute walk test in the prediction of outcome in chronic heart failure. The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD. Course length of 30 metres versus 10 metres has a significant influence on six-minute walk distance in patients with COPD: an experimental crossover study. The effect of helium and oxygen on exercise performance in chronic obstructive pulmonary disease: a randomized crossover trial. Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease. Age-Specific Normal Values for the Incremental Shuttle Walk Test in a Healthy British Population The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen The effects of a "new" walking aid on exercise performance in patients with COPD: a randomized crossover trial.
abstract: 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 BACKGROUND The protocol used for the 6-min walk test ( 6MWT ) influences its results . The only study to examine the effect of modifying track layout performed a retrospective analysis and concluded that institutions using continuous tracks yield greater distances than those using straight tracks . Agreement between the distances measured on different tracks could not be examined . We evaluated the effect of modifying track layout on walk distance and examined the agreement and repeatability of distances measured on different tracks . METHODS In a prospect i ve , r and omized , cross-over study , 27 COPD subjects ( FEV(1 ) , 38 + /- 14 % [ mean + /- SD ] ; 15 men ) attended three separate test sessions , completing six 6MWTs . To familiarize all subjects with both tracks , the first two sessions comprised two 6MWTs on either a circular or straight track . During the final session , each subject was tested once on the straight and once on the circular track . RESULTS The distance walked on the circular track exceeded the straight track by 13 + /- 17 m ( p < 0.001 ) . The limit of agreement between tracks was 33 m. Coefficient of repeatability values when the test was completed on different days for the straight and circular tracks were 51 m and 65 m , respectively . CONCLUSIONS When evaluating changes in 6-min walk distance in groups of patients , track layout should be st and ardized . However , the effect of modifying track layout on an individual 's walking distance is small compared to their daily variability in walk distance . Therefore , st and ardizing track layout for any given individual may be inconsequential when evaluating the change in distances from tests performed on different days 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 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 Background The COPD ( chronic obstructive pulmonary disease ) assessment test ( CAT ) is a recently introduced , simple to use patient-completed quality of life instrument that contains eight questions covering the impact of symptoms in COPD . It is not known how the CAT score performs in the context of clinical pulmonary rehabilitation ( PR ) programmes or what the minimum clinical ly important difference is . Methods The introduction of the  CAT score as an outcome measure was prospect ively studied by PR programmes across London . It was used alongside other measures including the St George 's Respiratory Question naire , the Chronic Respiratory Disease Question naire , the Clinical COPD Question naire , the Hospital Anxiety and Depression score , the Medical Research Council ( MRC ) dyspnoea score and a range of different walking tests . Patients completed a 5-point anchor question used to assess overall response to PR from ‘ I feel much better ’ to ‘ I feel much worse ’ . Results Data were available for 261 patients with COPD participating in seven programmes : mean ( SD ) age 69.0 ( 9.0 ) years , forced expiratory volume in 1 s ( FEV1 ) 51.1 ( 18.7 ) % predicted , MRC score 3.2 ( 1.0 ) . Mean change in CAT score after PR was 2.9 ( 5.6 ) points , improving by 3.8 ( 6.1 ) points in those scoring ‘ much better ’ ( n=162 ) , and by 1.3(4.5 ) in those who felt ‘ a little better ’ ( n=88 ) ( p=0.002 ) . Only eight individuals reported no difference after PR and three reported feeling ‘ a little worse ’ , so comparison with these smaller groups was not possible . Conclusion The CAT score is simple to implement as an outcome measure , it improves in response to PR and can distinguish categories of response 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 BACKGROUND high walking frames may improve exercise capacity in young patients with chronic obstructive pulmonary disease ( COPD ) . We have assessed the effect of Zimmer , rollator and gutter frames on 6-min walking distance and on arterial oxygenation during exercise in elderly patients with COPD . METHODS 27 out- patients ( 15 men ) aged 70 - 82 ( mean 75 ) years were recruited . Exclusions comprised : COPD exacerbation or oral steroid use within 6 weeks , confusional state , participation in a pulmonary rehabilitation programme and exercise limitation by other diseases . Subjects completed 6-min walk tests unaided and with the three frames on four separate days in r and om order 30 min after nebulized salbutamol ( 5 mg ) and ipratropium ( 0.5 mg ) and were accompanied by an investigator blinded to results of all other walk tests undertaken .  Oxygen saturation ( SaO2 ) was monitored by finger probe during exercise . Grouped t-tests were used to compare distances and reductions in SaO2 . RESULTS Unaided , the mean ( SEM ) 6-min walk distance was 210 ( 16 ) m and fall in oxygen saturation was 6.0 (1.1)% . Use of a rollator frame did not significantly affect either of these values . Using the Zimmer frame reduced the mean distance to 165 ( 13 ) m ( t=5.2 , P < 0.001 vs unaided walk ) with an SaO2 fall similar to that recorded during the unaided walk . Using the gutter frame increased the mean distance to 234 ( 150 ) m ( t=3 . 1 , P=0.004 vs unaided walk ) and reduced the fall in SaO2 to 3.7 (0.8)% ( t=2.3 , P=0.03 vs unaided walk ) . CONCLUSIONS gutter frames improve exercise capacity and SaO2 during exercise in elderly COPD patients who remain symptomatic on optimal therapy , whereas unwheeled Zimmer frames have a deleterious effect in such patients Supplemental oxygen has acute beneficial effects on exercise performance in patients with chronic obstructive pulmonary disease ( COPD ) . The purpose of this study was to investigate whether oxygen-supplemented training enhances the effects of training while breathing room air in patients with severe COPD . A r and omized controlled trial was performed in 24 patients with severe COPD who developed hypoxaemia during incremental cycle exercise ( arterial oxygen saturation ( Sa , O2 ) < 90 % at peak exercise ) . All patients participated in an in-patient pulmonary rehabilitation programme of 10 weeks duration . They were assigned either to general exercise training while breathing room air ( GET/RA group : forced expiratory volume in one second ( FEV1 ) 38 % of predicted ; arterial oxygen tension ( Pa , O2 ) 10.5 kPa at rest ; Pa , O2 7.3 kPa at peak exercise ) , or to GET while breathing supplemental oxygen ( GET/O2 group : FEV1 29 % pred ; Pa , O2 10.2 kPa at rest ; Pa , O2 7.2 kPa at peak exercise ) . Sa , O2 was not allowed to fall below 90 % during the training . The effects on exercise performance while breathing air and oxygen , and on quality of life were compared . Maximum workload ( Wmax ) significantly increased in the GET/RA group ( mean ( SD ) 17 ( 15 ) W , p<0.01 ) , but not in the GET/O2 group ( 7 ( 25 ) W ) . Six minute walking distance ( 6MWD ) , stair-climbing , weight-lifting exercise ( all while breathing room air ) and quality of life significantly increased in both groups . Acute administration of oxygen improved exercise performance before and after training . Training significantly increased Wmax , peak carbon dioxide production ( V'CO2 ) and 6MWD while breathing oxygen in both groups . Differences between groups were not significant . Pulmonary rehabilitation improved exercise performance and quality of life in both groups . Supplementation of oxygen during the training did not add to the effects of training on room air OBJECTIVE To determine the repeatability of the 6-minute walk test ( 6MWT ) in adolescents and adults with cystic fibrosis ( CF ) . METHODS This was a prospect i ve cross-sectional study . We included consecutive patients ages > or=15 years attending an adult CF program . The patients underwent the 6MWT , pulmonary function tests , and clinical evaluation . The second 6MWT was performed following a rest period of 60 min . RESULTS Thirty-one patients were included . The mean+/-SD age was 23.5+/-6.7 y , and the mean FEV1 was 61+/-28 % of predicted . The mean+/-SD walked distance in the first 6MWT was 583.6+/-68.6 m and in the second 6MWT was 590.0+/-72.2 m. The mean difference between the first and second 6MWT was -6.5 m , with limits of agreement between -74.9 m and 61.9 m , and the coefficient of variation was 4.3 % . The mean oxygen desaturation in the first 6MWT was 2.5+/-4.5 % , and in the second test it was 1.8+/-4.0 % . The mean difference between the first and second test was 0.6 % , and the coefficient of variation was 104 % . CONCLUSIONS Although the 6MWT distance was reproducible , the wide limits of agreement exceeded the minimum important difference for this test . These findings indicate that , in the routine evaluation of CF patients , at least two 6MWTs are required on any testing occasion to obtain a reliable estimate of the 6MWT distance The 6-minute walk test is used in clinical practice and clinical trials of lung diseases ; however , it is not clear whether replicate tests need to be performed to assess performance . Furthermore , little is known about the impact of walking course layout on test performance . We conducted 6-minute walks on 761 patients with severe emphysema ( mean + /- SD FEV1 % predicted = 26.3 + /- 7.2 ) who were participants in the National Emphysema Treatment Trial . Four hundred seventy participants had repeated walks on a separate day . The second test was improved by an average of 7.0 + /- 15.2 % ( 66.1 + /- 146 feet , p < 0.0001 , by paired t test ) , with an intraclass correlation coefficient of 0.88 between days . The course layout had an effect on the distance walked . Participants tested on continuous ( circular or oval ) courses had a 92.2-foot longer walking distance than those tested on straight ( out and back ) courses . Course length had no significant effect on walking distance . The training effect found in these patients with severe emphysema is less than in previous reports of patients with chronic obstructive pulmonary disease . Furthermore , the layout of the track may influence the 6-minute walk performance Idiopathic pulmonary fibrosis ( IPF ) is a relentlessly progressive disease with a median survival of ∼3 yrs . Measurements of airflow and lung volumes at rest are generally used to monitor the clinical course in this disorder . This study was design ed to determine if a modified version of the 6-min walk test , called the timed walk test , accurately characterises disease severity and survival in IPF . The study population consisted of 28 patients with well-characterised progressive IPF . The timed walk test and concurrent measures of disease severity were assessed at baseline . Participants were prospect ively followed for ≥4 yrs to determine the relationship between parameters of the timed walk test and survival . There were strong correlations between the end-exercise saturation and walk-velocity parameters of the timed walk test and diffusing capacity , and arterial oxygen tension at rest . In univariate Cox proportional-hazards models , end-exercise saturation , change in saturation with exercise , walk distance and walk velocity were associated with survival . In unadjusted logistic regression models , odds of death at 2 yrs were associated with the same parameters . In conclusion ,  the timed walk test relates to disease severity and long-term outcome in progressive idiopathic pulmonary fibrosis UNLABELLED The 6-min walk ( 6MW ) test is commonly used to assess exercise capacity in patients with COPD and to track functional change result ing from disease progression or therapeutic intervention . Not surprisingly , distance covered has been the preferred outcome for this test . However , distance walked does not account for differences in body weight that are known to influence exercise capacity . OBJECTIVE The aim of this study was to evaluate the  6-min distance x body weight product ( 6MWORK ) as an improved outcome measure with a solid physiologic foundation . PATIENTS AND METHODS One hundred twenty-four men and women with moderate-to-severe COPD volunteered and completed the testing sequence , which included pulmonary function , a peak effort ramp cardiopulmonary exercise study with gas exchange , and the 6MW . Means and SD were generated for the variables of interest . Differences were analyzed using analysis of variance techniques . Correlation coefficients and receiver operating characteristic ( ROC ) curves were calculated for the 6-min walk distance ( 6MWD ) and 6MWORK with indexes of pulmonary function , work performance , and Borg scores for dyspnea and effort . RESULTS Men and women presented with a significant smoking history that also differed by gender ( 48 vs 66 pack-years , respectively ; p < 0.01 ) . The mean ( + /- SD ) FEV(1 ) values were 45 + /- 12.6 % and 48 + /- 12.1 % , respectively ( not significant ) , while the diffusing capacity of the lung for carbon monoxide ( DLCO ) was 14.7 + /- 6.1 vs 10.3 + /- 3.9 mL/min/mm Hg , respectively ( p < 0.001 ) , for men and women . The 6MWD averaged 416.8 + /- 79.0 m for men and 367.8 + /- 78.6 m for women , and these differences were significant ( p < 0.002 ) . When 6MWD was compared as the percent predicted of normal values , each gender presented with a similar reduction of 78.6 + /- 14.5 % vs 79.9 + /- 17.5 % ( p > 0.05 ) , respectively . 6MWORK averaged 35,370 + /- 9,482 kg/m and 25,643 + /- 9,080 kg/m ( p < 0.0001 ) for men and women , respectively . 6MWORK yielded higher correlation coefficients than did 6MWD when correlated with DLCO , lung diffusion for alveolar ventilation , FEV(1 ) , FEV(1)/FVC ratio , watts , peak oxygen uptake , peak minute ventilation , and peak tidal volume . The ROC curve demonstrated that 6MWORK had a significantly larger calculated area under the curve ( p < 0.05 ) [ plot of 100-sensitivity to specificity for each variable of interest for all subjects ] than 6MWD when differentiating an objective ly selected definition of low work capacity vs high work capacity ( bike ergometry work , < 55 vs > 55 W , respectively ) . CONCLUSIONS We conclude that work calculated as the product of distance x body weight is an improved outcome measure for the 6MW . 6MWORK can be used whenever the 6MW is required to estimate a patient 's functional capacity . This measure is also a common measure , which can be converted to indexes of caloric expenditure for direct cross-modality comparisons PURPOSE This study assessed the effect of a wheeled walking aid on disability , oxygenation , and breathlessness in patients with severe disability secondary to chronic irreversible airflow limitation . METHODS Eleven subjects with chronic irreversible airflow limitation , mean forced expired volume in 1 second ( FEV1 ) 0.71 L + /- .33 L , were studied . Subjects performed four 6-minute walk tests , two on each of two study days , twice unaided and twice with the assistance of a wheeled walking aid . A r and omized cross-over design was used . All subjects were oriented to 6-minute walk tests , use of bronchodilators was controlled , and st and ard encouragement was given during each walk test . Outcome measures were the distance walked in 6 minutes , change in oxyhemoglobin saturation during the walk , and breathlessness using a modified Borg Scale . RESULTS The use of a wheeled walker result ed in a significant increase in 6-minute walking distance , a significant reduction in hypoxemia with walking and a significant reduction in breathlessness during the walk test . CONCLUSIONS The use of a wheeled walker result ed in significant decreases in disability , hypoxemia , and breathlessness during a 6-minute walk test . By reducing disability and breathlessness , a wheeled walker may improve quality of life in individuals with severe impairment in lung function 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 Walking tests , frequently used to document effects of treatment on exercise capacity , have never been st and ardised . We studied the effects of encouragement on walking test performance in a r and omised study that controlled for the nature of the underlying disease , time of day , and order effects . We r and omised 43 patients with chronic airflow limitation or chronic heart failure or both to receive or not receive encouragement as they performed serial two and six minute walks every fortnight for 10 weeks . Simple encouragement improved performance ( p less than 0.02 for the six minute walk ) , and the magnitude of the effect was similar to that reported for patients in studies purporting to show beneficial effects of therapeutic manoeuvres . Age and test repetition also affected performance . These results demonstrate the need for careful st and ardisation of the performance of walking tests , and suggest caution in interpreting studies in which st and ardisation is not a major feature of the study design Background Sarcoidosis is a chronic disease with different phenotypic manifestations . Health-related quality of life is an important aspect in sarcoidosis , yet difficult to measure . The objective of this study was to identify clinical markers predictive of poor quality of life in sarcoidosis patients that can be followed over time and targeted for intervention . Methods We assessed the quality of life of 162 patients with confirmed sarcoidosis in a prospect i ve , cross-sectional study using the Sarcoidosis Health Question naire ( SHQ ) and Short Form-36 Health Survey ( SF-36 ) . We evaluated the validity of these question naires and sought to identify variables that would best explain the performance scores of the patients . Results On multivariate regression analyses , the very best composite model to predict total scores from both surveys was a model containing the distance-saturation product and Borg Dyspnea Scale score at the end of a 6-min walk test . This model could better predict SF-36 scores ( R2 = 0.33 ) than SHQ scores ( R2 = 0.24 ) . Substitution of distanced walked in 6 min for the distance-saturation product in this model result ed in a lesser ability to predict both scores ( R2 = 0.26 for SF-36 ; R2 = 0.22 for SHQ ) . Conclusions Both the SHQ and SF-36 surveys are valuable tools in the assessment of health-related quality of life  in sarcoidosis patients . The best model to predict quality of life among these patients , as determined by regression analyses , included the distance-saturation product and Borg score after the 6-min walk test . Both variables represent easily obtainable clinical parameters that can be followed over time and targeted for intervention 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 Background Measurements of Energy Expenditure ( EE ) at rest ( REE ) and during physical activities are increasing in interest in chronic patients . In this study we aim ed at evaluating the validity/reliability of the SenseWear ® Armb and ( SWA ) device in terms of REE and EE during assisted walking in Chronic Respiratory Failure ( CRF ) patients receiving long-term oxygen therapy ( LTOT ) . Methodology /Principal Findings In a two-phase prospect i ve protocol we studied 40 severe patients and 35 age-matched healthy controls . In phase-1 we determined the validity and repeatability of  REE  measured by SWA ( REEa ) in comparison with st and ard calorimetry ( REEc ) . In phase-2 we then assessed EE and Metabolic Equivalents-METs by SWA during the 6-minute walking test while breathing oxygen in both assisted ( Aid ) or unassisted ( No-Aid ) modalities . When compared with REEc , REEa was slightly lower in patients ( 1351±169 vs 1413±194 kcal/day respectively , p<0.05 ) , and less repeatable than in healthy controls ( 0.14 and 0.43 coefficient respectively ) . COPD patients with CRF patients reported a significant gain with Aid as compared with No-Aid modality in terms of meters walked , perceived symptoms and EE . Conclusions / Significance SWA provides a feasible and valid method to assess the energy expenditure in CRF patients on LTOT , and it shows that aided walking results in a substantial energy saving in this population Because additive effects of inhaled corticosteroids and long-acting anticholinergics are unclear , we undertook this study to compare the efficacy of tiotropium alone and tiotropium plus budesonide in patients with chronic obstructive pulmonary disease . The study subjects were r and omized to receive either tiotropium 18 µg once daily with or without budesonide 200 µg twice daily for 6 weeks . The efficacy variables were changes in trough forced expiratory volume in one second ( FEV1 ) , St. George 's Respiratory Question naire ( SGRQ ) , 6-minute walk distance ( 6MWD ) , and use of rescue medication . One hundred patients were r and omized and 81 completed the study . The mean age was 64.0 yr , and the mean FEV1 was 39.7 % predicted . Compared with tiotropium alone ( N=40 ) , the tiotropium/budesonide combination ( N=41 ) was related to an improvement in the SGRQ total score  ( tiotropium -2.8 units and tiotropium/budesonide -5.6 units , p=0.003 ) . 6MWD was improved by 13.5 m in the tiotropium group and by 22.5 m in the tiotropium/budesonide group ( p=0.031 ) . Changes in trough FEV1 and the use of rescue medication were similar between two groups . In conclusion , compared with tiotropium alone , the tiotropium/budesonide combination was related to an improved health-related quality of life . These data support that low-dose budesonide may enhance the efficacy of tiotropium 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 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 Our aim was to determine the minimal important difference ( MID ) for 6-min walk distance ( 6MWD ) and maximal cycle exercise capacity ( MCEC ) in patients with severe chronic obstructive pulmonary disease ( COPD ) . 1,218 patients enrolled in the National Emphysema Treatment Trial completed exercise tests before and after 4–6 weeks of pre-trial rehabilitation  , and 6 months after r and omisation to surgery or medical care .  The St George 's Respiratory Question naire ( domain and total scores ) and University of California San Diego Shortness  of Breath Question naire ( total score ) served as anchors for anchor-based MID estimates . In order to calculate distribution-based estimates , we used the st and ard error of measurement , Cohen 's effect size and the empirical rule effect size . Anchor-based estimates for the 6MWD were 18.9 m ( 95 % CI 18.1–20.1 m ) , 24.2 m ( 95 % CI 23.4–25.4 m ) , 24.6 m ( 95 % CI 23.4–25.7 m ) and 26.4 m ( 95 % CI 25.4–27.4 m ) , which were similar to distribution-based MID estimates of 25.7 , 26.8 and 30.6 m. For MCEC , anchor-based estimates for the MID were 2.2 W ( 95 % CI 2.0–2.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) and 3.3 W ( 95 % CI 3.0–3.5 W ) , while distribution-based estimates were 5.3 and 5.5 W. We suggest a MID of 26±2 m for 6MWD and 4±1 W for MCEC for patients with severe COPD 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 PURPOSE To investigate whether the acute benefits of rollator use are consistent over time in individuals with moderate to severe chronic obstructive pulmonary disease . METHODS Thirty-one stable subjects with chronic obstructive pulmonary disease ( 13 men , 18 women ) , aged 68 + /- 8 years , with a forced expiratory volume in 1 second of 0.7 + /- 0.2 L ( 33 % + /- 12 % predicted ) and a baseline 6-minute walk ( 6MW ) of 261 + /- 68 m , were recruited from a respiratory clinic after completion of a pulmonary rehabilitation program . Two 6MWs were performed at baseline , 4 weeks , and 8 weeks , one walking unaided and the other walking with the assistance of a rollator . The test order was r and omly chosen at baseline , and the same test order was used at each time point . The primary outcome measures were distance walked in 6 minutes ( meters ) , perceived dyspnea using a modified Borg scale , and number of rests taken . RESULTS Subjects achieved higher 6MW distances during assisted compared with unassisted walking at baseline ( 292 + /- 67 vs 263 + /- 67 m ) , 4 weeks ( 296 + /- 62 vs 275 + /- 63 m ) , and 8 weeks ( 283 + /- 65 vs 259 + /- 68 m ) ( P = .013 ) , with no time effect ( P = .5 ) . In addition , use of a rollator result ed in a significant improvement in dyspnea ( P = .004 ) at baseline , 4 weeks , and 8 weeks , with no time effect ( P = .7 ) . The use of a rollator also reduced the number of rests taken during the 6MW ( P < .001 ) , with no time effect ( P = .9 ) . CONCLUSIONS Rollator use result ed in improvements in performance in the 6MW , which were consistent over time among individuals with moderate to severe chronic obstructive pulmonary disease who walk less than 375 m during an unaided 6MW The effect of oxygen on breathlessness and exercise tolerance was examined in " pink and puffing " patients with fixed airways obstruction . When breathing oxygen , patients were less breathless and walked further . This was true whether the cylinder was carried by the patient or by an assistant . It was not possible to identify those patients who would benefit most . The best method of assessing improvement was by comparing breathlessness on a st and ardised progressive exercise test on a treadmill .  Four patients had a greater than 30 % reduction in breathlessness on submaximum exercise when breathing oxygen . Breathing oxygen for five or fifteen minutes before exercise but not during exercise ( predose ) result ed in a similar improvement in exercise tolerance . For short periods of exercise predosing with oxygen provides a convenient alternative to continuous oxygen . For longer periods of exercise the benefits of portable oxygen in selected patients have been previously underestimated RATIONALE There is no consensus regarding which exercise test to use to evaluate the functional impact of bronchodilators in patients with chronic obstructive pulmonary disease . OBJECTIVE AND METHODS Bronchodilator-induced changes in endurance time were evaluated during cycling and walking in 17 patients with chronic obstructive pulmonary disease who completed two cycle endurance tests and two endurance shuttle walks at 80 % of peak capacity . Each endurance test was preceded by the nebulization of a placebo or 500 microg of ipratropium bromide using a r and omized , double-blind , crossover design . Quadriceps twitch force was measured with magnetic stimulation of the femoral nerve before and after each endurance test . RESULTS Cycling endurance time did not improve significantly after bronchodilation despite a significant increase in FEV1 ( delta endurance time ipratropium bromide - placebo : 51 + /- 255 s , p = 0.42 ) . A similar change in FEV1 was associated with a significant improvement in walking endurance time ( delta endurance time ipratropium bromide - placebo : 164 + /- 177 s , p < 0.01 ) . A 22 + /- 17 % fall in quadriceps twitch force was observed after cycling , whereas no significant change was seen after walking . CONCLUSION The endurance shuttle walk is a sensitive test to detect changes in exercise tolerance after bronchodilation . Differences in the occurrence of quadriceps muscle fatigue may explain , in part , the different responsiveness to change between cycling and walking BACKGROUND Exercise tolerance is an important clinical aspect of chronic obstructive pulmonary disease that can be easily and reliably measured with the 6-minute walking test ( 6MWT ) . To improve the utility of the 6MWT for patient and health care system management , the interpretation of the functional status measure in relation to death and hospitalization should be eluci date d. METHODS Three-year , prospect i ve , multicenter observational study to evaluate the predictive power of 6MWD for death or exacerbation-related hospitalization and to evaluate the factors that help determine 6MWD . RESULTS We measured 6MWD at baseline and annually in 2110 patients with clinical ly stable Global Initiative for Obstructive Lung Disease ( GOLD ) stage II-IV COPD and recorded exacerbation-related hospitalizations and all-cause mortality .  During the study , 200 patients died and 650 were hospitalized .  Using receiver operating characteristics , the best predictive thresholds of the 6MWD were 334 m for increased risk of death and 357 m for exacerbation-related hospitalization ( area under the curve 0.67 and 0.60 respectively ) ; however , the discriminatory thresholds , especially for mortality , were influenced by age . The mean ( SE ) 6MWD declined by 1.6 ( 1.2 ) m per year in GOLD II , 9.8 ( 1.3 ) m per year in GOLD III , and 8.5 ( 2.4 ) m per year in GOLD IV . CONCLUSION The 6MWD provides prognostic information that may be useful for identifying high-risk patients with COPD STUDY OBJECTIVE We analyzed the effects of the use of a rollator on walking distance and physiologic variables : pulmonary gas exchange , heart rate , minute ventilation ( Ve ) , oxygen saturation , and symptoms during the 6-min walk test ( 6MWT ) in patients with COPD . SETTING Outpatient clinic at university hospital . PATIENTS Fourteen patients with COPD in stable clinical condition . One patient had mild COPD , five patients had moderate COPD , six patients had severe COPD , and two patients had very severe COPD . INTERVENTIONS Two 6MWTs were performed with a portable metabolic system ( VmaxST 1.0 ; Viasys Healthcare ; MEDA ; Aartselaar , Belgium ) with a rollator and without a rollator , in r and om order . In addition , maximal voluntary ventilation ( MVV ) was measured with and without a rollator , r and omly . RESULTS The median 6MWT distance increased significantly with a rollator : 416 m without a rollator ( interquartile range [ IQR ] , 396 to 435 m ) , vs 462 m with a rollator ( IQR , 424 to 477 m ) [ p = 0.04 ] . Significant increases were also seen in oxygen uptake ( 0.04 L/min [ IQR , - 0.002 to 0.09 L/min ] ) ; tidal volume ( 0.06 L/min [ IQR , - 0.001 to 0.11 L/min ] ) ; and Ve ( 0.95 L/min [ IQR , - 0.67 to 7.1 L/min ] ) , recorded in the last minute of the 6MWT ; as well as in MVV ( 3 L/min [ IQR , 0 to 12 L/min ] ) [ p < 0.05 for all ] . Borg dyspnea scores tended to be lower with a rollator : 6 ( IQR , 4 to 7 ) without a rollator , vs 5 ( IQR , 4 to 7 ) with a rollator ( p = 0.10 ) . The variation in the 6MWT was explained by individual changes in walking efficiency ( partial R(2 ) = 0.31 ) and changes in Ve ( partial R(2 ) = 0.36 ) [ p model < 0.04 ] . CONCLUSION The use of a rollator improves walking distance of patients with COPD through an increased ventilatory capacity and /or better walking efficiency Background : There is a concern that comorbidity or frailty in older people could limit the usefulness of currently available exercise tests for chronic lung disease . This study evaluated the feasibility and reproducibility of the incremental shuttle walking test ( SWT ) in people aged 70 years or over , compared exercise tolerance with other disability markers , and assessed whether the SWT is responsive to change after bronchodilators . Methods : Fifty elderly patients with chronic airflow limitation ( CAL ) and 32 controls without airflow limitation attempted the SWT before and after combined nebulised salbutamol/ipratropium bromide . Subjects also completed the Nottingham Extended Activities of Daily Living index ( NEADL ) and the London H and icap score ( LHS ) . Results : Forty four subjects with CAL ( 88 % ) and 29 controls ( 84 % ) completed the SWT , including many with co-morbidities . Two week repeatability was good and the SWT was strongly associated with EADL ( r=0.51 , p<0.001 ) and LHS ( r=0.43 , p<0.004 ) , but only weakly with forced expiratory volume in 1 second ( FEV1 ) ( r=0.31 , p=0.05 ) . Subjects with CAL walked a mean distance of 177.7 m compared with 243.3 m in controls ( p<0.001 ) ; following bronchodilator therapy the distance walked increased in the CAL group by 13.2 % ( p=0.009 ) . Conclusion : The SWT is a feasible and reproducible measure of exercise tolerance in elderly people with and without airflow obstruction and correlates with other markers of disability . It is sensitive to change following bronchodilation in subjects with CAL , although the change correlates less well with improvements in FEV1 . Overall , these results suggest that the SWT might be an appropriate measure to assess interventions in elderly people Spencer LM , Alison JA , McKeough ZJ :  Six-minute walk test as an outcome measure : are two six-minute walk tests necessary immediately after pulmonary rehabilitation and at three-month follow-up ? Am J Phys Med Rehabil 2008;87:224–228.A 3-mo prospect i ve , longitudinal , repeated- measures study was undertaken in subjects with chronic obstructive pulmonary disease ( COPD ) . The study aim ed to determine whether there was a difference in 6-min walk distance ( 6MWD ) when two 6-min walk tests were performed after pulmonary rehabilitation ( n = 44 ) and at 3-mo follow-up ( n = 40 ) , and whether the results reflected the program outcomes . There was a significant increase in 6MWD between two 6-min walk tests before rehabilitation ( P < 0.001 ) , and at 3-mo follow-up ( P < 0.001 ) , but not immediately after rehabilitation ( P = 0.1 ) . In terms of program outcomes , there was an increase in 6MWD from before to after pulmonary rehabilitation ( P < 0.001 ) ; however , the increase was greater if the better of two tests was reported .  Six-minute walk tests  performed twice before and after pulmonary rehabilitation programs and at 3-mo follow-up assessment s ensure accuracy of measurement of the 6MWD and program outcomes 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 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 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 STUDY OBJECTIVES To assess oxygen desaturation during activities and to evaluate the short-term effects of supplemental O(2 ) use in patients with severe COPD who do not qualify for long-term O(2 ) therapy . DESIGN A double-blind , r and omized , placebo-controlled trial . SETTING Out patients from the pulmonary diseases division of a tertiary-care university hospital . PATIENTS Twenty patients with stable COPD with FEV(1)/FVC ratios of < 50 % , FEV(1 ) levels < 55 % of the predicted normal value , and PaO(2 ) levels of > 60 mm Hg when resting . INTERVENTIONS Patients were initially evaluated with  pulmonary function tests , blood gas analysis , and Doppler echocardiography  , and they underwent the following three 6-min walking tests ( WTs ) in a r and om sequence : basal WT ( BWT ) ; WT while breathing compressed air ( CAWT ) ; and WT while breathing O(2 ) ( O(2)WT ) . MEASUREMENTS AND RESULTS The distance walked was recorded in meters . Dyspnea was measured by Borg scale measurement before and after the tests , and arterial oxygen saturation measured by pulse oximetry ( SpO(2 ) ) was continuously monitored . Results were analyzed by grouping patients in the following manner : desaturators ( DSs ) ( ie , patients with a drop in SpO(2 ) of at least 5 % and < 90 % during the WT ) vs nondesaturators ( NDSs ) ; and O(2 ) responders ( ie , patients with an increase of at least 10 % in the distance walked and /or a decrease of at least 3 points in Borg index score ) vs nonresponders . During the BWT , 11 of 20 patients ( 55 % ) were defined as desaturators . During the O(2)WT , the SpO(2 ) remained at > 90 % in every patient . The distance walked increased by 22 % ( p < 0.02 ) , and dyspnea decreased 36 % ( p < 0.01 ) in DS patients . In NDS patients , O(2 ) administration reduced dyspnea by 47 % ( p < 0.001 ) , but the distance walked did not improve . Responses were markedly different from one patient to another . No significant differences were noticed between the results of the BWT and CAWT in any of the groups . Thirteen O(2 ) responders did not differ from 7 nonresponders either in basal data or in desaturation measure during the BWT , except that all walking responders ( five patients ) were above the median of basal left ventricle performance . CONCLUSIONS Most of the studied COPD patients desaturated during the BWT . O(2 ) administration avoided desaturation and could increase the distance walked and reduce dyspnea , but these effects were not related to walking desaturation in individual cases . Improvements were not a placebo effect . The therapeutic role of O(2 ) during activities in some patients with severe COPD needs to be individually assessed The 6-min walk test ( SMWT ) performed in the hallway ( HW ) is used as a clinical indicator of functional capacity in patients with lung disease . A 6-min walk test utilizing a treadmill ( TM ) is easier to perform and allows easier patient monitoring . Therefore , we formulated a st and ardized TM SMWT protocol and compared the results with those of a HW SMWT .  All patients were enrolled in a pulmonary rehabilitation program . Patients with current infection , recent change in inhaled medications or oral steroid use , and significant cardiovascular disease were excluded . Each subject performed three HW SMWTs and three TM SMWTs assigned r and omly on subsequent days . There was a 30-min rest between each walk and at least a 48-h rest between each test day . All patients completed both HW and TM SMWT within 7 d. Supplemental oxygen was utilized or increased if the saturation fell below 88 % . The best of the three tests was used for data analysis . Twenty-one subjects completed the protocol . The mean age was 65 + /- 10.9 yr ( range , 35 to 79 yr ) . Ten subjects were receiving supplemental oxygen . The mean FEV(1 ) was 1.07 + /- 0.53 L. The mean HW SMWT distance was 1,228 + /- 255 ft ( range , 612 to 1,679 ft ) and the mean TM SMWT distance was 1,060 + /- 389 ft ( range , 475 to 1,819 ft ) , which were statistically different ( p = 0.01 ) . The mean difference was 168 + /- 280 ft ( range , -326 to 743 ft ) . Oxygen saturation and supplemental oxygen requirements did not differ significantly . The intra-test variability of the three HW SMWTs was similar to the three TM SMWTs and no significant difference in the coefficient of variation was found . A st and ardized TM SMWT is feasible and allows easier patient monitoring , but there is a statistically significant difference between the HW and TM SMWT distance and therefore they are not interchangeable . However , the intratest reproducibility of the TM and HW SMWTs are similar when three walks are performed in a single test session . The role of the TM SMWT in pulmonary rehabilitation requires further exploration It is unclear whether short-term benefits from supplemental oxygen translate into improved quality of life in patients with severe COPD . In a 12 wk double-blind r and omized crossover study , we assessed the effects of supplemental air and oxygen on exercise performance ( step tests and 6 min walking distance [ 6MWD ] ) initially and after two 6 wk periods at home using exertional cylinder air or oxygen . We measured quality of life at baseline and after the two 6 wk domiciliary periods . The 26 patients ( 24 males ) had a mean age of 73 + /- 6 yr ; mean FEV1 , 0.9 + /- 0.4 L ; mean DLCO , 10.6 + /- 2.4 ml/min/mm Hg ; mean resting PO2 , 69 + /- 8.5 ( range 58 to 82 ) mm Hg ; mean PCO2 , 41 + /- 3.3 mm Hg ; and mean resting SaO2 , 94 + /- 2.1 ( mean + /- SD ) . Laboratory tests were performed breathing intranasal air or oxygen at 4 L/min , and measurements were made of SaO2 and Borg dysnea scores .  Supplemental oxygen increased 6MWD and steps by small , statistically significant increments acutely at baseline and after 6 and 12 wk , without corresponding falls in Borg score . Degree of desaturation at baseline did not correlate with increase in 6MWD or steps achieved at baseline or at 6 or 12 wk , nor with the domiciliary gas used . There was no difference in 6MWD or steps achieved while breathing supplemental oxygen after 6 wk of domiciliary oxygen compared with domiciliary air . Small improvements in quality of life indices were found after domiciliary oxygen , and mastery also improved after domiciliary air . There were no differences in quality of life , however , when domiciliary oxygen was compared with domiciliary air . Although oxygen supplementation induced small acute increments in laboratory exercise performance , such improvements had little impact on the patients ' daily lives BACKGROUND The goal of the 6-min walk test ( 6MWT ) is to enable patients to walk " as far as possible " as a measure of their functional ability . The impact of the specific walk instructions on patient 6MWT performance is unknown . METHODS Patients with pulmonary arterial hypertension ( PAH ) , idiopathic pulmonary fibrosis ( IPF ) , and other forms of interstitial lung disease ( ILD ) were recruited to perform four identical 6MWTs with one differing instructional phrase . The st and ard instruction to walk " as far as possible " was substituted in r and om order with " as fast as possible , " " at your normal pace , " or " at a leisurely pace . " RESULTS Twenty-four patients ( 10 with PAH , eight with IPF , six with other ILD ) were enrolled and completed all four 6MWTs . Patients attained the greatest distance with the fast instruction , exceeding the st and ard instruction distance by a mean of 52.7 m ( P < .001 ) . The mean difference between the fast and st and ard walks was 41.5 m in the PAH group , 66.5 m in the IPF group , and 53 m in the other ILD group . CONCLUSIONS Patients do not walk as far as they are able with the st and ard American Thoracic Society instruction for 6MWT . Changing the wording from " far " to " fast " may facilitate a better effort and greater distance during the test . It is possible that this modified 6MWT instruction may result in improved accuracy and reproducibility , thereby enhancing its clinical and research trial usefulness 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 OBJECTIVE To establish the minimal important difference ( MID ) for the six-minute walk distance ( 6MWD ) in persons with chronic obstructive pulmonary disease ( COPD ) . DESIGN Analysis of data from an observational study using distribution- and anchor-based methods to determine the MID in 6MWD . SETTING Outpatient pulmonary rehabilitation program at 2 teaching hospitals . PARTICIPANTS Seventy-five patients with COPD ( 44 men ) in a stable clinical state with mean age 70 years ( SD 9 y ) , forced expiratory volume in one second 52 % ( SD 21 % ) predicted and baseline walking distance 359 meters ( SD 104 m ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Participants completed the  six-minute walk test  before and after a 7-week pulmonary rehabilitation program . Participants and clinicians completed a global rating of change score while blinded to the change in 6MWD . RESULTS The mean change in 6MWD in participants who reported themselves to be unchanged was 17.7 meters , compared with 60.2 meters in those who reported small change and 78.4 meters in those who reported substantial change ( P=.004 ) . Anchor-based methods identified an MID of 25 meters ( 95 % confidence interval 20 - 61 m ) . There was excellent agreement with distribution-based methods ( 25.5 - 26.5 m , kappa=.95 ) . A change in 6MWD of 14 % compared with baseline also represented a clinical ly important effect ; this threshold was less sensitive than for absolute change ( sensitivity .70 vs .85 ) . CONCLUSIONS The MID for 6MWD in COPD is 25 meters . Absolute change in 6MWD is a more sensitive indicator than percentage change from baseline . These data support the use of 6MWD as a patient-important outcome in research and clinical practice Background : Despite widespread use of the incremental shuttle walk distance ( ISWD ) , there are no reference equations for predicting it . Objectives : We aim ed to evaluate ISWD in healthy subjects and to establish a reference equation for its prediction . Methods : 131 Brazilian individuals ( 61 males ; 59 ± 10 years ) performed 2 walk tests in a 10-m long corridor . We assessed height , weight , body mass index , forced expiratory volume in 1 s , forced vital capacity and self-reported physical activity  . Results : Mean ISWD was greater in males than in females ( 606 ± 167 vs. 443 ± 117 m ; p < 0.001 ) . ISWD correlated significantly ( p < 0.05 ) with age ( r = –0.51 ) , height ( r = 0.54 ) and weight ( r = 0.20 ) . A predictive model including age , height , weight and gender explained 50.3 % of the ISWD variance . In an additional group of 20 subjects prospect ively studied , the difference between measured and predicted ISWD was not statistically significant ( 534 ± 84 vs. 552 ± 87 m , respectively ) , representing 97 ± 12 % of the predicted value calculated with our reference equation for ISWD . Conclusions : This reference equation including demographic and anthropomorphic attributes could be useful for interpreting the walking performance of patients with chronic diseases that affect exercise capacity We prospect ively analysed the potential usefulness of a symptom-limited walk test , the shuttle walk test ( SWT ) , in the prediction of major cardiac events in 46 consecutive patients with chronic heart failure ( NYHA class II-IV , ejection fraction < 0.40 ) and compared it with that of a time-limited walk test , the six-minute walk test ( 6-MT ) . After a mean follow-up of 17 months ( range , 8 - 28 months ) , 15 of 46 patients ( 33 % ) experienced a major cardiac event , defined as a cardiac death , urgent transplantation , or hospital admission for continuous inotropic or mechanical support . Distance walked in the SWT  was shown to be a predictor of outcome at one year of follow-up ( P=0.03 ) , but distance ambulated in the 6-MT was not ( P=0.07 ) . In multivariate analysis , percentage of age-gender predicted peak oxygen uptake was the best predictor of major cardiac events . When patients were divided into tertiles according to performance in both walk tests , there was an overall difference in event-free survival at 12 months among SWT tertiles ( P=0.004 ) , but not among 6-MT tertiles ( P=0.09 ) . A low performance in the SWT  ( distance ambulated < 450 m ) allowed identification of a subgroup of patients with a high risk for major cardiac events at short-term . We conclude that , in patients with chronic heart failure , distance ambulated in the SWT  predicts event-free survival at one year better than that in the 6-MT 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 QUESTIONS Do patients with chronic obstructive pulmonary disease ( COPD ) achieve a different distance on the six minute walk test ( 6MWT ) conducted on a 10 m course versus on a 30 m course ? When assessing the distance on a 6MWT conducted on a 10 m course , is it valid to use existing reference equations that were generated on longer courses ? DESIGN A r and omised double-crossover experimental study . PARTICIPANTS Forty-five patients with COPD in primary physiotherapy care . INTERVENTION All patients performed a 6MWT twice over a 10 m course and twice over a 30 m course . The 6MWTs were performed in accordance with the American Thoracic Society guidelines . OUTCOME MEASURES 6MWD was assessed and predicted distance was calculated based on a range of reference equations . RESULTS The 6MWD on the 10 m course was 49.5 m shorter than on the 30 m course , which was statistically significant ( 95 % CI 39.4 to 59.6 ) . By using existing reference equations for a 6MWT conducted on the 10 m course , the predicted distance is highly overestimated ( with a range of 30 % to 33 % ) and the average distance as a percentage of the predicted value is 8%pred lower compared to a 6MWT conducted on the 30 m course , result ing in a worse representation of a COPD patient 's functional exercise capacity . CONCLUSION This study shows that the impact of course length on the 6MWD and on the use of reference equations in patients with COPD is substantial and clinical ly relevant ( based on the most conservative published minimum clinical ly important difference ) . Therefore , existing reference equations established for a 6MWT conducted over a 30 m ( or longer ) course can not be applied to predict the distance achieved on the 6MWT on a 10 m course , which is frequently used in primary care physiotherapy practice s for patients with COPD RATIONALE Breathing supplemental oxygen reduces breathlessness during exercise in patients with chronic obstructive pulmonary disease ( COPD ) . Replacing nitrogen with helium reduces expiratory flow resistance and may improve lung emptying . Combining these treatments should be independently effective . OBJECTIVES Study the effect of changing oxygen or helium concentration in inspired gas during exercise in patients with stable COPD . METHODS In 82 patients ( mean age , 69.7 yr ; mean FEV(1 ) , 42.6 % predicted ) , we measured endurance shuttle walking distance , resting and exercise oxygen saturation , and end-exercise dyspnea ( Borg scale ) while patients breathed  Heliox28  ( 72 % He/28 % O(2 ) ) , Heliox21 ( 79 % He/21 % O(2 ) ) , Oxygen28 ( 72 % N(2)/28 % O(2 ) ) , or medical air ( 79 % N(2)/21 % O(2 ) ) . Gases were administered using a r and omized , blinded , crossover design via a face mask and an inspiratory dem and valve . RESULTS Breathing Heliox28 increased walking distance ( mean+/-SD , 147+/-150 m ) and reduced Borg score ( -1.28+/-1.30 ) more than any other gas mixture . Heliox21 significantly increased walking distance ( 99+/-101 m ) and reduced dyspnea ( Borg score , -0.76+/-0.77 ) compared with medical air . These changes were similar to those breathing Oxygen28 . The effects of helium and oxygen in Heliox28 were independent . The increase in walking distance while breathing Heliox28 was inversely related to baseline FEV(1 ) breathing air . CONCLUSION Reducing inspired gas density can improve exercise performance in COPD as much as increasing inspired oxygen . These effects can be combined as Heliox28 and are most evident in patients with more severe airflow obstruction OBJECTIVES To investigate the feasibility of an outdoor 6-minute walk test ( 6MWT ) as a measure of functional status among individuals with chronic obstructive pulmonary disease ( COPD ) , and to examine the relationship between performance on an indoor and an outdoor 6MWT . DESIGN An experimental , repeated- measures crossover design . Subjects were studied on 2 separate days in the same week . Two 6MWTs-one indoors and the other outdoors-were performed on each study day , with a rest in between . The test order was r and omly selected on the first day and reversed on the second day . Outdoor tests were performed on days of moderate weather conditions ( mean temperature + /- st and ard deviation , 21 degrees + /-3 degrees C ; mean wind speed , 15+/-7 km/h ; no precipitation ) and on a flat surface ( sidewalk ) . SETTING  Outpatient rehabilitation program in Ontario . PARTICIPANTS Eighteen subjects with COPD ( 10 men , 8 women ; age , 70+/-8y ) , 5 using supplemental oxygen at rest ( forced expiratory volume in 1s , 1.0+/-0.3L ; 42%+/-8 % of predicted ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Distance walked in 6 minutes ( in meters ) , duration of rest ( in seconds ) , and change in rate of perceived dyspnea . RESULTS There was no significant effect of setting ( indoors vs outdoors ) on distance walked ( 394+/-86 m vs 398+/-84 m , P=0.4 ) , duration of rest ( 13+/-28s vs 9+/-20s , P=0.4 ) , or change in rate of perceived dyspnea ( 2.3+/-1.7 vs 2.3+/-2.0 , P=0.8 ) . Testing day had no significant effect on walk test performance ( all P>0.1 ) . CONCLUSIONS The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors 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 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 BACKGROUND Generally , the use of a rollator improves mobility in patients with COPD . Nevertheless , not all patients benefit from its use , and many patients feel embarrassed about using it . Therefore , other walking aids are worthwhile to consider . We compared the direct effects of a " new " ambulation aid ( a modern draisine ) with the effects of a rollator on 6-min walk distance ( 6MWD ) in patients with COPD . METHODS Twenty-one patients with COPD performed two 6-min walk tests ( 6MWTs ) during prerehabilitation assessment ( best 6MWD : 369 ± 88 m ) . Additionally , two extra 6MWTs were performed on two consecutive days in r and om order : one time with a rollator and one time with a modern draisine . Walking pattern ( n = 21 ) was determined using an accelerometer , and metabolic requirements ( n = 10 ) were assessed using a mobile oxycon . RESULTS Walking with the modern draisine result ed in a higher 6MWD compared with walking with the rollator ( 466 ± 189 m vs 383 ± 85 m ) . Moreover , patients had fewer strides ( 245 ± 61 vs 300 ± 49 ) and a greater stride length ( 1.89 ± 0.73 m vs 1.27 ± 0.14 m ) using the modern draisine compared with the rollator  ( all P ≤ .001 ) . Oxygen uptake , ventilation , heart rate , oxygen saturation , and Borg symptom scores were comparable between both walking aids . Ten percent of the patients felt embarrassed using the modern draisine compared with 19 % for the rollator , and a significantly smaller proportion of patients would use the modern draisine in daily life . CONCLUSIONS The mean difference in 6MWD between a modern draisine and a rollator seems clinical ly relevant , with the same metabolic requirements and symptom Borg scores . Therefore , this " new " ambulation aid could be a good alternative to the rollator to improve functional exercise performance in patients with COPD . TRIAL REGISTRY The Netherl and s National Trial Registry ; No. : NTR1542 ; URL : www.trialregister.nl
target: 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 .
background: 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 .