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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 standard operating procedures for the 6MWT, ISWT and ESWT, which can be consistently employed by clinicians and researchers.The Technical Standard was developed by a multidisciplinary and international group of clinicians and researchers with expertise in the application of field walking tests. The procedures are underpinned by a concurrent systematic review of literature relevant to measurement properties and test conduct in adults with chronic respiratory disease.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. It is important that two tests are conducted for the 6MWT and ISWT.This Technical Standard for field walking tests reflects current evidence regarding procedures that should be used to achieve robust results. OverviewThe aim of this Technical Standard is to document the standard operating procedures for the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease. The testing procedures were developed by a multinational and multidisciplinary group of experts in field exercise testing, informed by a systematic review of the measurement properties and interpretation of the 6MWT, ISWT and ESWT in adults with chronic respiratory disease [1].The key findings of the Technical Standard are as follows.1) The 6-min walking distance (6MWD), ISWT and ESWT demonstrate good construct validity. Strong relationships with measures of exercise performance and physical activity support their conceptualisation as tests of functional exercise performance.2) A lower 6MWD is strongly associated with increased risk of hospitalisation and mortality in people with chronic respiratory disease, with a small number of studies suggesting a similar relationship for the ISWT.3) The 6MWD, ISWT and ESWT exhibit good test-retest reliability; however, there is strong evidence of a learning effect for the 6MWT and ISWT. Two tests should be performed when the 6MWT or ISWT are used to measure change over time.4) The 6MWD, ISWT and ESWT are responsive to treatment effects in people with chronic respiratory disease; however, most studies have evaluated responsiveness to rehabilitation and fewer data are available to confirm responsiveness to other interventions.5) The 6MWD and ISWT elicit a peak oxygen uptake (V9O 2 peak) that is similar to that during a cardiopulmonary exercise test (CPET). As a result, the contraindications and precautions for field testing should be consistent with those ...

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This document has been developed by an international committee and has been endorsed by both the ATS and the ERS. It places pulmonary rehabilitation within the concept of integrated care. The World Health Organization has defined integrated care as "a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion" (1). Integration of services improves access, quality, user satisfaction, and efficiency of medical care. As such, pulmonary rehabilitation provides an opportunity to coordinate care and focus on the entire clinical course of an individual's disease.Building on previous statements (2, 3), this document presents recent scientific advances in our understanding of the multisystemic effects of chronic respiratory disease and how pulmonary rehabilitation addresses the resultant functional limitations. It was created as a comprehensive statement, using both a firm evidence-based approach and the clinical expertise of the writing committee. As such, it is complementary to two current documents on pulmonary rehabilitation: the American College of Chest Physicians and American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) evidence-based guidelines (4), which formally grade the level of scientific evidence, and the AACVPR Guidelines for Pulmonary Rehabilitation Programs (5), which give practical recommendations.

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