Background-The purpose of this study was to develop an externally controlled, constant paced field walking test to assess endurance capacity in patients with chronic obstructive pulmonary disease (COPD). There were four objectives: (1) to develop a protocol; (2) to compare treadmill and shuttle walk tests of endurance capacity; (3) to examine the repeatability of the endurance shuttle walk test; and (4) to compare the sensitivity to pulmonary rehabilitation of endurance and incremental shuttle walk tests. Methods-The test was designed to complement the incremental shuttle walk test (ISWT) using the same 10 m shuttle course and an audio signal to control pace. The intensity of the field endurance test was related to a percentage of each patient's maximum field exercise performance assessed by the ISWT. A number of cassette tapes were prerecorded with a range of audio signal frequencies to dictate walking speeds between 1.80 and 6.00 km/h. In the first limb of the study 10 patients with COPD (mean (SD) forced expiratory volume in one second (FEV 1) 1.0 (0.36) l, 35% predicted) performed three endurance shuttle walk tests (ESWTs) and three treadmill endurance tests. The walking speeds were calculated to elicit 75%, 85%, and 95% of each patient's maximum ISWT performance for the field tests and measured peak oxygen consumption for the treadmill tests. In a separate group of patients the repeatability of the ESWT at an intensity of 85% of the ISWT performance was evaluated. Finally, the ESWT (at the 85% intensity) and the ISWT were performed at the start of a five week control period and at the start and end of a seven week pulmonary rehabilitation programme in 21 patients with COPD (mean FEV 1 0.80 (0.18) l). Results-The mean (SE) times achieved during the ESWT were 13.1 (2.3), 10.2 (2.5), and 5.3 (1.7) min for the walks at 75%, 85%, and 95% intensities, respectively. Patients tended to walk for longer on the treadmill than during the field tests at all intensities, but there were no significant diVerences between the end of test heart rates or Borg ratings of breathlessness or perceived exertion. Following one practice ESWT at the 85% intensity, the mean diVerence and limits of agreement (2SD) between tests 2 and 3 was +15 (42) s (p>0.05). There was no significant change in performance on either test following the five week control period prior to rehabilitation. Following rehabilitation the ESWT duration increased by 160 (24)% and the ISWT distance increased by 32 (11)% (eVect sizes 2.90 and 0.41, respectively). Conclusions-The ESWT was simple to perform, acceptable to all patients, and exhibited good repeatability after one practice walk. The test showed major improvement following rehabilitation and was more sensitive to change than the field test of maximal capacity.

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infrequently performed in the United Kingdom. We however, have persisted with video assisted thoracoscopic (VATS) LVRS and report the results of our first 200 operations. Patients/methods Surgical candidates for LVRS were selected by a multidisciplinary team approach using radionuclide scintigraphy in all cases. After the initial 20 open cases we adopted policy of two stage bilateral VATS LVRS with the timing of the second operation determined by the patient. 160 patients have completed one-stage LVRS: median age 60 (39e73) years and 20 patients have completed two-stage bilateral LVRS: median age 59 (41e66) years. Data from a prospective database were analysed to assess the postoperative changes in pulmonary function and health status (SF 36 questionnaire) recorded at three, six and, twelve months and thence annually.Results 30-day mortality was 6% and 25% required post-operative ventilation (9 of 50 for <24 h). Hospital stay was 14 (2e110) days. FEV 1 in both groups showed significant continuous improved at the 3-month, 6-month and 1-year postoperative review (p#0.035). Furthermore, significant improvements (p#0.05) in SF 36 were seen across the seven domains assessed: Physical Functioning (up to 1 year), Social Functioning (up to 1 year), Role-Physical (up to 1 year), Role-Emotional (at 5 years), Mental Health (up to 1 year), Energy/Vitality (up to 1 year), and General Health (up to 1 year). There has however been a significant reduction in the domain of Bodily Pain up to 4 years post LVRS (p#0.05). More lasting improvements are seen in two-stage bilateral group compared to the one-stage group. Conclusion The use of a multidisciplinary team approach and a prolonged surgical strategy can achieve durable postoperative benefits from LVRS for up to 4 years with acceptable risk.

established. Two small studies have previously shown no benefit; this may have been due to study power or methodology. Our study investigated whether ambulatory oxygen provides additional benefit to patients undergoing PR who meet the 2006 UK Department of Health criteria for ambulatory oxygen use. Methods A single blind (researcher) randomised controlled trial compared the effect of a 6 week PR programme either with or without ambulatory oxygen. The study was powered to show an 80% difference between groups. Eligible patients were those who desaturated on baseline exercise testing by >4% to <90% and whose exercise tolerance improved by >10% with ambulatory oxygen. Outcome measures included the Endurance Shuttle Walk Test (ESWT) and the self report Chronic Respiratory Questionnaire (CRQ-SR). Results Between September 2007 and June 2009 62 patients consented; one patient withdrew choosing to use ambulatory oxygen, ten dropped out of PR. The majority of subjects had Chronic Obstructive Pulmonary Disease; eight had another chronic respiratory condition. Groups were similar at baseline except for weight and BMI (higher in the room air (RA) group). A far greater improvement in ESWT was found in the oxygen group (p¼0.000) (Abstract S71 Table 1). When the acute effect of oxygen is excluded the oxygen group improved by 75% more than the RA group; this did not meet statistical significance since the study was powered to show an 80% improvement. The oxygen group gained improvements in three CRQ-SR domains (emotion, fatigue and mastery) above the minimally clinically important difference (MCID) but this was not the case for the RA group; the difference between groups for these domains also reached the MCID. Improvements in the dyspnoea domain were similar between groups, although the oxygen group walked 490 m (122%) further. ConclusionFor patients who desaturate and with an acute positive response to oxygen, ambulatory oxygen significantly enhances the effect of PR.