Reference values for the incremental shuttle walk test in patients with cardiovascular disease entering exercise-based cardiac rehabilitation

Abstract

The incremental shuttle walk test (ISWT) is used to assess functional capacity of patients entering cardiac rehabilitation. Factors such as age and sex account for a proportion of the variance in test performance in healthy individuals but there are no reference values for patients with cardiovascular disease. The aim of this study was to produce reference values for the ISWT. Participants were n = 548 patients referred to outpatient cardiac rehabilitation who underwent a clinical examination and performed the ISWT. We used regression to identify predictors of performance and produced centile values using the generalised additive model for location, scale and shape model. Men walked significantly further than women (395 ± 165 vs. 269 ± 118 m; t = 9.5, P < 0.001) so data were analysed separately by sex. Age (years) was the strongest predictor of performance in men (β = -5.9; 95% CI: -7.1 to -4.6 m) and women (β = -4.8; 95% CI: -6.3 to 3.3). Centile curves demonstrated a broadly linear decrease in expected ISWT values in males (25-85 years) and a more curvilinear trend in females. Patients entering cardiac rehabilitation present with highly heterogeneous ISWT values. Much of the variance in performance can be explained by patients' age and sex. Comparing absolute values with age-and sex-specific reference values may aid interpretation of ISWT performance during initial patient assessment at entry to cardiac rehabilitation.

Determinants of walking fitness in patients with heart failure attending cardiac rehabilitation

“…Although the ISWT does not represent a ‘criterion maximal test’, of exercise capacity it is a recommended submaximal surrogate measure of exercise capacity13 that is positively validated against CPET 14. Some studies have used the ISWT to investigate potential determinants of walking fitness in conventional cardiac patients15 16 identifying age, height, body mass index (BMI) and the presence of diabetes as significant predictors of distanced achieved. The New York Heart Association (NYHA) Functional Classification is an established symptom and function-aligned measure, classifying the extent of HF severity in patients, yet has not been investigated for its role in determining walking fitness as measured by the ISWT in HF.…”

Talent identification and recruitment in youth soccer: Recruiter’s perceptions of the key attributes for player recruitment

“…Similar to previous studies [28–29], this approach allows participants more scope to develop a rationale for their opinions through conversation. Open-ended questions promoted consistent discussion to identify the key attributes participants value when identifying talented youth players for selection into a regional representative team to compete at the national championships, including technical, physiological, anthropometric, psychological and tactical attributes (e.g., when you are identifying talent at an Under 13 level what is it you are looking for?).…”

“…Thus, the Delphi method provides more in depth and reliable analysis of the research questions and is more effective than a single interview or questionnaire [28]. For the current study the modified Delphi method [28–29] was adopted. This design entailed an initial interview followed by two rounds of questionnaires.…”

“…The Delphi method requires purposeful sampling of a small panel of domain-specific experts to achieve reliable responses, as a result a strict selection criterion was enforced for participant selection [28–29, 31]. Participant selection was based upon the unique perspectives and experiences in elite youth soccer coaching within Australia.…”

“…The justification for the ranking provided by the participants in the questionnaire was also compiled. Example of the justification that best reflects the participant’s perceptions are provided to support all numerical values [29]. …”