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Validity of the Incremental Shuttle Walk Test to Assess Exercise Safety When Initiating Cardiac Rehabilitation in Low-Resource Settings

Lelis, Joana D'arc, BSc; Chaves, Gabriela, PhD; Ghisi, Gabriela Lima de Melo, PhD; Grace, Sherry L., PhD; Britto, Raquel Rodrigues, PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: May 2019 - Volume 39 - Issue 3 - p E1–E7
doi: 10.1097/HCR.0000000000000412
Cardiac Rehabilitation

Purpose: To evaluate the validity of the Incremental Shuttle Walk Test (ISWT) for determining risk stratification in cardiac rehabilitation (CR).

Methods: This is a cross-sectional study at a major CR center in a middle-income country. Clinically stable adult cardiac patients underwent an ISWT and an exercise test (ET), wore a pedometer for 7 d, and completed the Godin-Shepherd Leisure-Time Physical Activity Questionnaire. Metabolic equivalents of task (METs) achieved on the ISWT were calculated.

Results: One hundred fifteen patients were evaluated. The mean ± standard deviation distance on the ISWT was 372.70 ± 128.52 m and METs were 5.03 ± 0.62. The correlation of ISWT distance with ET METs (7.57 ± 2.57), steps/d (4556.71 ± 3280.88), and self-reported exercise (13.08 ± 15.19) was rs = 0.61 (P < .001), rs = 0.37 (P < .001), and rs = 0.20 (P = .031), respectively. Distance on the ISWT accurately predicted METs from the ET (area under the receiver operating characteristic curve = 0.774). The ability to walk ≥410 m on the ISWT predicted, with a specificity of 81.5% and a sensitivity of 65.6%, a functional capacity of ≥7 METs on ET.

Conclusion: The ISWT is an alternative way to evaluate functional capacity in CR and can contribute to the process of identifying patients at low risk for a cardiac event during exercise at moderate intensity.

The Incremental Shuttle Walk Test (ISWT) was tested as a risk stratification tool in cardiac rehabilitation (CR). Results showed that patients who can walk 410 m on the ISWT and have no other clinical contraindications to exercise can be considered safe to initiate a program of moderate-intensity exercise in CR.

Rehabilitation Science Graduate Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil (Ms D'arc Lelis and Drs Chaves and Britto); Cardiovascular Prevention and Rehabilitation Program, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Ghisi and Grace); and School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada (Drs Ghisi and Grace).

Correspondence: Raquel Rodrigues Britto, PhD, Rehabilitation Science Graduate Program, Universidade Federal de Minas Gerais, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil (

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.