EXERCISE TOLERENCE TEST

EXERCISE TOLERENCE TEST
Dr. ANERI PATWARI(PT)
MPT

TEST TERMINOLOGY
• MAXIMAL OXYGEN UPTAKE(VO2 MAX)= Demand of heart and lungs
• METABOLIC EQUIVALENT(MET)=Caloric Consumption.
1 met= 3.5 ml O2/kg/min
• MYOCARDIAL OXYGEN CONSUMPTION= Supply+ Demand of heart

TYPES OF MUSCLE CONTRACTION
1. Mechanical
a) Dynamic: isotonic: concentric, eccentric; isokinetic; isoinertial
b)Static: isometric
2. Metabolic
a) Aerobic
b)anaerobic

TYPES OF EXERCISES
• 3 types of exercise can be used to stress cardiovascular system.
1) Static( Isometric)
2) Dynamic( Isotonic)
3) Mixed

ETT
• Exercise is most common physiological stress and places major
demand on cardiopulmonary system
• ETT, stress testing is non invasive tool to evaluate cardiopulmonary
system to accommodate to increasing metabolic demand.
• ETT is 2nd most common cardiologic procedure performed .

• usually use the end point of the PMHR or
terminate when a patient is limited by
symptoms .
• used to measure functional capacity as
well as to diagnose CAD.
• The protocol for testing involves
performing a progressive workload until
the patient perceives an inability to
continue because of some limiting
symptom such as shortness of breath, leg
fatigue, or chest discomfort.
Examples:
1. Treadmill
a) Naughton, Åstrand,, Balke , Ellestad, Harbor
b) Bruce and Modified bruce
2. Bicycle ergomrter and
3. Arm ergometer
4. Shuttle walk test:
a) Incremental and endurance
5. Canadian and queens step test
Submaximal Tests
• Are Terminated On Achievement Of A
Predetermined End Point (Unless Symptoms
Otherwise Limit Completion Of The Test).
• The Predetermined End Point May Be Either
The Achievement Of A Certain Percentage Of
The Patient’s Predicted Maximal Heart Rate
(Pmhr; E.G., 75% Of PMHR) Or The
Attainment Of A Certain Workload (E.G., 2.5
Mph, 12% Grade) .
• A Special Subset Of Submaximal Testing Is
Low-level Testing, Performed On Patients
During The Recuperative Phase After
Myocardial Injury Or Coronary Bypass
Surgery
• Examples:
1. 6mwt
2. Copper 12 min test
3. Bag and carry test
4. Time up and go test
Maximal stress tests

INDICATIONS
• Patients with s/sx suggestive of CAD
• Patients with significant risk factors for CAD
• To evaluate in patients with unexplained fatigue and shortness of
breath
• To evaluate BP response to exercise in patients with borderline
hypertension
• To look for exercise-induced serious irregular heart beats
• To evaluate effect of medical and surgical therapy or intervention

ABSOLUTE CONTRAINDICATIONS
• Acute MI, within 2 days
• Ongoing unstable angina
• Uncontrolled cardiac arrhythmia with hemodynamic compromise
• Active endocarditis
• Symptomatic severe aortic stenosis
• Decompensated heart failure
• Acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis
• Acute myocarditis or pericarditis
• Acute aortic dissection
• Physical disability that precludes safe and adequate testing

RELATIVE CONTRAINDICATIONS
• Known obstructive left main coronary artery stenosis
• Moderate to severe aortic stenosis with uncertain relation to symptoms
• Tachyarrhythmias with uncontrolled ventricular rates
• Acquired advanced or complete heart block
• Hypertrophic obstructive cardiomyopathy with severe resting gradient
• Recent stroke or transient ischemic attack
• Mental impairment with limited ability to cooperate
• Resting hypertension with systolic or diastolic blood pressures >200/110
mm Hg
• Uncorrected medical conditions, such as significant anemia, important
electrolyte imbalance, and hyperthyroidism

TESTING
INTERMITTENT CONTINUOUS
• utilize incrementally progressive
workloads until the test is
terminated because of patient
symptoms or a defined end point.
• intersperses progressive
workloads with short rest periods
to give the subject time to
recover and decrease the effect
of peripheral fatigue

METHODOLOGY OF EXERCISE
TESTING
• Exercise testing appears safer today (< 1 untoward event per 10,000 tests) than it
did 20 years ago.
• The equipment's use should have front and side rails to help subjects steady
themselves.
• It should be calibrated monthly.
• A defibrillator must be instantly available.
• A complete trolley of cardiac resuscitation equipment should be on hand,
including intubation equipment and full range of cardiac drugs.
• Automate blood pressure measurement during exercise not recommended.
• The time-proven method of holding the subject’s arm with a stethoscope placed
over the brachial artery remains the most reliable. SAFETY PRECAUTIONS
AND EQUIPMENT

INTERPRETATIONS
1. Stress test are interpreted as either positive (+) or Negative (-)
2. A positive ETT Indicates that there is a point at which the
myocardial oxygen supply is in adequate to meet the myocardial
oxygen demand. And the test is positive for ischemia.
3. A Negative ETT Indicates that at every tested physiological
workload there is a balanced myocardial oxygen supply and demand.
4. A false negative ETT is one that is interpreted as negative but the
patient in fact has ischemia.
5. A false positive ETT is one that is interpreted as positive but the
patient does not have ischemia.

PRE-TEST PREPERATIONS
• The patient should be instructed not to eat, drink, or
smoke at least 2 hours prior to the test and to come
dressed for exercise, including proper footwear.
• The physician should also review the patient’s medical
history, making note of any conditions that can increase
the risk of testing (the absolute and relative
contraindications to exercise testing).
• A physical examination— including assessment of systolic
murmurs— should be performed before all exercise tests.
• An echocardiogram should be considered prior to
• Pretest standard 12-lead ECGs are necessary

PRE-TEST PREPERATIONS
• Good skin preparation is necessary for good conductance to avoid artifacts
and is especially important for elderly patients who have a higher skin
resistance and tendency toward contact noise.
• The areas for electrode application are first shaved and then rubbed with
alcohol-saturated gauze.
• Disposable electrodes used in exercise testing are generally silver– silver
chloride combinations with adherent gel.
• The changes caused by exercise electrode placement can be kept to a
minimum by keeping the arm electrodes off the chest and placing them on
the shoulders, placing the ground (right leg) electrode on the back out of the
cardiac field, placing the left leg electrodes below the umbilicus PRETEST
PREPARATIONS (Cont‘d)

MONITORING
1. HR, ECG;
2. Cardiac Rhythm; BP; Perceived Exertion; Clinical Signs
3. Patient-reported Symptoms Suggestive Of Myocardial Ischemia,
4. Inadequate Blood Perfusion, Gas Diffusion,
5. And Limitations In Pulmonary Ventilation

REQUIRED EQUIPMENT
1. Commercial Treadmill, Stopwatch
2. A 12 Lead ECG Machine & Leads
3. Sticking Tape, Clips
4. Stethoscope And Sphygmomanometer (With Hand-held Dial Or With A Stand)
5. Ratings Of Perceived Exertion (RPE) Scale
6. Heart Rate (HR) Monitor (Optional)
7. Medical Tape

ASTRAND-RYHMING CYCLE
ERGOMETER TEST

DEFINITION
• The Astrand Test Is A Submaximal Cycle Ergometer Aerobic
Fitness Test, Based On The Relationship Between Heart Rate
During Work And Percentage Of Maximal Aerobic Capacity.

EQUIPMENT REQUIRED
• Cycle Ergometer
• Clock Or Stopwatch
• Heart Rate Monitor
• ECG Monitor (Optional)

PRE-TEST
• Explain The Test Procedures To The Subject.
• Perform Screening Of Health Risks And Obtain Informed Consent.
• Prepare Forms And Record Basic Information Such As Age, Height,
Body Weight, Gender, Test Conditions.
• Calibrate And Adjust The Cycle Ergometer. Attach Heart Rate
Monitor.

What is steady state heart rate?
• If The Intensity Of Exercise Remains Constant Then The Heart Rate
Will Rise Until It Reaches What Is Known As “Steady State “ ,,,,
Where It Stays Relatively Constant As The Cardiovascular System
Meets The Demands Placed On It By The Exercise.

PROCEDURE
• Instruct The Client To Maintain A Steady Pace Throughout The Test.
• Record RPE And HR At Each Minute To Ensure The Client Is Staying Within The
Recommended Target Heart-rate Range (THRR).
• Blood Pressure Should Be Assessed And Recorded At The Four-minute Mark.
• Record The Client’s HR At Minute 5 And Minute 6. These Values Will Be Averaged And
Used For Determining Vo2max.
• Once The Test Is Completed, The Client Should Cool Down At A Reduced Workload For
Three To Five Minutes, Until Hr And Breathing Rate Return To Normal.
• The Trainer Should Continue To Observe The Client, As Negative Symptoms Can Arise
Immediately Post-exercise.

PROCEDURE
• Allow The Subject To Warm‐up On The Cycle Ergometer For 2 To 3 Minutes With A Resistance
Of 0 Kg And At A Cadence Of 50.
• The Subject Pedals For 6 Minutes At A Workload Chosen To Try And Elicit A Steady-state Heart
Rate Between 125 And 170 Bpm.
• Record Heart Rate Every Minute During The Test and HR during the fifth and sixth minutes.
• If The Heart Rate difference At 5 And 6 Minutes Is Not Within 5 Beats/Min, Continue For One
Extra Minute until the steady –state HR is achived.
• If The Steady-state Heart Rate Achieved Is Not Between 125 And 170 Bpm, Adjust The Workload
Appropriately And Continue For A Second 6 Minute Period Otherwise, The Test Is Completed

SCORING (NOMOGRAM)
• Generally The Lower The Steady-state Heart Rate The Better Your Fitness.
• The Steady-state Heart Rate And Workload Are Looked Up On The Nomogram To
Determine An Estimation Of Vo2max.
• Scoring (Formula): Here Is Also The Formula (Buono Et Al. 1989) That The
Nomogram Is Based On, Where Predicted Vo2max Is In L/Min, Hrss Is The Steady
Heart Rate After 6 Min Of Exercise, And The Workload In Kg.M/Min.
• To Convert A Load In Watts To Kg.M/Min, Multiply The Watts By 6.12.

• Females: Vo2max = (0.00193 X Workload + 0.326) / (0.769 X Hrss - 56.1) X 100
Males: Vo2max = (0.00212 X Workload + 0.299) / (0.769 X Hrss - 48.5) X 100

SUBMAXIMAL
Men women
Conditioned 600-900 450-600
unconditioned 300-600
kip/m/min
300-450
kp/m/min
MAXIMAL
WOMEN MEN
300 KG /MIN 600 kg/min

ADVANTAGES
• This is A simple test to administer,
reasonably accurate and appropriate
for ECG monitoring during exercise.
DISADVANTAGES
• The Test Score Would Be Influenced By The
Variability In Maximum Heart Rate In Individuals.
• It Would Underestimate The Fitness Of Those With
A High Maximum Heart Rate, And Overestimate
Fitness With Advancing Age (As Max Hr Reduces
With Age).
• As It Is Performed On A Cycle Ergometer, It Would
Favor Cyclists.

• Clinical exercise testing has been part of the differential diagnosis of
patients with suspected ischemic heart disease (IHD) for more than
50 yr.
• Also called as symptom limited test.
• During a clinical exercise test, patients are monitored while
performing incremental (most common) or constant work rate
exercise using standardized protocols and procedures and typically
using a treadmill or a stationary cycle ergometer
• The clinical exercise test typically continues until the patient
reaches a sign (e.g., ST-segment depression) or symptom-
limited (e.g., angina, fatigue) maximal level of exertion.

INDICATIONS FOR A CLINICAL EXERCISE TEST
• (A) Diagnosis (E.G., Presence Of Disease Or Abnormal Physiologic
Response),
• (B) Prognosis (E.G., Risk For An Adverse Event),
• (C) Evaluation Of The Physiologic Response To Exercise (E.G., Blood
Pressure [BP] And Peak Exercise Capacity).

• The Most Common Diagnostic Indication Is The Assessment Of Symptoms
Suggestive Of IHD.
• The American College Of Cardiology (Acc) And The American Heart
Association (Aha) Recommend A Logistic Approach To Determining The
Type Of Test To Be Used In The Evaluation Of Someone Presenting With
Stable Chest Pain.

Testing Mode and Protocol
• ,.
In the United States,
treadmill is the most
frequently used mode
whereas a cycle
ergometer is
more common in
Europe

Monitoring and Test Termination
• Hr;
• Ecg;
• Cardiac rhythm;
• Bp;
• Perceived exertion; and
• Clinical signs and patient-reported symptoms suggestive of
myocardial ischemia, inadequate blood Perfusion, inadequate gas
diffusion, and limitations in pulmonary ventilation

• Measurement Of Expired Gases Through Open Circuit Spirometry
During A CPET And Oxygen Saturation Of Blood Through Pulse
Oximetry And/Or Arterial Blood Gases Are Also Obtained When
Indicated

INTERPRETING THE CLINICAL EXERCISE TEST
 Heart Rate Response: To Increase With Increasing Workloads At A Rate Of ≈10 Beats · Min−1 Per 1 MET
 Blood Pressure Response: Response: An SBP >250 Mm Hg Is A Relative Indication To Stop A Test.
• Hypotensive Response: A Decrease Of SBP Hypotensive Response: A Decrease Of SBP Below The Pretest Resting Value Or By >10 Mm Hg After A Preliminary Increase, Particularly In The
Presence Of Other Indices Of Ischemia,
• Below The Pretest Resting Value Or By >10 Mm Hg After A
 Rate-pressure Product (Also Known As Double Product) Is Calculated By Multiplying The Values For HR And SBP That Occur
At The Same Time During Rest Or Exercise.
• There Is A Linear Relationship Between Myocardial Oxygen Uptake And Both Coronary Blood Flow And Exercise Intensity.
• The Normal Range For Peak Ratepressure
• Product Is 25,000–40,000 Mm Hg · Beats · Min−1
• reliminary Increase, Particularly In The Presence Of Other Indices Of Ischemia,
Hypertensive: An SBP
>250 Mm Hg Is A
Relative Indication To
Stop A Test.
Hypotensive: A Decrease Of
SBP Below The Pretest
Resting Value Or By >10 Mm
Hg After A Preliminary
Increase, Particularly In The
Presence Of Other Indices Of
Ischemia,

Electrocardiogram
• St-segment Changes (I.E., Depression And Elevation) Are
Widely Accepted Criteria For Myocardial Ischemia And
Injury.
• Horizontal Or Downsloping St-segment Depression ≥1 Mm
(0.1 Mv) At 80 Ms After The J Point Is A Strong Indicator
Of Myocardial Ischemia.
• Clinically Significant St-segment Depression That Occurs
During Postexercise Recovery Is An Indicator Of Myocardial
Ischemia.
• St-segment Depression At A Low Workload Or Low Rate-
pressure Product Is Associated With Worse Prognosis And
Increased Likelihood For Multivessel Disease.
Symptoms
Symptoms That Are Consistent With Myocardial Ischemia
(E.G., Angina, Dyspnea Or Hemodynamic Instability (E.G.,
Light-headedness) Should Be Noted An Correlated With
ECG, HR, And BP Abnormalities (When Present).
• Exercise-induced Angina Is Associated With An Increased
Risk For Ihd.

Exercise Capacity
• Evaluating Exercise Capacity Is An Important Aspect Of Exercise Testing.
• Healthy Individuals With A Peak Exercise Capacity Of 13–15 METS & In Patients With Cardiac Or
Pulmonary Disease METS
High exercise
capacity
Absence of
limitation

Symptom limited test WITH IMAGING
• exercise testing may be coupled with other techniques.
• Various radioisotopes can be used to evaluate the presence of a myocardial perfusion abnormality.
• When Exercise Testing Is Coupled With Myocardial Perfusion Imaging (E.G., Nuclear Stress Test) Or
Echocardiography, All Other Aspects Of The Exercise Test Should Remain The Same, Including HR
And BP Monitoring During And After Exercise, Symptom Evaluation, Rhythm Monitoring, And
Symptom-limited Maximal Exertion.
• The Two Most Common Isotopes Are Thallium And Mtechnetium Sestamibi (Cardiolite).

08-11-2023 6 Minute Walk Test 59
6 Minute Walk Test

DEFINITION
• The 6MWT is a practical simple test that requires a 100-ft. This test measures the
distance that a patient can quickly walk on a flat, hard surface.

INDICATIONS
Lung resection and lung volume surgery
• Pulmonary rehabilitation & Pulmonary hypertension Heart failure
• COPD
Pre and post-treatment
comparisons of Lung
transplantation:
COPD, Heart failure
• Cystic fibrosis, Peripheral vascular disease
• Fibromyalgia & Older patients
Functional status
(single measurement)
Heart Failure
• COPD
• Primary Pulmonary Hypertension
Predictor of morbidity
and mortality

CONTRAINDICATIONS
Unstable angina during the previous month
and myocardial infarction during the previous
month.
Absolute
contraindications
RHR > 120
>180/100
• Stable exertional angina is not an absolute
contraindication, but patients with these symptoms
should perform the test after using their antianginal
medication, and rescue nitrate medication should
be readily available.
Relative
contraindications

SAFTEY ISSUES
• Rapid and appropriate response to an emergency is possible.
• Required equipment's and supplies must be there.
• The technician should be certified in CPR with a minimum of BLS by an AHA–
approved CPR course.
• Oxygen should be given at their standard rate or as directed by a physician or a
protocol.

REASONS FOR IMMEDIATELY
STOPPING A 6MWT
1.Chest pain Intolerable dyspnea
1.Leg cramps
1.Staggering
1.Diaphoresis
1.Pale or Ashen appearance

TECHNICALASPECTS OF THE 6MWT1
LOCATION
• It should be performed indoors, along a long, flat, straight,
enclosed corridor with a hard surface that is seldom traveled.
• The walking course must be 30 m in length.
• A 100-ft hallway is, therefore, required.
• The length of the corridor should be marked every 3 m.
• A starting line, which marks the beginning and end of each 60-m
lap, should be marked on the floor using brightly colored tape.

REQUIRED EQUIPMENT

PATIENT PREPARATION1
1.Comfortable clothing and Appropriate shoes
1.should use their usual walking aids during the test (cane, walker, etc).
1.usual medical regimen should be continued.
1.A light meal is acceptable before early morning or early afternoon
tests.
1.Patients should not have exercised vigorously within 2 hours of
beginning the test.

PROCEDURE1
a) No “warm-up” period before the test. Subject sat on chair located near the
starting position, for at least 10 minutes before the test starts. During this time,
all the vitals were checked: BP, RR, PR, SPO2, HR, BORG SCALE
b) Use an even tone of voice when using the standard phrases.
c) Post-test: Record the post walk Borg dyspnea and asked this: “What, if
anything, kept you from walking farther?” and check all vital again
d) Record the number of laps and additional distance covered (the number of
meters in the final partial lap). Congratulated the subject on good effort and
offer a drink of water.

PHRASES1
• Only the standardized phrases can be used during the test.
After the first minute (In even tones): You are doing well. You have 5
minutes to go.
When the timer shows 4 minutes remaining Keep up the good work. You have 4 minutes to
go.
When the timer shows 3 minutes remaining You are halfway done.
When the timer shows 2 minutes remaining, Keep up the good work. You have only 2
minutes left.
When the timer shows only 1 minute
remaining
You are doing well. You have only 1 minute to
go.
When the timer is 15 seconds from
completion,
In a moment I’m going to tell you to stop. When
I do, just stop right where you are and I will
come to you.

FACTORS AFFECTING 6MWD1
FACTORS DECREASING 6MWD
1. Shorter height
2. Older age
3. Higher body weight
4. Female sex Impaired cognition
5. A shorter corridor (more turns)
6. Pulmonary disease (COPD, asthma,
cystic fibrosis, interstitial lung
disease)
7. Cardiovascular disease (angina, MI,
CHF, stroke, TIA, PVD, AAI)
8. Musculoskeletal disorders (arthritis,
ankle, knee, or hip injuries, muscle
wasting, etc.)
FACTORS INCREASING
6MWD
1. Taller height (longer legs)
2. Male sex
3. High motivation
4. A patient who has previously
performed the test.
5. Medication for a disabling disease
taken just before the test Oxygen
supplementation in patients with
exercise-induced hypoxemia.

CONCLUSION
• The 6-minute walk test (6MWT) is a simple, practical, reliable, and valid
measure of submaximal exercise capacity in healthy children and with
chronic disease or neuromuscular disorders or cardiopulmonary
disease. 6MWT is standardized, safe, inexpensive, and requires minimal
equipment, training, and time to administer. It is considered as the most
relevant walk test that reflects physical activity of daily living as well as
cardiopulmonary fitness.

CRF MEASUREMENT
• 6MWTD is the alone significantly associated with objectively measured fitness than other simple,
laboratory and field based submaximal exercise test as a predictor of both functional (distance) and
objective (VO2 max) fitness .
• The published ATS standardized guidelines for performing the test and considers factors such as gender,
height, age, length of the walkway and encouragement to have impact on the distance walked (6MWD).
FORMULA TO MEASURE VO2max
• VO 2 max (mL⋅kg−1 ⋅min−1) = 70.161 + (0.023 × 6MWT [m]) – (0.276 × weight [kg]) – (6.79 × sex,
where m = 0, f = 1) − (0.193 × resting HR [beats per minute]) – (0.191 × age [y])

INCREMENTAL SHUTTLE WALK TEST
• It was developed to simulate a cardiopulmonary exercise test using a
field walking test.
• Developed to overcome problems associated with fixed-time, self-
paced walking tests.
• 10m course marked by 2 cones set 0.5m from each end.
• Walking speed set by an audio signal on a tape/cd.
• Initial pace is 0.5m/sec. Walking speed increases by 0.17m/sec each
minute of the test, indicated by a triple beep from the tape.

INCREMENTAL SHUTTLE WALK TEST
• Number of shuttles increases by 1 each time the speed of walking
increases.
• Test ends when the patient is exhausted or too breathless to continue
or when the patient is more than .5m from the cone when the turn
signal sounds.
• Max 12 levels.

STANDARDISATION
• The ISWT must be measured on two occasions to account for a learning effect.
Please note that: The best result is recorded.
• If the repeat test is performed on the same day, 30 minutes rest should be
allowed between tests. Debilitated individuals may require tests to be performed
on separate days, but aim for tests to be less than one week apart.
• Only standardized instructions from the CD should be used. In contrast to the six-
minute walking test, no encouragement should be given throughout the ISWT.
• A comfortable ambient temperature and humidity should be maintained for all
tests.
• The walking track must be the same for all tests for a patient:
 Cones are placed nine meters apart.
 The distance walked around the cones is 10 meters.

• Any prescribed inhaled bronchodilator medication should be taken within one hour of
testing or when the patient arrives for testing.
• The patient should rest for at least 15 minutes before beginning the ISWT
• HR, SpO2, BORG Dyspnea scale
BEFORE
• Each time the beep sounds: Increase your speed now.”
• Use the following prompt if the patient is less than 0.5 m away from the cone when the
beep sounds. “You‟re not going fast enough; try to make up the speed this time.”
• Record each shuttle that is completed on the ISWT recording sheet.
• Monitor the patient for untoward signs and symptoms.
DURING
• The patient is more than 0.5 m away from the cone when the beep sounds (allow one
lap to catch up).
• The patient reports that they are too breathless to continue. The patient reaches 85% of
predicted maximum heart rate (maximum heart rate = 210 – 0.65 x age).
ENDING

END THE ISWT
• The patient exhibits any of the following signs and symptoms:
• Chest pain that is suspicious of / for angina.
• Evolving mental confusion or lack of coordination. o Evolving light-
headedness.
• Intolerable dyspnea.
• Leg cramps or extreme leg muscle fatigue.
• Persistent SpO2 < 85%.
• Any other clinically warranted reason.

AT THE END OF THE ISWT
• Seat the patient or, if the patient prefers, allow the patient to stand.
• Note: The measurements taken before and after the test should be taken
with the patient in the same position.
• Immediately record oxygen saturation (SpO2)%, heart rate and dyspnea
rating.
• Two minutes later, record SpO2% and heart rate to assess the recovery
rate.
• Record the total number of shuttles. Record the reason for terminating the
test. The patient can be asked: “What do you think stopped you from
keeping up with the beeps?” The patient should remain in a clinical area for
at least 15 minutes following an uncomplicated test.

ISWT AS AN OUTCOME MEASURE
• The change in the distance walked in the ISWT can be used to
evaluate the efficacy of an exercise training program and / or to track
the change in exercise capacity over time.
• An improvement of 47.5 meters in ISWT indicates that patients with
COPD are slightly better and an improvement of 78.7 meters
represents better.

THE ENDURANCE SHUTTLE
WALKING TEST (ESWT)

THE ENDURANCE SHUTTLE
WALKING TEST (ESWT)
• It is a derivative of the ISWT, where patients walk for as long as
possible at a predetermined percentage of maximum walking
performance as assessed by the ISWT, frequently in the range of 70–
85%.
• To set the speed for the ESWT, the ISWT must have been determined
previously.
• One test is sufficient to obtain a reliable measure.

EXERCISE TOLERENCE TEST

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