The incremental shuttle walk test (ISWT) is used to assess aerobic fitness in cardiac rehabilitation. It involves walking back and forth between two cones placed 10 meters apart at an increasing pace dictated by an audio signal. The test starts at a slow pace and gradually increases each minute. Patients walk until too breathless to maintain the pace. The number of shuttles completed is recorded. Standardization is important, including using only the audio instructions, maintaining consistent testing conditions, and allowing adequate rest between repeat tests. Outcomes include distance walked and change over time or after an exercise program.

1. SUBJECT- PHYSIOTHERAPY IN CARDIOPULMONARY CONDITION (BPT-402)
SUBMITTED TO : DR.JAMAL ALI MOIZ
SUBMITTED BY: FARAH TABASSUM
CLASS : BPT 4TH YEAR
Date of presentation – 15/02/2021
CENTRE FOR PHYSIOTHERAPY AND REHABILITATION SCIENCES
JAMIA MILLIA ISLAMIA
INCREMENTAL SHUTTLE WALK TEST

2. INCREMENTAL SHUTTLE WALK TEST
• The incremental shuttle walk test (ISWT) was developed to simulate a cardiopulmonary exercise test using a
field walking test. It is a low cost, submaximal exercise test, which is commonly used in the assessment of
aerobic fitness in a cardiac rehabilitation (CR) setting.
• The ISWT is available from Prof Sally Singh, Department of Respiratory Medicine, Glenfield Hospital NHS
Trust, Groby Road, Leicester LE3 9QP, UK.
• Test requires the patient to walk up and down a 10 m course, with the walking speed dictated by a prerecorded
audio signal played on a cassette recorder.
• The course was identified by two cones inset 0.5 m from either end to avoid the need for abrupt changes in
direction.
• Initially, the walking speed is very slow, but each minute the required walking speed progressively increases.
• The patient walks for as long as they can until they are either too breathless or can no longer keep up with the
beeps, at which time the test ends.
• The number of shuttles is recorded. Each shuttle represents a distance of ten metres (i.e each time the patient
reaches a cone is 1 shuttle).

3.  ABSOLUTE CONTRAINDICATION
• Acute myocardial infarction (3–5 days)
• Unstable angina
• Uncontrolled arrhythmias causing symptoms or hemodynamic compromise
• Syncope
• Active endocarditis
• Acute Myocarditis or Pericarditis
• Symptomatic severe aortic stenosis
• Acute pulmonary embolus or pulmonary infarction
 RELATIVE CONTRAINDICATION
• Left main coronary stenosis or its equivalent
• Moderate stenotic valvular heart disease
• Severe untreated arterial hypertension at rest (200 mmHg systolic, 120 mmHg diastolic)
• Tachyarrhythmias or bradyarrhythmias
• High-degree atrioventricular block

4. Standardisation
• Standardisation of the ISWT is very important for obtaining meaningful outcomes.
• Only standardised 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 metres apart.
• The distance walked around the cones is 10 metres.
• 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.
•The results of the ISWT can be used to prescribe the intensity of walking training .

6. Before the ISWT
• Instruct the patient to dress comfortably and to wear appropriate footwear.
• 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.
• Record:
• Blood pressure.
• Heart rate.
• Oxygen saturation.
• Dyspnoea score.
• Note: Show the patient the dyspnoea scale (e.g. borg scale) and give standardised instructions on how to obtain a
score.

7. During the ISWT
• Follow the instructions on the CD, and use the following standard prompts:
• 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.”
• The object of the progressive shuttle walking test is to walk as long as possible, there and back along the 10-
metre course keeping to the speed indicated by the bleeps on the audio recording.
• You will hear these beeps at regular intervals.
• You should walk at a steady pace, aiming to turn around the cone at one end of the course when you hear the
first beep, and at the other end when you hear the next.

8. • The initial walking speed was 0.5 m/s and it increased by 0.17 m/s each minute.
• Each single beep signals the end of a shuttle and each triple beep signals an increase in walking speed.
• You should stop walking only when you become too breathless to maintain the required speed or can no
longer keep up with the set pace.
• Record each shuttle that is completed on the ISWT recording sheet.
• Monitor the patient for untoward signs and symptoms.

9. Ending the ISWT
• The ISWT ends if any one of the following occur:
• 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)
• 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.
• Evolving light-headedness.
• Intolerable dyspnoea.
• Leg cramps or extreme leg muscle fatigue.
• Persistent SpO2 < 85%.
• Any other clinically warranted reason.

10. At the End of the ISWT
• Seat the patient or, if the patient prefers, allow to the patient to stand.
• Immediately record oxygen saturation (SpO2)%, heart rate and dyspnoea 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.

11. ISWT as an outcome measure
• The change in the distance walked in the ISWT can be used to evaluate the effectiveness of an exercise
training program and / or to track the change in exercise capacity over time.
• An improvement of 47.5 metres in ISWT indicates that patients with COPD are ‘slightly better’ and an
improvement of 78.7 metres represents ‘better’.

13. REFERENCES
• Singh SJ, Morgan MD, Scott S, et al Development of a shuttle walking test of disability in patients with
chronic airways obstruction. Thorax 1992;47:1019-1024.
• Vanessa S. Probst, Nidia A. Hernandes, Denilson C. Teixeira, Josiane M. Felcar, Rafael B. Mesquita, Cristiane
G. Gonçalves, Daniela Hayashi, Sally Singh, Fabio Pitta,Reference values for the incremental shuttle walking
test.