Is a practice incremental shuttle walk test really necessary?

The incremental and endurance shuttle walking tests (ISWT and ESWT) are measures of exercise tolerance commonly used in pulmonary rehabilitation (PR). A practice ISWT is advocated but often omitted by PR centres. We aimed to investigate the effect of such an omission within a clinical PR service. Between October 2002 and October 2008, 392 patients attending PR completed a practice ISWT and an ISWT. Results showed that patients walked significantly further on ISWT compared to practice ISWT (p ≤ 0.001). A significant difference in ESWT level was found between those calculated from practice ISWT and those calculated from ISWT (p ≤ .001). Despite a visual trend towards a negative relationship between distance walked at baseline (practice ISWT) and magnitude of the difference between the two walks, this did not meet statistical significance (p = 0.409). Absence of a practice ISWT could lead to possible clinical misjudgements.