The shuttle walking test: a reproducible method for evaluating the impact of shortness of breath on functional capacity in patients with advanced cancer

Background-Breathlessness leading to exercise limitation is common in patie nts with advanced cancer and is ineffectively treated. There are few resear ch data to guide clinicians on best practice. The shuttle walking test has been validated for some conditions such as chronic obstructive pulmonary di sease but not for advanced cancer. One of the well documented difficulties of doing clinical research in palliative care is the acceptability of asses sment tests. This study examined the reproducibility of the shuttle walking test in patients with advanced cancer to help facilitate the systematic ev aluation of interventions designed to improve breathlessness. Methods-Patients performed three shuttle walks on separate days with contin uous monitoring of arterial oxygen saturation and heart rate; simple pulmon ary function (FEV,) was also recorded. Data on quality of life, anxiety, an d depression were collected throughout the study period using appropriate q uestionnaires. Breathlessness was measured before and after exercise using a visual analogue scale. Results-Data from 22 patients were compared betwee n visits 2 and 3. There were no significant differences between the FEV, (1 .89 v 1.90, p=0.73), distance walked on each test (245 m v 256 m, p=0.14), end-exercise levels of heart rate (107/min v 108/min, p=0.11), oxygen satur ation (93.4% v 93.2%, p=0.38), or breathlessness scores (p=0.62) on the two occasions. Indices of quality of life, anxiety, and depression were also n ot different between the two tests. The investigation was very acceptable t o patients, families, and staff. Conclusions-The shuttle walking test is a reproducible test of functional c apacity in ambulant patients with advanced cancer, WHO performance status I or 2. The data indicate that a practice session is needed. It is easy to c arry out and acceptable for patients with advanced cancer. (Thorax 2001;56: 146-150).