Treadmill versus shuttle walk tests of walking ability in intermittent claudication

Purpose: To compare treadmill and shuttle walk tests for assessing functional capacity in patients with intermittent claudication, with respect to test-retest reliability, cardiovascular responses, and patient preferences. Methods: Patients with stable intermittent claudication (N = 55, ages 52-85 yr, median age 68 yr) were recruited from the Sheffield Vascular Institute at the Northern General Hospital, Sheffield, UK. Each patient performed an incremental shuttle walk test, a constant-pace shuttle walk test, and a standardized treadmill test (3.2 km(.)h(-1), 12% gradient), each on three occasions. The incremental shuttle walk began at 3 km(.)h(-1) and increased by 0.5 km(.)h(-1) every minute, whereas the constant-pace shuttle walk was performed at the fixed pace of 4 km(.)h(-1). Claudication distance (CD), maximum walking distance (MWD), heart rate (HR), and blood pressure were assessed in each testing session. The patients also completed a test preference questionnaire. Results: CD and MWD for both shuttle walks were greater than the corresponding walking distances achieved in the treadmill test (P < 0.001). Average coefficients of variation for repeated incremental shuttle walk, constant-pace shuttle walk, and treadmill tests were 15.9%, 21.1%, and 18.7%, respectively, for MWD, corresponding to average intraclass correlation coefficients of 0.87, 0.82, and 0.87. Treadmill walking evoked greater increases in HR and blood pressure (P < 0.001), and fewer patients expressed a preference for it (24 vs 43% for shuttle walking). Conclusion: These findings indicated that shuttle walk testing exhibits similar test-retest reliability as treadmill testing, but that it evoked a lower level of cardiovascular stress and is preferred to treadmill testing by a large proportion of patients.