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An investigation of factors that best predict incremental shuttle walk test distance in cardiac rehabilitation patients
1University Of York, Health Sciences - York - United Kingdom
European Journal of Preventive Cardiology
Purposes: in cardiac rehabilitation (CR), increased cardiorespiratory fitness (CRF) is a desired and major outcome of CR. Assessing CRF by exercise testing at the initial assessment for the patient before entering a CR programme is strongly recommended in the guidelines. However, issues with the feasibility of using fitness testing tend to limit CRF assessment in clinical settings due to a lack of equipment, space, and skilled staff. The aim of this study is to investigate the ability of baseline characteristics to predict the distance walked during the Incremental Shuttle Walk Test (ISWT) in the cardiac rehabilitation population. Methods: secondary analysis was conducted on the National Audit Cardiac Rehabilitation (NACR) data collected between 2010 and 2015. Patients were included in the analysis if they were adults (>18years) and had been assessed at baseline before they started CR and had a complete record of the ISWT. Stepwise regression was used to identify which factors can predict the distance covered during the ISWT. Age, gender, BMI, physical fitness assessment and pain assessment scales were the independent variables. The first three variables were chosen based on the literature using different populations while the physical fitness assessment and pain assessment scales were the best self-reported perception variables available in the NACR data related to fitness and physical activity. The ISWT distance was the dependent variable. Results: A total of 10281 participants had completed the ISWT at the assessment baseline prior to starting a cardiac rehabilitation programme (7847 males and 2434 females). The participants’ mean age was 63+11.45 and ranged from 18 to 99 years. There were no significant differences in the mean age or BMI between males and females. The mean ISWT distance was 353.46m ± 176.74. A stepwise regression analysis using age, gender and BMI explained 29% of the variance of the distance covered in the ISWT. This increased to 36% when pre-CR physical fitness and pain assessment variables were added (r = 0.60, R2 = 0.36, adjusted R2 = 0.36, SEE = 140.39, P < 0.001). Age was the best predictor explaining 20% of the variance. The remaining four variables: gender, the physical fitness scale, BMI, and pain assessment scale were significant predictors explaining 6%, 5%, 3%, and 2% of the variance respectively. Conclusions: the ISWT is the most common CRF field test in CR centres in the UK. Age, gender and BMI, which are the most routinely measured in a clinical setting, were found to be the commonly determined key factors of fitness as defined by ISWT distance. The five predictors in this study explained 36% of the variance in the distance walked during ISWT. Of them, age was the best predictor. However, a large proportion of the variance in walking distance remained unexplained, highlighting the complexity of predicting fitness as defined by ISWT distance.
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