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Comparison of the physiological responses of the Incremental Shuttle Walk test and Glittre-ADL test: complementary instruments for the evaluation of functional capacity

Dayane Montemezzo Danielle Aparecida Gomes Pereira Giane Amorim Ribeiro-Samora Sabrina Costa Lima Bianca Louise Carmona Rocha Marcelo Velloso Raquel Rodrigues Britto About the authors

RESUMO

O objetivo deste estudo foi avaliar e comparar respostas metabólicas, cardiovasculares e ventilatórias do incremental shuttle walk test (ISWT) e do Glittre activities of daily living test (Glittre-ADL test). Trata-se de um estudo transversal, realizado com indivíduos saudáveis. A capacidade funcional (CF) foi avaliada pela distância percorrida e consumo de oxigênio pico (VO2pico) no ISWT e pelo tempo gasto e VO2 no Glittre-ADL test. Trinta indivíduos percorreram 656,67 (IC95%:608,8-704,5) metros no ISWT e executaram o Glittre-ADL test em 2,4 (IC95%:2,2-2,6) minutos. O VO2 pico do ISWT foi 27,8 (IC95%25,6-29,9) versus 22,2 (IC95%20,5-24,1)mL×kg−1×min−1 (p<0,001) no estado estável (EE) do Glittre-ADL test. As correlações entre distância percorrida no ISWT e o tempo gasto no Glittre-ADL test, o VO2pico do ISWT e o VO2 no EE do Glittre-ADL test e a FC no pico do ISWT e no EE do Glittre-ADL test foram de moderada a alta magnitude. O Glittre-ADL test apresenta menores respostas metabólicas, cardiovasculares e ventilatórias se comparado ao ISWT.

Descritores
Consumo de Oxigênio; Teste de Esforço; Atividades Cotidianas; Teste de Caminhada

RESUMEN

El presente estudio tuvo el objetivo de evaluar y comparar las respuestas metabólicas, cardiovasculares y ventilatorias de incremental shuttle walk test (ISWT) y de Glittre activities of daily living test (Glittre-ADL test). Es un estudio transversal realizado con individuos sanos. La capacidad funcional (CF) se evaluó utilizando la distancia recorrida y consumo máximo de oxígeno (VO2máx) en el ISWT y el tiempo empleado y VO2 en el Glittre-ADL test. Treinta individuos caminaron 656,67 (IC95%:608,8-704,5) metros en el ISWT y realizaron el Glittre-ADL test en 2,4 (IC95%:2,2-2,6) minutos. El VO2 máx del ISWT fue de 27,8 (IC95%25,6-29,9) versus 22,2 (IC95%20,5-24,1)mL×kg−1×min−1 (p<0,001) en el estado estable (EE) del Glittre-ADL test. Las correlaciones entre la distancia recorrida en el ISWT y el tiempo empleado en el Glittre-ADL test, el VO2máx del ISWT y el VO2 en el EE de Glittre-ADL test y la FC en el máximo del ISWT y en el EE de Glittre-ADL test fueron de moderada a alta magnitud. El Glittre-ADL test presenta respuestas metabólicas, cardiovasculares y ventilatorias más bajas en comparación con el ISWT.

Palabras clave
Consumo de Oxígeno; Prueba de Esfuerzo; Actividades Cotidianas; Prueba de Paso

ABSTRACT

The aim of the study was to assess and compare the cardiovascular, ventilatory and metabolic responses of the Incremental Shuttle Walk test (ISWT) and Glittre Activities of Daily Living test (Glittre-ADL test). This is a cross-sectional study with individuals. The functional capacity (FC) was evaluated by distance and peak oxygen consumption (VO2peak) in the ISWT and time spent and VO2 in Glittre-ADL test. Thirty individuals went through 656.67 (CI95%:608.8-704.5) meters at the ISWT and performed the Glittre-ADL test in 2.4 (CI95%:2.2-2.6) minutes. The peak VO2 of the ISWT was 27.8 (CI95%25.6-29.9) vs. 22.2 (CI95%20.5-24.1) mL×kg−1×min−1 (p<0.001) in the steady state (SS) of the Glittre-ADL test. Correlations between distance traveled in the ISWT and the time spent in Glittre-ADL test, VO2 peak of ISWT and VO2 in SS of Glittre-ADL test and HR at the ISWT peak and at the Glittre-ADL test SS were moderate to high magnitude. The Glittre-ADL test has lower metabolic, cardiovascular and ventilatory responses compared to ISWT, despite correlations between variables.

Keywords
Oxygen Uptake; Exercise Test; Activities of Daily Living; Walk Test

INTRODUCTION

Field tests associated with predictive equations to indirectly determine peak oxygen consumption (VO2peak) have been extensively used in clinical practice11. Neves CDC, Lacerda ACR, Lage VKS, Lima LP, Fonseca SF, Avelar NCP, et al. Cardiorespiratory responses and prediction of peak oxygen uptake during the shuttle walking test in healthy sedentary adult men. PLoS One. 2015;10(2):e0117563. doi: 10.1371/journal.pone.0117563
https://doi.org/10.1371/journal.pone.011...
as reproducible alternatives22. Lewis M, Newall C, Townend J, Hill S, Bonser R. Incremental shuttle walk test in the assessment of patients for heart transplantation. Heart. 2001;86(2):183-7. doi: 10.1136/heart.86.2.183
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for assessing functional capacity (FC), as they are able to express the functional capacities of the respiratory, cardiovascular and musculoskeletal systems33. Haskell WL, Lee I-M, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423-34. doi: 10.1249/mss.0b013e3180616b27
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. They are operationally simple, accessible and low cost44. Dourado VZ, Guerra RLF, Tanni SE, Antunes LCDO, Godoy I. Valores de referência para o teste de caminhada com carga progressiva em indivíduos saudáveis: da distância percorrida às respostas fisiológicas. J Bras Pneumol. 2013;39(2):190-7. doi: 10.1590/S1806-37132013000200010
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. The use of these tests makes it possible to assess FC and identify limiting factors for exercise performance, as well as the response to interventions quickly and safely55. Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Gonçalves CG, et al. Reference values for the incremental shuttle walking test. Respir Med. 2012;106(2):243-8. doi: 10.1016/j.rmed.2011.07.023.
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.

These are tests applied under different health conditions, in which the predominant activity is walking66. Seixas DM, Seixas DMT, Pereira MC, Moreira MM, Paschoal IA. Dessaturação em indivíduos saudáveis submetidos ao incremental shuttle walk test. J Bras Pneumol. 2013;39(4):440-6. doi: 10.1590/S1806-37132013000400007
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)- (88. Jürgensen SP, Antunes LCO, Tanni SE, Banov MC, Lucheta PA, AF Bucceroni, et al. The incremental shuttle walk test in older Brazilian adults. Respiration. 2011;81(3):223-8. doi: 10.1159/000319037
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. The incremental shuttle walk test (ISWT), controlled by external audible signals, aims to assess FC, considering limiting symptoms99. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019-24. doi: 10.1136/thx.47.12.1019
https://doi.org/10.1136/thx.47.12.1019...
), (1010. Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428-46. doi: 10.1183/ 09031936.00150314
https://doi.org/10.1183/...
. The test is valid and reliable to estimate the FC of individuals with chronic respiratory disorders, in addition to being responsive to pulmonary rehabilitation and the use of bronchodilator agents1111. Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1447-78. doi: 10.1183/09031936.00150414
https://doi.org/10.1183/09031936.0015041...
), (1212. Parreira VF, Janaudis-Ferreira T, Evans RA, Mathur S, Goldstein RS, Brooks D. Measurement properties of the incremental shuttle walk test: a systematic review. Chest. 2014;145(6):1357-69. doi: 10.1378 / chest.13-2071.
https://doi.org/10.1378...
. The Glittre activities of daily living test (Glittre-ADL test), a multitasking test1313. Janaudis-Ferreira T, Beauchamp MK, Robles PG, Goldstein RS, Brooks D. Measurement of activities of daily living in patients with COPD: a systematic review. Chest. 2014;145(2):253-71. doi: 10.1378/chest.13-0016
https://doi.org/10.1378/chest.13-0016...
), (1414. Reis CMD, Karloh M, Fonseca FR, Biscaro RRM, Mazo GZ, Mayer AF. Functional capacity measurement: reference equations for the Glittre activities of daily living test. J Bras Pneumol. 2018;44(5):370-7. doi: 10.1590/S1806-37562017000000118
https://doi.org/10.1590/S1806-3756201700...
, is valid for assessing the FC of individuals with chronic obstructive pulmonary disease (COPD). It has adequate test-retest reliability1515. Skumlien S, Hagelund T, Bjørtuft Ø, Ryg MS. A field test of functional status as performance of activities of daily living in COPD patients. Respir Med. 2006;100(2):316-23. doi: 10.1016/j.rmed.2005.04.022
https://doi.org/10.1016/j.rmed.2005.04.0...
, reproducible for different populations1616. Fernandes-Andrade AA, Britto RR, Soares DCM, Velloso M, Pereira DAG. Evaluation of the Glittre-ADL test as an instrument for classifying functional capacity of individuals with cardiovascular diseases. Rev Bras Fisioter. 2017;21(5):321-8. doi: 10.1016/j.bjpt.2017.06.001
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)- (1818. José A, Dal Corso S. Reproducibility of the six-minute walk test and Glittre ADL-test in patients hospitalized for acute and exacerbated chronic lung disease. Rev Bras Fisioter. 2015;19(3):235-42. doi: 10.1590/bjpt-rbf.2014.0092
https://doi.org/10.1590/bjpt-rbf.2014.00...
, and is responsive to pulmonary rehabilitation1515. Skumlien S, Hagelund T, Bjørtuft Ø, Ryg MS. A field test of functional status as performance of activities of daily living in COPD patients. Respir Med. 2006;100(2):316-23. doi: 10.1016/j.rmed.2005.04.022
https://doi.org/10.1016/j.rmed.2005.04.0...
) and valid for differentiating the functional status of healthy individuals from those with COPD1919. Corrêa KS, Karloh M, Martins LQ, Santos KD, Mayer AF. Can the Glittre-ADL test differentiate the functional capacity of COPD patients from that of healthy subjects? Rev Bras Fisioter. 2011;15(6):467-73. doi: 10.1590/S1413-35552011005000034
https://doi.org/10.1590/S1413-3555201100...
.

Considering that both tests are indicated to assess FC under different aspects, the possibility of identifying its peculiarities provides subsidies for physical therapists and expands the body of knowledge on the subject. Thus, the study aimed to evaluate and compare the metabolic, cardiovascular and ventilatory responses of ISWT and Glittre-ADL test in healthy individuals.

METHODOLOGY

This is a cross-sectional study, approved by the institution’s Ethics Committee. All participants signed the Free and Informed Consent Form. Healthy individuals between 18 and 59 years old; regular body mass index (BMI) (2020. World Health Organization. Global database on body mass index [Internet]. 2006 [cited 17 Feb 2020]. Available from: https://bit.ly/37CtsDc
https://bit.ly/37CtsDc...
and spirometric parameters2121. Pereira CA, Sato T, Rodrigues SC. New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol. 2007;33(4):397-406. doi: 10.1590/S1806-37132007000400008
https://doi.org/10.1590/S1806-3713200700...
; non-smokers1919. Corrêa KS, Karloh M, Martins LQ, Santos KD, Mayer AF. Can the Glittre-ADL test differentiate the functional capacity of COPD patients from that of healthy subjects? Rev Bras Fisioter. 2011;15(6):467-73. doi: 10.1590/S1413-35552011005000034
https://doi.org/10.1590/S1413-3555201100...
; without neuromuscular, respiratory and/or cardiac diseases2222. Franco Parreira V, França D, Zampa C, Fonseca M, Tomich G, Britto R. Pressões respiratórias máximas: valores encontrados e preditos em indivíduos saudáveis. Rev Bras Fisioter. 2007;11(5):361-8. doi: 10.1590/S1413-35552007000500006
https://doi.org/10.1590/S1413-3555200700...
; and without limitation for walking were eligible. Those with resting blood pressure (BP)≥160/105 mmHg2323. Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. VI diretrizes brasileiras de hipertensão. Arq Bras Cardiol [Internet]. 2010 [cited 17 Feb 2020];95 Suppl 1:S1-S51. Available from: https://bit.ly/2SW67qI
https://bit.ly/2SW67qI...
and/or peripheral oxygen saturation (SpO2 )<90%2424. Goldstein R, De Rosie J, Long S, Dolmage T, Avendano MA. Applicability of a threshold loading device for inspiratory muscle testing and training in patients with COPD. Chest. 1989;96(3):564-71. doi: 10.1378/chest.96.3.564
https://doi.org/10.1378/chest.96.3.564...
and/or heart rate (HR)>120bpm2525. American Thoracic Society, European Respiratory Society. Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518-624. doi: 10.1164/rccm.166.4.518
https://doi.org/10.1164/rccm.166.4.518...
were excluded before the tests were performed, in addition to those unable to understand and/or perform the study procedures.

The sample calculation initially considered the following variables: oxygen consumption (VO2) in the steady state (SS) of the Glittre-ADL test and VO2peak of the ISWT, with statistical power of 0.80 and effect size of the difference of 0.50 established arbitrarily2626. Portney LG, Watkins MP. Correlation. In: Portney LG, Watkins MP. Foundations of clinical research applications to practic. New Jersey: Pearson; 2009. p. 523-38., in which the sample size was 64 participants. Later, with 31 participants, the effect size of the difference was 2.47, corresponding to nine individuals.

Procedures were carried out by trained researchers. BP, respiratory rate (f), HR and SpO2 were measured and the percentage of HRmaximum was calculated2727. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153-6. doi: 10.1016/S0735-1097(00)01054-8
https://doi.org/10.1016/S0735-1097(00)01...
. The spirometric data obtained in the pulmonary function test2828. Pereira CDC, Jansen J, Barreto SM, Marinho J, Sulmonett N, Dias R. Espirometria. J Pneumol [Internet]. 2002 [cited 18 Feb 2020];28 Suppl 3:S1-S82. Available from: https://bit.ly/32aGhDp
https://bit.ly/32aGhDp...
) were compared to those predicted2121. Pereira CA, Sato T, Rodrigues SC. New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol. 2007;33(4):397-406. doi: 10.1590/S1806-37132007000400008
https://doi.org/10.1590/S1806-3713200700...
, with values ≥80% of expected. The perceived level of physical activity was assessed using the human activity profile (HAP) (2929. Souza AC, Magalhães LDC, Teixeira-Salmela LF. Adaptação transcultural e análise das propriedades psicométricas da versão brasileira do Perfil de Atividade Humana. Cad Saúde Pública. 2006;22(12):2623-36. doi: 10.1590/S0102-311X2006001200012
https://doi.org/10.1590/S0102-311X200600...
.

Functional capacity was evaluated by the ISWT and Glittre-ADL test1515. Skumlien S, Hagelund T, Bjørtuft Ø, Ryg MS. A field test of functional status as performance of activities of daily living in COPD patients. Respir Med. 2006;100(2):316-23. doi: 10.1016/j.rmed.2005.04.022
https://doi.org/10.1016/j.rmed.2005.04.0...
, with direct measurement of breath-by-breath gas exchange3030. Macfarlane DJ, Wong P. Validity, reliability and stability of the portable Cortex MetaMax 3B gas analysis system. Eur J Appl Physiol. 2012;112(7):2539-47. doi: 10.1007/s00421-011-2230-7
https://doi.org/10.1007/s00421-011-2230-...
, made with a portable gas analyzer MetaMax 3B (MetaSoft Cortex, from Germany). The participant received specific instructions and demonstrations on how to perform each test99. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019-24. doi: 10.1136/thx.47.12.1019
https://doi.org/10.1136/thx.47.12.1019...
), (1515. Skumlien S, Hagelund T, Bjørtuft Ø, Ryg MS. A field test of functional status as performance of activities of daily living in COPD patients. Respir Med. 2006;100(2):316-23. doi: 10.1016/j.rmed.2005.04.022
https://doi.org/10.1016/j.rmed.2005.04.0...
, in a random order, within an interval of 20 minutes. Metabolic, cardiovascular and ventilatory variables were recorded during one minute of rest in a sitting position, cardiovascular parameters and the subjective perception of pre and post-test effort. HR was recorded continuously using a cardiofrequency meter (Polar, HR Transmitter Belt H7, from Finland). At the end of both tests, the cardiovascular parameters were again. The considered operational variables for the Glittre-ADL test were time spent and VO2 in the SS and for the ISWT, the distance covered and the VO2peak. The VO2 achieved in the Glittre-ADL test was compared to the predicted values3131. Almeida AE, Stefani CM, Nascimento JA, Almeida NM, Santos AC, Stein R. An equation for the prediction of oxygen consumption in a Brazilian population. Arq Bras Cardiol. 2014;103(4):299-307. doi: 10.5935/abc.20140137
https://doi.org/10.5935/abc.20140137...
.The VO2 processing of the Glittre-ADL test was performed by analyzing time series to define the SS3232. Latorre MRD, Cardoso MRA. Análise de séries temporais em epidemiologia: uma introdução sobre os aspectos metodológicos. Rev Bras Epidemiol. 2001;4(3):145-52. doi: 10.1590/S1415-790X2001000300002
https://doi.org/10.1590/S1415-790X200100...
and the ISWT was related to the 10 seconds with the highest VO2 average, obtained during the last 30 seconds of the test3030. Macfarlane DJ, Wong P. Validity, reliability and stability of the portable Cortex MetaMax 3B gas analysis system. Eur J Appl Physiol. 2012;112(7):2539-47. doi: 10.1007/s00421-011-2230-7
https://doi.org/10.1007/s00421-011-2230-...
.

The data were reported as measures of central tendency and dispersion, according to the Shapiro-Wilk test. Paired t-tests or Wilcoxon tests were applied for comparison while Pearson correlation was applied between variables. The statistical power and the magnitude of the correlations were considered according to Portney and Watkins2626. Portney LG, Watkins MP. Correlation. In: Portney LG, Watkins MP. Foundations of clinical research applications to practic. New Jersey: Pearson; 2009. p. 523-38.. Statistical significance was considered 5% (Statistical Package for Social Science-SPSS®, version 15).

RESULTS

Among 42 eligible participants, 11 were excluded due to pulmonary function (Figure 1).

Figure 1
Study flowchart

Table 1 shows demographic and anthropometric characteristics, lung functionality and the perceived level of physical activity of the participants.

Table 1
Characterization of study participants

At ISWT, participants completed the test between the 7th and 12th level (median=10; Q1-Q3: 9-10) and walked, on average, 656.67 (95%CI: 608.84-704.5) meters (m), in 9.1 (95%CI: 8.71-9.5) min, reaching a final speed close to 2 m/s. For the execution of the Glittre-ADL test, the average time spent was 2.4 (95%CI: 2.24-2.62) min.

Figure 2 shows the metabolic, cardiovascular and ventilatory variables obtained at the beginning and at the end of the ISWT and the Glittre-ADL test. A significant difference of 5.3 (95%CI: 4.1 - 6.5) mL×kg−1×min−1 was found in the VO2 achieved in the ISWT, equivalent to 81.6% of the predicted maximum, compared to the value achieved in the Glittre-ADL test, equal to 61.6%. The average percentage of HR reached in the ISWT represented 85.1% and in the Glittre-ADL test, 71.5%, of the predicted HRmaximum, which resulted in a statistically significant difference of 25.4 (95%CI: 21.4-29.3) bpm between tests. The ratio of ventilation and maximum voluntary ventilation (VE/VVM) was also significantly higher in the ISWT (46% of predicted), when compared to the Glittre-ADL test (27.4% of predicted), resulting in an average difference of 21.7 (95%CI: 18.2-25.3) L/min between tests.

Figure 3 shows the associations between distance covered in the ISWT and time spent in the Glittre-ADL test, VO2 peak in the ISWT and VO2 in the SS of the Glittre-ADL test and HR in the ISWT peak and in the steady state of the Glittre-ADL test.

Figure 2
Data presented as mean and 95% confidence interval of the mean for metabolic, cardiovascular and ventilatory variables at the beginning, peak, stable state and end of the tests.

Figure 3
Correlation between time spent in the Glittre-ADL test and distance covered in the ISWT (upper), VO2 in the steady state of the Glittre-ADL test and VO2 peak of the ISWT (average), HR in the stable state of the Glittre-ADL test and in the peak of the ISWT (bottom)

DISCUSSION

The main result of the study indicates that the Glittre-ADL test requires lesser metabolic, cardiovascular and ventilatory overload. There was an increase of 25.2% in VO2 and 19.2% in HR (power 99% and 96%; p<0.001, respectively) to perform the ISWT, when compared to the Glittre-ADL test. This finding confirms the proposal of the Glittre-ADL test to evaluate FC through mimicking of ADLs1515. Skumlien S, Hagelund T, Bjørtuft Ø, Ryg MS. A field test of functional status as performance of activities of daily living in COPD patients. Respir Med. 2006;100(2):316-23. doi: 10.1016/j.rmed.2005.04.022
https://doi.org/10.1016/j.rmed.2005.04.0...
), (3333. Dechman G, Scherer SA. Outcome measures in cardiopulmonary physical therapy: focus on the Glittre ADL-Test for people with chronic obstructive pulmonary disease. Cardiopulm Phys Ther J. 2008;19(4):115. doi: 10.1097/01823246-200819040-00003
https://doi.org/10.1097/01823246-2008190...
.

The greater overload required by ISWT was expected to be an incremental and externally paced test. Singh et al. showed that the ISWT reflects similar responses to the cardiopulmonary stress test (TECP) in individuals with COPD, in addition to showing a high correlation between VO2peak and workload, being valid for assessing maximum exercise capacity99. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019-24. doi: 10.1136/thx.47.12.1019
https://doi.org/10.1136/thx.47.12.1019...
), (1111. Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1447-78. doi: 10.1183/09031936.00150414
https://doi.org/10.1183/09031936.0015041...
. Depending on the health condition, the ISWT can be representative of a maximum stress test. In this study, although the VO2peak of the ISWT represents 81.6% of the VO2 estimated by equations, the respiratory exchange ratio (R) achieved in the ISWT was >1, indicating a maximum effort even in young and healthy individuals. This finding in the Glittre-ADL test characterizes it as a submaximal test (R=0.71) (3434. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. Clinician's guide to cardiopulmonary exercise testing in adults a scientific statement from the American heart association. Circulation. 2010;122(2):191-225. doi: 10.1161/cir.0b013e3181e52e69
https://doi.org/10.1161/cir.0b013e3181e5...
.

Cardiovascular overload, assessed by the percentage of expected maximum HR generated by ISWT, was significantly higher when compared to the Glittre-ADL test. Previous studies have shown that in healthy individuals3535. Couser Junior JI, Martinez FJ, Celli BR. Respiratory response and ventilatory muscle recruitment during arm elevation in normal subjects. Chest. 1992;101(2):336-40. doi: 10.1378/chest.101.2.336
https://doi.org/10.1378/chest.101.2.336...
and in those with COPD3636. Velloso M, Stella SG, Cendon S, Silva AC, Jardim JR. Metabolic and ventilatory parameters of four activities of daily living accomplished with arms in COPD patients. Chest. 2003;123(4):1047-53. doi: 10.1378/chest.123.4.1047
https://doi.org/10.1378/chest.123.4.1047...
, activities with the upper limbs may cause significant cardiovascular overload. Although the Glittre-ADL test is on average 3.8 times shorter than the ISWT, there was a 16.2% difference in the HR achieved in the two tests. This behavior is evidenced by the cardiovascular overload generated when performing activities with the upper limbs.

In individuals with COPD, Karloh et al. (3737. Karloh M, Karsten M, Pissaia FV, Araujo CL, Mayer AF. Physiological responses to the Glittre-ADL test in patients with chronic obstructive pulmonary disease. J Rehabil Med. 2014;46(1):88-94. doi: 10.2340/16501977-1217
https://doi.org/10.2340/16501977-1217...
compared responses induced by the Glittre-ADL test and the six-minute walk test and observed a high magnitude correlation between the VO2peak of the two tests, being significantly higher at the end of the Glittre-ADL test. Systematic reviews1111. Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1447-78. doi: 10.1183/09031936.00150414
https://doi.org/10.1183/09031936.0015041...
), (1212. Parreira VF, Janaudis-Ferreira T, Evans RA, Mathur S, Goldstein RS, Brooks D. Measurement properties of the incremental shuttle walk test: a systematic review. Chest. 2014;145(6):1357-69. doi: 10.1378 / chest.13-2071.
https://doi.org/10.1378...
) showed a strong correlation between VO2 peak in TECP and ISWT in individuals with COPD, suggesting that the two tests may cause similar behavior in physiological responses.

The time spent on the Glittre-ADL test and the distance covered on the ISWT are moderately correlated. The individual who takes the Glittre-ADL test in the shortest time is likely to travel the longest distance on the ISWT. However, VO2 and HR had a strong correlation, indicating that these variables showed the same behavior. Although the Glittre-ADL test is self-certified, it requires at least 80% cardiovascular/metabolic and 60% ventilatory demand than that required by ISWT. This finding contributes to the choice of the FC assessment instrument, considering the individual’s health condition and the objectives of the assessment.

The results presented are restricted to healthy individuals and their generalization to other health conditions must be considered with caution.

CONCLUSION

It is recommended that the evaluated tests become complementary tools in the evaluation of FC. Although the Glittre-ADL test presents lower metabolic, cardiovascular and ventilatory responses, when compared to ISWT, the correlations between these variables are moderate to high. Thus, the choice for an assessment method depends on goals, resource availability and the specificities of the population to which they will be applied.

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  • 5
    Study conducted at the Laboratory for Assessment and Research on Cardiorespiratory Performance at the Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil.
  • Financing source: Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
  • 8
    Approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais CAAE: 21864913.7.0000.5149

Publication Dates

  • Publication in this collection
    06 Apr 2020
  • Date of issue
    Jan-Mar 2020

History

  • Received
    17 Dec 2018
  • Accepted
    13 Jan 2019
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