The Endurance Shuttle Walk Test (ESWT)

The endurance shuttle walk test (ESWT) is a constant-load exercise test which measures the ability of the participant to sustain a given sub-maximal exercise capacity. The ESWT speed is calculated based on the protocol developed by (Revill, et al., 1999)9, (Hill, et al., 2012)10 and (Wootton, et al., 2014)11 and is performed according to the original protocol. Two ESWTs are performed to account for any learning effect.9 The endpoint of the test is how long the participant walks at the constant endurance speed.  The test consists of 8 tapes (or 8 tracks on CD’s) pre-recorded with a signal at different frequencies giving a total of 16 walking speeds.

The participant is asked to walk up and down a 10m course. Two cones are set 0.5m from either end to avoid sudden change in direction (figure 1). At the start of each test there is a slower ‘warm up’ speed which lasts for 90 seconds. At the end of the warm up a message instructs the participant to increase their walking speed at the next signal. It is recommended that the tester reinforces this message to the participant.

  • In PAH pre -test screening should also include assessment of recent illness, syncope, evidence of RHF, chest pain and any increase in breathlessness.
  • If a patient is on inhaled vasodilator therapy this should be administered 30 minutes prior to the exercise  test
Level Speed Km/h Time/Shuttle Level Speed Km/h Time/Shuttle
1 1.78 20.3 9 4.11 8.8
2 2.09 17.3 10 4.36 8.3
3 2.44 14.8 11 4.65 7.8
4 2.72 13.3 12 4.97 7.3
5 3 12 13 5.14 7
6 3.27 11 14 5.54 6.5
7 3.6 10.0 15 5.76 6.3
8 3.79 9.5 16 6.00 6.0

Signal Frequency of the ESWT

The appropriate walking speed is chosen according to the total distance performed in the baseline 6MWT. Standard instruction is given to each participant before the test. The participant is asked to walk as long as possible until they are unable to continue.  It is important that the participant is NOT informed of any time limit.

Monitoring & Recording

  1. Record BP, HR, SpO2 and BORG (breathlessness) at the start.
  2. START the tape then START the stopwatch after the warm up at the triple beep.  Say to the participant:  “Speed up now”
  3. Record HR and SpO2 towards the end of each minute i.e (50 secs, 1.50, 2.50 etc…)
  4. If the participant is 0.5 metre behind the turn at the beep say:  “Can you speed up?”
  5. End the test if the participant misses (e.g. is 0.5m behind the turn) 2 consecutive shuttles
  6. End the test if the participant’s SpO2 < 80 % on 2 consecutive readings
  7. STOP the stopwatch at the END of the test.  This is your final time and MOST IMPORTANT measure
  8. Count the first shuttle the participant passed (even if they did not make it) as the final distance but do not count the very last shuttle that was missed.
  9. At the end of the test, record HR, SpO2, BORG (breathlessness), RPE (effort), and reason for termination

The Toolkit

Getting Started
Getting Started
Patient Assessment
Patient Assessment
Exercise Training
Exercise Training
Patient Education
Patient Education
Patient Re-assessment
Patient Re-Assessment
Additional Resources
Additional Resources

Endorsed by the following organisations according to their respective approved criteria: