Prediction equations for distance walked in the incremental shuttle walking test and the modified shuttle test in children and adolescents
Abstract
Objectives: To provide a review of studies on prediction equations for the distance walked in the Incremental Shuttle Walking Test (ISWT) and Modified Shuttle Test (MST) in healthy children and adolescents and the methodology used. Materials and methods: Literature review carried out in the databases MEDLINE (US National Library of Medicine), SciELO (Scientific Electronic Library Online), EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, PEDro (Physiotherapy Evidence Database) and The Cochrane Library with period of publication of studies from January 2000 to May 2024. Terms used: shuttle test, reference values, normative values, reference equation, healthy children, healthy adolescents, distance. Searching in gray literature was allowed. Results: There are few studies that proposed reference values or prediction equations for the distance walked in the ISWT or MST in healthy children and adolescents. The predictor variables used in the equations in all studies were sex, age, and BMI. In all studies, boys had a greater distance walked than girls. The r2 values described were between 0.48 and 0.54, and all equations were performed in single centers with a sample ranging from 108 to 180 participants. Conclusion: There are equations available for ISWT and its modified version, however R2 values are relatively low, and the sample is not very representative of the population.
References
-Anderson, S.E.; Must, A. Interpreting the Continued Decline in the Average Age at Menarche: Results from Two Nationally Representative Surveys of U.S. Girls Studied 10 Years Apart. The Journal of Pediatrics. Vol. 147. Num. 6. 2005. p. 753-760.
-Aksglaede, L.; Olsen, L.W.; Sørensen, T.I.A.; Juul, A. Forty Years Trends in Timing of Pubertal Growth Spurt in 157,000 Danish School Children. PLoS ONE. Vol. 3. Num. 7. 2008. p. e2728.
-Bradley, J.; Howard, J.; Wallace, E.; Elborn, S. Validity of a modified shuttle test in adult cystic fibrosis. Thorax. Vol. 54. Num. 5. 1999. p. 437-439.
-Buttke, D.E.; Sircar, K.; Martin, C. Exposures to Endocrine-Disrupting Chemicals and Age of Menarche in Adolescent Girls in NHANES (2003–2008). Environmental Health Perspectives. Vol. 120. Num. 11. 2012. p. 1613-1618.
-Dourado, V.Z.; Guerra, R.L.F. Reliability and validity of heart rate variability threshold assessment during an incremental shuttle-walk test in middle-aged and older adults. Brazilian Journal of Medical and Biological Research. Vol. 46. Num. 2. 2013. p. 194-199.
-Eisenmann, J.; Malina, R. Age- and sex-associated variation in neuromuscular capacities of adolescent distance runners. Journal of Sports Sciences. Vol. 21. Num. 7. 2003. p. 551-557.
-Gomes, A.L.; Mendonça, V.A.; Silva, T.S.; Pires, C.K.V; Lima, L.P.; Silva, A.M. Cardiorespiratory and metabolic responses and reference equation validation to predict peak oxygen uptake for the incremental shuttle waking test in adolescent boys. PLoS One. Vol. 13. Num. 12. 2018. p. e0208826.
-Jürgensen, S.P.; Trimer, R.; Dourado, V.Z.; Thommazo-Luporini, L.Di; Bonjorno-Junior, J.C.; Oliveira, C.R.; Arena, R.; Mendes, R.G.; Borghi-Silva, A. Shuttle walking test in obese women: test-retest reliability and concurrent validity with peak oxygen uptake. Clinical Physiology and Functional Imaging. Vol. 35. Num. 2. 2015. p. 120-126.
-Kelly, A.; Winer, K.K.; Kalkwarf, H.; Oberfield, S. E.; Lappe, J.; Gilsanz, V.; Zemel, B.S. Age-Based Reference Ranges for Annual Height Velocity in US Children. The Journal of Clinical Endocrinology & Metabolism. Vol. 99. Num. 6. 2014. p. 2104-2112.
-Kim, B.Y.; Nattiv, A. Health Considerations in Female Runners. Physical Medicine and Rehabilitation Clinics of North America. Vol. 27. Num. 1. 2016. p. 151-178.
-Lanza, F.D.C.; Zagatto, E.D.P.; Silva, J.C.; Selman, J.P.R.; Imperatori, T.B.G.; Zanatta, D.J.M.; Carvalho, L.N.; Reimberg, M.M.; Dal Corso, S. Reference Equation for the Incremental Shuttle Walk Test in Children and Adolescents. Journal of Pediatrics. Vol. 167. Num. 5. 2015. p. 1057-1061.
-Mota, J.; Esculcas, C. Leisure-time physical activity behavior: Structured and unstructured choices according to sex, age, and level of physical activity. International Journal of Behavioral Medicine. Vol. 9. Num. 2. 2002. p. 111-121.
-Nici, L.; Donner, C.; Wouters, E.; Zuwallack, R.; Ambrosino, N.; Bourbeau, J.; ... & Troosters, T. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. American journal of respiratory and critical care medicine. Vol. 173. Num. 12. 2006. p. 1390-413.
-Palange, P.; Ward, S.A.; Carlsen, K.-H.; Casaburi, R.; Gallagher, C.G.; Gosselink, R.; O’donnell, D.E.; Puente-Maestu, L.; Schols, A. M.; Singh, S.; Whipp, B.J. Recommendations on the use of exercise testing in clinical practice. European Respiratory Journal. Vol. 29. Num. 1. 2006. p. 185-209.
-Pinho, T.; Jácome, C.; Pinto, J.; Marques, A. Reference equation for the incremental shuttle walk test in Portuguese children and adolescents. Pulmonology. Vol. 25. Num. 4. 2019. p. 208-214.
-Portney, L.G.; Watkins, M.P. Foundations of clinical research: applications to practice. 2009.
-Probst, V.S.; Hernandes, N.A.; Teixeira, D.C.; Felcar, J.M.; Mesquita, R.B.; Gonalves, C.G.; Hayashi, D.; Singh, S.; Pitta, F. Reference values for the incremental shuttle walking test. Respiratory Medicine. Vol. 106. Num. 2. 2012. p. 243-248.
-Rogol, A.D. Sex steroids, growth hormone, leptin and the pubertal growth spurt. Endocrine Development. Vol. 17. 2009. p. 77-85.
-Singh, S.J.; Morgan, M.D.L.; Scott, S.; Walters, D.; Hardman, A.E. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. Vol. 47. Num. 12. 1992. p. 1019-1024.
-Slyper, A.H. The pubertal timing controversy in the USA, and a review of possible causative factors for the advance in timing of onset of puberty. Clinical Endocrinology. Vol. 65. Num. 1. 2006. p. 1-8.
-Spruit, M.A.; Singh, S.J.; Garvey, C.; ZuWallack, R.; Nici, L.; Rochester, C.; Wouters, E.F. An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine. Vol. 188. Num. 8. 2013. p. e13-e64.
-Selvadurai, H.C.; Cooper, P.J.; Meyers, N.; Blimkie, C.J.; Smith, L.; Mellis, C.M.; Asperen, P.P. Van. Validation of shuttle tests in children with cystic fibrosis. Pediatric Pulmonology. Vol. 35. Num. 2. 2003. p. 133-138.
-Theintz, G.; Buchs, B.; Rizzoli, R.; Slosman, D.; Clavien, H.; Sizonenko, P.C.; Bonjour, J.P. Longitudinal monitoring of bone mass accumulation in healthy adolescents: evidence for a marked reduction after 16 years of age at the levels of lumbar spine and femoral neck in female subjects. The Journal of Clinical Endocrinology & Metabolism. Vol. 75. Num. 4. 1992. p. 1060-1065.
-Tsopanoglou, S.P.; Davidson, J.; Goulart, A.L.; Moraes Barros, M.C.; Santos, A.M.N. Functional capacity during exercise in very-low-birth-weight premature children. Pediatric Pulmonology. Vol. 49. Num. 1. 2014. p. 91-98.
-Vardhan, V.; Palekar, T.; Dhuke, P.; Baxi, G. Normative values of incremental shuttle walk test in children and adolescents: an observational study. International Journal of pharma and Bio Sciences. Vol. 8. Num. 4. 2017.
-Verschuren, O.; Bosma, L.; Takken, T. Reliability of a shuttle run test for children with cerebral palsy who are classified at Gross Motor Function Classification System level III. Developmental Medicine & Child Neurology. Vol. 53. Num. 5. 2011. p. 470-472.
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