The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19

PHOSP-COVID Study Collaborative Group; Molly M Baldwin; Enya Daynes; Urvee Karsanji; Hamish J C McAuley; Nicolette C Bishop; Charlotte E Bolton; William D-C Man; Ioannis Vogiatzis; James D Chalmers; Ling-Pei Ho; Alex Horsley; Michael Marks; Krisnah Poinasamy; Betty Raman; Olivia C Leavy; Matthew Richardson; Omer Elneima; Aarti Shikotra; Amisha Singapuri; Marco Sereno; Ruth M Saunders; Victoria C Harris; Linzy Houchen-Wolloff; Neil J Greening; Ewen M Harrison; Annemarie B Docherty; Nazir I Lone; Jennifer K Quint; Louise V Wain; Christopher E Brightling; Rachael A Evans; Sally J Singh

doi:10.1183/23120541.00089-2025

The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19

PHOSP-COVID Study Collaborative Group, Molly M Baldwin^*, Enya Daynes, Urvee Karsanji, Hamish J C McAuley, Nicolette C Bishop, Charlotte E Bolton, William D-C Man, Ioannis Vogiatzis, James D Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Betty Raman, Olivia C Leavy, Matthew Richardson, Omer Elneima, Aarti Shikotra, Amisha SingapuriMarco Sereno, Ruth M Saunders, Victoria C Harris, Linzy Houchen-Wolloff, Neil J Greening, Ewen M Harrison, Annemarie B Docherty, Nazir I Lone, Jennifer K Quint, Louise V Wain, Christopher E Brightling, Rachael A Evans, Sally J Singh

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: The incremental shuttle walk test (ISWT) may be a valuable tool for measuring exercise tolerance in patients after a hospital admission with COVID-19. However, the safety, physiological response and repeatability of the ISWT are unknown in this cohort. The present study aimed to explore the properties of this test using the Post-Hospital COVID-19 (PHOSP-COVID) study.

METHODS: Participants performed two ISWTs, with a 30-min rest between tests, at 5 and 12 months post-hospital discharge for COVID-19. Heart rate and fingertip peripheral oxygen saturation were recorded pre- and post-test. Reasons for test termination were noted.

RESULTS: 1593 individuals (median (interquartile range) age 58 (50-66) years and body mass index 31.2 (27.6-35.8) kg·m - 2; 967 (60.7%) males) performed an ISWT; two tests were performed by 1034 and 390 participants at the 5- and 12-month visit, respectively. At 5 months post-discharge, six patients (0.4%) had an adverse event and the most common reason contributing to test termination was breathlessness (826 (54.2%) participants). 336/1470 (22.9%) participants experienced exertional desaturation. Distance walked was greater in the second ISWT compared to the first ISWT at 5 and 12 months post-discharge (mean±sd difference: 5 months: 19±94 m; 12 months: 11±80 m; p<0.05), with an intraclass correlation coefficient estimate of 0.96 (95% CI 0.95-0.97) at 5 months and 0.97 (95% CI 0.96-0.97) at 12 months.

CONCLUSIONS: The ISWT appeared to be safe in this large cohort, supporting use of this field walking test for this population in clinical and research settings. A familiarisation test is recommended, with further study needed to determine the number of familiarisation tests required to achieve acceptable within-day repeatability.

Original language	English
Article number	00089-2025
Number of pages	13
Journal	ERJ Open Research
Volume	11
Issue number	6
Early online date	1 Nov 2025
DOIs	https://doi.org/10.1183/23120541.00089-2025
Publication status	Published - 15 Dec 2025

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Post-hospitalisation COVID-19 study: a national consortium to understand and improve long-term health outcomes (PHOSP-COVID)
Baillie, K. (Principal Investigator) & Parsons, M. (Co-investigator)
Medical Research Council
30/07/20 → 31/03/26
Project: Research

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PHOSP-COVID Study Collaborative Group, Baldwin, M. M., Daynes, E., Karsanji, U., McAuley, H. J. C., Bishop, N. C., Bolton, C. E., Man, W. D.-C., Vogiatzis, I., Chalmers, J. D., Ho, L.-P., Horsley, A., Marks, M., Poinasamy, K., Raman, B., Leavy, O. C., Richardson, M., Elneima, O., Shikotra, A., ... Singh, S. J. (2025). The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19. ERJ Open Research, 11(6), Article 00089-2025. https://doi.org/10.1183/23120541.00089-2025

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title = "The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19",

abstract = "BACKGROUND: The incremental shuttle walk test (ISWT) may be a valuable tool for measuring exercise tolerance in patients after a hospital admission with COVID-19. However, the safety, physiological response and repeatability of the ISWT are unknown in this cohort. The present study aimed to explore the properties of this test using the Post-Hospital COVID-19 (PHOSP-COVID) study.METHODS: Participants performed two ISWTs, with a 30-min rest between tests, at 5 and 12 months post-hospital discharge for COVID-19. Heart rate and fingertip peripheral oxygen saturation were recorded pre- and post-test. Reasons for test termination were noted.RESULTS: 1593 individuals (median (interquartile range) age 58 (50-66) years and body mass index 31.2 (27.6-35.8) kg·m - 2; 967 (60.7\%) males) performed an ISWT; two tests were performed by 1034 and 390 participants at the 5- and 12-month visit, respectively. At 5 months post-discharge, six patients (0.4\%) had an adverse event and the most common reason contributing to test termination was breathlessness (826 (54.2\%) participants). 336/1470 (22.9\%) participants experienced exertional desaturation. Distance walked was greater in the second ISWT compared to the first ISWT at 5 and 12 months post-discharge (mean±sd difference: 5 months: 19±94 m; 12 months: 11±80 m; p<0.05), with an intraclass correlation coefficient estimate of 0.96 (95\% CI 0.95-0.97) at 5 months and 0.97 (95\% CI 0.96-0.97) at 12 months. CONCLUSIONS: The ISWT appeared to be safe in this large cohort, supporting use of this field walking test for this population in clinical and research settings. A familiarisation test is recommended, with further study needed to determine the number of familiarisation tests required to achieve acceptable within-day repeatability.",

author = "\{PHOSP-COVID Study Collaborative Group\} and Baldwin, \{Molly M\} and Enya Daynes and Urvee Karsanji and McAuley, \{Hamish J C\} and Bishop, \{Nicolette C\} and Bolton, \{Charlotte E\} and Man, \{William D-C\} and Ioannis Vogiatzis and Chalmers, \{James D\} and Ling-Pei Ho and Alex Horsley and Michael Marks and Krisnah Poinasamy and Betty Raman and Leavy, \{Olivia C\} and Matthew Richardson and Omer Elneima and Aarti Shikotra and Amisha Singapuri and Marco Sereno and Saunders, \{Ruth M\} and Harris, \{Victoria C\} and Linzy Houchen-Wolloff and Greening, \{Neil J\} and Harrison, \{Ewen M\} and Docherty, \{Annemarie B\} and Lone, \{Nazir I\} and Quint, \{Jennifer K\} and Wain, \{Louise V\} and Brightling, \{Christopher E\} and Evans, \{Rachael A\} and Singh, \{Sally J\}",

note = "Copyright {\textcopyright}The authors 2025.",

year = "2025",

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day = "15",

doi = "10.1183/23120541.00089-2025",

language = "English",

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PHOSP-COVID Study Collaborative Group, Baldwin, MM, Daynes, E, Karsanji, U, McAuley, HJC, Bishop, NC, Bolton, CE, Man, WD-C, Vogiatzis, I, Chalmers, JD, Ho, L-P, Horsley, A, Marks, M, Poinasamy, K, Raman, B, Leavy, OC, Richardson, M, Elneima, O, Shikotra, A, Singapuri, A, Sereno, M, Saunders, RM, Harris, VC, Houchen-Wolloff, L, Greening, NJ, Harrison, EM , Docherty, AB , Lone, NI, Quint, JK, Wain, LV, Brightling, CE, Evans, RA & Singh, SJ 2025, 'The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19', ERJ Open Research, vol. 11, no. 6, 00089-2025. https://doi.org/10.1183/23120541.00089-2025

TY - JOUR

T1 - The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19

AU - PHOSP-COVID Study Collaborative Group

AU - Baldwin, Molly M

AU - Daynes, Enya

AU - Karsanji, Urvee

AU - McAuley, Hamish J C

AU - Bishop, Nicolette C

AU - Bolton, Charlotte E

AU - Man, William D-C

AU - Vogiatzis, Ioannis

AU - Chalmers, James D

AU - Ho, Ling-Pei

AU - Horsley, Alex

AU - Marks, Michael

AU - Poinasamy, Krisnah

AU - Raman, Betty

AU - Leavy, Olivia C

AU - Richardson, Matthew

AU - Elneima, Omer

AU - Shikotra, Aarti

AU - Singapuri, Amisha

AU - Sereno, Marco

AU - Saunders, Ruth M

AU - Harris, Victoria C

AU - Houchen-Wolloff, Linzy

AU - Greening, Neil J

AU - Harrison, Ewen M

AU - Docherty, Annemarie B

AU - Lone, Nazir I

AU - Quint, Jennifer K

AU - Wain, Louise V

AU - Brightling, Christopher E

AU - Evans, Rachael A

AU - Singh, Sally J

PY - 2025/12/15

Y1 - 2025/12/15

N2 - BACKGROUND: The incremental shuttle walk test (ISWT) may be a valuable tool for measuring exercise tolerance in patients after a hospital admission with COVID-19. However, the safety, physiological response and repeatability of the ISWT are unknown in this cohort. The present study aimed to explore the properties of this test using the Post-Hospital COVID-19 (PHOSP-COVID) study.METHODS: Participants performed two ISWTs, with a 30-min rest between tests, at 5 and 12 months post-hospital discharge for COVID-19. Heart rate and fingertip peripheral oxygen saturation were recorded pre- and post-test. Reasons for test termination were noted.RESULTS: 1593 individuals (median (interquartile range) age 58 (50-66) years and body mass index 31.2 (27.6-35.8) kg·m - 2; 967 (60.7%) males) performed an ISWT; two tests were performed by 1034 and 390 participants at the 5- and 12-month visit, respectively. At 5 months post-discharge, six patients (0.4%) had an adverse event and the most common reason contributing to test termination was breathlessness (826 (54.2%) participants). 336/1470 (22.9%) participants experienced exertional desaturation. Distance walked was greater in the second ISWT compared to the first ISWT at 5 and 12 months post-discharge (mean±sd difference: 5 months: 19±94 m; 12 months: 11±80 m; p<0.05), with an intraclass correlation coefficient estimate of 0.96 (95% CI 0.95-0.97) at 5 months and 0.97 (95% CI 0.96-0.97) at 12 months. CONCLUSIONS: The ISWT appeared to be safe in this large cohort, supporting use of this field walking test for this population in clinical and research settings. A familiarisation test is recommended, with further study needed to determine the number of familiarisation tests required to achieve acceptable within-day repeatability.

AB - BACKGROUND: The incremental shuttle walk test (ISWT) may be a valuable tool for measuring exercise tolerance in patients after a hospital admission with COVID-19. However, the safety, physiological response and repeatability of the ISWT are unknown in this cohort. The present study aimed to explore the properties of this test using the Post-Hospital COVID-19 (PHOSP-COVID) study.METHODS: Participants performed two ISWTs, with a 30-min rest between tests, at 5 and 12 months post-hospital discharge for COVID-19. Heart rate and fingertip peripheral oxygen saturation were recorded pre- and post-test. Reasons for test termination were noted.RESULTS: 1593 individuals (median (interquartile range) age 58 (50-66) years and body mass index 31.2 (27.6-35.8) kg·m - 2; 967 (60.7%) males) performed an ISWT; two tests were performed by 1034 and 390 participants at the 5- and 12-month visit, respectively. At 5 months post-discharge, six patients (0.4%) had an adverse event and the most common reason contributing to test termination was breathlessness (826 (54.2%) participants). 336/1470 (22.9%) participants experienced exertional desaturation. Distance walked was greater in the second ISWT compared to the first ISWT at 5 and 12 months post-discharge (mean±sd difference: 5 months: 19±94 m; 12 months: 11±80 m; p<0.05), with an intraclass correlation coefficient estimate of 0.96 (95% CI 0.95-0.97) at 5 months and 0.97 (95% CI 0.96-0.97) at 12 months. CONCLUSIONS: The ISWT appeared to be safe in this large cohort, supporting use of this field walking test for this population in clinical and research settings. A familiarisation test is recommended, with further study needed to determine the number of familiarisation tests required to achieve acceptable within-day repeatability.

U2 - 10.1183/23120541.00089-2025

DO - 10.1183/23120541.00089-2025

M3 - Article

C2 - 41403426

SN - 2312-0541

VL - 11

JO - ERJ Open Research

JF - ERJ Open Research

IS - 6

M1 - 00089-2025

ER -

The safety, physiological response and repeatability of the incremental shuttle walk test in survivors of COVID-19

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Post-hospitalisation COVID-19 study: a national consortium to understand and improve long-term health outcomes (PHOSP-COVID)

Cite this