IJPR.2025.119
Type of Article: Original Research
Volume 13; Issue 3 (September 2025)
Page No.: 4885-4890
DOI: https://dx.doi.org/10.16965/ijpr.2025.119
Comparison between 6 Min Walk Test and Incremental Shuttle Walk Test in Middle Aged Women with Type 2 Diabetes: A Pilot Study
Vishnu K Nair 1, Balachandra A Shetty 2, Prathik *3
1 Assistant Professor, Laxmi Memorial College of Physiotherapy, Balmatta, Mangalore, Karnataka, India.
2 Professor and Head of the Department, Department of General Medicine, AJ Institute of Medical Sciences, Mangalore, Karnataka, India.
*3 Postgraduate student, Laxmi Memorial College of Physiotherapy, Rajiv Gandhi University of Health Sciences, Karnataka, India.
Corresponding author: Prathik, Postgraduate student, Laxmi Memorial College of Physiotherapy, Rajiv Gandhi University of Health Sciences, Karnataka, India. E-Mail: prathiksuraj8@gmail.com
ABSTRACT
Background: It is estimated that ~415 million individuals around the globe are living with diabetes, with 91% of them having type 2 diabetes mellitus (T2DM). Cardiovascular disease (CVD) poses a significant clinical and economic burden for individuals with type 2 diabetes mellitus (T2DM). Women with type 2 diabetes have a 25–50% higher relative risk of experiencing a cardiovascular event compared to men with the same condition.
Objective: To compare the incremental shuttle, walk test (ISWT) and the 6-minute walk test (6MWT) in middle-aged women with type 2 diabetes.
Method: A pilot cross-sectional study was conducted to assess cardio-respiratory fitness using the incremental shuttle walk test (ISWT) and the 6-minute walk test (6MWT) in middle-aged women with type 2 diabetes, and to compare ISWT and 6MWT in middle-aged women with type 2 diabetes. A total of 15 participants were recruited according to the inclusion and exclusion criteria. Both tests, with a 30-minute rest in between, were conducted.
Result: Comparison between two cardio-respiratory fitness tests was done using a paired t-test. The mean VO₂ max for the 6-minute walk test was 17.616±2.775, while for the incremental shuttle walk test, it was slightly lower at 16.851±1.084. The t-value of 1.347 and p-value of 0.199 indicate that the difference is not statistically significant (p > 0.05). The t-value of 10.748 and p-value of p<0.001 suggest a highly significant difference (p < 0.05), indicating that the 6-minute walk test allows for significantly greater distance coverage compared to the incremental shuttle walk test.
Conclusion: The significant difference in distance suggests the 6-minute walk test is better for assessing endurance, while the incremental shuttle walk test induces higher perceived exertion and cardiovascular stress.
Keywords: Type 2 diabetes, Women, Incremental shuttle walk test, 6-minute walk test.
REFERENCES
[1]. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovascular diabetology. 2018 Dec;17:1-9.
https://doi.org/10.1186/s12933-018-0728-6
PMid:29884191 PMCid:PMC5994068
[2]. Luhar S, Kondal D, Jones R, Anjana RM, Patel SA, Kinra S, Clarke L, Ali MK, Prabhakaran D, Kadir MM, Tandon N. Lifetime risk of diabetes in metropolitan cities in India. Diabetologia. 2021 Mar;64:521-9.
https://doi.org/10.1007/s00125-020-05330-1
PMid:33225415 PMCid:PMC7864818
[3]. International Diabetes Federation. Diabetes and cardiovascular disease. Brussels: International Diabetes Federation; 2016. p. 1-144. Available from CVD_in_diabetes_report_compressed.pdf
[4]. De Rosa S, Arcidiacono B, Chiefari E, Brunetti A, Indolfi C, Foti DP. Type 2 diabetes mellitus and cardiovascular disease: genetic and epigenetic links. Frontiers in endocrinology. 2018 Jan 17;9:2.
https://doi.org/10.3389/fendo.2018.00002
PMid:29387042 PMCid:PMC5776102
[5]. Einarson TR, Acs A, Ludwig C, Panton UH. Economic burden of cardiovascular disease in type 2 diabetes: a systematic review. Value in Health. 2018 Jul 1;21(7):881-90.
https://doi.org/10.1016/j.jval.2017.12.019
PMid:30005761
[6]. Peters SA, Huxley RR, Woodward M. Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events. Diabetologia 2014;57(8):1542-1551.
https://doi.org/10.1007/s00125-014-3260-6
PMid:24859435
[7]. Huebschmann AG, Huxley RR, Kohrt WM, Zeitler P, Regensteiner JG, Reusch JE. Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. Diabetologia. 2019 Oct;62:1761-72.
https://doi.org/10.1007/s00125-019-4939-5
PMid:31451872 PMCid:PMC7008947
[8]. Regensteiner JG, Bauer TA, Huebschmann AG et al. Sex differences in the effects of type 2 diabetes on exercise performance. Med Sci Sports Exerc. 2015; 47(1):58-65.
https://doi.org/10.1249/MSS.0000000000000371
PMid:24811327 PMCid:PMC4296732
[9]. Naci H, Ioannidis JP. (2013) Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577.
https://doi.org/10.1136/bmj.f5577
PMid:24473061 PMCid:PMC3788175
[10]. Liu Y, Li N, Zhang S, Feng Y, Zhang Y, Shao Y, Wu J. Independent influence of type 2 diabetes on reduced cardiopulmonary fitness in patients after percutaneous coronary intervention: a cross-sectional study. Scientific Reports. 2025 Feb 19;15(1):6071.
https://doi.org/10.1038/s41598-025-90281-z
PMid:39972067 PMCid:PMC11839949
[11]. Lee MC. Validity of the 6-minute walk test and step test for evaluation of cardio respiratory fitness in patients with type 2 diabetes mellitus. Journal of exercise nutrition & biochemistry. 2018 Mar 31;22(1):49.
https://doi.org/10.20463/jenb.2018.0008
PMid:29673246 PMCid:PMC5909078
[12]. Kammin EJ. The 6-minute walk test: indications and guidelines for use in outpatient practices. The Journal for Nurse Practitioners. 2022 Jun 1;18(6):608-10.
https://doi.org/10.1016/j.nurpra.2022.04.013
PMid:35578650 PMCid:PMC9095083
[13]. Agarwal B, Shah M, Andhare N, Mullerpatan R. Incremental shuttle walk test: Reference values and predictive equation for healthy Indian adults. Lung India. 2016 Jan 1;33(1):36-41.
https://doi.org/10.4103/0970-2113.173056
PMid:26933305 PMCid:PMC4748663
[14]. Zeiher J, Ombrellaro KJ, Perumal N, Keil T, Mensink GB, Finger JD. Correlates and determinants of cardiorespiratory fitness in adults: a systematic review. Sports medicine-open. 2019 Dec;5:1-24.
https://doi.org/10.1186/s40798-019-0211-2
PMid:31482208 PMCid:PMC6722171
[15]. Dourado VZ, Nishiaka RK, Simões MS, Lauria VT, Tanni SE, Godoy I, Gagliardi AR, Romiti M, Arantes RL. Classification of cardiorespiratory fitness using the six-minute walk test in adults: Comparison with cardiopulmonary exercise testing. Pulmonology. 2021 Nov 1;27(6):500-8.
https://doi.org/10.1016/j.pulmoe.2021.03.006
PMid:33958319
[16]. Pepera G, Karanasiou E, Blioumpa C, Antoniou V, Kalatzis K, Lanaras L, Batalik L. Tele-assessment of functional capacity through the six-minute walk test in patients with diabetes mellitus type 2: validity and reliability of repeated measurements. Sensors. 2023 Jan 25;23(3):1354.
https://doi.org/10.3390/s23031354
PMid:36772396 PMCid:PMC9920804
[17]. Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Gonçalves CG, Hayashi D, Singh S, Pitta F. Reference values for the incremental shuttle walking test. Respiratory medicine. 2012 Feb 1;106(2):243-8.
https://doi.org/10.1016/j.rmed.2011.07.023
PMid:21865021
[18]. Jürgensen SP, Trimer R, Dourado VZ, Di Thommazo‐Luporini L, Bonjorno‐Junior JC, Oliveira CR, Arena R, Mendes RG, Borghi‐Silva A. Shuttle walking test in obese women: test‐retest reliability and concurrent validity with peak oxygen uptake. Clinical physiology and functional imaging. 2015 Mar;35(2):120-6.
https://doi.org/10.1111/cpf.12135
PMid:24589245
[19]. Kuziemski K, Słomiński W, Jassem E. Impact of diabetes mellitus on functional exercise capacity and pulmonary functions in patients with diabetes and healthy persons. BMC endocrine disorders. 2019 Dec;19:1-8.
https://doi.org/10.1186/s12902-018-0328-1
PMid:30606177 PMCid:PMC6318966
[20]. Janevic MR, Janz NK, Connell CM, et al. Progression of symptoms and functioning among female cardiac patients with and without diabetes. J Women’s Health (Larchmt). 2011;20:107-15.
https://doi.org/10.1089/jwh.2010.2123
PMid:21091196 PMCid:PMC3052276
[21]. Sperandio EF, Guerra RL, Dourado VZ. Dynamic physiological responses to the incremental shuttle walk test in adults. Fisioterapia em Movimento. 2017;30(4):821-30.
https://doi.org/10.1590/1980-5918.030.004.ao18
[22]. Paulino Geisel P, de Oliveira Nascimento I, Mendonça Gonçalves Machado M, Lucas Gomes Mateus dos Santos R, Nézio Gomes BR, Pontes Przybysz GM, de Figueiredo Magalhães Pereira I, Gomes Pereira DA. Incremental shuttle walking test for calf muscle oxygenation assessment in peripheral arterial disease: a cross-sectional study. Scientific Reports. 2025 Jan 2;15(1):488.
https://doi.org/10.1038/s41598-024-84662-z
PMid:39747567 PMCid:PMC11696925
[23]. Lim HJ, Jee SJ, Lee MM. Comparison of incremental shuttle walking test, 6-minute walking test, and cardiopulmonary exercise stress test in patients with myocardial infarction. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022 Oct 17;28:e938140-1.
https://doi.org/10.12659/MSM.938140
PMid:36245105 PMCid:PMC9585920
