Measured courses

Introduction
The use of an established route with a known distance for exercise can be of value in settings where more sophisticated measurements are either inappropriate or unavailable. Severely limited patients may be able to walk for only short distances before they are forced to stop because of shortness of breath, claudication, or severely compromised oxygen delivery, such as in patients with chronic heart failure. Apparently healthy individuals are often able to complete the measured course by running. The practitioner may wish to consider whether the measured course should be one with distance or time as the criterion variable. For example, will the patient respond best, and are conditions better controlled, when the patient covers a speciWed distance (e.g., 400 m) with time as the criterion measurement? Or, is it more desirable if the patient exercises for a speciWc period of time (e.g., 12 min) with distance covered as the criterion variable? Both approaches are frequently used, but the measurement of time to complete a premeasured distance is preferable as both time and distance can be known more precisely. When a patient walks for a Wxed period of time, distance can be measured, but often with less precision, and usually with more diYculty. Additionally, knowing, and when possible, being able to see the distance to be covered seem to set a more easily interpreted endpoint for the participant. Walking and running courses should be chosen so that barriers and hazards are kept clear. A busy hospital corridor is clearly an inappropriate place. However, underutilized corridors, or other areas in medical or rehabilitation facilities, parking lots, school tracks, or sports facilities are ideal.

Indoor courses
Description and principle ofoperation Indoor walking courses are typically shorter due to space limitations and may be appropriate for more severely disabled individuals. Indoor courses have the advantage of controlling for temperature, wind, and air-borne pollutants that might adversely aVect the test outcome. Additionally, patient monitoring

may be easier to perform. Indoor courses should be chosen with care not to include too many turns (which slows down the pace) or distractions that may inXuence test performance. This latter point is especially important for the elderly, in whom multitasking may lead to falls. This may even include attempting to attend to the task of walking while attention is diverted to a changing Xoor pattern. Measured courses used for walking should have few turns (especially U-turns) and distances of 100 400 m. Courses established for shuttle walking or running tests require only 10 or 20 m, respectively, plus turn areas of 5m at each end. See Chapter 3 for an illustration and description of the shuttle course. Calibration, accuracy, and precision A measuring wheel provides the easiest way to measure a walking or running course accurately. Alternatively, careful measurement with a 30-m tape measure would be acceptable. The accuracy of such courses need not be perfect. However, reproducible starting and ending points, as well as a reproducible route, are of primary importance. Marks along the baseboard on a wall or on the Xoor are useful for tallying distance covered. The walking or running path should be clearly delineated so that the patient is sure of the route. Maintenance Measured courses should be kept clear of obstacles (including other people), with care taken