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PubMed2004

[Can anxiety and depression influence the six-minute walking test performance in post-surgical heart valve patients? A pilot study].

UNLABELLED: Various functional indicators are utilized to measure outcome in cardiac rehabilitation. Little information exists regarding the role played by psychological variables during the rehabilitative period, after cardiac valve surgery. The present study aims at exploring the relationship existing between different levels of functional capacity measured by six-minute walking test, (6MWT) and emotional aspects such as anxiety and depression. MATERIALS AND METHODS: 126 post-surgical heart valve patients underwent at the beginning and at the end of the rehabilitative programme: 1) 6MWT; 2) assessment of anxiety and depression (A-D Questionnaire according to the CBA-2.0 Primary Scale). RESULTS: Cardiac rehabilitation was associated with a general and significant improvement in the 6MWT (273 +/- 98 metres versus 363 +/- 96; p < 0.001) and the functional performance parameters (diastolic blood pressure; p < 0.001 and fatigue p < 0.001). Simultaneously there was a significant improvement of patient-reported quality of life, revealed by the A-D questionnaire in both male and female patients. The Depression Questionnaire score is predictive of functional capacity. It was demonstrated that no matter what the clinical condition of the patient, the depression score influences the patient's performance during the 6MWT, not only regards the distance covered (p = .008), but also fatigue expressed by the Borg RPE index (p = .044). CONCLUSION: Depression, an emotional variable, self-evaluated by the standardized questionnaire can, even if only partially, influence the 6MWT, a functional indicator of exercise tolerance, widely utilized in cardiac rehabilitation.

Adult↗
PubMed1983

The diagnosis intermittent claudication. The value of walking test, ankle pressure index and calf plethysmography in relation to the clinical findings.

Three hundred and forty-nine patients with the diagnosis intermittent claudication (IC) based on Rose's questionnaire were all found to have clinical abnormality based on pulse palpation, and/or auscultation in lower abdomen and groin. The diagnosis was in the majority of cases (87-95%) confirmed by standardized walking test (WT), ankle pressure index (AI) and venous occlusion calf plethysmography (VOP). In clinical abnormality based on bruit only in groin, AI and VOP confirmed the diagnosis less frequently than in the other clinical abnormalities (p less than 0.01).

Adult↗
PubMed1996

Objective assessment of the response to treatment of severe heart failure using a 9-minute walk test on a patient-powered treadmill.

BACKGROUND: No previous studies have demonstrated the changes in exercise capacity that occur during treatment of decompensated severe heart failure. The authors assessed the efficacy and safety of using a patient-powered treadmill to objectively measure exercise capacity and its relationships, if any, to symptom scores and body weight. METHODS AND RESULTS: Changes in time-limited exercise capacity on a patient-powered treadmill were assessed during inpatient treatment of 12 patients with decompensated chronic heart failure (New York Heart Association classes III and IV). Patients performed a 9-minute walk test daily for 7 days and again at the 6-week follow-up examination. They also completed a 24-item symptom score questionnaire. After treatment, there was a rapid, significant increase in total distance walked, with the increase beginning as early as the second day after admission (mean distance walked +/- SEM, 54 +/- 27 m and 174 +/- 54 m on admission and on day 2, respectively, P < .05). Improvement was maintained throughout the period in the hospital and at 6 weeks (P < .001). Patients reported symptomatic improvement, but this did not reach significance until 4 days after admission (P < .05). Weight loss was not significant. Improved exercise capacity correlated with reduced symptoms and weight loss, but preceded these by several days. CONCLUSIONS: In patients with decompensated chronic heart failure, this exercise test provides a safe, practical, inexpensive, and objective assessment of functional capacity, providing certain advantages over other indices of response to therapy, such as symptom scores and weight loss. Improvement of exercise capacity does not occur concurrently with relief of symptoms and weight loss.

Adult↗
PubMed2003

6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD.

STUDY OBJECTIVES: Some respiratory patients exhibit oxygen desaturation during rehabilitative walking but not during maximal cardiopulmonary exercise testing (CPET). We evaluated exercise-induced desaturation during 6-min walk testing (6MWT) in comparison with CPET in patients with COPD and determined the reproducibility of the phenomenon. PATIENTS: We tested 80 consecutive patients with COPD (FEV(1), 62.4 +/- 2% predicted) and 10 patients with supplementary COPD (FEV(1), 59.1 +/- 5% predicted) [mean +/- SEM] to determine the reproducibility. MEASUREMENTS AND RESULTS: First, patients with COPD performed cycle CPET (first CPET [CPET-1]). Three days later, they performed two 6MWTs (first 6MWT [6MWT-1] and second 6MWT [6MWT-2]). Pulse oximetric saturation (SpO(2)) was recorded every minute in both tests. Three groups emerged: desaturation at 6MWT not observed at CPET (DND) [n = 23], desaturation in both tests (n = 16), and no desaturation in either test (n = 41). Second, to evaluate reproducibility, 10 additional subjects with COPD who exhibited desaturation during two successive 6MWTs but not in CPET performed a second CPET (CPET-2) and a single-bout 6MWT (6MWT-3) in a supplementary trial. When two CPETs were performed, lack of O(2) desaturation was noted in both. O(2) desaturation was confirmed in 6MWT-2 and 6MWT-3 (7.4 +/- 1% and 7.4 +/- 1.5%, respectively). CONCLUSION: Twenty-eight percent of patients with COPD presented DND. The phenomenon was reproducible and not protocol dependent, emphasizing the clinical interest of the 6MWT.

Exercise Test↗
PubMed1992

Validity of a two kilometre walking test for estimating maximal aerobic power in overweight adults.

In our earlier study a regression model, with heart rate and time in a 2 km fast walk, body mass index (BMI) or weight (kg) and age as explanatory variables, explained 75% of the variation in the VO2max of adults with normal weight. The present study was designed to test whether the prediction model based on a 2km fast walk and simple site measurements is valid in estimating the VO2max of overweight men and women and to compare 1km and 2km test distances. Forty-five women and thirty-two men, BMI 27-40, aged 20-65 years, with no cardiorespiratory or musculoskeletal restrictions for a maximal stress test and fast walk, were studied. The VO2max was determined in an uphill walk to maximal effort on a treadmill. Two walking tests, 1km and 2km, were conducted on a flat dirt road. Heart rate was recorded during the walks, and the mean rate during the last 30 seconds was used in the model. The correlation coefficients between the measured and predicted VO2max in the 2km test were 0.77 for the women and 0.75 for men, corrected for body weight (ml/kg/min), and 0.77 and 0.69 respectively in absolute values (1/min). These results suggest that the 2km walk test previously developed for adults within normal weight limits is a reasonably valid test of the cardiorespiratory fitness of overweight, but otherwise healthy, women and men.

Adult↗
PubMed2006

Heart rate responses during the 6-minute walk test in pulmonary arterial hypertension.

Patients with pulmonary arterial hypertension (PAH) exhibit a limited increase in stroke volume on exercise, and the heart rate (HR) increases may reflect the main mechanism that allows cardiac output to increase. The current prospective study documented the contribution of HR to the 6-min walking distance (6MWD) in idiopathic (IPAH) and nonidiopathic PAH. Eighty-three patients (46 IPAH and 37 nonidiopathic PAH) underwent haemodynamic evaluation and a 6MWD test. Chronotropic response (peak walking HR minus resting HR) and peripheral oxygen saturation were monitored. Fifty-seven patients were also assessed after 5+/-2 months of treatment (bosentan n = 38, epoprostenol n = 14, bosentan-epoprostenol n = 3, iloprost n = 2). Before treatment, the 6MWD was related to numerous demographic, haemodynamic and walking test characteristics. Stepwise regression analysis indicated that the only factors significantly associated with the 6MWD were stroke volume and chronotropic response in both IPAH and nonidiopathic PAH patients. Following treatment, changes in 6MWD were significantly related to changes in chronotropic response in both IPAH and nonidiopathic PAH. In conclusion, baseline stroke volume and chronotropic response were independently associated with the 6-min walking distance in pulmonary arterial hypertension. The lack of chronotropic response may reflect the loss in normal physiological reserve in more unwell patients.

Analysis of Variance↗
PubMed1994

Evaluation of six minute walking test in patients with single chamber rate responsive pacemakers.

OBJECTIVE: To validate a simplified exercise protocol (the six minute walk) as a means of evaluating pacing modes and rate responsive pacemakers. DESIGN: Two groups of patients with different pacemaker types (activity and dual sensor) were randomly assigned to four consecutive pacing settings (fixed rate--or VVI at 60, 85, and 110/min, and optimal rate response--or VVIR). A third group of elderly patients without arrhythmias or conduction disturbances formed a control population. SETTING: Ambulatory consultation for patients with a pacemaker in a tertiary referral centre for treatment of arrhythmias. SUBJECTS: 16 patients with rate responsive pacemakers for complete heart block and limited functional capacity and 13 controls with normal chronotropic competence. INTERVENTIONS: Submaximal exercise protocol with 6 minutes walking and continuous recording of electrocardiogram. MAIN OUTCOME MEASURES: Achieved distance and scored degree of exertion during walking in the four settings in the patients with a pacemaker; differences in rate behaviour in VVIR mode between the two pacemaker types; comparison of the pacing rate with the heart rate of the control population. RESULTS: The six minute walk was performed better in VVIR than VVI 60. In VVI 85 the distance was also significantly longer than in VVI 60. The rise in pacing rate of activity pacemakers was steeper than that of the dual sensor pacemakers and differed from the heart rate in the controls at 90 seconds. CONCLUSIONS: The studied test protocol was able to show differences in exercise capacity between pacing modes. Different rate responses between the evaluated sensor types could be established. The six minute walking test gives enough information to program and reprogram single chamber rate responsive pacemakers.

Aged↗
PubMed2003

Cardiovascular and dyspnea response to six-minute and shuttle walk tests in COPD patients.

UNLABELLED: Previous studies focusing on the changes of heart rate, systolic blood pressure and dyspnea caused by the six-minute (6MWT) and shuttle walking distance tests (ISWT) have produced conflicting data. The present study aims at comparing the cardiovascular and dyspnea responses to 6MWT and ISWT in patients with chronic obstructive pulmonary disease (COPD). Twenty patients with clinically stable COPD (age, 56 +/- 9 yrs; BMI, 27.8 +/- 7.7 kg.m(-2); FEV1%pred, 42 +/- 19%; mean +/- Sx) performed three 6MWTs and two ISWTs using standardised protocols. The distances walked in the third 6MWT and second ISWT were 458 +/- 105 and 365 +/- 116 m, respectively. There was a significant correlation between the distances covered in the two tests (r = 0.87; p < 0.001). The 6MWT and ISWT showed similar correlation coefficients with the Baseline Dyspnea Index (r = 0.86; p < 0.001 and r = 0.76; p < 0.001), the Clinical Symptom Scale (r= -0.72; p < 0.001 and r= -0.55; p = 0.011), FEV1 L (r = 0.36; NS and r = 0.30; NS), PImax (r = 0.59; p < 0.008 and r = 0.60; p = 0.001) and the mean pulmonary artery pressure, Doppler echocardiography (r= -0.51; p < 0.029 and r = -0.51; p = 0.032). Although the response to ISWT tended to be greater, we found no statistically significant differences between the two tests in the changes of heart rate (HR), systolic blood pressure (SBP) and dyspnea (Borg) (deltaHR, 17.9 +/- 13.4 vs 23.8 +/- 15.4; deltaSBP, 7.7 +/- 14.6 vs 13.0 +/- 17.0 and deltaBorg, 1.7 +/- 1.1 vs 2.2 +/- 0.9; NS). CONCLUSION: The cardiovascular and dyspnea response caused by ISWT is greater (but statistically not significant) than that generated by 6MWT. The more limited the functional capacity of COPD patients the more similar the response generated by 6MWT and ISWT.

Blood Pressure↗
PubMed2001

Walk-rotate-walk test identifies patients responding to Lempert's maneuver, with benign paroxysmal positional vertigo of the horizontal canal.

Two hundred and fifteen patients were diagnosed and treated for benign paroxysmal positional vertigo of the horizontal canal (BPPV-HC). All patients were tested with conventional positional nystagmus tests lying supine and rotating head for geotropic nystagmus, registered with Frenzels glasses, and in 109 cases with ENG. The walk-rotate-walk (WRW) test, developed by one of us (T.R.) and described in the text, was applied to all patients. The immediate good treatment results with Lempert's maneuver verify the correct diagnosis of BPPV-HC. The WRW test is a more sensitive test for BPPV-HC than earlier positional tests. The unhabituated acute phase of vestibular neuritis shows positive test results and must be eliminated with caloric tests. The WRW test identifies as a dynamic test patients with symptoms of even lesser magnitude, where the compensatory capacity of the equilibrium system suppresses the diagnostic findings with earlier positional horizontal canal tests.

Adolescent↗
PubMed1976

Twelve-minute walking test for assessing disability in chronic bronchitis.

The distance covered in 12 minutes' walking was used to test exercise tolerance in chronic bronchitis. The distance covered bore a poor relation to the forced expiratory volume in 1 second but a significant relation to the forced vital capacity and the maximum oxygen consumption and ventilation on a bicycle ergometer. The test may be a simple practical guide to everyday disability in chronic bronchitis.

Adult↗
PubMed2004

Isokinetic leg muscle strength in older americans and its relationship to a standardized walk test: data from the national health and nutrition examination survey 1999-2000.

OBJECTIVES: To describe isokinetic knee extensor muscle strength in older U.S. men and women by age and race/ethnicity and to ascertain its relationship to a standard, timed walking-speed test. SETTING: The U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2000. DESIGN: A cross-sectional nationally representative health examination survey. PARTICIPANTS: All surveyed persons aged 50 and older (N=1,499) who performed muscle strength and timed walk examinations in the NHANES mobile examination center. MEASUREMENTS: Concentric peak torque (strength) of the knee extensors at 1.05 rads/ s(-1) velocity and a 6-m walk timed in seconds. RESULTS: Knee extensor strength was inversely associated with age (P<.01), and women had less knee extensor muscle strength than men (P<.01). After adjustment for standing height, no significant difference in muscle strength was found across the three race/ethnicity groups (Mexican Americans, non-Hispanic blacks, and non-Hispanic whites) for men or women. After adjustment for age, race/ethnicity, weight, and height, increasing knee extensor strength was associated with significant increases in meters walked per second (P<.01). CONCLUSION: Knee extensor muscle strength is affected by age and sex but not by race/ethnicity and it is significantly associated with timed walk.

Black or African American↗
PubMed2002

Reliability of gait speed measured by a timed walking test in patients one year after stroke.

OBJECTIVE: To assess the reliability of gait speed in late-stage stroke patients. DESIGN: Test-retest reliability of three timed walks to 10 metres repeated during two assessments one week apart. SETTING: The patient's home. SUBJECTS: Twenty-two stroke patients with mobility problems more than one year after stroke. MAIN OUTCOME MEASURE: Gait speed measured in seconds taken to walk 10 metres. STATISTICAL ANALYSIS: Intraclass correlations (ICCs) with 95% confidence interval (CI) and the Bland and Altman method for assessing agreement by calculating the mean difference between measurements (d); the 95% CI for d; the standard deviation of the difference (SDdiff); a reliability coefficient and the 95% limits of agreement. RESULTS: There was a trend for decreased times taken to walk 10 metres both within each assessment and between assessments. ICCs for within-assessment reliability were 0.95-0.99. The d (SDdiff) for the second and third walks for assessment 1 was -1.00 (2.63) seconds and for assessment 2 was -0.70 (1.58) seconds. The reliability coefficient was 5.26 for assessment 1 and 3.17 for assessment 2. ICCs for between-assessment reliability were 0.87-0.88. The d (SDdiff) for the comparison of the third walks at assessment 1 and assessment 2 was -0.90 (5.01) seconds. The reliability coefficient was 10.02 and the 95% limits of agreement were -10.92 to +9.12 seconds. CONCLUSION: Within-assessment gait speed measured at home is highly reliable. The between-assessment reliability of gait speed measurement is less reliable but comparable with other studies.

Adult↗
PubMed2002

The 6-minute walk test in mobility-limited elders: what is being measured?

BACKGROUND: The 6-minute walk (6mw) is a well-established measure of aerobic capacity in elders with cardiorespiratory and peripheral vascular disease and may be an accurate measure of functional performance in healthy elders. In mobility-limited elders, a population at risk for disability, impairments in strength and power are predictive of performance-based measures of function. Though commonly utilized as an outcome measure among otherwise healthy mobility-limited elders, it is not clear whether the 6mw best represents a measure of functional limitation, aerobic capacity, or both. METHODS: We hypothesized that the 6mw would be strongly representative of performance-based measures of function being determined by impairments in muscle strength and power. We performed a cross-sectional analysis of 45 community-dwelling elders with mild to moderate mobility limitations. RESULTS: The 6mw was strongly associated with established functional measures (r =.61-.83; p <.001), but was poorly associated with indirect measures of aerobic capacity (r <.25; p >.05). Multivariate linear regression models demonstrated that impairments in leg strength and power, especially those at the knee and ankle, were predictive of 6mw performance. CONCLUSIONS: These findings emphasize the 6mw as a measure of functional limitation among mobility-limited elders without cardiorespiratory or peripheral vascular disease.

Activities of Daily Living↗
PubMed1995

Evaluation of imbalance of the vestibulo-spinal reflex by "the circular walking test".

A sensitive method of demonstrating latent imbalance of labyrinthine function was devised. The subject was asked to walk at his or her usual speed with eyes closed in a circle 2 m in diameter. This test was done by 22 patients whose vestibular function as tested by the Romberg, Mann, Fukuda and Babinski-Weil's methods had become normal after an attack of vertigo due to unilateral vestibular disorder. Eighteen patients complained of difficulty in walking while turning toward the affected side, and 11 tended to fall to the inside of the circle. Turning in the opposite direction, however, was performed without any difficulty. It was thought that disorders of the cristospinal reflex became manifest during circular walking toward the affected side. The body is inclined to the inner side of circular walking. Endolymph flows toward the ampulla of the lateral semicircular canal on the same side as turning. This would exert a facilitatory action on extensor neurons and give the ipsilateral leg assistance for supporting the body's weight which shifts to the centre of the circle. Disorders of the cristospinal reflex would cause difficulty in circular walking toward the affected side.

Humans↗
PubMedDate not supplied

Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years.

PURPOSE: To (1) identify greatest 6-minute walk distance (6MWD) from among several repetitions (best 6MWD) in a wide age range of healthy volunteers to develop reference values for the multiple repetition 6MWD, and (2) investigate the influence of demographics, anthropometrics, and habitual exercise activity on best 6MWD. METHODS: Four 6MWD were performed on the same day in a 20-meter corridor by 41 male and 38 female healthy volunteers ranging in age from 20 to 80 years. The greatest 6MWD by each subject from among four 6MWDs was the primary outcome measure. RESULTS: Eighty-six percent had their best 6MWD after the first walk; an average increase of 43 meters was observed from first to best 6MWD (P < 0.003). Best 6MWD averaged 698 +/- 96 meters and was inversely related to age (P < 0.001), directly to height (P < 0.001), and was greater in men than women (P < 0.0002). A regression model accounted for 41% of between-subject variability in best 6MWD (P < 0.00000001). In a subset of older subjects, predicted 6MWD significantly underestimated measured best 6MWD when reference values were used from another study where test familiarization was not provided, but this difference disappeared when value were used from the present and a third study where test familiarization was provided. CONCLUSIONS: The present study is the first to provide predicted 6MWD values performed with multiple repetitions and for subjects in the 20-40-year-old age range. Selection of appropriate predicted 6MWD values for interpretation of performance should be guided by subject age and degree of test familiarization provided.

Adult↗