Correlation between the Six-Minute Walk Test and Subjective Functional Class in Patients with Heart Failure

Introduction: The Six-Minute Walk Test (6MWT) is an inexpensive method to objectively evaluate physical capacity or limitation and stratify prognosis in patients with Heart Failure (HF). Since the clinical perception of symptoms may be adapted or compromised, regular evaluation from medical interviews often fails to determine functional classification. This study aimed to assess the correlation between New York Heart Association Functional Class (NYHA-FC) and the distance walked in the 6MWT. Methods: We conducted a cross-sectional observational study that included patients with HF with reduced ejection fraction followed up at an outpatient service of a teaching hospital, from August 2018 to April 2019. Patients in NYHA-FC I, II, or III were included. We compared NYHA-FC subjectively obtained during the consultation with the 6MWT performed after medical consultation, and the correlation between these two parameters was assessed. Results: The study included 70 patients with HF, 41 (58.6%) of whom were female. The mean age was 61.2 ± 12.7 years. The most prevalent etiologies were dilated idiopathic cardiomyopathy (35.7%) followed by ischemic cardiomyopathy (25.7%). The mean ejection fraction was 34.1% ± 9.8%. The average distance walked in the 6MWT by NYHA-FC I patients was 437.8 ± 95.8 meters, NYHA-FC II 360.1 ± 96.4, and NYHA-FC III 248.4 ± 98.3. Functional class measured by the 6MWT was different than that estimated by NYHA-FC in 34 patients (48.6%), 23 (32.9%) for a higher functional class and 11 (15.7%) for a lower one (p = 0.07). Pearson’s correlation coefficient between NYHA-FC and the 6MWT was -0.55. Conclusion: There was a moderate correlation between the subjective NYHA-FC and the 6MWT. The 6MWT revealed a different classification from NYHA-FC in almost half of the patients. Among those who presented discrepancies between methods, 6MWT reclassification towards a higher functional class was more common.

An Assessment of Cardiovascular Functional Capacity of a Group of Chronic Heart Failure Patients Using the 6-Minute Walk Test in a Cameroonian Urban Setting

Background: Chronic heart failure is a public health problem worldwide. It has a high mortality rate and is accompanied by a decreased functional capacity and alteration of the quality of life. Objective: This study aimed to assess the cardiovascular functional capacity of a group of patients suffering from heart failure using the 6-minute walk test (6 MWT). Methods: This was a cross-sectional study carried out in the cardiology unit of Douala’s general hospital for 4 months. We included all eligible patients aged 18 years or more who had stable chronic heart failure and gave informed consent. Those who had an acute coronary syndrome (≤1 month), tachycardia (HR ≥ 120 bpm), high blood pressure (SBP ≥ 180 mmHg and/or DBP ≥ 100 mmHg) and reduced mobility due to orthopaedic reasons were excluded. A 6 MWT was done according to the American Thoracic Society guidelines. The 6 MWT result was considered poor for - 450 m and good for >450 m. Results: We recruited a total of 81 patients (61.7% women) with a mean age of 65.9 ± 10.6 years. The most frequent risk factor for heart failure was high blood pressure (77.8%), alcohol consumption(69.1%) and a sedentary lifestyle (53.1%). The left ventricular ejection fraction was mostly preserved (42.0%) or mildly altered (46.9). The 6 MWT results were poor in 55.6% of cases, average in 19.8% of cases and good in only 24.7% of cases. More than half (59.3%) of the participants perceived the effort as being difficult. The cardiovascular functional capacity was significantly associated with age, heart failure stage and physical activity (p Conclusion: Most patients suffering from chronic stable heart failure in the general hospital of Douala have poor cardiovascular functional capacity.

Application of Six-minute Walk Test in Heart Transplantation Patients

Objectives To analyze the six-minute walk test （6MWT） and gas exchange of 5 heart transplantation patients and to approach the variation tendency of exercise tolerance, oxygen uptake （ VO2 ） and heart rate chronotropic response. Methods 5 cases of heart transplantation patients （ age 25 - 52 years） were undertaken 6MWT 6 - 30 months after operation, synchronizing gas exchanging parameters were measured by wireless portable remote sensing K4B^2 gas analyzer, 51 normal controls were compared. Results The six-minute walk distance （6MWD） of 5 patients were （592.6 ± 26.7 ） m （558 - 625 ） m, the ascending tendency during exercise was slower, the maximum heart rates were 80% ± 6% of age-predicting maximal heart rate, lower than normal control （86%） ; the end point VO2/kg were （21.8 ± 1.4 ） mL/min · kg （ 19. 94 - 23.60） mL/min · kg. Conclusions The 6WMD and VO2 of 5 patients reached normal range, but the heart rate chronotropic response and VO2 ascending tendency were slower than those of normal controls.

A Study of Real-time Peak Oxygen Consumption and Six-minute Walk Test

Objectives To assess the relationship between peak oxygen consumption （PVO2） and the ambulation distance in six-minute walk test （6MWT）among the healthy subjects. Methods The 51 healthy subjects were recruited for the six-minute walk test. Data of pulmonary gas exchange breath by breath, such as VO2 , VCO2 were real-time measured with wireless remote sensing K4B2, so to study the relationship between peak oxygen uptake and the ambulation distance. Results It was noticed that there was a positive linear correlation between the ambulation distance and PVO2 （ r =0. 619, P 〈0. 001 ） in six-minute walk test. The regression equation was set up （ VO2/kg =0. 05D -6. 331, P 〈 0. 001 ）. PVO2 〉 PVCO2 ,R 〈 1 were found,which suggested that 6MWT was a test below anaerobic threshold. Conclusions There was a closely positive linear correlation between the ambulation distance and PVO2, which is safety, convenient and valuable for the evaluation of cardiopulmonary function and the treatment of cardiopulmonary rehabilitation.

Six Minute Walk Test to assess functional capacity in chronic liver disease patients

AIM: To examine the utility of Six Minute Walk Test (6MWT) in patients with chronic liver disease (CLD). METHODS: Two hundred and fifty subjects between the ages of 18 and 80 (mean 47) years performed 6MWT and the Six Minute Walk Distance (6MWD) was measured. RESULTS: The subjects were categorized into four groups. Group A (n = 45) healthy subjects (control); group B (n = 49) chronic hepatitis B patients; group C (n = 54) chronic hepatitis C patients; group D (n = 98) liver cirrhosis patients. The four groups differed in terms of 6MWDs (P < 0.001). The longest distance walked was 421 ± 47 m by group A, then group B (390 ± 53 m), group C (357 ± 72 m) and group D (306 ± 111 m). The 6MWD correlated with age (r = -0.482, P < 0.01), hemoglobin (r = +0.373, P < 0.001) and albumin (r = +0.311, P < 0.001) levels. The Child-Pugh classification was negatively correlated with the 6MWD in cirrhosis (group D) patients (r = -0.328, P < 0.01). At the end of a 12 mo follow-up period, 15 of the 98 cirrhosis patients had died from disease complications. The 6MWD for the surviving cirrhotic patients was longer than for non-survivors (317 ± 101 vs 245 ± 145 m, P = 0.021; 95% CI 11-132). The 6MWD was found to be an independent predictor of survival (P = 0.024). CONCLUSION: 6MWT is a useful tool for assessing physical function in CLD patients. We suggest that 6MWD may serve as a prognostic indicator in patients with liver cirrhosis.

Value of the 6 minute walk test in predicting multi vessel coronary arterial disease

The 6 minute walk test (6MWT) is well established in the clinical assessment of heart failure, pulmonary hypertension and COPD. Its value as a submaximal stress test in the risk stratification of chronic stable ischaemic syndromes is as yet not validated. 95 patients undergoing coronary angiography for assessment of chronic stable angina performed the 6MWT according to a modified protocol. The gamma correlation test indicated a moderately significant relationship between ECG changes plus symptoms at the end of the 6MWT and multi vessel coronary arterial disease. The T wave changes showed no significant correlation. Hence the 6MWT is a useful tool in the risk stratification of stable ischaemic syndromes which can be safely performed in a general ward prior to hospital discharge. It would be a useful preliminary test before planning a programme of cardiac rehabilitation.

Effects of 6-minute walk test on the QT dispersion in patients with congestive heart failure

Objective: To investigate the clinical value of QT dispersion (QTd) and the effects of 6-minute walk test (6-MWT) mimicking the patients' daily activities on QTd in patients with congestive heart failure (CHF).Methods: Twenty-eight CHF patients and 22 normal subjects participated these study, who all completed 6-MWT without developing severe arrhythmias.Before and after 6-MWT, standardized 12-lead surface ECGs were obtained to measure QTd and corrected QTd (QTcd).Results: Both before and after 6-MWT, the QTd and QTcd in CHF patients were longer than those in the controls (P<0.001), and QTd and QTcd after 6-MWT were significantly shorter than those before 6-MWT in CHF patients (P=0.007, and 0.018).There was no significant difference in the measurement in the control group.Conclusion: QTd and QTcd are longer in CHF patients than in normal subjects.Moderate exercise may improve the inhomogeneity of ventricular repolarization dispersion in CHF patients.

Six-Minute Walk Test in Patients with Rheumatoid Arthritis

Background: The 6-minute walk test (6TC) was initially used as an instrument for assessing physical and cardiorespiratory capacity, but is currently being used to monitor treatments, and compare physical interventions and prognostic evaluation. Although already recognized as a research method in several specialties, 6TC has not been used in rheumatology. Patients with rheumatoid arthritis (RA) may have impaired functional capacity as well as increased cardiovascular mortality. An adequate functional evaluation of these patients is necessary and the 6TC may be useful in this sense. Objective: The aim of this study was to perform the 6-minute walk test in RA patients and to compare the performance with a control group. Method: A cross-sectional study was carried out in which the sample consisted of 85 women, 46 patients with rheumatoid arthritis and 39 healthy controls. A descriptive analysis of the data was performed. One-Way ANOVA methodology was used to compare the patient and control groups followed by the graphic analysis. Results: The distance walked on the 6TC by RA patients was on average 522.2 meters. In the distance control group found in the 6TC was on average 628.8 meters, the difference being statistically significant. Conclusion: In this study the distance covered in 6TC by women with RA was lower than that of healthy women of the same age.

Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities

Background The relationship between the 6-minute walk test （6MWT） and pulmonary function test in stable chronic obstructive pulmonary disease （COPD） remains unclear. We evaluate the correlation of 6MWT and spirometric parameters in stable COPD with different severities. 6MWT data assessed included three variables： the 6-minute walk distance （6MWD）, 6-minute walk work （6MWORK）, and pulse oxygen desaturation rate （SPO2%）. Methods 6MWT and pulmonary function test were assessed for 150 stable COPD patients with different severities. Means and standard deviations were calculated for the variables of interest. Analysis of variance was performed to compare means. Correlation coefficients were calculated for 6MWT data with the spirometric parameters and dyspnea Borg scale. Multiple stepwise regression analysis was used to screen pulmonary function-related predictors of 6MWT data. Results The three variables of 6MWT all varied as the severities of the disease. The 6MWD and 6MWORK both correlated with some spirometric parameters （positive or negative correlation; the absolute value of r ranging from 0.34 to 0.67; P 〈0.05） in severe and very severe patients, and the SPO2% correlated with the dyspnea Borg scale in four severities （t= -0.33, -0.34, -0.39, -0.53 respectively; P 〈0.05）. The 6MWD was correlated with the 6MWORK in four severities （r=0.56, 0.57, 0.72, 0.81 respectively, P 〈0.05）, and neither of them correlated with the SPO2%. The percent of predicted forced expiratory volume in 1 second （FEV1% predicted） and residual volume to total lung capacity ratio （RV/TLC） were predictors of the 6MWD, and the maximum voluntary ventilation （MW） was the predictor of the 6MWORK. Conclusions 6MWT correlated with the spirometric parameters in severe and very severe COPD patients. 6MWT may be used to monitor changes of pulmonary function in these patients.

Nine-hole Peg Test and Ten-meter Walk Test for Evaluating Functional Loss in Chinese Charcot-Marie-Tooth Disease

Background：The 9-hole peg test （9-HPT） and 10-meter walk test （10-MWT） are commonly used to test finger motor function and walking ability.The aim of this present study was to investigate the efficacy of these tests for evaluating functional loss in Chinese Charcot-Marie-Tooth （CMT） disease.Methods：Thirty-four Chinese CMT patients （CMT group） from August 2015 to December 2016 were evaluated with 9-HPT,10-MWT,CMT disease examination score,overall neuropathy limitation scale （ONLS）,functional disability score,and Berg Balance Scale （BBS）.Thirty-five age-and gender-matched healthy controls （control group） were also included in the study.Student＇s nonpaired or paired t-test were performed to compare data between two independent or related groups,respectively.The Pearson test was used to examine the correlations between recorded parameters.Results：The mean 9-HPT completion time in the dominant hand of CMT patients was significantly slower than that in the healthy controls （29.60 ± 11.89 s vs.19.58 ± 3.45 s;t =-4.728,P 〈 0.001）.Women with CMT completed the 9-HPT significantly faster than men with CMT （dominant hand：24.74 ± 7.93 s vs.33.01 ± 13.14 s,t =2.097,P =0.044）.The gait speed of the average self-selected velocity and the average fast-velocity assessed using 10-MWT for CMT patients were significantly slower than those in the control group （1.03 ± 0.18 m/s vs.1.44 ± 0.17 m/s,t =9.333,P 〈 0.001;1.31 ± 0.30 m/s vs.1.91 ± 0.25 m/s,t =8.853,P 〈 0.00 1,respectively）.There was no difference in gait speed between men and women.Both 9-HPT and 10-MWT were significantly correlated with the ONLS,functional disability score,and BBS （P 〈 0.05 for all）.Conclusion：The 9-HPT and 10-MWT might be useful for functional assessment in Chinese patients with CMT.

Six-minute walking test performance is associated with survival in cirrhotic patients

BACKGROUND Patients with cirrhosis are at risk of cirrhotic cardiomyopathy,with resulting cardiac dysfunction and exercise limitations.Six minute walking test(6MWT)assesses functional status and predicts morbidity and mortality in cardiopulmonary diseases.AIM To determine if it associates with mortality by analyzing 6MWT performance in patients with liver cirrhosis.METHODS A cohort of 106 cirrhotic patients was evaluated in the outpatient setting with echocardiogram and 6MWT and follow up for one year to document hepatic decompensation and mortality.The distance in meters was recorded at the end of 6 min(6MWD).RESULTS This cohort had a mean age of 51 years and 56%male;patients were staged as Child A in 21.7%,B 66%and C 12.3%.Walk distance inversely correlated with Child scores,and was significantly reduced as Child stages progresses.Patients who died(10.4%)showed shorter mean 6MWD(P=0.006).Low 6MWD was an independent predictor of mortality(P=0.01).CONCLUSION 6MWT is a noninvasive inexpensive test whose result is related to Child scores and mortality.It is useful to identify patients with liver cirrhosis at high risk of mortality for closer monitoring and potential early intervention.

RFD-Rao and RFD-Wald tests for distributed targets with range walking effect

提出两种新型自适应分布式目标检测器:距离频域Rao(RFD-Rao)和距离频域Wald(RFD-Wald)检测器。该方法考虑相参处理间隔(CPI)内部分均匀干扰环境和目标距离走动效应的影响,分析检测器的渐近性能,并给出不同杂波协方差矩阵和功率水平下的恒虚警率(CFAR)特性分析。将本文所提出的自适应检测器的性能通过蒙特卡罗试验进行了验证,仿真结果证明所提出的检测算法与现有的类似检测器相比的有效性。

Reply to"Six-minute walking test performance is associated with survival in cirrhotic patients"to the editor

Use of the six-minute walk test has been proposed as a prognostic marker in liver cirrhosis.In the Letter to the Editor presented here,the authors highlight some important points,which were raised after the article was published in the November issue of the World Journal of Hepatology.

Chair-rising and 3-min walk: A simple screening test for functional mobility

Aging induces decrease of locomotor capacity and its decrease is associated with an increased risk of falls. Several lines of evidence indicate that both change in muscle power and aerobic fitness are causative. Mobility tests are usually based on a maximal exercise stress test;however, this test is often difficult and sometimes frightening to older persons. Therefore, the objective of this study was to examine age and gender differences in 3-min walk distance test (3WDT), and time of chair-rising test (CRT) of functional mobility. 153 men and 159 women aged from 20 to 78 years were recruited as subjects of the present study. The body composition measured the height, body mass (BM), body mass index (BMI), lean tissue mass (LTM), and waist circumference (WC). The Functional mobility tests measured the peak oxygen uptake (VO2peak), 3WDT, leg extension strength (LES), and times of CRT. Both in men and women, height and BMI, WC decreased and increased, respectively, with age. Height, BM, LTM, WC in men are higher than in women. We found no correlation between ages and 3WDT in women and a significant, negative correlation in men. All parameters of fitness performance were negatively correlated with age. Both in men and women, all parameters of fitness performance were positively correlated with sex. Both in men and women, VO2peak, 3WDT, and LES decreased with age. All parameters of fitness performance in men are higher than in women. Both in men and women were observed for the correlation between 3WDT and VO2peak, LES and CRT respectively. Although as the correlation coefficient between 3WTD and VO2peak, LES and CRT were low (r = 0.28 - 0.38), an error may occur, this study shows that 3WDT and CRT test can be a feasible method of providing the information for muscle power and aerobic fitness, possibly avoiding the need for a maximal stress test.

Effects of a Graded Brisk Walking Test with Different Intensity Levels on Elderly Patients with Essential Hypertension:A Prospective Study in Shanghai,China

Background:This study aimed to clarify the effects of a Graded Brisk Walking Test(GBWT)program on blood pressure(BP)control in elderly patients with essential hypertension and to determine its appropriate degree of intensity for elderly people.Methods:In total,421 out of 620 participants were randomly sampled from a community health center in Shanghai,China.Among them,200 and 221 patients were assigned to the intervened and control groups,respectively.They were all treated with the GBWT program for 8 weeks,16 weeks,and 24 weeks.Results:Based on ANOVA,there was no significant time main effect,condition main effect,or time by condition interaction both in heart rate and body mass index indicators(P>0.05).There were significant condition main effects,time by condition interaction,or time main effects in blood pressure(F=21.875,33.457,65.342,respectively;All P<0.05).After the intervention,significant differences in systolic blood pressure(SBP)and diastolic blood pressure(DBP)values were also observed in the two groups(P<0.05);the average values of the baseline and second phases of the intervention group were significantly lower than those of the control group(P<0.05).Significant differences in blood pressure values after the first two phases were also observed when compared with those before the intervention.Similarly,a significant difference in the first phase and second phase was also found between the BP group and intervention group.However,after the third phase(24 weeks,high-intensity exercise),no significant differences existed both in SBP and DBP groups compared with those before the intervention(P=0.07).Conclusion:GBWT is an effective exercise prescription to mitigate the essential hypertension in elderly Chinese patients,and the intensity,walking distance,and target number of steps can be adjusted according to the age of the patients.

4R危机管理理论在结缔组织病相关肺动脉高压患者6分钟步行试验中的应用效果

目的:评价4R危机管理理论在结缔组织病相关肺动脉高压患者进行6分钟步行试验中的效果。方法:便利选取120例2022年1月—12月在北京协和医院风湿免疫内科肺动脉高压专病门诊就诊的结缔组织病相关肺动脉高压行6分钟步行试验的患者,按时间先后进行分组,对照组给予常规管理流程,干预组应用4R危机管理理论更新的6分钟步行试验管理流程。针对6分钟步行试验后两组患者的血氧饱和度情况及不良事件发生情况进行分析。结果:干预组和对照组患者6分钟步行距离差异无统计学意义(P>0.05);干预组患者6分钟步行试验后及测试后3分钟血氧饱和度显著高于对照组(P<0.05);干预组患者6分钟步行试验期间低氧饱和度及不良事件发生情况显著少于对照组(P<0.05)。结论:结缔组织病相关肺动脉高压行6分钟步行试验患者经4R危机管理理论干预能够显著降低低氧饱和度发生率,降低患者不良反应发生率,该方案为结缔组织病相关肺动脉高压患者实施6分钟步行试验提供了安全保障。

Functional Capacity of Patients with Venous Thromboembolic Disease Six to Twelve Months after Treatment

Background: Venous thromboembolism (VTE) is among the leading causes of hospital-related disability-adjusted life years lost. We aimed to determine the prevalence and determinants of functional capacity impairment six to twelve months after an acute VTE event. Methods: This was a cross-sectional study conducted between January and April 2021 in two referral hospitals of Yaoundé, including consenting adult patients admitted to these hospitals six to twelve months ago for VTE. We excluded dead patients and those with any comorbidity or symptoms limiting physical activity. The functional outcome was assessed with the six-minute walk test. Functional capacity impairment was defined as walking distance lower than the expected value. Results: We included 27 cases in this study with a mean age of 53.2 ± 14.4 years. The prevalence of functional capacity impairment was 29.6% (95% CI: 14.8 - 48.1). Factors associated with poor functional outcome were obesity (OR: 59.5;95% CI: 4.6 - 767.2;p - 207.4;p = 0.017), massive PE (OR: 30;95% CI: 2.5 - 354;p = 0.004), and poor adherence to treatment (OR: 30.3;95% CI: 2.5 - 333.3;p = 0.004). Conclusion: Functional capacity impairment is common in the medium-term after VTE and factors associated with this poor outcome are obesity, the severity of the VTE, and poor adherence to treatment.

督脉十三针联合五脏俞加膈俞针刺治疗帕金森病临床研究

目的:观察督脉十三针联合五脏俞加膈俞针刺治疗帕金森病患者运动症状的有效性和安全性。方法:将58例帕金森病患者随机分为对照组和治疗组,对照组28例,治疗组30例。治疗组给予督脉十三针联合五脏俞加膈俞针刺治疗,对照组给予常规针刺治疗方案,每周治疗3次,共治疗8周。分别于治疗前后观察两组患者帕金森病综合评价量表(MDS-UPDRS)、10米步行试验(10MWT)、改良Webster症状评分量表、Hoehn-Yahr(H-Y)分级量表的变化情况,并比较临床疗效。结果:治疗后,两组MDS-UPDRS评分、10MWT、改良Webster症状评分均较治疗前下降(P<0.05),且在MDS-UPDRS评分、10MWT的改善方面,治疗组优于对照组(P<0.05),两组改良Webster症状评分变化比较差异无统计学意义(P>0.05),两组治疗前后H-Y分级组内及组间比较差异均无统计学意义(P>0.05)。结论:督脉十三针联合五脏俞加膈俞针刺治疗可改善帕金森病运动症状,提高患者的生活质量。

胸腔镜肺部手术后恶心呕吐严重程度与术后恢复质量及活动能力的相关性

目的评估胸腔镜肺部手术患者术后恶心呕吐(PONV)严重程度与术后恢复质量及早期活动能力的相关性。方法选择择期胸腔镜肺部手术患者125例,男80例,女45例,年龄18~64岁,BMI 18~35 kg/m^(2),ASAⅠ—Ⅲ级。采用PONV影响量表评估术后第1天PONV的严重程度,根据严重程度将患者分为三组:无PONV组(n=87)、轻度PONV组(n=38)和中重度PONV组(n=7)。采用15项恢复质量(QoR-15)量表评估术后第1天的恢复质量,6分钟步行试验(6-MWT)评估术后第2天的活动能力。采用多重线性回归模型分析PONV严重程度与术后恢复质量及活动能力的相关性。结果校正后的多重线性回归模型结果显示,与无PONV患者比较,轻度和中重度PONV患者术后第1天QoR-15量表评分分别降低4.5分(95%CI-8.9~-0.04分,P=0.048)和15.8分(95%CI-24.8~-6.8分,P=0.001);轻度(MD=-27.4 m,95%CI-70.1~15.4 m,P=0.207)和中重度PONV(MD=-57.0 m,95%CI-145.7~31.6 m,P=0.204)与术后第2天6-MWT距离缩短无明显相关性。结论在肺部手术患者中,PONV严重程度的增加与更差的恢复质量存在相关性。积极地预防和治疗PONV可能有助于患者的早期康复。