Normative values in healthy adults for the 6-minute and 2-minute walk tests in Belgium and Vietnam: implications for clinical practice.

OBJECTIVE: To establish reference values for the 6-minute walk test (6MWT) and 2-minute walk test (2MWT) distances, to investigate the correlation between these 2 tests, and to establish prediction equations for these distances in healthy populations of Belgium and Vietnam. DESIGN: Cross-sectional study. SUBJECTS AND METHODS: The 6MWT and 2MWT were administered to a convenience sample of 239 Belgian and 303 Vietnamese participants between the ages of 18 and 80 years. RESULTS: The mean (standard deviation; SD) 2MWT distances were 215 (32.8) m for Belgian participants and 156 (25.5) m for Vietnamese participants. The mean (SD) 6MWT distances were 625 (90.7) m for Belgian participants and 449 (70.4) m for Vietnamese participants. The Pearson correlation coefficient between the 2 tests was 0.901 (p < 0.001) for Belgian participants and 0.871 (p < 0.001) for Vietnamese participants. Age and sex were the 2 most important predictors of walking distance, followed by body mass index for Belgium and height for Vietnam. The adjusted R² ranged from 0.31 to 0.49 across 4 predictive equations. CONCLUSION: These results can be used to determine the presence of walking performance deficits and to guide future studies. The 2MWT is suggested as a useful and convenient alternative to the 6MWT for assessing walking performance in clinical practice.

Kinematic parameters related to functional capacity, fatigue, and breathlessness during the 6-min walk test in older adults with heart failure with preserved ejection fraction.

AIMS: This paper aims to assess kinematic parameters related to functional capacity, fatigue, and breathlessness during the 6-min walk test (6MWT) in patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: A cross-sectional study was conducted in which adults 70 years or older with HFpEF were voluntarily recruited between April 2019 and March 2020. An inertial sensor was placed at the L3-L4 level and another on the sternum to assess kinematic parameters. The 6MWT was divided into two 3-min phases. Leg fatigue and breathlessness, assessed by the Borg scale, the heart rate (HR), and the oxygen saturation (SpO2), were measured at the beginning and the end of the 6MWT. The difference in kinematic parameters between the 6MWT two 3-min phases was also calculated. Bivariate Pearson correlations and subsequent multivariate linear regression analysis were performed. Seventy older adults with HFpEF (mean = 80.74 years old) were included. Kinematic parameters explained 81.00% of the functional capacity, 45.50% of the leg fatigue and 66.10% of the breathlessness variance. Moreover, kinematic parameters could explain 30.90% of the SpO2 variance at the end of the 6MWT. Kinematic parameters also explained 33.10% of the SpO2 difference between the beginning and end of 6MWT. Kinematic parameters explained neither the HR variance at the end of 6MWT nor the HR difference between the beginning and end. CONCLUSION: Gait kinematics from L3-L4 and sternum explain a part of the variance in subjective outcomes, assessed by the Borg scale, and objective outcomes such as functional capacity and SpO2. The kinematic assessment allows clinicians to quantify fatigue and breathlessness through objective parameters related to the patient's functional capacity. REGISTRATION: ClinicalTrials.gov NCT03909919.

Preoperative 6-minute walk distance is associated with postoperative complications in patients undergoing laparoscopic gastrointestinal cancer surgery.

OBJECTIVE: The 6-min walk test (6MWT) is a simple and valid method to evaluate cardiopulmonary function. We performed this prospective study in patients undergoing laparoscopic gastrointestinal cancer surgery to explore the association between preoperative 6MWT performance and overall postoperative complications. METHODS: This study was registered at clinicaltrials.gov (NCT03711526). The study consecutively enrolled patients receiving laparoscopic gastrointestinal cancer surgery in our institution. All patients performed the 6MWT upon recruitment and received 30 days of postoperative follow-up. The primary outcome was overall complications, defined by ≥ grade I Clavien-Dindo (CD) classification (2004) complications. Multivariable logistic regression was used to test the association of 6-min walk distance (6MWD) with the outcome. RESULTS: A total of 184 patients were included in the final analyses. In the 37 (20.1 %) patients with overall complications, the mean (standard deviation) preoperative 6MWD was 469.1 (86.8) m. In patients with no complications, the 6MWD was 502.6 (90.2) m. The mean difference was 33.5 m (95 % confidence interval, 1.3, 65.7; P = 0.042). A longer preoperative 6MWD was associated with a lower odds of developing postoperative complications (odds ratio, 0.994 per meter increase; 95 % confidence interval, 0.989, 0.999; p = 0.023). CONCLUSION: This study indicated an association between the preoperative 6MWD and postoperative complications in patients undergoing laparoscopic gastrointestinal cancer surgery.

Impact of Test Instructions on 6-min Walk Distance in Adults With Chronic Respiratory Disease: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: The 6-min walk test (6MWT) is commonly used to assess functional exercise capacity in people with chronic respiratory disease in both clinical and research settings. However, two tests are required to achieve accurate results, due to a well-documented learning effect for the 6-min walk distance (6MWD). Whether it is possible to reduce or eliminate the learning effect by optimizing 6MWT instructions is not known. METHODS: People with chronic respiratory disease referred to pulmonary rehabilitation undertook two 6MWT with random allocation to modified instructions ( fast -walk as fast as possible; n = 46) or usual instructions ( far -walk as far as possible; n = 49). The primary outcome was the learning effect, defined as the difference in the 6MWD between test one and test two. Subgroup analyses investigated whether effects varied in those who were naïve to the 6MWT or according to diagnosis (chronic obstructive pulmonary disease, interstitial lung disease, and bronchiectasis). RESULTS: A learning effect was present in both groups, with a mean improvement in the 6MWD on the second test of 14 m in the fast (modified) group (95% CI, 6-22) and 11 m in the far (usual) group (95% CI, 4-19). There was no statistically or clinically significant difference between groups in the magnitude of the learning effect (between-group difference -3 m, 95% CI, -14 to 8). There was no significant effect of naivety to the 6MWT or diagnosis. CONCLUSION: The current recommended procedures for the 6MWT, including standardized instructions and performance of two tests on each occasion, should be retained.

Validity and reliability of an app-based medical device to empower individuals in evaluating their physical capacities.

BACKGROUND: Cardiorespiratory fitness and muscle strength are valid markers of health and strong predictors of mortality and morbidity. The tests used to measure these variables require in-person visits with specialized equipment and trained personnel-leading to organizational constraints both for patients and hospitals, and making them difficult to implement at a large scale. In this context, technologies embedded in smartphones offer new opportunities to develop remote tests. OBJECTIVES: This study aimed to test the validity and reliability of MediEval, a newly developed app-based medical device that allows individuals to perform the 6-minute walk test (6MWT) and the 30-second sit-to-stand (30s-STS) test on their own using GPS signal and camera detection with a skeleton extraction algorithm. METHODS: A total of 53 healthy adults performed the two tests in three different sessions to determine the intra- and inter-day reproducibility. Test validity was assessed by comparing the results obtained from the app to gold standard measures. Pearson correlations and concordance correlation coefficients, the relative measurement error, intraclass correlation coefficients, the standard error of measure and the minimal detectable change were computed for each test.s. RESULTS: The results revealed high to excellent validity of the app in comparison to gold standards (ρ = 0.84 for the 6MWT and ρ = 0.99 for the 30s-STS test) with low relative measurement error. The mean differences between the app and the gold standard measures were 8.96m for the 6MWT and 0.28 repetition for the 30s-STS test. Both tests had good test-retest reliability (ICCs = 0.77). The minimal detectable changes were respectively 97.56 meters for the 6MWT and 7.37 repetitions for the 30s-STS test. CONCLUSION: The MediEval medical device proposes valid and reproducible measures of the 6MWT and the 30s-STS test. This device holds promise for monitoring the physical activity of large epidemiologic cohorts while refining patient experience and improving the scalability of the healthcare system. Considering minimal detectable change values, it may be important to ask participants to perform several tests and average them to improve accuracy. Future studies in clinical context are needed to evaluate the responsiveness and the smallest detectable changes of the device for specific populations with chronic diseases.

Relación entre la distancia recorrida en la prueba de caminata de 6 minutos y el sexo, la edad, comorbilidades y la disnea en pacientes con EPOC / Relationship between the Distance Traveled in the Test of 6- Minute Walk and Sex, Age, Comorbidities and Dyspnea in Patients with CORP

Introducción: la enfermedad pulmonar obstructiva crónica (EPOC) es un trastorno res-piratorio caracterizado por síntomas clínicos y compromiso funcional que afecta la ca-pacidad aeróbica limitando las actividades cotidianas y la calidad de vida. La prueba de caminata de 6 minutos (C6M) es una prueba sencilla y de bajo costo que evalúa la capa-cidad de los pacientes para realizar sus actividades cotidianas. Objetivo: evaluar la re-lación entre la capacidad aeróbica medida por la distancia recorrida en la C6M y el se-xo, edad, disnea y comorbilidades cardiometabólicas en pacientes con EPOC. Material y métodos: estudio de corte transversal, descriptivo, basado en pruebas de caminatas de 6 minutos (C6M) realizadas en pacientes con EPOC. Resultados: se evaluaron 101 pacientes, hombres (63,4%), con una edad promedio de 74,1±8,7 años. Al correlacionar C6M con otras variables se encontraron diferencias estadísticamente significativas. La distancia media recorrida fue mayor en hombres que en mujeres (DM: 58,3 metros, IC 95%; 16 - 100,6, p=0,007). Los pacientes < 75 años, sin comorbilidades y disnea < 2 tu-vieron mejor desempeño en la C6M que los > 75 años (DM; 62,012 metros IC 95% 21,5 - 102,4, p=0,003), con comorbilidades (DM: 42,2 metros, IC 95%, 0.003 - 84,4; p=0,050) y disnea ≥ 2 (DM: 65,8 IC 95% 23,9 - 107,6, p=0,002). Conclusiones: el sexo femenino, la presencia de comorbilidad cardiovascular y metabólica, y la edad se asocian con dis-minución en la capacidad física aeróbica y funcional en los pacientes con EPOC. (AU)

Introduction: chronic obstructive pulmonary disease (COPD) is a respiratory disorder characterized by clinical symptoms and functional impairment that affects aerobic capacity, limiting daily activities and quality of life. The 6-minute walk test (C6M) is a simple, low-cost test that assesses a patient's ability to perform their daily activities. Objective: to evaluate the relationship between aerobic capacity measured by the distance covered in the C6M and gender, age, dyspnea and cardiometabolic comorbidities in patients with COPD. Materials and methods: cross-sectional, descriptive study, based on 6-minute walk tests (C6M) performed in patients with COPD. Results: 101 male patients (63.4%), with a mean age of 74.1 ± 8.7 years, were evaluated. When correlating C6M with other variables, statistically significant differences were found. The mean distance traveled was greater in men than in women (MD: 58.3 meters, 95% CI: 16 - 100.6, p=0.007). Patients <75 years old, without comorbidities and dyspnea <2 had better performance in the C6M than those >75 years old (MD; 62 meters CI 95% 21.5 - 102.4, p=0.003), with comorbidities (MD: 42.2 meters, 95% CI, 0.003 - 84.4; p=0.050) and dyspnea ≥ 2 (MD: 65.8, 95% CI 23.9 - 107.6, p=0.002). Conclusions: female sex, the presence of cardiovascular and metabolic comorbidity, and age are associated with decreased aerobic and functional physical capacity in patients with COPD. (AU)

Validity of the 30-Second Chair-Stand Test to Assess Exercise Tolerance and Clinical Outcomes in Patients with Esophageal Cancer: A Retrospective Study with Reference to 6-Minute Walk Test Results.

This retrospective study aimed to investigate the validity of a 30-sec chair stand test (CS-30) as a simple test to assess exercise tolerance and clinical outcomes in 53 Japanese patients with esophageal cancer. There was a strong correlation between the results of CS-30 and the 6-min walk test (6MWT), the gold standard for assessing exercise tolerance (r=0.759). Furthermore, fewer patients whose CS-30 score was greater than 16 (the cutoff value defined based on 6MWT) experienced pneumonia in their postoperative course. These results suggest that exercise tolerance could be assessed using CS-30, and its cutoff value may be useful in predicting postoperative pneumonia risk.

Which field test should be used to compare the functional exercise capacities of patients with type 2 diabetes mellitus with and without diabetic peripheral neuropathy? Cross-sectional study.

BACKGROUND: The 6-minute step test (6MST) has begun to be used as a simple and effective alternative for assessing functional exercise capacity. There is no study using 6MSTs to evaluate the exercise capacities of patients with type 2 diabetes mellitus (DM) with and without diabetic peripheral neuropathy (DPN). OBJECTIVE: To compare the cardiorespiratory responses of the 6-minute walk test (MWT) and the 6MST exercise tests and to analyze the usability of the 6MST in Type 2 DM patients with and without neuropathy. METHODS: 32 non-neuropathic Type 2 DM, 32 neuropathic Type 2 DM patients, and 30 healthy volunteers were included in this cross-sectional study. Functional exercise capacity was evaluated with the 6MWT and the 6MST. The 30-second sit-stand test (30s STS) was used to evaluate general lower extremity muscle strength and function. RESULTS: There was a significant difference in the results of 6MWT (m), 6MST (number of steps), and 30s STS of the three groups (p<0.05). The 6MST results of patients with neuropathic Type 2 DM were significantly lower than those of non-neuropathic diabetics and those who were healthy (number of steps; 114.07±25.57 vs. 133.48±33.57 vs. 160.35±28.52, respectively) (p=0.001). The change in cardiorespiratory response in systolic blood pressure, heart rate, perceived dyspnea, and leg fatigue severity was significantly higher at 6MST than 6MWT in the three groups (p<0.05). 6MST was correlated with 6MWT (r=0.679, p=0.001), and 30s STS (r=0.589, p=0.001) in patients with Type 2 DM. CONCLUSIONS: Cardiorespiratory responses increased more in 6MST compared to 6MWT. In patients with Type 2DM, 6MWT and 6MST were moderately correlated with each other. 6MST is an effective and safe assessment method that may better reveal the differences in functional exercise capacity between neuropathic and non-neuropathic individuals in clinics.

Pediatric Walking Speed Normal Reference Values in a Local Population.

PURPOSE: This study's aim was to develop a local walking speed norm using the 10-m walk test (10MWT) for 5- to 17-year-old children and youth who are developing typically. METHODS: Healthy child and adolescent participants were recruited from schools in one rural Alaska school district. The 10MWT was performed using a 2 repetitions per speed protocol. Outcome measures were average time for the normal and fast-speed trials, separated by age and gender. RESULTS: Average walking speed was established in this group of children and youth who are developing typically by age and gender. CONCLUSIONS: Local walking speed norms for 5- to 17-year-olds can be accurately obtained by examining students in a rural school district.

One-minute sit-to-stand test as a quick functional test for people with COPD in general practice.

Assessing changes in functional exercise capacity is highly relevant in the treatment of people with Chronic Obstructive Pulmonary Disease (COPD), as lung function is often static. In Denmark, most people with COPD are followed in general practice where traditional functional tests, like six-minute walk test, require too much time and space. Therefore, there is an urgent need for a quick functional exercise capacity test that can be performed in a limited setting, such as general practice. This study aimed to identify a quick test to measure functional exercise capacity in people with COPD and identify which factors could affect the implementation of such a test in general practice. A mixed method feasibility study composed of a literature review and qualitative interviews was used. Quick functional tests for people with COPD were identified and evaluated through the COSMIN methodology. For the interviews, 64 general practices were included, and 50 staff members and 14 general practitioners (GPs) participated in the interviews. Responses were categorized and thematically analyzed. The 1 min sit-to-stand-test (1 M STST) was found suitable for a general practice setting. The COSMIN methodology rated it "sufficient" in reliability (ICC 0.90-0.99), measurement error (MID 2.5-3), construct validity and responsiveness (AUC 0.72), and found a moderate to strong correlation in criterion validity (r = 0.4-0.75). Several GPs wished for a quick functional test and emphasized evidence, information, and limitations as essential when deciding on implementation. Other factors identified included time, other tests, and economy. 1 M STST is a valid test to assess functional exercise capacity in people with COPD. The test is quick and can easily be performed in a standard consultation, and several GPs wished for such a test.

Assessment of exercise capacity using field walking tests in patients after the Fontan procedure: A case-control study.

BACKGROUND: Despite the frequent use of the 6-minute walk test (6MWT), exercise capacity has not been assessed with the incremental shuttle walk test (ISWT) in patients who have undergone the Fontan procedure. It is unclear whether these tests cause clinically relevant cardiorespiratory responses in these patients. OBJECTIVES: We aimed to assess cardiorespiratory responses to the 6MWT and ISWT in Fontan patients, compare the responses with those in the controls, and examine the agreement between the two field tests. METHODS: Submaximal exercise capacity was assessed using the 6MWT, maximal exercise capacity using the ISWT, quadriceps isometric muscle strength with a hand dynamometer, and body composition using a bioelectrical impedance device. RESULTS: Twenty-one Fontan patients (16.42±6.63 years, 5F/16M) and 21 controls (16.57±4.30 years, 7F/14M) were included. While body composition was similar between the groups (p>0.05), quadriceps isometric muscle strength and 6MWT and ISWT distance were lower in the Fontan patients than in the controls (p<0.05). In both the 6MWT and ISWT, pre- and post-test heart rate (HR), oxygen saturation (SpO2), dyspnea, and leg fatigue differed significantly between the Fontan patients and the controls (p<0.05). In addition, the ISWT resulted in a more significant change in HR, SpO2, and leg fatigue than the 6MWT in the Fontan patients (p<0.05). Bland-Altman plots for the 6MWT vs. the ISWT indicated agreement between the two tests. CONCLUSION: There were remarkable changes in HR, SpO2, dyspnea, and leg fatigue in both tests. With similar safety to the 6MWT but with more caution applied for adverse events, the ISWT can also be performed as a field test to evaluate exercise capacity and identify more pronounced exercise-induced responses (especially oxygen desaturation) in Fontan patients.

Tele-Assessment of Functional Capacity through the Six-Minute Walk Test in Patients with Diabetes Mellitus Type 2: Validity and Reliability of Repeated Measurements.

A tele-assessed 6MWT (TL 6MWT) could be an alternative method of evaluating functional capacity in patients with diabetes mellitus type 2 (DM2). This study aimed to assess the validity and reliability of a TL 6MWT. The functional capacity of 28 patients with DM2 (75% men) aged 61 ± 13 years was evaluated twice via an indoor, center-based 6MWT (CB 6MWT) and twice outside each patient's home via a web-based platform TL 6MWT. The study showed a high statistically significant correlation between the CB and TL 6MWT (Pearson's r = 0.76, p < 0.001). Reliability testing showed no statistically significant differences in the distance covered (CB1: 492 ± 84 m and CB2: 506 ± 86 m versus TL1: 534 ± 87 m and TL2: 542 ± 93 m, respectively) and in the best distance of the TL 6MWT (545 ± 93 m) compared to the best CB distance (521 ± 83 m). Strong internal reliability for both the CB (intraclass correlation coefficient (ICC) = 0.93) and the TL 6MWT (ICC = 0.98) was found. The results indicate that a TL 6MWT performed outdoors can be a highly valid and reliable tool to assess functional capacity in patients with DM2. No learning effect between the TL and CB assessment was found, minimizing the need for repetition.

Reliability and validity of the incremental shuttle walk test in patients with fully ambulatory multiple sclerosis.

BACKGROUND: Functional exercise capacity evaluation is crucial to monitor treatment effects and disease progression in people with multiple sclerosis (pwMS). Compared to other tests, the incremental shuttle walking test (ISWT), which more accurately reflects cardiovascular responses, may be more useful for assessing exercise capacity. The aim of the study is to investigate the reliability and validity of the ISWT. METHODS: Thirty-six pwMS with an Expanded Disability Status Scale (EDSS) score<4.5 between the ages of 25 and 65 were included in the study. The subjects underwent practice (ISWT-p) before undergoing the test-retest protocol in order to rule out the ISWT learning effect (ISWT-1 - ISWT-2). ISWT-1 and ISWT-2 were administered with a 3-7 day interval for test-retest reliability. Six-minutes walking test (6MWT) were applied for concurrent validity. The EDSS, pulmonary function tests, Fatigue Impact Scale (FIS), respiratory muscle strength [maximum inspiratory and expiratory pressure (MIP-MEP)] measurements were made for convergent validity. RESULTS: ISWT was found to have excellent test-retest reliability with an ICC value of 0.97. The area under the curve value was 0.904 indicating that ISWT has a good performance for predicting disease severity. The moderate correlation between ISWT and 6MWT (rho: 0.68, p<0,001) proved concurrent validity. It was also moderately correlated with EDSS, MEP (rho: -0.58 and 0.47 respectively), weakly correlated with MIP and FIS (rho:0.37 and -0.36, respectively) while not correlated with pulmonary function tests. CONCLUSION: The ISWT had excellent test-retest reliability, acceptable criterion and construct validity in ambulatory MS patients.

The increased perceived exertion during the six minute walking test is not accompanied by changes in cost of walking, gait characteristics or muscle fatigue in persons with multiple sclerosis.

BACKGROUND: Persons with Multiple Sclerosis (pwMS) frequently experience walking difficulties, often expressed as a slower walking speed during the 6 Minute Walking Test (6MWT). In addition, slower walking speeds are also related to higher levels of perceived exertion. PwMS are also known to have a higher energetic Cost of walking (Cw) and may experience muscle fatigue during prolonged walking. In this study, we aimed to explore changes in Rate of Perceived Exertion (RPE) and the Cw within participants during the 6MWT in pwMS. Additionally, concomitant changes in the mean and variability of gait characteristics and changes in muscle activation describing muscle fatigue were assessed. METHODS: The 6MWT was performed on an instrumented treadmill while three-dimensional motion capture and gas exchange were measured continuously. RPE on the 6-20 borg-scale was questioned directly before and after the 6MWT. Cost of walking was expressed in Joules/kg/m. Muscle fatigue was assessed by increases in Root Median Square (RMdS) and decreases in Median Frequency (MF) of the recorded EMGs. Wilcoxon-Signed Rank test was used to assess a difference in RPE before and after the 6MWT. Linear mixed models, while controlling for walking speed, were used to assess changes in Cw, mean and variability of gait characteristics and RMdS and MF of muscle activation. RESULTS: 28 pwMS (23 females, mean ± standard deviation age 46 ± 10 years, height 1.69 ± 0.08 meter, weight 76 ± 18 kilogram, EDSS 2.7 ± 1.3) were included. Although the RPE increased from 8 to 12, no changes in Cw were found. Walking speed was the only spatiotemporal parameter which increased during the 6MWT and RMdS of the gastrocnemius and tibialis anterior muscles increased. The soleus muscle decreased in MF over time. CONCLUSION: The increases in RPE and walking speed was not accompanied by a change in Cw during the 6MWT which indicates that the perceived exertion was not accompanied by an increased physical exertion. Changes in muscle activation might give an indication for muscle fatigue but were inconclusive. Although the 6MWT reflects daily life walking challenges for pwMS, this test did not show the expected changes in gait parameters in our sample.

Body functions and structure, activity, and participation limitations of adult cystic fibrosis patients under the international classification of functioning, disability, and health framework.

Objective: There is no study in the literature evaluating impairments and functional limitations in adults with cystic fibrosis (CF) under the framework of the International Classification of Functioning, Disability, and Health (ICF). To evaluate the adults with CF using ICF model. Methods: Twenty-three adults with CF and 23 age-sex matched healthy individuals included in this cross-sectional study. The participants evaluated according to the selected items for domain b, domain s, and domain d from the Obstructive Pulmonary Diseases (OPD) Comprehensive Core Set. The body composition, pulmonary functions, respiratory and peripheral muscle strength/endurance tests and anxiety/depression level were evaluated for domain b and s. For domain d, the Incremental Shuttle Walk Test (ISWT) and Short Form-36 (SF-36) Health Survey were used. Results: The fat-free mass (p = .044), pulmonary functions (p < .05), respiratory muscle endurance (p = .010), absolute and %quadriceps muscle strength (p = .001, p = .025, respectively), number of sit-ups (p = .020), walking speed (p = .035), ISWT and ISWT% distance (p < .001) and peak oxygen consumption (p < .001) were significantly lower in adults with CF compared to healthy individuals (p < .05). There were only significant differences in SF-36 physical functioning and role physical subdimension scores between groups (p = .009, p = .045 respectively). Conclusions: The ICF framework is applicable to comprehensively evaluate limitations of adults with CF among rehabilitation professionals. Especially age, respiratory function, respiratory muscle strength and endurance, dyspnea perception, peripheral muscle endurance were related to activity and participation limitation.

Shuttle walk test categorization according to the qualifiers of the International Classification of Functioning, Disability, and Health: proposal for use in patients with difficult-to-treat asthma, a cross-sectional study.

AIM: To classify functional capacity of people with difficult-to-treat asthma based on the International Classification of Functioning, Disability and Health (ICF). METHODS: Fifty-seven patients underwent the Incremental Shuttle Walk Test (ISWT) to assess functional capacity, in order to categorize them functionally we used the ICF qualifiers. To qualify ISWT results the individual's impairment (i.e. percentage of distance walked in relation to the percentage of predicted) was analyzed. Additionally, body mass index (BMI); physical activity level (IPAQ); and pulmonary function were evaluated. In order to analyze the difference between functional capacity levels, two groups were compared (i.e. mild/moderate vs. severe impairment); therefore, the participants were matched according to age and BMI and the unpaired Student t test was used. RESULTS: Among the fifty-seven included individuals, only one (1.8%) presented mild functional capacity limitation, 12 (21.1%) moderate limitation and 44 (77.2%) severe limitation. There was a significant difference between the ISWT distance between groups (F = 0.217, p < .001). The other variables did not present differences between the mild/moderate and severe groups. CONCLUSION: The ICF qualifiers were able to categorize the ISWT and classified the functional capacity limitation as mild, moderate and severe. Therefore, it has proved to be a useful clinical tool for evaluation, follow-up and clinical decision-making.

The correlates and reference values for the 6-minute walk distance in Taiwanese adults with schizophrenia.

PURPOSE: The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan. METHODS: A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol. RESULTS: A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60. CONCLUSIONS: Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.IMPLICATIONS FOR REHABILITATIONHeight and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ).The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness.Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.

The 2 min step test: A reliable and valid measure of functional capacity in older adults post coronary revascularisation.

PURPOSE: Exercise training is the central component in Cardiac Rehabilitation (CR). A baseline assessment of aerobic capacity is paramount for exercise prescription and safety. The Two-Minute Step Test (2MST) has been used to measure aerobic capacity in healthy older adults. However, the reliability and validity of the 2MST in older adults post-coronary revascularisation (CRV) is unknown. METHODS: A prospective observational study was conducted in a single CR centre. Two 2MSTs and one six-minute walk test (6MWT) were completed in a single session. The 2MST measurements were recorded by two raters for each individual. The six-minute walk distance (6MWD) and 2MST steps recorded by both raters were analysed to determine the relationship and agreement between measurements. RESULTS: Thirty one participants with a median (IQR) age of 66 (62,73) years old were included in the study post CRV. Strong positive correlations were found between steps achieved during the 2MSTs and the 6MWD (r = 0.87, 95% CI 0.82-0.91, p < 0.0001). Excellent inter-rater reliability was demonstrated between raters during the 2MSTs (ICC = 0.999-1.000, p = 0.000). Excellent relative test-retest reliability was demonstrated in both 2MSTs recorded by both raters (ICC = 0.927-0.934, p = 0.000). However, absolute test-retest reliability may have been limited by a learning effect between repeated 2MSTs. CONCLUSIONS: The results of this study indicate that the 2MST may be used as an alternative to the 6MWT as an outcome measure for aerobic capacity in older adults post-CRV. However, a practice trial is recommended at baseline to account for a learning effect.

An Equation With Clinical Applicability and Adequate Validity to Predict the Maximum Oxygen Consumption of Individuals Post-stroke.

OBJECTIVE: To develop an equation with clinical applicability and adequate validity to predict the maximum oxygen consumption (V̇o2max) of individuals post-stroke. DESIGN: A cross-sectional study. SETTING: A university laboratory. PARTICIPANTS: Individuals post-stroke in the chronic phase (at least 6 months post-stroke). Step-1 (equation development): n=50, aged 55±12 years; Step-2 (validity investigation): n=20, aged 58±8 years (N=50 [step 1], N=20 [step 2]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Step-1 (equation development): multiple linear regression analysis was performed. DEPENDENT VARIABLE: V̇o2max (mL/kg/min) in the cardiopulmonary exercise test. INDEPENDENT VARIABLES: age (years), sex (1-women, 2-men), body mass index (BMI) (kg/m2), and distance (meters) in the Six-Minute Walk Test (6MWT) (6MWT-Equation) or in the Incremental Shuttle Walk Test (ISWT) (ISWT-Equation). Step-2 (validity investigation): agreement between the V̇o2max measured and predicted was evaluated with the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and the Bland-Altman method (α=5%). RESULTS: In step-1 (equation development), the 4 independent variables for each equation were retained (6MWT-Equation: R2=0.68, P<.001; ISWT-Equation: R2=0.58, P<.001). In step-2 (validity investigation), the 6MWT-Equation showed an ICC of 0.73 (95% CI=0.30, 0.89; P=.004) and a mean bias of 0.003 mL/kg/min; and the ISWT-Equation showed an imprecise ICC of 0.55 (95% CI=-0.12, 0.82; P=.045) and a mean bias of 0.971 mL/kg/min. 6MWT-Equation (V̇o2max=22.239+0.02 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI) showed adequate validity. CONCLUSIONS: An equation with clinical applicability and adequate validity in the investigated sample was developed to predict the V̇o2max of individuals post-stroke in the chronic phase (6MWT-Equation). Future studies with larger sample should investigate its external validity.

Clinically Meaningful Change in 6 Minute Walking Test and the Incremental Shuttle Walking Test following Coronary Artery Bypass Graft Surgery.

The 6-min walk test (6MWT) and incremental shuttle walk test (ISWT) are widely used measures of exercise tolerance, which depict favorable performance characteristics in a variety of cardiac and pulmonary conditions. Both tests are valid and reliable method of assessing functional ability in cardiac rehabilitation population. Several studies have calculated the minimal clinically important difference (MCID) of these exercise tests in different populations. The current study aims to estimate MCID of 6MWT and ISWT in patients after Coronary artery bypass graft (CABG) surgery. In this descriptive observational study, nonprobability purposive sampling technique was used to assess 89 post CABG patients. The participants performed the 6MWT and ISWT along with vital monitoring on third, fifth and seventh post operative days. The data was with calculation of 6MWT and ISWT MCID through distribution and anchor-based methods. Results showed significant improvement (p < 0.001) in 6MWT as well as in ISWT after seven days of in-patient cardiac rehabilitation. The minimal detectable difference of 6MWT determined by the distribution-based method was 36.11 whereas MCID calculated by Anchor based method was 195 m. The minimal detectable difference of ISWT determined by the distribution-based method was 9.94 whereas MCID calculated by Anchor based method was 42.5 m. In conclusion our results will assist the future researchers and clinicians to interpret clinical trials as well as to observe the clinical course of post operative cardiac patients.