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      6-minute walking test: a useful tool in the management of heart failure patients

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          Abstract

          Reduced functional ability and exercise tolerance in patients with heart failure (HF) are associated with poor quality of life and a worse prognosis. The 6-minute walking test (6MWT) is a widely available and well-tolerated test for the assessment of the functional capacity of patients with HF. Although the cardiopulmonary exercise test (a maximal exercise test) remains the gold standard for the evaluation of exercise capacity in patients with HF, the 6MWT (submaximal exercise test) may provide reliable information about the patient’s daily activity. The current review summarizes the value of 6MWT in patients with HF and identifies its usefulness and limitations in everyday clinical practice in populations of HF. We aimed to investigate potential associations of 6MWD with other measures of functional status and determinants of 6MWD in patients with HF as well as to review its prognostic role and changes to various interventions in these patients.

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          The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure.

          G H Guyatt, M J Sullivan, P Thompson … (1985)
          Cycle and treadmill exercise tests are unsuitable for elderly, frail and severely limited patients with heart failure and may not reflect capacity to undertake day-to-day activities. Walking tests have proved useful as measures of outcome for patients with chronic lung disease. To investigate the potential value of the 6-minute walk as an objective measure of exercise capacity in patients with chronic heart failure, the test was administered six times over 12 weeks to 18 patients with chronic heart failure and 25 with chronic lung disease. The subjects also underwent cycle ergometer testing, and their functional status was evaluated by means of conventional measures. The walking test proved highly acceptable to the patients, and stable, reproducible results were achieved after the first two walks. The results correlated with the conventional measures of functional status and exercise capacity. The authors conclude that the 6-minute walk is a useful measure of functional exercise capacity and a suitable measure of outcome for clinical trials in patients with chronic heart failure.
          Article 0 comments Cited 300 times – based on 0 reviews     Review now
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            The 6-min walk distance in healthy subjects: reference standards from seven countries.

            C Casanova, B R Celli, P Barria … (2011)
            The 6-min walk distance (6MWD) predicted values have been derived from small cohorts mostly from single countries. The aim of the present study was to investigate differences between countries and identify new reference values to improve 6MWD interpretation. We studied 444 subjects (238 males) from seven countries (10 centres) ranging 40-80 yrs of age. We measured 6MWD, height, weight, spirometry, heart rate (HR), maximum HR (HR(max)) during the 6-min walk test/the predicted maximum HR (HR(max) % pred), Borg dyspnoea score and oxygen saturation. The mean ± sd 6MWD was 571 ± 90 m (range 380-782 m). Males walked 30 m more than females (p < 0.001). A multiple regression model for the 6MWD included age, sex, height, weight and HR(max) % pred (adjusted r² = 0.38; p < 0.001), but there was variability across centres (adjusted r² = 0.09-0.73) and its routine use is not recommended. Age had a great impact in 6MWD independent of the centres, declining significantly in the older population (p < 0.001). Age-specific reference standards of 6MWD were constructed for male and female adults. In healthy subjects, there were geographic variations in 6MWD and caution must be taken when using existing predictive equations. The present study provides new 6MWD standard curves that could be useful in the care of adult patients with chronic diseases.
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              The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure.

              M Mathier, Lawrence P Cahalin, G Dec … (1996)
              The 6-min walk test (6'WT) is a simple measure of functional capacity and predicts survival in patients with moderate heart failure (HF). To assess the role of the 6'WT in the evaluation of patients with advanced HF, 45 patients (age 49 +/- 8 years, mean +/- SD; New York Heart Association class 3.3 +/- 0.6; left ventricular ejection fraction 0.20 +/- 0.06; right ventricular ejection fraction 0.31 +/- 0.11) underwent symptom-limited cardiopulmonary exercise testing and the 6'WT during cardiac transplant evaluation. Mean 6'WT distance ambulated was 310 +/- 100 m and peak oxygen uptake (peak Vo2) was 12.2 +/- 4.5 mL/kg/min. There was a significant correlation between 6'WT distance ambulated and peak Vo2 (r = 0.64, p < 0.001). Multivariate analysis of patient characteristics, resting hemodynamics, and 6'WT results identified the distance ambulated during the 6'WT as the strongest predictor of peak Vo2 (p < 0.001). 6'WT distance ambulated less than 300 m predicted an increased likelihood of death or pretransplant hospital admission for continuous inotropic or mechanical support within 6 months (p = 0.04), but did not predict long-term overall or event-free survival with a mean follow-up of 62 weeks. Peak Vo2 was the best predictor of long-term overall and event-free survival. In patients with advanced HF evaluated for cardiac transplantation, distance ambulated during the 6'WT predicts (1) peak Vo2 and (2) short-term event-free survival.
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                Author and article information

                Contributors
                Sophia Giannitsi
                Mara Bougiakli
                Aris Bechlioulis:
                ORCID: https://orcid.org/0000-0003-1721-2539
                Anna Kotsia
                Lampros K. Michalis
                Katerina K. Naka
                Journal
                Journal ID (nlm-ta): Ther Adv Cardiovasc Dis
                Journal ID (iso-abbrev): Ther Adv Cardiovasc Dis
                Journal ID (publisher-id): TAK
                Journal ID (hwp): sptak
                Title: Therapeutic Advances in Cardiovascular Disease
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 1753-9447
                ISSN (Electronic): 1753-9455
                Publication date (Electronic): 23 August 2019
                Publication date Collection: 2019
                Volume: 13
                Electronic Location Identifier: 1753944719870084
                Affiliations
                [1-1753944719870084]Second Department of Cardiology and Michaelidion Cardiac Center, Medical School University of Ioannina, Ioannina, Greece
                [2-1753944719870084]Second Department of Cardiology and Michaelidion Cardiac Center, Medical School University of Ioannina, Ioannina, Greece
                [3-1753944719870084]Second Department of Cardiology, University of Ioannina Medical School, University Campus, Stavros Niarchos Avenue, Ioannina, 45 500, Greece
                [4-1753944719870084]Second Department of Cardiology and Michaelidion Cardiac Center, Medical School University of Ioannina, Ioannina, Greece
                [5-1753944719870084]Second Department of Cardiology and Michaelidion Cardiac Center, Medical School University of Ioannina, Ioannina, Greece
                [6-1753944719870084]Second Department of Cardiology and Michaelidion Cardiac Center, Medical School University of Ioannina, Ioannina, Greece
                Author notes
                Author information
                https://orcid.org/0000-0003-1721-2539
                Article
                Publisher ID: 10.1177_1753944719870084
                DOI: 10.1177/1753944719870084
                PMC ID: 6710700
                PubMed ID: 31441375
                SO-VID: 469e5788-cf42-4491-af84-2952a6594e21
                Copyright © © The Author(s), 2019
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 21 January 2019
                Date accepted : 22 July 2019
                Categories
                Subject: Review
                Custom metadata
                cover-date January-December 2019

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: functional capacity,heart failure,heart failure with reduced ejection fraction,6-minute walking test
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: functional capacity, heart failure, heart failure with reduced ejection fraction, 6-minute walking test

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