title: Resistance training on physical performance in disabled older female cardiac patients. The 200-m Fast-Walk Test Compared with the 6-min Walk Test and the Maximal Cardiopulmonary Test: A Pilot Study Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Exercise training improves overall physical fitness and quality of life in older women with coronary artery disease. Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test Is the 6-minute walk test a reliable substitute for peak oxygen uptake in patients with dilated cardiomyopathy? Six-minute walk performance and quality of life comparisons in North Carolina cardiac rehabilitation programs. Older adults in cardiac rehabilitation: a new strategy for enhancing physical function. Repeat six-minute walk tests in patients with chronic heart failure: are they clinically necessary?
abstract: PURPOSE We evaluated the value of resistance training on measures of physical performance in disabled older women with coronary heart disease ( CHD ) . METHODS The study intervention consisted of a 6-month program of resistance training in a r and omized controlled trial format . Training intensity was at 80 % of the single-repetition maximal lift . Control patients performed light yoga and breathing exercises . Study participants included 42 women with CHD , all > or= 65 yr of age and community dwelling . Subjects were screened by question naire to have low self-reported physical function . The primary study measurements related to the performance of 16 household activities of the Continuous Scale Physical Functional Performance test ( CSPFP ) . These ranged from dressing , to kitchen and cleaning activities , to carrying groceries and walking onto a bus with luggage , and a 6-min walk . Activities were measured in time to complete a task , weight carried during a task , or distance walked . Other measures included body composition , measures of aerobic fitness and strength , and question naire-based measures of physical function and depression score . RESULTS Study groups were similar at baseline by age , aerobic capacity , strength , body composition , and in performing the CSPFP . After conditioning , 13 of 16 measured activities were performed more rapidly , or with increased weight carried , compared with the control group ( all P < 0.05 ) . Maximal power for activities that involved weight-bearing over a distance , increased by 40 % ( P < 0.05 ) . CONCLUSIONS Disabled older women with CHD who participate in an intense resistance-training program improve physical capacity over a wide range of household physical activities . Benefits extend beyond strength-related activities , as endurance , balance , coordination , and flexibility all improved . Strength training should be considered an important component in the rehabilitation of older women with CHD Gremeaux V , Deley G , Duclay J , Antoine D , Hannequin A , Casillas JM : The 200-m fast-walk test compared with the 6-min walk test and the maximal cardiopulmonary test : A pilot study . Objective : The 200-m fast-walk test has been proposed as a high- intensity performance test in healthy , elderly subjects . Adaptation of low-risk coronary artery disease patients during this test were compared with those in a 6-min walk test and a maximal cardiopulmonary exercise test . Design : Thirty patients with stable coronary artery disease ( 51.9 ± 8.7 yrs ) , referred to the cardiac rehabilitation department , performed a cardiopulmonary exercise test , then a 200-m fast-walk test and a 6-min walk test in a r and om order , before and after the training period ( 6 wks , 3 days per week ) . Heart rate was monitored during each test . Peak workload of cardiopulmonary exercise test , distance walked on the 6-min walk test , and time to perform the 200-m fast-walk test were measured . A sub sample of ten patients performed the exercise test with gas exchange measurements , with ventilatory threshold determination . Results : All subjects completed walk tests without complaint or incidents . Compared with the cardiopulmonary exercise test , the cardiac relative intensity was higher during the 200-m fast-walk test than during the 6-min walk test , both before ( 89.6 % vs. 78.1 % of cardiopulmonary exercise test maximal heart rate ; P < 0.05 ) and after ( 83.8 % vs. 74.3 % ; P < 0.05 ) training . Among the sub sample of ten patients , the 200-m fast-walk test heart rate was significantly higher than the ventilatory threshold heart rate , which did not differ from the 6-min walk test heart rate . The 200-m fast-walk test time significantly decreased after training ( −9.1 % , P < 0.01 ) . Conclusion : In patients with coronary artery disease at low risk , the 200-m fast-walk test explores higher levels of cardiorespiratory capacity than the 6-min walk test . Thus , this could be a useful field test in complement to the cardiopulmonary exercise test to assess functional capacity improvement and up date training targets regularly during the course of high-intensity rehabilitation programs in this population The 6-minute walk test is used in clinical practice and clinical trials of lung diseases ; however , it is not clear whether replicate tests need to be performed to assess performance . Furthermore , little is known about the impact of walking course layout on test performance . We conducted 6-minute walks on 761 patients with severe emphysema ( mean + /- SD FEV1 % predicted = 26.3 + /- 7.2 ) who were participants in the National Emphysema Treatment Trial . Four hundred seventy participants had repeated walks on a separate day . The second test was improved by an average of 7.0 + /- 15.2 % ( 66.1 + /- 146 feet , p < 0.0001 , by paired t test ) , with an intraclass correlation coefficient of 0.88 between days . The course layout had an effect on the distance walked . Participants tested on continuous ( circular or oval ) courses had a 92.2-foot longer walking distance than those tested on straight ( out and back ) courses . Course length had no significant effect on walking distance . The training effect found in these patients with severe emphysema is less than in previous reports of patients with chronic obstructive pulmonary disease . Furthermore , the layout of the track may influence the 6-minute walk performance OBJECTIVE To estimate the minimal clinical ly important difference ( MCID ) for the 6-minute walk test ( 6MWT ) and the 200-m fast-walk test ( FWT ) in patients with coronary artery disease ( CAD ) during a cardiac rehabilitation program . DESIGN Prospect i ve study using distribution- and anchor-based methods . SETTING Out patients from a cardiac rehabilitation unit . PARTICIPANTS Stable patients with CAD ( N=81 ; 77 men ; mean±SD age , 58.1±8.7y ) enrolled 31±12.1 days after an acute coronary syndrome ( ACS ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  6MWT and 200-m FWT results before and after an 8-week cardiac rehabilitation program and at the 6th and 12th sessions . Patients and physiotherapists who supervised the training were asked to provide a global rating of perceived change in walking ability while blinded to changes in walk test performances . RESULTS Mean change in 6MWT distance ( 6MWD ) in patients who reported no change was -6.5 m versus 23.3 m in those who believed their performance had improved ( P<.001 ) . This result was consistent with the MCID determined by using the distribution method ( 23 m ) . Considering a 25-m cutoff , positive and negative predictive values were 0.9 and .63 , respectively . Conversely , there was no difference in 200-m FWT performance between these 2 groups ( 0.1 vs -1.4s , respectively ) . There was poor agreement with the physiotherapist 's perceived change . CONCLUSIONS The MCID for 6MWD in patients with CAD after ACS was 25 m . This result will help physicians interpret 6MWD change and help research ers estimate sample sizes in further studies using 6MWD as an endpoint BACKGROUND Older women with coronary artery disease ( CAD ) have reduced peak aerobic power ( Vo(2)peak ) , muscle strength , and quality of life ( QOL ) . Exercise interventions that can improve Vo(2)peak and muscle strength may also result in an improvement in QOL . This study compared the effect of aerobic training ( AT ) or combined aerobic and strength training ( COMT ) on Vo(2)peak , distance walked in 6 min , upper- and lower-extremity maximal strength , and QOL in 18 women ( age range , 60 to 80 years ) with documented CAD . METHODS After baseline testing , subjects were r and omly assigned to AT ( treadmill and cycle exercise , n = 9 ) or COMT ( treadmill and cycle exercise plus upper- and lower-extremity strength training , n = 9 ) , and each group exercised 3 d/wk for 8 weeks . RESULTS Both AT and COMT result ed in a similar increase in Vo(2)peak , distance walked in 6 min , lower-extremity strength , and emotional and global QOL . COMT improved upper-extremity strength , and physical and social QOL , which was unchanged after AT . CONCLUSIONS Older women with CAD should perform aerobic and strength training to attain optimal improvements in overall physical fitness and QOL Objective : To examine the utility of the six-minute walk test ( 6′WT ) , in assessing the effectiveness of a six-week cardiac rehabilitation programme , of which exercise training was an integral part . Setting : Royal Liverpool and Broad Green Hospitals Rehabilitation Unit . Design : Two hundred and thirty-nine consecutive patients referred for cardiac rehabilitation were allocated to one of two groups . In group A 209 entered and 159 completed the usual rehabilitation programme whilst group B patients ( n = 30 ) acted as a control by deferring entry to the programme for six weeks , continuing only activities of daily living . Outcome measures : Both groups were assessed using the 6′WT , peak expiratory flow rate ( PEFR ) and isometric grip strength at enrolment and six weeks . Results : At baseline , groups A and B were demographically identical without significant differences in terms of 6′WT , PEFR or grip strength . Following the study period , group A showed a significant increase in 6′WT from 314.7 ± 76.2 to 377.3 ± 78.6 m , in PEFR from 406.9 ± 115.9 to 437.8 ± 118.6 litres per minute and in grip strength from 28.8 ± 9.31 to 30.3 ± 8.93 kg , all p < 0.001 . There were no significant changes in group B. Conclusions : The 6′WT proved to be a simple and effective measurement of functional capacity in patients performing cardiac rehabilitation . The clinical programme investigated successfully increased patients ' functional capacity as assessed by the 6′WT . Significant improvement in PEFR and grip strength was also demonstrated , compared with a control population AIMS The 6-min walk test may serve as a more simple clinical tool to assess functional capacity in congestive heart failure than determination of peak oxygen uptake by cardiopulmonary exercise testing . The purpose of the study was to prospect ively examine whether the distance ambulated during a 6-min walk test ( i ) correlates with peak oxygen uptake , ( ii ) allows peak oxygen uptake to be predicted , and ( iii ) provides prognostic information similar to peak oxygen uptake in patients with dilated cardiomyopathy and left ventricular ejection fraction < or = 35 % . METHODS AND RESULTS In 113 patients ( age : 54+/-12 years , NYHA : 2.2+/-0.8 ) with dilated cardiomyopathy ( left ventricular ejection fraction 19+/-7 % ) a 6-min walk test and cardiopulmonary exercise testing were performed . The 6-min walk test and peak oxygen uptake were closely correlated at the initial visit ( r=0.68 , n=113 ) , as well as after 263+/-114 ( r=0.71 , n=28 ) and 381+/-170 days ( r=0.74 , n=14 ) . During serial exercise testing the 6-min walk test allowed peak oxygen uptake to be reliably predicted ( r=0.76 between calculated and real peak oxygen uptake ) . After 528+/-234 days , 42 patients were hospitalized due to worsening heart failure and /or died from cardiovascular causes . Compared to clinical ly stable patients , these 42 patients walked a shorter distance ( 423+/-104 vs 501+/-95 m , P<0.001 ) and had a lower peak oxygen uptake ( 12.7+/-4.0 vs 17.4 + 5.6 ml x min(-1 ) x kg(-1 ) , P<0.001 ) . By univariate analysis the 6-min walk test outperformed other prognostic parameters such as left ventricular ejection fraction , cardiac index and plasma norepinephrine concentration and conferred a prognostic power similar to peak oxygen uptake . This predictive value could be further improved in a multivariate model , by combining the 6-min walk test with independent variables , such as left ventricular ejection fraction or cardiac index . CONCLUSION The 6-min walk test correlated with peak oxygen uptake when tested serially over the course of the disease . Although both tests define two distinct domains of functional capacity , the 6-min walk test provides prognostic information very similar to peak oxygen uptake in congestive heart failure patients with dilated cardiomyopathy OBJECTIVE The purpose s of this study were ( 1 ) . to determine if six-minute walk ( 6MW ) performance improved after short-term cardiac rehabilitation ( CR ) across multiple outpatient programs ; ( 2 ) . to examine differences in 6MW performance by patient age , sex , and race ; and ( 3 ) . to determine what relationships existed , if any , between 6MW performance and subscales of the Ferrans and Powers ' Quality of Life Index-Cardiac Version III ( QOLI ) . DESIGN Study design was nonexperimental , prospect i ve , and comparative . SETTING Study setting included 14 outpatient CR programs from urban and rural setting s across North Carolina . PATIENTS Adults aged 40 to 89 years ( N = 630 ; men = 424 [ 67 % ] , women = 206 [ 33 % ] ; mean age , 61 + /- 10.32 years ) with medically or surgically treated coronary heart disease enrolled in outpatient CR . OUTCOME MEASURES Study measures included scores on the QOLI and distance walked ( feet ) on the 6MW test . RESULTS Six-minute walk tests and QOLI surveys were administered before and immediately after short-term CR participation . Six-minute walk distance increased for all patients in all age categories across programs after CR ( P < .0001 ) . As a group , women improved 6MW distance by 15 % ( 1243.9 + /- 301.2 to 1435.3 + /- 298.1 ; P < .001 ) . Men also improved 6MW distance by 15 % ( 1463.3 + /- 339.5 to 1683.7 + /- 346.9 ; P < .001 ) and walked farther than women on both the initial and follow-up 6MW tests ( P < .0001 ) . By age , there were no differences in 6MW scores between men and women aged 40 to 49 years ( n = 58 ) and 50 to 59 years ( n = 140 ; P = 0.54 ) . Both of these age groups had greater initial and discharge 6MW scores than those aged 70 to 79 years ( n = 183 ) and 80 to 89 years ( n = 22 ; P < .001 ) . Those aged 60 to 69 years ( n = 227 ) had lower 6MW scores than those aged 40 to 49 years ( P = 0.001 ) and 50 to 59 years ( P < .05 ) , and greater scores than those aged 70 to 79 years ( P < .05 ) and 80 to 89 years ( P < .05 ) . Those aged 70 to 79 years had greater initial and follow-up 6MW scores than those aged 80 to 89 years(P < .001 ) . Overall improvements in 6MW performance were found in both white subjects ( n = 575 ; P < .001 ) and African-Americans ( n = 54 ; P < .001 ) . There were no apparent relationships between 6MW performance and overall or Health and Function QOLI scores ( r < .21 ) . CONCLUSIONS Participation in short-term outpatient CR improved 6MW performance in patients aged 40 to 89 years across 14 programs in North Carolina . No relationships were found between 6MW performance and any domain of the QOLI , including the Health and Function domain PURPOSE This study contrasted the effect of a group-mediated cognitive-behavioral intervention ( GMCB ) versus traditional cardiac rehabilitation ( CRP ) upon changes in objective and self-reported physical function of older adults [ mean ( SD ) age of 64.7 ( 7.5 ) yr ] after 3 months of exercise therapy . METHODS This r and omized clinical trial enrolled 147 participants who were eligible for inclusion into cardiac rehabilitation .  Baseline to 3-month changes in self-reported and performance related measures of physical function were assessed using a physical functioning question naire , a 6-min walk test , and measured MET levels . RESULTS Paired t-tests revealed that participants made improvements in all measures across the first 3 months of the study , irrespective of group treatment ( P < 0.001 ) . General linear models including effects for baseline levels of physical function , treatment , and gender revealed that lower functioning men in the GMCB treatment made greater improvements than any other subgroup on the two performance outcomes : 6-min walk and measured MET levels ( P < 0.01 ) . Gender did not moderate change in self-reported level of physical function ( P > 0.05 ) ; however , the lower functioning participants in the GMCB intervention experienced greater improvements in self-reported physical function than those in CRP ( P < 0.05 ) . CONCLUSIONS Exercise therapy is a valuable intervention for improving physical function of older adults with cardiovascular disease ( CVD ) and those at increased risk for CVD . Baseline level of physical function and gender are important variables to consider when study ing the relationship between exercise therapy and improvements in physical function Background : Owing to a reported learning effect in patients with chronic cardiopulmonary disease , performance of at least two six-minute walk tests ( 6MWT ) are recommended as st and ard practice . Patients with chronic heart failure ( CHF ) are typically elderly and frail and it is unknown whether current guidelines are practical in a clinical setting . Aims : The aim of this study was to determine whether repeat performance of 6MWTs in patients with CHF is related to between-test interval or baseline performance . Methods : This was a multisite observational study enrolling participants entering into heart failure rehabilitation programmes . Participants performed two 6MWTs with r and omly allocated inter-test intervals between 15 and 90 minutes . Distance walked in the second test was compared with the first test using a paired t test . Results : Eighty-eight participants ( 45 females , age 65 ± 14 years ) with stable CHF were enrolled . Mean distance walked increased from 301 metres in test 1 to 313 metres in test 2 ( p < 0.001 ) . No significant change was recorded between test 1 and test 2 for those whose baseline distance was < 300 metres . The interval between tests had no significant effect on the distance walked . Conclusion : The change in 6MWT distance was significantly associated with better baseline performance but not with the interval between tests
target: Qualitative analysis indicated moderate evidence for repeatability of the 6MWT in patients undergoing cardiac rehabilitation , for a 2 % to 8 % learning effect between repeated 6MWTs , for a relationship between peak heart rate during the 6MWT and during cycle exercise at the ventilatory threshold , and for moderate-to-high correlation between the 6-minute walk distance and maximum metabolic equivalents achieved on symptom-limited exercise tests .
  Strong evidence suggests that the 6MWT is responsive to clinical change following cardiac rehabilitation .
background: BACKGROUND The  6-minute walk test ( 6MWT ) is a common outcome measurement in cardiac rehabilitation .
  However , a search of the literature found no established guidelines for use of the 6MWT in cardiac rehabilitation .
  OBJECTIVES Systematic review of the validity , reliability and responsiveness of the 6MWT in cardiac rehabilitation .