A Review of the Six-Minute Walk Test: Its Implication as a Self-Administered Assessment Tool

Catastrophizing, Kinesiophobia, and Acceptance as Mediators of the Relationship Between Perceived Pain Severity, Self-Reported and Performance-Based Physical Function in Women with Fibromyalgia and Obesity

Purpose

Individuals with fibromyalgia and obesity experience significant impairment in physical functioning. Pain catastrophizing, kinesiophobia, and pain acceptance have all been identified as important factors associated with the level of disability. The objective of this study was to evaluate the role of pain catastrophizing, kinesiophobia, and pain acceptance as mediators of the association between perceived pain severity and physical functioning in individuals with fibromyalgia and obesity.

Patients and Methods

In this cross-sectional study, 165 women with fibromyalgia and obesity completed self-report questionnaires of perceived pain severity (ie, Numeric Pain Rating Scale), pain catastrophizing (ie, Pain Catastrophizing Scale), kinesiophobia (ie Tampa Scale of Kinesiophobia), pain acceptance (ie, Chronic Pain Acceptance Questionnaire), and perceived physical functioning (ie, Physical Functioning subscale of the Fibromyalgia Impact Questionnaire). In addition, a performance-based test (ie, 6-minute walking test) was conducted to assess objective physical functioning. Two multiple mediation analyses were performed.

Results

Pain acceptance and kinesiophobia mediated the relationship between pain severity and self-reported physical functioning. Pain catastrophizing and kinesiophobia mediated the relationship between pain severity and performance-based functioning.

Conclusion

Pain acceptance, kinesiophobia, and pain catastrophizing should be addressed in rehabilitative intervention to improve physical functioning. Interestingly, the subjective and objective aspects of physical functioning are influenced by different factors. Therefore, interventions for women with fibromyalgia and obesity should focus on factors related to both subjective and performance-based physical functioning.

Controlled randomized trial of walking exercise with positive education on cardiovascular fitness and happiness in retired older adults

AIM

Regular walking exercise (RWE) is associated with increased cardiovascular fitness and might elevate subjective psychological well-being. Positive education links positive psychology concepts with self-efficacy through the curriculum, which helps foster well-being. This study examines if regular walking exercise with positive education has better effects on cardiovascular fitness and happiness than RWE alone in retired older adults.

METHODS

Three arms of experimental design were used: pedometer walking exercise training (PWET); positive education and pedometer walking exercise training (PEPWET); and pedometer walking exercise (PWE). Trained walking exercise was provided to the PWET and PEPWET groups by a walking exercise coach three times per week, for 45 min per session for 12 weeks. Positive education was designed and led by a licensed PhD psychologist every other week. Of 150 participants, 60, 60 and 30 were randomly assigned to PWET, PEPWET and PWE, respectively. Demographic information, Chinese Happiness Inventory, RWE, and 6-min walking distance were assessed before and after the intervention.

RESULTS

The percentage of participants who practiced RWE after 12 weeks was significantly higher in the PEPWET group (96.7%), followed by the PWET (75%) and PWE groups (40%). Cardiovascular fitness in the PWET and PEPWET groups was significantly better than in the PWE group. Chinese Happiness Inventory scores in the PWET and PEPWET groups were significantly higher than in the PWE group, and the PEPWET group also showed significantly higher Chinese Happiness Inventory scores than the PWET group.

CONCLUSIONS

In addition to RWE, the study findings show that positive education can be beneficial to promote older adults' RWE, cardiovascular fitness and happiness. Geriatr Gerontol Int 2019; 19: 879-884.

The use of commercially available games for a combined physical and cognitive challenge during exercise for individuals with Parkinson's disease - a case series report

Complexity of an animal's environment has been shown to affect structural and functional changes in the brain. Evidence from animal models of Parkinson's disease (PD) suggests that exercising in an enriched environment may protect against the onset of Parkinsonian symptoms in rats that are exposed to 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. The variety of activities and visual interfaces that can be created using commercially available gaming devices provide cognitively stimulating as well as physically challenging environments for exercise. This case series will: 1) elaborate on the rationale behind selection of specific games to target common deficits seen in PD; and 2) present preliminary results on clinical outcomes from three pilot participants who each completed six sessions of exercise. All three participants had mild to moderate PD. They were functionally independent individuals leading an active lifestyle. Participants were tested on the outcome measures before and after the six exercise sessions. On average, participants showed a 33.8% (22.8) improvement in functional reach test, 12.7% (35.0) improvement in single limb stance (SLS) time-right leg, 55.2% (33.9) improvement in SLS time-left leg, 11.9% (7.3) improvement in 6-min walk test, 2% (6.8) improvement in self-selected gait speed (GS), and 8.0% (5.8) improvement in fastest possible GS. Further investigation is warranted to study if these effects can be replicated over a longer exercise intervention and in a larger group, and if these effects are maintained at follow-up testing after the enriched exercise intervention is discontinued.

Association of physiological and psychological health outcomes with physical activity and sedentary behavior in adults with type 2 diabetes

PURPOSE

To examine the association between change in moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) over a 6-month period with physiological and psychological factors in adults with type 2 diabetes (T2D).

METHODS

Participants included 26 middle-aged (mean age=56.1±10.8 years; 42% women), overweight/obese (mean body mass index (BMI) =37.22±8.78 kg/m2) adults who had been diagnosed with T2D within the past 5 years (mean HbA1c=7.81%). Participants underwent a physical examination, blood tests, and psychological questionnaires, including a self-report questionnaire that assessed the consumption of high glycemic and low glycemic load foods. Participants wore an Actigraph accelerometer for 7 days to assess MVPA and SB. All measures were collected at baseline and at the 6-month follow-up. Spearman rank correlations and regression models were conducted to examine the relationship between activity variables, and the association of activity measures with health outcomes at the 6-month follow-up.

RESULTS

Decreases in duration of SB bouts and increases in MVPA were associated with decreased levels of HbA1c (p<0.05). Over 50% of the variance in HbA1c levels could be attributed to changes in MVPA and SB.

CONCLUSIONS

MVPA and SB were independently associated with diabetes-related health outcomes. Results suggest that emphasis should be placed on increasing MVPA while decreasing SB, particularly duration of SB bouts. This suggests that even small changes in daily behavior may contribute to improvement in diabetes-related health outcomes.

Evaluation of group and individual change in a multidisciplinary pain management program

OBJECTIVES

Systematic reviews have consistently shown that multidisciplinary interventions are more effective than waitlist and other unimodal active treatments for a range of chronic pain conditions. However, these group-based statistics fail to inform us whether these programs result in clinically meaningful improvement at the individual level. The current study examines group changes and individual responsiveness to a CBT-informed multidisciplinary chronic pain management program.

METHODS

The analyses are based on data obtained from 263 outpatients. In addition to examining group-based treatment effects, we evaluated individual responsiveness to the program using 3 different criteria for assessing clinically important change.

RESULTS

Statistically significant improvement was found for all measures at posttreatment, with effect sizes ranging from small to medium. Gains were largely maintained at follow-up. The results of the clinically important change analysis revealed that not everyone improved uniformly, and the magnitude of change varied across the 3 different methods. This variability in the extent of improvement prompted further analyses in an attempt to identify individual differences that could predict responsiveness to treatment. No differences were found between responders and nonresponders to treatment.

DISCUSSION

The results of our study are consistent with previous research, and highlight the potential for multidisciplinary programs to improve the well-being of individuals with chronic pain. Clinically important change analyses underscore the variability that exists in chronic pain patients and allows for a more fine grained evaluation of individual responsiveness to treatment. Considering the strengths and limitations of each methodological approach for assessing clinically important change, guidelines are offered for future research and program development.

Relationships between obesity, functional exercise capacity, physical activity participation and physical self-perception in people with schizophrenia

OBJECTIVE

This study compared differences in functional exercise capacity between patients with schizophrenia and healthy controls. Physical self-perception and physical activity variables contributing to the variability in the distance achieved during a walk test were identified.

METHOD

A total of 25 normal weight, 25 overweight and 10 obese patients and 40 healthy volunteers were included. Functional exercise capacity was explored with a 6-minute walk test. Level of physical activity was assessed using the Baecke questionnaire and physical self-perception using the physical self-perception profile.

RESULTS

Obese patients walked a significantly shorter distance than overweight and normal weight patients (450.6 ± 97.7, 580.2 ± 116.0 and 615.8 ± 92.4 m resp., P < 0.001). All patients walked a shorter distance than healthy controls (710.6 ± 108.4 m, P < 0.001). Dyspnoea was only prevalent in schizophrenia (28.3%, P < 0.001) and especially in obese patients (90% vs. 40% in overweight and 27.3% in normal weight patients, P < 0.001). In multiple regression analysis, 59% of the variance in walking distance was explained by body mass index, perceived sports competence and condition, physical self-worth, level of sports participation and smoking behaviour.

CONCLUSION

Functional exercise capacity in patients with schizophrenia is reduced not only by obesity, perceived discomfort and pain but also by a sedentary, unhealthy life style and a reduced physical self-perception.

The 6-min walk test: is it an effective method for evaluating heart failure therapies?

The 6-min walk (6MW) is a self-paced test for measuring functional capacity. Lower 6MW distances have been associated with adverse outcomes in patients with heart failure. The purpose of this article is to describe the history of the 6MW test and to evaluate its reliability, validity, and predictive value as well as the responsiveness of the test to therapies. In the literature we reviewed, reliability was affected by several factors including learning effects and protocol deviations. The 6MW distance was moderately correlated with peak oxygen consumption derived from cardiopulmonary exercise stress testing. In some studies the 6MW distance was predictive of hospitalization and mortality. In pharmacological and cardiac resynchronization trials the 6MW distance did not consistently detect clinical improvements. Despite limitations, the 6MW test is a viable alternative to stress testing for objectively evaluating functional capacity in some settings. We provide recommendations for using the 6MW test in future studies.