Teste do degrau e teste da cadeira: comportamento das respostas metábolo-ventilatórias e cardiovasculares na DPOC

Procedures and measurement properties of the 6-min step test: A systematic review with clinical recommendations

OBJECTIVE

To provide information regarding the procedures, safety, tolerability, and measurement properties of the 6-min step test.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, and SPORTDiscus (from inception until January 2024).

REVIEW METHODS

Studies that examined adults with acute or chronic diseases, and outcomes related to procedures, safety, tolerability, or measurement properties of the 6-min step test were included. Outcome data were summarized and combined in meta-analyses. The quality of included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system.

RESULTS

Fourteen studies, involving 847 participants, were included. All studies performed the 6-min step test in 6 min; however, some studies varied the step height and the use of upper limb support. The test appears to be safe and well tolerated by individuals. Moderate- to high-quality evidence demonstrated appropriate results for test-retest reliability (4 studies; Intraclass correlation coefficient 0.96; 95% CI 0.91-0.98; n = 125), criterion validity (4 studies; r = 0.53; 95% CI 0.30-0.71; n = 307), and construct validity (4 studies; r = 0.63; 95% CI 0.52-0.73; n = 233).

CONCLUSION

This review provides recommendations for applying the 6-min step test in clinical and research settings. No adverse events were reported, and the test appears to be well tolerated. Adequate results were found for test-retest reliability, criterion validity, and construct validity.

REVIEW REGISTRATION

PROSPERO (CRD42022347744).

Applicability of the step test for physical fitness assessment of women with chronic venous disease symptoms: a cross-sectional study

Abstract Background Chronic Venous Disease (CVD) can seriously impact physical fitness. Certain measures and aptitude tests can be employed to evaluate this condition in people with CVD that are simple, quick, and less expensive alternatives when compared to laboratory methods. Objectives To evaluate the applicability of the 4-minute step test, correlating its results with those of other measures and tests used with people with CVD symptoms. Methods Cross-sectional descriptive study carried out with 47 active women with CVD symptoms who participate in public physical exercise programs and were recruited by spontaneous demand. After clinical evaluation of disease stage, sociodemographic data were collected and calf circumference measurements, ankle goniometry, the tiptoe test, and the 4-minute step test were conducted. The women were already familiar with the apparatus used. Results The step test showed significant correlations (p<0.05) with calf measurements (r=0.31 and 0.32), flexibility (r=0.48 and 0.47), and the tiptoe test (r=0.33 for number of repetitions and 0.42 for speed of execution), in addition to an inverse correlation with disease severity (r=-0.29). Significant correlations were also found by age group (r=0.60 and 0.54, for calf circumference in the elderly) and by classification in tests and measurements (r=0.19 for the tiptoe test, and r=0 .29, for ankle flexibility). Conclusions The step test proved applicable and its use in conjunction with other aptitude tests offers a more complete evaluation of active women with CVD symptoms.

Aplicabilidade do teste do degrau na avaliação da aptidão física de mulheres com sintomas de doença venosa crônica: estudo transversal

Resumo Contexto A doença venosa crônica (DVC) pode impactar a aptidão física dos indivíduos. Algumas medidas e testes de aptidão são aplicados para avaliar essa condição em pessoas com DVC, sendo alternativas simples, rápidas e menos dispendiosas de avaliação comparadas a métodos laboratoriais. Objetivos Avaliar a aplicabilidade do teste do degrau de 4 minutos, correlacionando seus resultados com os de outras medidas e testes aplicados a pessoas com sintomas de DVC. Métodos Estudo descritivo transversal realizado com 47 mulheres ativas com sintomas de DVC, participantes de programas públicos de exercícios físicos e recrutadas por demanda espontânea. Foi realizada avaliação clínica da doença, e foram coletados dados sociodemográficos, medidas de perimetria de panturrilha e goniometria de tornozelo, teste ponta do pé e teste do degrau de 4 minutos. As mulheres já eram familiarizadas com o implemento utilizado. Resultados O teste do degrau apresentou correlações significativas (p < 0,05) com as medidas de panturrilha (r = 0,31 e 0,32), flexibilidade (r =0,48 e 0,47) e teste ponta do pé (r = 0,33 para n.º de repetições e 0,42 para velocidade de execução), além de correlação inversa com a gravidade da doença (r = -0,29). Correlações significativas também foram encontradas por faixa etária (r = 0,60 e 0,54, para perimetria de panturrilha em idosos) e por classificação nos testes e medidas (r = 0,19 para o teste ponta do pé e r = 0,29 para flexibilidade de tornozelo). Conclusões O teste do degrau se mostra aplicável, e sua utilização, em conjunto com outros testes de aptidão, permite uma avaliação mais completa de mulheres ativas com sintomas de DVC.

Responses of different functional tests in candidates for bariatric surgery and the association with body composition, metabolic and lipid profile

Individuals with obesity can have metabolic disorders and may develop impairments that affect the ability to exercise. The maximal incremental cardiopulmonary exercise test is widely used to assess functional capacity. However, submaximal tests such as the two-minute step test (2MST) and the six-minute walk test (6MWT) also allow this assessment. We propose to analyze whether body composition, metabolic and lipid profile influence the maximal and submaximal performance, and investigate these variables in response to different functional tests. Forty-four individuals with obesity, aged 18–50 years, underwent analysis of body composition, metabolic and lipid profile, incremental treadmill test (ITMT), 6MWT, and 2MST. One-way ANOVA, Pearson or Spearman correlation, and Stepwise multiple linear regression analysis were performed. ITMT induced a greater metabolic, ventilatory, cardiovascular, and perceived exertion demand when compared to the 6MWT and 2MST (p < 0.05). In addition, 2MST elicited a higher chronotropic (HR) and metabolic (V̇O₂) demand when compared to the 6MWT (p < 0.05). Significant correlations were found between tests and body composition, metabolic and lipid profile. Fat mass and low-density lipoprotein can explain 30% of the V̇O₂ variance in the ITMT; and fat mass, glucose, and performance in the 2MST can explain 42% of the variance of the distance walked in the ITMT. Obesity and its metabolic impairments are capable of influencing responses to exercise. ITMT generated greater demand due to the high stress imposed, however, 2MST demanded greater metabolic and chronotropic demand when compared to the 6MWT.

Validity and Reliability of the 6-Minute Step Test in Healthy Individuals: A Cross-sectional Study

OBJECTIVE

To determine the 6-minute step test's (6MST) reliability and validity and to establish reference performance values of this test.

DESIGN

Prospective observational cross-sectional study.

SETTING

Spirometry and Respiratory Physiotherapy Laboratory, Federal University of São Carlos (institutional).

PARTICIPANTS

Ninety-one individuals [42 men and 49 women, mean age = 39 years (SD, 17 years)] without any diagnosed diseases and with normal exercise capacity [6-minute walk test (6MWT) >75% of the predicted normal].

INDEPENDENT VARIABLES

Participants underwent two 6MST on 1 day and two 6MWT on another day in randomized order. Furthermore, age, gender, height, weight, lower limbs length, abdominal circumference, percentage of body fat, and fat-free mass were obtained.

MAIN OUTCOME MEASURES

Test-retest reliability was assessed by comparing the findings of the two 6MST using the intraclass correlation coefficient (ICC) and Bland-Altman plot. Validity was assessed by comparing outcomes of the 6MST to outcomes of 6MWT using the Pearson correlation coefficient. A multiple regression analysis was conducted using the stepwise method to develop an equation to predict reference values.

RESULTS

The performance (mean steps ± SD) in the first and second test was 149 ± 34 and 149 ± 36 steps, respectively, which was correlated to distance (in meters) in 6MWT (r = 0.72; P < 0.05). Six-minute step test performance was reliable (ICC = 0.9; 95% confidence interval: 0.85-0.93). The equation to predict reference values for the first 6MST was significant (P < 0.001 and R = 0.48): Performance(steps) = 174 to 1.05 × Age(years) to women and Performance(steps) = 209 to 1.05 × Age(years) to men.

CONCLUSIONS

Six-minute step test is a reliable and valid test. Moreover, the number of steps may be predicted by demographic and anthropometric variables with moderate strength of prediction.

CLINICAL RELEVANCE

Six-minute step test is an exercise test that is easy to be conducted, more tolerable than a graded exercise test, requires fewer equipments and space, and permits better monitoring of the participants. The assessment of the reliability, validity, and reference values will provide a better interpretability for clinicians to use it, especially in primary care.

Correlation between functional capacity and health-related quality of life in COPD: a case series

Objective To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearson's (parametric data) or Spearman's (non-parametric data) rank tests, with p < 0.05. Results The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.

Correlação entre o teste de caminhada de seis minutos e o teste do degrau em idosos

O teste do degrau pode ser uma alternativa para substituir o teste de caminhada de seis minutos quando não há um espaço físico amplo para sua realização. Existem, no entanto, poucos dados na literatura comparando e correlacionando ambos os testes. Dessa forma, o objetivo deste estudo foi correlacionar o teste de caminhada de seis minutos com o teste do degrau. Uma amostra de 38 idosos (68,5 ± 2,1 anos) realizou aleatoriamente o teste de caminhada de seis minutos e o teste do degrau, duas vezes cada teste, sendo considerado para fins de análise o maior valor obtido em cada teste. Frequência cardíaca, percepção subjetiva de esforço, de fadiga muscular e o VO2máx estimados ao final do teste do degrau foram significativamente maiores que ao final do teste de caminhada de seis minutos (p=0,001; 0,010; 0,017; 0,001, respectivamente). No presente estudo, não houve correlação entre a distância percorrida no teste de caminhada de seis minutos e o número de subidas e descidas no teste do degrau. Sendo assim, não se pode afirmar que um teste possa substituir o outro, mas levando-se em consideração os valores estatisticamente maiores para o teste do degrau nas variáveis analisadas e, por necessitar de espaço físico mínimo, sugere-se que o teste do degrau pode ser uma alternativa para a avaliação de idosos.