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Cavero-Redondo I, Saz-Lara A, Bizzozero-Peroni B, Núñez-Martínez L, Díaz-Goñi V, Calero-Paniagua I, Matínez-García I, Pascual-Morena C. Accuracy of the 6-Minute Walk Test for Assessing Functional Capacity in Patients With Heart Failure With Preserved Ejection Fraction and Other Chronic Cardiac Pathologies: Results of the ExIC-FEp Trial and a Meta-Analysis. SPORTS MEDICINE - OPEN 2024; 10:74. [PMID: 38886304 PMCID: PMC11183033 DOI: 10.1186/s40798-024-00740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Heart diseases, particularly heart failure, significantly impact patient quality of life and mortality rates. Functional capacity assessment is vital for predicting prognosis and risk in these patients. While the cardiopulmonary exercise test is considered the gold standard, the 6-minute walk test has emerged as a more accessible alternative. However, the screening accuracy and optimal cut-off points of the 6-minute walk test for detecting severely reduced functional capacity in cardiac pathologies, including heart failure with preserved ejection fraction, are unclear. The study aimed to analyse the diagnostic accuracy of the 6-minute walk test for detecting reduced functional capacity, defined as VO2max < 14 ml/kg/min, compared with the cardiopulmonary exercise test in participants with heart failure with preserved ejection fraction using data from the "Ejercicio en Insuficiencia Cardiaca con Fracción de Eyección Preservada" (ExIC-FEp) trial; and to compare these results with previous studies investigating the screening accuracy for assessing functional capacity of the 6-minute walk test in participants with other chronic cardiac pathologies through a meta-analysis. RESULTS The ExIC-FEp trial involved 22 participants with heart failure with preserved ejection fraction, who were not treated with beta-blockers, using the cardiopulmonary exercise test, specifically VO2max, as the reference test. The 6-minute walk test had a sensitivity of 70%, a specificity of 80%, and an area under the curve of 76% in the ExIC-FEp trial. Five studies were included in the meta-analysis showing a sensitivity of 79%, a specificity of 78%, and an area under the curve of 85%. CONCLUSION In conclusion, the 6-minute walk test holds promise as a screening tool for assessing functional capacity in heart failure with preserved ejection fraction and chronic heart diseases, with a VO2max < 14 ml/kg/min as a reference point. It demonstrates moderate to good screening accuracy. However, the screening accuracy and optimal cut-off points of the 6-minute walk test for detecting severely reduced functional capacity, regardless of aetiology, are unclear. TRIAL REGISTRATION NCT05726474. Registered 16 February 2023, https://clinicaltrials.gov/study/NCT05726474 .
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Affiliation(s)
- Iván Cavero-Redondo
- CarVasCare Research Group (2023-GRIN-34459), Faculta de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, 16001, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, 3460000, Chile
| | - Alicia Saz-Lara
- CarVasCare Research Group (2023-GRIN-34459), Faculta de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, 16001, Spain.
| | - Bruno Bizzozero-Peroni
- CarVasCare Research Group (2023-GRIN-34459), Faculta de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, 16001, Spain
- Instituto Superior de Educación Física, Universidad de la República, Rivera, 40000, Uruguay
| | | | - Valentina Díaz-Goñi
- CarVasCare Research Group (2023-GRIN-34459), Faculta de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, 16001, Spain
| | | | - Irene Matínez-García
- CarVasCare Research Group (2023-GRIN-34459), Faculta de Enfermería de Cuenca, Universidad de Castilla-La Mancha, Cuenca, 16001, Spain
| | - Carlos Pascual-Morena
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, 16001, Spain
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Muñoz-Cofré R, del Sol M, Lizana PA, Gómez-Bruton A, Fuentes Andaur MJ, Fierro ES, Gonzalez GO, Medina-González P, Valenzuela-Aedo F, Escobar-Cabello M. Comparison of distance covered, physiological cost, and perceived exertion in four six-minute walk test protocols. Front Physiol 2024; 15:1395855. [PMID: 38872832 PMCID: PMC11169617 DOI: 10.3389/fphys.2024.1395855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Objective: There is evidence that indicates that the Walked Distance (WD) in the 6-Minute Walk Test (6MWT) would be sensitive to the type of track and encouragement. The aim of study was compared the impact of track type and verbal encouragement provided in the 6MWT on WD, physiological cost, perceived exertion, and gait efficiency in healthy young adults unfamiliar with the test. Method: WD, heart rate, subjective sensation of dyspnea (SSD), and fatigue (SSF) were measured in four 6MWT protocols: i) 30 m linear track and protocolized encouragement (LT + PE), ii) 30 m linear track and constant encouragement (LT + CE), iii) 81 m elliptical track and protocolized encouragement (ET + PE), and iv) 81 m elliptical track and constant encouragement (ET + CE). In addition, the Gait Efficiency Index (GIE) associated with physiological cost, dyspnea and fatigue was calculated and compared between the different protocols. Results: The WD was significantly higher in the ET + CE protocol. The percentage of the heart rate reserve used (%HRRu) at minute 6 was higher in the ET + CE protocol. The SSD and SSD had difference in startup time between the protocols. The GEI was higher in %HRRu, SSD, and SSF for the ET + CE protocol. Conclusion: The ET + CE protocol showed a significant increase in WD during the 6MWT in healthy young adults. Although it obtained the highest physiological cost, it did not present perceptual differences when entering cardiopulmonary assessment windows relevant to a more efficient test for the participant. It is advisable to discuss, based on the findings, the fundamental objective of the 6MWT and national and international recommendations to achieve a result as close as possible to the real maximal effort.
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Affiliation(s)
- Rodrigo Muñoz-Cofré
- Programa de Doctorado en Ciencias Morfologicas, Universidad de la Frontera, Temuco, Chile
| | - Mariano del Sol
- Programa de Doctorado en Ciencias Morfologicas, Universidad de la Frontera, Temuco, Chile
| | - Pablo A. Lizana
- Laboratory of Epidemiology and Morphological Sciences, Instituto de Biologia, Pontificia Universidad Catolica de Valparaiso, Valparaiso, Chile
- Centro de Investigación Interdisciplinaria en Biomedicina, Biotecnología y Bienestar (C3B), Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Alejandro Gómez-Bruton
- Exer-GENUD (EXERCISE-Growth, Exercise, Nutrition and Development Research Group), Faculty of Health and Sport Sciences, Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
| | | | - Erika Soto Fierro
- Escuela de Kinesiología, Universidad Católica del Maule, Talca, Chile
| | | | - Paul Medina-González
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | | | - Máximo Escobar-Cabello
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
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Van Geel F, Moumdjian L, Lamers I, Bielen H, Feys P. Measuring walking-related performance fatigability in clinical practice: a systematic review. Eur J Phys Rehabil Med 2020; 56:88-103. [DOI: 10.23736/s1973-9087.19.05878-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Engel FA, Faude O, Kölling S, Kellmann M, Donath L. Verbal Encouragement and Between-Day Reliability During High-Intensity Functional Strength and Endurance Performance Testing. Front Physiol 2019; 10:460. [PMID: 31073290 PMCID: PMC6497006 DOI: 10.3389/fphys.2019.00460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/02/2019] [Indexed: 01/08/2023] Open
Abstract
As verbal encouragement (VE) is used in high intensity functional exercise testing, this randomized controlled crossover study aimed at investigating whether VE affects high intensity functional strength and endurance performance testing. We further examined between-day variability of high intensity functional strength and endurance performance testing with and without VE. Nineteen experienced athletes (seven females and 12 males, age: 23.7 ± 4.3 years) performed a standardized one repetition maximum (1 RM) squat test and a 12-min high-intensity functional training (HIFT) workout [as many repetitions as possible (AMRAP)] on four different days over a 2-week period. Athletes randomly performed each test twice, either with VE or without (CON), with a minimum of 72 h rest between tests. Very good to excellent relative between-day reliability with slightly better values for strength testing (ICC: 0.99; CV: 3.5–4.1%) compared to endurance testing (ICC 0.87–0.95; CV: 3.9–7.3%) were observed. Interestingly, VE led to higher reliability during endurance testing. Mean squat strength depicted higher strength values with VE (107 ± 33 kg) compared to CON (105 ± 33 kg; p = 0.009, Cohen’s d: 0.06). AMRAP in the endurance test showed negligible differences between VE (182 ± 33 AMRAP) and CON (181 ± 35 AMRAP; p = 0.71, Cohen’s d: 0.03). In conclusion, the effects of VE do not notably exceed day-to-day variability during high intensity functional strength (CV: 3.5–4.1%) and endurance (CV: 3.9–7.3%) testing. However, high intensity functional strength and endurance testing with VE seems to be slightly more reliable, particularly during endurance testing.
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Affiliation(s)
- Florian A Engel
- Department of Movement and Training Science, Institute of Sport and Sport Science, Heidelberg University, Heidelberg, Germany
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sarah Kölling
- Unit of Sport Psychology, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany.,Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Michael Kellmann
- Unit of Sport Psychology, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany.,School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
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Midgley AW, Marchant DC, Levy AR. A call to action towards an evidence-based approach to using verbal encouragement during maximal exercise testing. Clin Physiol Funct Imaging 2017; 38:547-553. [PMID: 28737294 DOI: 10.1111/cpf.12454] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/16/2017] [Indexed: 11/28/2022]
Abstract
By definition, maximal exercise testing inherently requires participants to give a maximal effort. This is an important practical issue as submaximal efforts can produce invalid test results. Verbal encouragement is commonly used to motivate participants to maintain or increase effort investment during maximal exercise testing. Accordingly, studies have reported significant increases in time to exhaustion of between 8% and 18% during VO2max and multistage shuttle run tests, and a significant 30·5 m mean increase in 6-min walk test distance. Significant improvements during shorter tests, such as the Wingate and 2-min walk tests, have not been observed however. Although participants typically perceive verbal encouragement positively during maximal exercise testing, around one-third have neutral or negative perceptions. Despite the ubiquity and importance of verbal encouragement during maximal exercise testing, surprisingly little research has investigated the characteristics of effective encouragement with respect to its content, timing and frequency. The only randomized controlled trial to investigate one of these issues observed that verbal encouragement delivered every 20 s increased time to exhaustion during VO2 max testing, but not every 60 or 180 s. Of particular concern is that several exercise testing guidelines have incorporated specific guidelines for the use of verbal encouragement, but not provided any theoretical or empirical justification, presumably because of the limited research to inform practice. Recent empirical research does provide some important insight into participant preference for the content and timing of verbal encouragement during maximal exercise testing; however, much more research is clearly required to establish comprehensive evidence-based guidelines.
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Affiliation(s)
- Adrian W Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk
| | - David C Marchant
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk
| | - Andrew R Levy
- Department of Psychology, Edge Hill University, Ormskirk, UK
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