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Six-Minute Walk Test for Assessing Physical Functional Capacity in Chronic Heart Failure

  • Self-Care and Health Outcomes (R. Gallagher and R. Clark, Section Editors)
  • Published:
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Abstract

Purpose of the Review

The six-minute walk test (6MWT) is a submaximal exercise test for evaluating physical functional capacity. This review aims to report the research on the use of the 6MWT in chronic heart failure (CHF) that has been published in the past 5 years.

Recent Findings

The 6MWT distance does not accurately reflect peak VO2. Minimal clinically important difference in the 6MWT distance, and additional measurements, such as heart rate recovery, can assist in the interpretation of the 6MWT distance, so management decisions can be made. Incorporating mobile apps and information technology in measuring the 6MWT distance extends the usefulness of this simple walk test and improve remote monitoring of patients with CHF.

Summary

The 6MWT is a useful tool in CHF programs. However, interpretation of the 6MWT distance must be with caution. With the advancement in technology, the 6MWT has the potential to facilitate the monitoring of people living in rural and remote areas.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Guyatt GH, Thompson PJ, Berman LB, Sullivan MJ, Townsend M, Jones NL, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985;132(8):919.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Enright PL. The six-minute walk test. Respir Care. 2003;48(8):783–5.

    PubMed  Google Scholar 

  3. Faggiano P, D’Aloia A, Gualeni A, Brentana L, Cas LD. The 6 minute walking test in chronic heart failure: indications, interpretation and limitations from a review of the literature. Eur J Heart Fail. 2004;6(6):687–91.

    Article  PubMed  Google Scholar 

  4. Zielińska D, Bellwon J, Rynkiewicz A, Elkady MA. Prognostic value of the six-minute walk test in heart failure patients undergoing cardiac surgery: a literature review. Rehabil Res Pract. 2013; doi:10.1155/2013/965494.

    PubMed  PubMed Central  Google Scholar 

  5. Du H, Newton PJ, Salamonson Y, Carrieri-Kohlman VL, Davidson PM. A review of the six-minute walk test: its implication as a self-administered assessment tool. Eur J Cardiovasc Nurs. 2009;8(1):2–8.

    Article  PubMed  Google Scholar 

  6. Ingle L, Cleland JG, Clark AL. The long-term prognostic significance of 6-minute walk test distance in patients with chronic heart failure. Biomed Res Int. 2014;2014:505969.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ingle L, Cleland JG, Clark AL. The relation between repeated 6-minute walk test performance and outcome in patients with chronic heart failure. Ann Phys Rehabil Med. 2014;57(4):244–53.

    Article  CAS  PubMed  Google Scholar 

  8. Wegrzynowska-Teodorczyk K, Rudzinska E, Lazorczyk M, Nowakowska K, Banasiak W, Ponikowski P, et al. Distance covered during a six-minute walk test predicts long-term cardiovascular mortality and hospitalisation rates in men with systolic heart failure: an observational study. J Physiother. 2013;59(3):177–87.

    Article  PubMed  Google Scholar 

  9. Nsenga Leunkeu A, Shephard RJ, Ahmaidi S. Six-minute walk test in children with cerebral palsy gross motor function classification system levels I and II: reproducibility, validity, and training effects. Arch Psys Med Rehabil. 2012;93(12):2333–9.

    Article  Google Scholar 

  10. Pollentier B, Irons SL, Benedetto CM, DiBenedetto AM, Loton D, Seyler RD, et al. Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: a systematic review. Cardiopulm Phys Ther J. 2010;21(1):13–21.

    PubMed  PubMed Central  Google Scholar 

  11. Palau P, Domínguez E, Núñez E, Sanchis J, Santas E, Núñez J. Six-minute walk test in moderate to severe heart failure with preserved ejection fraction: useful for functional capacity assessment? Int J Cardiol. 2016;203:800–2.

    Article  PubMed  Google Scholar 

  12. •• Maldonado-Martín S, Brubaker PH, Kaminsky LA, Moore JB, Stewart KP, Kitzman DW. Association between six-minute walk distance and objective variables of functional capacity after exercise training in elderly heart failure patients with preserved ejection fraction: a randomized exercise trial. Arch Psys Med Rehabil. 2016; doi:10.1016/j.apmr.2016.08.481. This study was the first to challenge the validity of the 6MWT for its correlation with peak VO 2 . This study measured the correlation between the change in the 6MWT distance and the change in peak VO 2 after an exercise training intervention

    Google Scholar 

  13. Forman DE, Fleg JL, Kitzman DW, Brawner CA, Swank AM, McKelvie RS, et al. 6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure. J Am Coll Cardiol. 2012;60(25):2653–61.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Deboeck G, Van Muylem A, Vachiéry JL, Naeije R. Physiological response to the 6-minute walk test in chronic heart failure patients versus healthy control subjects. Eur J Prev Cardiol. 2014;21(8):997–1003.

    Article  PubMed  Google Scholar 

  15. Papathanasiou JV, Ilieva E, Marinov B. Six-minute walk test: an effective and necessary tool in modern cardiac rehabilitation. Hell J Cardiol. 2013;54(2):126–30.

    Google Scholar 

  16. Pollentier B, Irons SL, Benedetto CM, DiBenedetto AM, Loton D, Seyler RD, et al. Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: a systematic review. Int J Cardiol. 2010;21(1):13–21.

    Google Scholar 

  17. Kaminsky LA, Tuttle MS. Functional assessment of heart failure patients. Heart Fail Clin. 2015;11(1):29–36.

    Article  PubMed  Google Scholar 

  18. Pepera GK, Sandercock GR, Sloan R, Cleland JJ, Ingle L, Clark AL. Influence of step length on 6-minute walk test performance in patients with chronic heart failure. Physiotherapy. 2012;98(4):325–9.

    Article  PubMed  Google Scholar 

  19. Ross RM, Murthy JN, Wollak ID, Jackson AS. The six minute walk test accurately estimates mean peak oxygen uptake. BMC Pulm Med. 2010;10(1):1.

    Article  Google Scholar 

  20. Ingle L, Goode K, Rigby AS, Cleland JG, Clark AL. Predicting peak oxygen uptake from 6-min walk test performance in male patients with left ventricular systolic dysfunction. Eur J Heart Fail. 2006;8(2):198–202.

    Article  CAS  PubMed  Google Scholar 

  21. Cahalin LP, Mathier MA, Semigran MJ, Dec GW, DiSalvo TG. The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest. 1996;110(2):325–32.

    Article  CAS  PubMed  Google Scholar 

  22. Zotter-Tufaro C, Mascherbauer J, Duca F, Koell B, Aschauer S, Kammerlander AA, et al. Prognostic significance and determinants of the 6-min walk test in patients with heart failure and preserved ejection fraction. JACC Heart Fail. 2015;3(6):459–66.

    Article  PubMed  Google Scholar 

  23. Vieira FC, Melo Marinho PÉ, Brandão DC, Silva OB. Respiratory muscle strength, the six-minute walk test and quality of life in Chagas cardiomyopathy. Physiother Res Int. 2014;19(1):8–15.

    Article  PubMed  Google Scholar 

  24. O’Keeffe ST, Lye M, Donnellan C, Carmichael DN. Reproducibility and responsiveness of quality of life assessment and six minute walk test in elderly heart failure patients. Heart. 1998;80(4):377–82.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wyrwich KW, Nienaber NA, Tierney WM, Wolinsky FD. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care. 1999;37(5):469–78.

    Article  CAS  PubMed  Google Scholar 

  26. Wyrwich KW, Tierney WM, Wolinsky FD. Further evidence supporting an SEM-based criterion for identifying meaningful intra-individual changes in health-related quality of life. J Cli. Epidemiol. 1999;52(9):861–73.

    Article  CAS  Google Scholar 

  27. Lydick E, Epstein R. Interpretation of quality of life changes. Qual Life Res. 1993;2(3):221–6.

    Article  CAS  PubMed  Google Scholar 

  28. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2016;4:4.

    Google Scholar 

  29. Ingle L, Shelton RJ, Rigby AS, Nabb S, Clark AL, Cleland JG. The reproducibility and sensitivity of the 6-min walk test in elderly patients with chronic heart failure. Eur Heart J. 2005;26(17):1742–51.

    Article  PubMed  Google Scholar 

  30. Dolmage TE, Hill K, Evans RA, Goldstein RS. Has my patient responded? Interpreting clinical measurements such as the 6-minute-walk test. Am J Respir Crit Care Med. 2011;184(6):642–6.

    Article  PubMed  Google Scholar 

  31. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Cli Epidemiol. 2007;60(1):34–42.

  32. Chan KS, Pfoh ER, Denehy L, Elliott D, Holland AE, Dinglas VD, et al. Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure. Chest. 2015;147(5):1316–26.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Barbosa R, Pagotti M, Paula T, Jacques T, Serpa R, Calil O, et al. Impact of heart failure clinic on six-minute walk test. Int J Cardiovasc Sci. 2015;28(6):451–9.

    Google Scholar 

  34. Shoemaker MJ, Curtis AB, Vangsnes E, Dickinson MG. Triangulating clinically meaningful change in the six-minute walk test in individuals with chronic heart failure: a systematic review. Cardiopulm Phys Ther J. 2012;23(3):5–15.

    PubMed  PubMed Central  Google Scholar 

  35. Täger T, Hanholz W, Cebola R, Fröhlich H, Franke J, Doesch A, et al. Minimal important difference for 6-minute walk test distances among patients with chronic heart failure. Int J Cardiol. 2014;176(1):94–8.

    Article  PubMed  Google Scholar 

  36. Shoemaker MJ, Curtis AB, Vangsnes E, Dickinson MG. Clinically meaningful change estimates for the six-minute walk test and daily activity in individuals with chronic heart failure. Cardiopulm Phys Ther J. 2013;24(3):21–9.

    PubMed  PubMed Central  Google Scholar 

  37. Guazzi M, Bandera F. Predictive value of 6-min walk test distance versus cardiopulmonary exercise testing in systolic heart failure: same value for different approaches? J Am Coll Cardiol. 2013;61(20):2112.

    Article  PubMed  Google Scholar 

  38. Swigris JJ, Olson AL, Shlobin OA, Ahmad S, Brown KK, Nathan SD. Heart rate recovery after six-minute walk test predicts pulmonary hypertension in patients with idiopathic pulmonary fibrosis. Respirology. 2011;16(3):439–45.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Minai OA, Gudavalli R, Mummadi S, Liu X, McCarthy K, Dweik RA. Heart rate recovery predicts clinical worsening in patients with pulmonary arterial hypertension. Am J Respir Crit Care Med. 2012;185(4):400–8.

    Article  CAS  PubMed  Google Scholar 

  40. Cahalin LP, Arena R, Labate V, Bandera F, Lavie CJ, Guazzi M. Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: a comparison with cardiopulmonary exercise testing. Eur J Heart Fail. 2013;15(5):519–27.

    Article  PubMed  Google Scholar 

  41. Peçanha T, Silva-Júnior ND, Forjaz CLM. Heart rate recovery: autonomic determinants, methods of assessment and association with mortality and cardiovascular diseases. Clin Physiol Funct Imaging. 2014;34(5):327–39.

    Article  PubMed  Google Scholar 

  42. Lindemberg S, Chermont S, Quintão M, Derossi M, Guilhon S, Bernardez S, et al. Heart rate recovery in the first minute at the six-minute walk test in patients with heart failure. Arq Bras Cardiol. 2014;102(3):279–87.

    PubMed  PubMed Central  Google Scholar 

  43. Zhou S, Chen P, Li H, Zeng C, Fang Y, Shi W, Yang C. Noninvasive measurement of cardiac output during 6-minute walk test by inert gas rebreathing to evaluate heart failure. Acta Cardiol. 2016;71(2):199–203.

    PubMed  Google Scholar 

  44. Vegh EM, Kandala J, Orencole M, Upadhyay GA, Sharma A, Miller A, et al. Device-measured physical activity versus six-minute walk test as a predictor of reverse remodeling and outcome after cardiac resynchronization therapy for heart failure. Am J Cardiol. 2014;113(9):1523–8.

    Article  PubMed  Google Scholar 

  45. Brooks GC, Vittinghoff E, Iyer S, Tandon D, Kuhar P, Madsen KA, et al. Accuracy and usability of a self-administered 6-minute walk test smartphone application. Circ Heart Fail. 2015;8(5):905–13.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Frederix I, Van Driessche N, Hansen D, Berger J, Bonne K, Alders T, et al. Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by telerehabilitation in coronary artery disease patients. 2013.

  47. Guazzi M, Dickstein K, Vicenzi M, Ross A. Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: a comparative analysis on clinical and prognostic insights. Circ Heart Fail. 2009;2(6):549–55.

    Article  PubMed  Google Scholar 

  48. Rasekaba T, Lee AL, Naughton MT, Williams TJ, Holland AE. The six-minute walk test: a useful metric for the cardiopulmonary patient. Intern Med. 2009;39(8):495–501.

    Article  CAS  Google Scholar 

  49. •• Prescher S, Schoebel C, Koehler K, Deckwart O, Wellge B, Honold M, et al. Prognostic value of serial six-minute walk tests using tele-accelerometry in patients with chronic heart failure: a pre-specified sub-study of the TIM-HF-trial. Eur J Prev Cardiol. 2016;23(2 suppl):21–6. This study evaluated the use of tele-accelerometer for conducting the 6MWT, over a 12-month follow-up period. Baseline 6MWTD was significantly different between the group who had at least one events (death or hospitalisation), and group who had no event [418.8 (95.6); 353.2 (82.4); p ≤ 0.001]

    Article  PubMed  Google Scholar 

  50. Barnett CT, Bisele M, Jackman JS, Rayne T, Moore NC, Spalding JL, et al. Gait Posture. 2016;44:221–6.

    Article  CAS  PubMed  Google Scholar 

  51. De Maeyer C, Beckers P, Vrints CJ, Conraads VM. Exercise training in chronic heart failure. Ther Adv Chronic Dis. 2013;4(3):105–17.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Zainuldin R, Mackey MG, Alison JA. Prescription of walking exercise intensity from the 6-minute walk test in people with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2015;35(1):65–9.

    Article  PubMed  Google Scholar 

  53. Marzolini S, Oh P, Corbett D, Dooks D, Calouro M, MacIntosh BJ, et al. Prescribing aerobic exercise intensity without a cardiopulmonary exercise test post stroke: utility of the six-minute walk test. Stroke Cerebrovasc Dis. 2016;25:2222–31.

    Article  Google Scholar 

  54. Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness—a systematic review. Physiotherapy. 98(4):277–86.

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Authors and Affiliations

  1. School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia

    Huiyun Du, Parichat Wonggom, Jintana Tongpeth & Robyn A. Clark

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H.D., P.W., J.T. and R.A.C. declare that they have no conflicts of interest.

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Du, H., Wonggom, P., Tongpeth, J. et al. Six-Minute Walk Test for Assessing Physical Functional Capacity in Chronic Heart Failure. Curr Heart Fail Rep 14, 158–166 (2017). https://doi.org/10.1007/s11897-017-0330-3

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