Methods of Evaluation of Tolerance yo Physical Activity Based on Six-Minute Walking Test During Outpatient Rehabilitation of Patients with Ischemic Heart Disease

Abstract

Background. Even though the six-minute walking test is a simple and widely available tool for the evaluation of the functional capacity of cardiac patients, its interpretation is associated with some difficulties and contradictions. Aims: To evaluate the dynamics of tolerance to physical activity during outpatient rehabilitation of patients with ischemic heart disease using predicted values of distance in the six-minute walking test. Materials and methods. 97 patients (70 men and 27 women, average age 59.6 [50; 60] years) after acute coronary syndrome and after myocardial revascularization were included. The six-minute walking test was performed at the beginning of the 3-weeks stage of cardiac rehabilitation and before the patients’ discharge. The results of the test were reported as an absolute value, a change in absolute value, and the percentage of predicted values, estimated with the reference equation by Enright and colleagues. Results. The absolute value of distance in the six-minute walking test was increased significantly from 418 [385; 465] m to 485 [440; 525] m (p <0.001). The number of patients with a distance less than 300 m was decreased significantly (12 patients, 12% vs 2 patients, 2%, p <0.001). In most patients, the absolute increase in distance was 30 m and more (81 people, 84%). After comparing the perceived data with the calculated predicted values, it was revealed that the distance raised from 79 [71; 82]% to 92 [88; 96]% of the predicted values. And 56 patients (58%) had a distance equal to 90% or more from its predicted value. Conclusions. During the third stage of cardiac rehabilitation the significant increase of the absolute value of the six-minute walking test, the growth of the percentage of predicted values, and the decrease of patients with a distance less than 300 m were found. All these estimation methods may be used to demonstrate and prove favourable changes of tolerance to physical activity in patients with ischemic heart disease.

Keywords

cardiac rehabilitation / tolerance to physical activity / six-minute walking test / ischemic heart disease / acute coronary syndrome

References

[1] American Thoracic Society Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–117. doi: 10.1164/ajrccm.166.1.at1102

[2] Holland AE, Spruit MA, Troosters T, et al. An official European respiratory society/American thoracic society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428–1446. doi: 10.1183/09031936.00150314

[3] Мишина И.Е., Сарана А.М., Михайловская Т.В., Иванова Г.Е. Принципы назначения аэробных физических тренировок при проведении амбулаторной кардиореабилитации // Вестник восстановительной медицины. 2020. Т. 97, № 3. С. 83–95. [Mishina IE, Sarana AM, Mikhailovskaya TV, Ivanova GE. Principles of the appointment of aerobic physical training during outpatient cardiorehabilitation. Vestnik vosstanovitel’noi meditsiny. 2020;97(3):83–95. (In Russ).] doi: 10.38025/2078-1962-2020-97-3-83-95

[4] Довгалюк Ю.В., Чистякова Ю.В., Воробьёва Т.В., Мишина И.Е. Динамика толерантности к физической нагрузке с учетом гендерных особенностей у больных, перенесших острый коронарный синдром, в процессе амбулаторного этапа реабилитации // Физическая и реабилитационная медицина, медицинская реабилитация. 2020. Т. 2, № 2. С. 126–132. [Dovgalyuk YV, Chistyakova YV, Vorobyova TV, Mishina IV. Gender-related dynamics of exercise tolerance in patients with acute coronary syndrome undergoing the outpatient phase of rehabilitation. Physical and Rehabilitation Medicine, Medical Rehabilitation. 2020;2(2):126–132. (In Russ).] doi: https://doi.org/10.36425/rehab26343

[5] Иванова Г.Е., Мельникова Е.В., Белкин А.А. и др. Как организовать медицинскую реабилитацию? // Вестник восстановительной медицины. 2018. № 2. С. 2–12. [Ivanova GE, Melnikova EV, Belkin AA, et al. How to organize medical rehabilitation? Vestnik vosstanovitel’noi meditsiny. 2018;(2):2–12. (In Russ).]

[6] Giannitsi S, Bougiakli M, Bechlioulis A, et al. 6-minute walking test: a useful tool in the management of heart failure patients. Ther Adv in Cardiovasc Dis. 2019;13: 1753944719870084. doi: 10.1177/1753944719870084

[7] Баклушин А.Е., Мишина И.Е., Романчук С.В. и др. Содержание и первые результаты реабилитации кардиологических больных в клинике // Вестник восстановительной медицины. 2014. № 6. С. 43–46. [Baklushin AE, Mishina IE, Romanchuk SV, et al. Content and first results of rehabilitation of cardiac patients in the clinic Vestnik vosstanovitel’noi meditsiny. 2014;(6):43–46. (In Russ).]

[8] Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998; 158(5 Pt 1):1384–1387. doi: 10.1164/ajrccm.158.5.9710086

[9] Beriault K, Carpentier AC, Gagnon C, et al. Reproducibility of the 6-minute walk test in obese adults. Int J Sports Med. 2009;30:725–727. doi: 10.1055/s-0029-1231043

[10] Arslan S, Erol MK, Gundogdu F, et al. Prognostic value of 6-minute walk test in stable outpatients with heart failure. Tex Heart Inst J. 2007;34:166–169.

[11] Curtis JP, Rathore SS, Wang Y, et al. The association of 6-minute walk performance and outcomes in stable outpatients with heart failure. J Card Fail. 2004;10:9–14.

[12] Ferreira JP, Duarte K, Graves TL, et al. Natriuretic peptides, 6-min walk test, and quality of life questionnaires as clinically meaningful endpoints in HF trials. J Am Coll Cardiol. 2016;68(24):2690–2707. doi: 10.1016/j.jacc.2016.09.936

[13] Ciani O, Piepoli M, Smart N, et al. Validation of exercise capacity as a surrogate endpoint in exercise-based rehabilitation for heart failure: a meta-analysis of randomized controlled trials. JACC Heart Fail. 2018;6(7):596–604. doi: 10.1016/j.jchf.2018.03.017

[14] Enright PL. The six-minute walk test. Respir Care. 2003; 48(8):783–785.

[15] Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999; 14(2):270–274. doi: 10.1034/j.1399-3003.1999.14b06.x

[16] Gibbons WJ, Fruchter N, Sloan S, et al. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil. 2001;21(2): 87–93. doi: 10.1097/00008483-200103000-00005

[17] Juocevicius A, Oral A, Lukmann A, et al. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for people with cardiovascular conditions. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med. 2018;54(4):634–643. doi: 10.23736/S1973- 9087.18.05310-8

RIGHTS & PERMISSIONS

Mikhailovskaya T.V., Mishina I.E., Nazarova O.A., Dovgalyuk Y.V., Chistyakova J.V.