Early 4‐Week Cardiac Rehabilitation Exercise Training in Elderly Patients After Heart Surgery Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training. Randomized trial of Nordic walking in patients with moderate to severe heart failure. Alexithymia in respiratory rehabilitation Home-Based Versus In-Hospital Cardiac Rehabilitation After Cardiac Surgery: A Nonrandomized Controlled Study Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Reproducibility of the 6-Minute Walk Test for Ambulatory Oxygen Prescription Validity and reliability of the modified shuttle walk test in patients with chronic obstructive pulmonary disease. Usefulness of the 6-minute walk test and the 200-metre fast walk test to individualize high intensity interval and continuous exercise training in coronary artery disease patients after acute coronary syndrome: a pilot controlled clinical study Pentraxin-3 Predicts Functional Recovery and 1-Year Major Adverse Cardiovascular Events After Rehabilitation of Cardiac Surgery Patients Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen Six-Minute Walk Test and Cardiopulmonary Exercise Testing in Patients With Chronic Heart Failure: A Comparative Analysis on Clinical and Prognostic Insights The Role of Ivabradine in Cardiac Rehabilitation in Patients With Recent Coronary Artery Bypass Graft Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial Group-based Aerobic Interval Training in Patients With Chronic Heart Failure: Norwegian Ullevaal Model Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery Repeat six-minute walk tests in patients with chronic heart failure: are they clinically necessary? Effects of aerobic exercise training on variability and heart rate kinetic during submaximal exercise after gastric bypass surgery – a randomized controlled trial Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure. Validity and reliability of the 10-m walk test and the 6-min walk test in spinal cord injury patients Feasibility and impact of a structured, exercise-based rehabilitation programme for intensive care survivors
PURPOSE The aim of this study was to assess the effects on exercise performance of supplementing a st and ard cardiac rehabilitation program with additional exercise programming compared to the st and ard cardiac rehabilitation program alone in elderly patients after heart surgery . METHODS In this prospect i ve , r and omized controlled trial , 60 patients ( 32 men and 28 women , mean age 73.1 ± 4.7 years ) completed cardiac rehabilitation ( initiated 12.2 ± 4.9 days postsurgery ) . Subjects were assigned to either a control group ( CG , st and ard cardiac rehabilitation program [ n = 19 ] ) , or an intervention group ( IG , additional walking [ n = 19 ] , or cycle ergometry training [ n = 22 ] ) . A symptom limited cardiopulmonary exercise test and 6-minute walk test ( 6MWT ) were performed before and after 4 weeks of cardiac rehabilitation . The MacNew question naire was used to assess quality of life ( QOL ) . RESULTS At baseline , no significant differences for peak oxygen uptake ( & OV0312;O2 ) , maximal power output , or the 6MWT were detected between IG and CG . Global QOL was significantly higher in IG . After 4 weeks of cardiac rehabilitation , patients significantly improved in absolute values of the cardiopulmonary exercise test , 6MWT , and QOL scores . Significant differences between groups were found for peak & OV0312;O2 ( IG : 18.2 ± 3.1 mL·kg−1·min−1 vs. CG : 16.5 ± 2.2 mL·kg−1·min−1 , P < .05 ) ; maximal power output ( IG : 72.2 ± 16 W vs. CG : 60.7 ± 15 W , P < .05 ) ; 6MWT ( IG : 454.8 ± 76.3 m vs. CG : 400.5 ± 75.5 m , P < .05 ) ; and QOL global ( IG : 6.5 ± 0.5 vs. CG : 6.3 ± 0.6 , P < .05 ) . CONCLUSION The supplementation of additional walking or cycle exercise training to st and ard cardiac rehabilitation programming compared to st and ard cardiac rehabilitation alone in elderly patients after heart surgery leads to significantly better exercise tolerance OBJECTIVE To estimate the minimal clinical ly important difference ( MCID ) for the 6-minute walk test ( 6MWT ) and the 200-m fast-walk test ( FWT ) in patients with coronary artery disease ( CAD ) during a cardiac rehabilitation program . DESIGN Prospect i ve study using distribution- and anchor-based methods . SETTING Out patients from a cardiac rehabilitation unit . PARTICIPANTS Stable patients with CAD ( N=81 ; 77 men ; mean±SD age , 58.1±8.7y ) enrolled 31±12.1 days after an acute coronary syndrome ( ACS ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  6MWT and 200-m FWT results before and after an 8-week cardiac rehabilitation program and at the 6th and 12th sessions . Patients and physiotherapists who supervised the training were asked to provide a global rating of perceived change in walking ability while blinded to changes in walk test performances . RESULTS Mean change in 6MWT distance ( 6MWD ) in patients who reported no change was -6.5 m versus 23.3 m in those who believed their performance had improved ( P<.001 ) . This result was consistent with the MCID determined by using the distribution method ( 23 m ) . Considering a 25-m cutoff , positive and negative predictive values were 0.9 and .63 , respectively . Conversely , there was no difference in 200-m FWT performance between these 2 groups ( 0.1 vs -1.4s , respectively ) . There was poor agreement with the physiotherapist 's perceived change . CONCLUSIONS The MCID for 6MWD in patients with CAD after ACS was 25 m . This result will help physicians interpret 6MWD change and help research ers estimate sample sizes in further studies using 6MWD as an endpoint OBJECTIVE To compare the effects of an 8-week , high-intensity interval training protocol versus continuous training . DESIGN R and omized controlled trial . SETTING Cardiac rehabilitation center . PARTICIPANTS Patients ( N=26 ; mean age ± SD , 54±12y ) with chronic heart failure were enrolled in a cardiac rehabilitation program for 8 weeks . INTERVENTIONS Patients were r and omly assigned into 2 groups that performed either interval training ( IT ) or continuous training ( CT ) . IT consisted of 3 sessions of 12 repetitions of 30 seconds of exercise at very high intensity , followed by 60 seconds of complete rest . The CT group performed CT exercises , which consisted of 45 minutes of aerobic exercise . MAIN OUTCOME MEASURES Parameters of gas exchanges : peak oxygen consumption ( Vo(2)peak ) , first ventilator threshold ( VT1 ) , distance at six-minute walk test ( 6MWT ) , and level of anxiety and depression were measured . RESULTS The IT group increased significantly their Vo(2)peak , the duration of the exercise test , the oxygen pulse , oxygen consumption at the VT1 , and the distance walked during the 6MWT . The CT group only increased the time at the VT1 and the distance performed at the 6MWT . The improvement in the time at the VT1 was significantly higher for the IT group than for the CT group . CONCLUSIONS This study shows that IT at very high intensity for patients with heart failure appears to be more effective than CT in improving indices of submaximal exercise capacity BACKGROUND Patients with heart failure are a growing population within cardiac rehabilitation . The purpose of this study was to compare , through a single-centre , parallel-group , r and omized controlled trial , the effects of Nordic walking and st and ard cardiac rehabilitation care on functional capacity and other outcomes in patients with moderate to severe heart failure . METHODS Between 2008 and 2009 , 54 patients ( aged 62.4 ± 11.4 years ) with heart failure ( mean ejection fraction = 26.9 % ± 5.0 % ) were r and omly assigned to st and ard cardiac rehabilitation care ( n = 27 ) or Nordic walking ( n = 27 ) ; both groups performed 200 to 400 minutes of exercise per week for 12 weeks . The primary outcome , measured after 12 weeks , was functional capacity assessed by a 6-minute walk test ( 6MWT ) . RESULTS Compared with st and ard care , Nordic walking led to higher functional capacity ( Δ 125.6 ± 59.4 m vs Δ 57.0 ± 71.3 m travelled during 6MWT ; P = 0.001 ) , greater self-reported physical activity ( Δ 158.5 ± 118.5 minutes vs Δ 155.5 ± 125.6 minutes ; P = 0.049 ) , increased right grip strength ( Δ 2.3 ± 3.5 kg vs Δ 0.3 ± 3.1 kg ; P = 0.026 ) , and fewer depressive symptoms ( Hospital Anxiety and Depression Scale score = Δ -1.7 ± 2.4 vs Δ -0.8 ± 3.1 ; P = 0.014 ) . No significant differences were found for peak aerobic capacity , left-h and grip strength , body weight , waist circumference , or symptoms of anxiety . CONCLUSIONS Nordic walking was superior to st and ard cardiac rehabilitation care  in improving functional capacity and other important outcomes in patients with heart failure . This exercise modality is a promising alternative for this population Purpose . To date , there are no studies that have investigated the role of alexithymia in respiratory rehabilitation . We aim ed to observe the prevalence of alexithymia in patients attending respiratory rehabilitation  and to verify the presence of a difference between alexithymics and non-alexithymics responsiveness to the respiratory rehabilitation st and ard protocol . Methods . A prospect i ve cohort study evaluating the influence of alexithymia on functional recovery of in- patients afferent to the Respiratory Rehabilitation Unit of IRCCS San Raffaele Pisana . Sixty patients were consecutively enrolled into the study and evaluated for alexithymia , anxiety and depression . Functional recovery was assessed with the  six-minute walking test ( 6MWT ) . Prior and post-completion of this test dyspnoea , oxygen saturation and cardiac frequency were recorded . Results . Alexithymia was not found to be significantly affecting the functional recovery of participants in respiratory rehabilitation . The distance walked at the 6MWT ( 6MWD ) increased in both alexithymics and non-alexithymics ( palexithymics = 0.014 ; pnon-alexithymics < 0.0001 ) . Dyspnoea strongly improved among non-alexithymics , although a signal for improvement was also found in alexithymics ( palexithymics = 0.046 ; pnon-alexithymics = 0.0001 ) . Conclusions . These findings suggest that alexithymia did not have a significant impact on functional recovery of patients in respiratory rehabilitation Background Exercise rehabilitation after cardiac surgery has beneficial effects , especially on a long-term basis . Rehabilitative programs with telemedicine plus appropriate technology might satisfy the needs of performing rehabilitation at home . Objective The purpose of this study was to compare exercise capacity after home-based cardiac rehabilitation ( HBCR ) or in-hospital rehabilitation in patients at low to medium risk for early mortality ( EuroSCORE 0–5 ) following cardiac surgery . Design A quasi-experimental study was conducted . Methods At hospital discharge , patients were given the option to decide whether to enroll in the HBCR program .  Clinical examinations ( electrocardiography , cardiac echo color Doppler , chest radiography , blood sample s ) of patients in the HBCR group were collected during 4 weeks of rehabilitation , and exercise capacity ( assessed using the Six-Minute Walk Test [ 6MWT ] ) was assessed before and after rehabilitation . A group of patients admitted to the in-hospital rehabilitation program was used as a comparison group . Patients in the HBCR group were supervised at home by a medical doctor and telemonitored daily by a nurse and physical therapist by video conference . Periodic home visits by health staff also were performed . Results One hundred patients were recruited into the HBCR group . An equal number of patients was selected for the comparison group . At the end of the 4-week study , the 2 groups showed improvement from their respective baseline values only in the 6MWT . No difference was found in time × group interaction . Limitations Because patients self-selected to enroll in the HBCR program and because they were enrolled from a single clinical center , the results of the study can not be generalized . Conclusions In patients who self-selected HBCR , the program was found to be effective and comparable to the st and ard in-hospital rehabilitative approach , indicating that rehabilitation following cardiac surgery can be implemented effectively at home when coadministered with an integrated telemedicine service RATIONALE The 6-minute-walk test ( 6MWT ) is a practical and clinical ly meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases . Performance characteristics in patients with idiopathic pulmonary fibrosis ( IPF ) have not been systematic ally evaluated . OBJECTIVES To assess the reliability , validity , and responsiveness of the 6MWT and estimate the minimal clinical ly important difference ( MCID ) in patients with IPF . METHODS The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b ( n = 822 ) .  Six-minute walk distance ( 6MWD )  and other parameters were measured at baseline and at 24-week intervals using a st and ardized protocol . Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function , dyspnea , and health-related quality of life . Both distribution-based and anchor-based methods were used to estimate the MCID . MEASUREMENTS AND MAIN RESULTS Comparison of two proximal measures of 6MWD ( mean interval , 24 d ) demonstrated good reliability ( coefficient = 0.83 ; P < 0.001 ) . 6MWD was weakly correlated with measures of physiologic function and health-related quality of life ; however , values were consistently and significantly lower for patients with the poorest functional status , suggesting good construct validity . Importantly , change in 6MWD was highly predictive of mortality ; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year ( hazard ratio , 4.27 ; 95 % confidence interval , 2.57- 7.10 ; P < 0.001 ) . The estimated MCID was 24 - 45 m. CONCLUSIONS The 6MWT is a reliable , valid , and responsive measure of disease status and a valid endpoint for clinical trials in IPF Background : Ambulatory oxygen is frequently prescribed for patients with chronic obstructive pulmonary disease ( COPD ) who have oxygen desaturation ≤88 % during exercise . The 6-min walk test ( 6MWT ) with continuous pulse oximetry monitoring is a common method to document this oxygen desaturation , but the reproducibility of this test in determining the need for ambulatory oxygen in patients with COPD is not well documented . Objective : The aim of this study was to establish the reproducibility of the 6MWT in determining the need for ambulatory oxygen prescription in stable COPD patients using the Centers for Medicare and Medicaid ( CMS ) criteria for ambulatory oxygen prescription . Methods : The study was design ed as a prospect i ve observational study in an academic health center and associated pulmonary rehabilitation program . Eighty-eight COPD patients referred to pulmonary rehabilitation underwent continuous pulse oximetry while performing st and ard 6MWT on 3 separate days . Results : Fifty-one ( 58 % ) of these patients desaturated by continuous pulse oximetry to an SpO2 ≤88 % on a least one of the 6MWTs . Only 26 patients ( 30 % ) demonstrated consistency in meeting the criteria for ambulatory oxygen set forth by the CMS on all three 6MWT with a κ statistic of 0.62 . The percent agreement between 6MWTs for ambulatory oxygen prescription was 72 % and the paired observation was 51 % . Conclusions : The 6MWT distance is simple and widely used as a consistent measure of functional capacity in patients with COPD ; however , the 6MWT oxygen saturation has only modest reproducibility in determining the need for ambulatory oxygen in stable COPD patients undergoing pulmonary rehabilitation OBJECTIVES ( 1 ) To examine the concurrent criterion validity of the modified shuttle walk test ( MSWT ) by using the 6- ( 6MWT ) and 12-minute walk test ( 12MWT ) , ( 2 ) to examine the concurrent criterion validity of the estimated maximum oxygen uptake ( Vo2max ) of the MSWT with actual Vo2max , and ( 3 ) to determine test-retest reliability of the MSWT in patients with chronic obstructive pulmonary disease ( COPD ) . DESIGN Validation study . SETTING Outpatient pulmonary rehabilitation program . PARTICIPANTS Thirty clinical ly stable adults with COPD . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Subjects were r and omly assigned to receive either the 6MWT and 12MWT or the MSWT first . The MSWT was repeated 1 week later ( N = 30 ) . Estimated Vo2max was calculated , and actual Vo2max was conducted by using the Jones test . Validity of the MSWT was assessed by comparing endurance scores and Vo2max with results from the 6MWT and 12MWT and Jones test , respectively . RESULTS There was a moderately high correlation between the  MSWT  and the 6MWT and 12MWT at initial testing ( .82 and .74 , respectively ) . Correlation between estimated and actual Vo2max was r equal to .68 . Test-retest reliability for the entire sample was high ( intraclass correlation coefficient , .88 ) . Results remained quite stable across severity , age , and sex subgroups . CONCLUSIONS The MSWT is a st and ardized externally paced submaximal endurance walking test . The results indicate that the MSWT has high concurrent validity and test-retest reliability for patients with COPD Objective : To study the effects of three individualized exercise training prescriptions using either a percentage of maximal heart rate ( HR ) , maximal 6-minute walk test ( 6MWT ) HR , or maximal 200-metre fast walk test ( 200-mFWT ) HR , on walking performance and exercise capacity in coronary artery disease ( CAD ) patients . Design : Controlled clinical study . Participants : Twenty-seven out patients enrolled in a rehabilitation programme after an acute coronary syndrome . Setting : Cardiac rehabilitation unit . Interventions : Three groups : ( A ) : moderate intensity continuous exercise ( MICE ) at 70 % of the maximal HR of the grade d maximal exercise test ( n = 10 ) ; ( B ) : MICE at the maximal 6MWT HR ( n = 8) ; ( C ) : high intensity interval training ( HIIT ) based on the 6MWT and the 200-mFWT maximal HR ( n = 9 ) . Group B and C performed walk tests every 2 weeks , to readjust training HR ( THR ) if needed . Measures : 6MWT and 200-mFWT performances , peak VO2 and peak power ( Pmax ) . Results : 6MWT and 200-mFWT performances improved significantly and similarly in all groups ( P < 0.05 ) . Peak VO2 improved significantly in all groups ( P < 0.05 ) , this improvement being higher in group C ( HIIT ) versus A ( P < 0.05 ) . Group B was closer to the recommended THR during exercise sessions compared to group A. Conclusion : This pilot study showed that using the 6MWT and 200-mFWT HR to individualize MICE or HIIT prescription is feasible in CAD patients , and could lead them closer to THR objective , to similar improvements in walking performance , and greater peak VO2 increase for HIIT . Future r and omised studies should investigate long-term effects of programmes prescribed from walk tests HR , especially for HIIT modality BACKGROUND : Inflammatory and vascular markers have proved to be predictors of outcome in myocardial infa rct ion and heart failure . We evaluated several circulating markers of cardiac stress , inflammation , and endothelial function to investigate their ability to predict short-term functional recovery and long-term clinical outcome in heart surgery patients undergoing inpatient rehabilitation . METHODS : This prospect i ve , multicenter study enrolled 223 patients after heart surgery , included in a 3-week program of st and ardized and supervised physical training .  The association between biomarkers ( pentraxin-3 [ PTX3 ] , brain natriuretic peptide , high-sensitivity cardiac troponin-T [ hs-cTnT ] and C-reactive protein [ hsCRP ] , creatine kinase , myoglobin , and urinary albumin excretion [ UACR ] ) and exercise capacity ( 6-minute walk test , 6MWT ) or 1-year incidence of major adverse cardiovascular events ( MACE ) was tested in models that included biohumoral markers , and clinical and instrumental variables . RESULTS : The patients ( 69.5 % men , mean age of 67 ± 11 years ) were enrolled after valvular surgery ( 52.7 % ) and 58.6 % after coronary artery bypass grafting ( CABG ) . Exercise capacity improved during rehabilitation ( 6MWT distance from 279 ± 95 to 386 ± 91 m ; P < .0001 ) ; concentrations of most biomarkers decreased ( hsCRP : 79 % [ P < .0001 ] ; hs-cTnT : 57 % [ P < .0001 ] ; UACR : 36 % [ P = .05 ] ) . Among the tested markers , PTX3 showed the closest association with 6MWT distance ( P = .01 ) and was the only predictor of MACE , also in the subgroup of CABG patients ( OR [ 95 % CI ] = 1.14 [ 1.03–1.27 ] ; P = .015 ) . CONCLUSION : PTX3 , a marker of vascular inflammation and cardiovascular damage , is a predictor of short-term functional recovery and 1-year MACE in patients undergoing rehabilitation after cardiac surgery , regardless of clinical and instrumental parameters OBJECTIVE To establish the test-retest reliability and concurrent validity with maximum oxygen consumption ( VO2max ) for 3 submaximal exercise tests in persons with chronic stroke : ( 1 ) submaximal treadmill test , ( 2 ) submaximal cycle ergometer test , and ( 3 ) 6-minute walk test ( 6MWT ) . DESIGN Prospect i ve study using a convenience sample . SETTING Free-st and ing tertiary rehabilitation center . PARTICIPANTS A volunteer sample of 12 community-dwelling individuals who had a stroke with moderate motor deficits . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Heart rate , blood pressure , and oxygen consumption ( VO2 ) were assessed during the exercise tests . RESULTS Test-retest reliability was good to excellent for the exercise tests ( maximal and submaximal tests ) . VO2 for all submaximal measures related to VO2max ( r range , .66-.80 ) . Neither the 6MWT distance , self-selected gait speed , nor hemodynamic measures related to VO2max . CONCLUSION The VO2 measures of the submaximal exercise tests had excellent reliability and good concurrent validity with VO2max . Submaximal exercise tests may be a method by which to monitor the effects of interventions after a screening test ( eg , symptom-limited grade d exercise test , dobutamine stress echocardiograph ) UK guidelines for domiciliary oxygen have suggested the six-minute walk test or shuttle walk tests as suitable functional measures for the clinical assessment of ambulatory oxygen ( AO ) . To date , there is limited evidence that would support the use of shuttle walk tests as assessment tools for AO . The endurance shuttle walk test ( ESWT ) is used increasingly as an assessment tool within pulmonary rehabilitation ( PR ) but its potential as an investigative test for AO has not been explored . Using the same test for both PR and AO assessment is appealing since it would improve efficiency and act to st and ardise outcome measures in this patient population . The aim of this study was to examine the responsiveness and repeatability of the ESWT to AO and to compare the response with that of the six-minute walk test ( 6MWT ) .  Twenty-three patients with chronic obstructive pulmonary disease ( COPD ) performed , in r and om order , the ESWT and the 6MWT on air and whilst breathing AO . Oxygen saturation and Borg ratings of breathlessness and perceived exertion were recorded . On a third day , eleven patients repeated the ESWT with AO in order to measure repeatability . There was a significantly greater change in the ESWT with oxygen than the change recorded from the 6MWT ( 66 [ 91 ] vs 6 [ 28 ] m respectively ; P < .05 ) . When repeated on a separate day , the mean difference ( 95 % CI ) between distances walked on the ESWT with AO was 0.91 ( -47 , 49 ) m. The ESWT was more responsive than the 6MWT for detecting improvements in walking endurance whilst breathing AO Background —The six-minute walk test ( 6MWT ) and cardiopulmonary exercise testing ( CPET ) are the 2 testing modalities most broadly used for assessing functional limitation in patients with heart failure ( HF ) . A comprehensive comparison on clinical and prognostic validity of the 2 techniques has not been performed and is the aim of the present investigation . Methods and Results —Two hundred fifty-three patients diagnosed with systolic ( n=211 ) or diastolic ( n=42 ) HF ( age : 61.9±10.1 years ; New York Heart Association Class : 2.2±0.78 ) underwent a 6MWT and a symptom-limited CPET evaluation and were prospect ively followed up . During the 4-year tracking period , there were 43 cardiac-related deaths with an annual cardiac mortality rate of 8.7 % . The 6MWT distance correlated with CPET-derived variables ( ie , peak Vo2 , Vo2 at anaerobic threshold , and Ve/Vco2 slope ) and was significantly reduced in proportion with lower peak Vo2 and higher Ve/Vco2 slope classes and presence of an exercise oscillatory breathing ( EOB ) pattern ( P<0.01 ) . However , no significant differences were observed in distance covered between survivors and nonsurvivors ( 353.2±95.8 m versus 338.5±76.4 m ; P = NS ) . At univariate and multivariate Cox proportional analyses , the association of the 6MWT distance with survival was not significant either as a continuous or dicotomized variable ( ≤300 m ) . Conversely , CPET-derived variables emerged as prognostic with the strongest association found for EOB ( systolic HF ) and Ve/Vco2 slope ( entire population with HF and patients with a 6MWT≤300 m ) . Conclusions —The 6MWT is confirmed to be a simple and reliable first-line test for quantification of exercise intolerance in patients with HF . However , there is no supportive evidence for its use as a prognostic marker in alternative to or in conjunction with CPET-derived variables Background : Little is known about ivabradine in cardiac rehabilitation in patients with coronary artery bypass graft ( CABG ) . Methods : In this prospect i ve , r and omized study , suitable patients admitted for cardiac rehabilitation after recent CABG were r and omized to ivabradine 5 mg twice a day + st and ard medical therapy including bisoprolol 1.25 mg once daily ( group I-BB , n = 38 ) or st and ard medical therapy including bisoprolol 2.5 to 3.75 mg once daily ( group BB , n = 43 ) . Patients were evaluated at admission , discharge , and 3 months . The primary end point was improvement in functional status , and other end points were improvement in diastolic function and recovery of systolic function . End points were assessed by distance covered in 6-minute walking test ( 6MWT ) , percentage with normal diastolic function , and percentage increase in left ventricular ejection fraction ( LVEF ) . Results : Cardiac rehabilitation improved functional capacity in both groups . In group BB , distances covered in the 6MWT at admission , discharge , and 3 months were 215 ± 53 , 314 ± 32 , and 347 ± 42 m , respectively . Corresponding distances in group I-BB were 180 ± 91 , 311 ± 58 , and 370 ± 55 m. Normal diastolic function was restored in I-BB patients , increasing from 24 % at admission to 50 % and 79 % at discharge and 3 months ; in BB patients , it decreased from 23 % to 19 % and 16 % . The LVEF improved in I-BB patients , from 57 % ± 3 % at admission to 62 % ± 4 % at discharge and 66 % ± 3 % at 3 months , while remaining unchanged in BB patients ( 57 % ± 3 % , 59 % ± 4 % , and 59 % ± 3 % ) . Conclusion : Adding ivabradine to low-dose bisoprolol during cardiac rehabilitation in patients with CABG improved functional capacity , enhanced recovery of systolic function , and reduced diastolic dysfunction Objective To compare home-based cardiac rehabilitation ( CR ) with usual care ( control group with no rehabilitation ) in elderly patients who declined participation in centre-based CR . Design R and omised clinical trial with 12 months follow-up and mortality data after 5.5 years ( mean follow-up 4½ years ) . Setting Rehabilitation unit , Department of Cardiology , Copenhagen , Denmark . Participants Elderly patients ≥65 years with coronary heart disease . Intervention A physiotherapist made home visits in order to develop an individualised exercise programme that could be performed at home and surrounding outdoor area . Risk factor intervention , medical adjustment , physical and psychological assessment s were offered at baseline and after 3 , 6 and 12 months . Main outcome measurements The primary outcome was 6 min walk test ( 6MWT ) . Secondary outcomes were blood pressure , body composition , cholesterol profile , cessation of smoking , health-related quality of life ( HRQoL ) , anxiety and depression . Results 40 patients participated . The study population was characterised by high age ( median age 77 years , range 65–92 years ) and high level of comorbidity . Patients receiving home-based CR had a significant increase in the primary outcome 6MWT of 33.5 m ( 95 % CI : 6.2 to 60.8 , p=0.02 ) at 3 months , whereas the usual care group did not significantly improve , but with no significant differences between the groups . At 12 months follow-up , there was a decline in 6MWT in both groups ; −55.2 m ( 95 % CI : 18.7 to 91.7 , p<0.01 ) in the home group and −52.1 m ( 95 % CI : −3.0 to 107.1 , p=0.06 ) in the usual care group . There were no significant differences in blood pressure , body composition , cholesterol profile , cessation of smoking or HRQoL after 3 , 6 and 12 months follow-up . Conclusions Participation in home-based CR improved exercise capacity among elderly patients with coronary heart disease , but there was no significant difference between the home intervention and the control group . In addition , no significant difference was found in the secondary outcomes . When intervention ceased , the initial increase in exercise capacity was rapidly lost Background and Purpose : The purpose of this case report is to describe the responses of 4 patients with chronic heart failure ( CHF ) to a novel rehabilitation program : a group-based , high-intensity , interval-training program that includes aerobic , resistance , flexibility , and balance activities . Case Descriptions : Four patients ( 55–71 years of age ) with CHF ( New York Heart Association class III ) participated in the rehabilitation program twice per week for 16 weeks . Outcome measures included a 6-minute walk test ( 6MWT ) , a cycle ergometer test ( aerobic capacity ) , and a quality -of-life question naire . Outcomes : Patients 1 , 2 , and 3 increased their aerobic capacity ( 17 % , 25 % , and 52 % , respectively ) . Patient 4 did not complete the cycle ergometer test because of limitations associated with his pacemaker . All patients increased their 6MWT distance ( 117 , 66 , 135 , and 143 m for patients 1 , 2 , 3 , and 4 , respectively ) . No adverse events were reported . Discussion : The Norwegian Ullevaal Model of cardiac rehabilitation is a novel high-intensity , interval-training program . The 4 patients with CHF in this case series who participated in this program experienced improvements in physical capacity and quality of life and had no adverse events . These results are consistent with recent evidence supporting the efficacy of high-intensity interval training in people with CHF . R and omized clinical trials are needed to evaluate the clinical efficacy of this group-based , high-intensity , aerobic interval-training program for patients with CHF Background Evidence suggests that elective cardiac patients are at risk of functional and psychological deterioration in the time preceding surgery . This poses a risk to successful post-operative rehabilitation . This prospect i ve one-group pre-test , post-test evaluation was design ed to assess a clinical Pre-operative Rehabilitation ( PREHAB ) home-based exercise programme , to optimise pre-operative physical function and frailty in patients awaiting elective Coronary Artery By-Pass Graft ( CABG ) or Valve Surgery . Method Consenting patients awaiting cardiac surgery , with wait time ≥ 6 weeks were referred to a Senior Physiotherapist for baseline assessment . Patients were offered PREHAB in the form of functional home-based exercise that was prescribed from baseline physical outcomes . All patients were followed up via telephone to ensure progression of exercise and any problems associated with it . This continued weekly until the patient attended Surgical Pre- assessment clinic , where all outcome measures were re-assessed . Results Twenty two patients , out of a total number of 36 patients seen in the surgical clinic between March 2016 and August 2016 , participated in the prehab clinical evaluation . Twenty patients completed their prescribed exercises on a weekly basis prior to surgery . No adverse events or cardiac symptoms were reported as a result of the home exercise intervention . Paired t-Test analyses revealed a significant mean difference in clinical frailty score ( CFS ) of −0.53 ± 0.51 ( 95 % CI [ −0.774 , −0.279 ] , P = 0.0003 ) . Significant mean difference in six-minute walk test ( 6MWT ) distance of 42.5 ± 27.8 m ( 95 % CI [ 23.840 , 61.251 ] , P = 0.0005 ) , 6MWT walking speed of 0.5 ± 0.4 kmh ( 95 % CI , [ 0.2433 , 0.7567 ] , P = 0.001 ) , and short physical performance battery ( SPPB ) total score of 2.2 ± 1.7 , ( 95 % CI [ 3.066 , 1.200 ] , P = 0.0002 ) were also observed . The change in 6MWT distance was shown to be significantly associated with hospital length of stay ( LOS ) ( r = 0.7 ; P = 0.03 ) . Conclusion This small exploratory evaluation suggests that providing a home-based PREHAB programme for frail patients undergoing CABG or Valve surgery may be able to improve functional ability and reduce hospital length of stay for those patients undergoing cardiac surgery . A frailty score with greater sensitivity may be required to eluci date the influence frailty could have in reducing length of stay . A large r and omised controlled study is required to reveal the potential beneficial effects of PREHAB in this patient population Background : Owing to a reported learning effect in patients with chronic cardiopulmonary disease , performance of at least two six-minute walk tests ( 6MWT ) are recommended as st and ard practice . Patients with chronic heart failure ( CHF ) are typically elderly and frail and it is unknown whether current guidelines are practical in a clinical setting . Aims : The aim of this study was to determine whether repeat performance of 6MWTs in patients with CHF is related to between-test interval or baseline performance . Methods : This was a multisite observational study enrolling participants entering into heart failure rehabilitation programmes . Participants performed two 6MWTs with r and omly allocated inter-test intervals between 15 and 90 minutes . Distance walked in the second test was compared with the first test using a paired t test . Results : Eighty-eight participants ( 45 females , age 65 ± 14 years ) with stable CHF were enrolled . Mean distance walked increased from 301 metres in test 1 to 313 metres in test 2 ( p < 0.001 ) . No significant change was recorded between test 1 and test 2 for those whose baseline distance was < 300 metres . The interval between tests had no significant effect on the distance walked . Conclusion : The change in 6MWT distance was significantly associated with better baseline performance but not with the interval between tests Background : This study aim ed to determine whether morbidly obese women have an alteration of heart rate ( HR ) kinetics and HR variability ( HRV ) during the 6-min walk test ( 6MWT ) and if an aerobic exercise training can modify these indexes after gastric bypass surgery ( GBS ) . Design and methods : Nineteen morbidly obese women were r and omized to a trained ( TG ) or control group and 12 women of eutrophic group ( EG ) were also evaluated . The obese women were tested on two occasions : 1 week before and 4 months after GBS through record of HR and R-R intervals during 6MWT for analysis HR kinetics . The TG underwent an aerobic exercise training program on a treadmill ( 1-h session , totaling 36 sessions over 12-week ) . Results : Both obese groups demonstrated a significant reduction of rMSSD and slower HR kinetics during the 6MWT when compared to the EG . In addition , only the TG demonstrated a significant improvement in HRV indexes , walking distance , faster time constant and mean response time of HR during 6MWT after training ( p < 0.05 ) . Conclusion : Morbidly obese women have slower HR kinetics and altered cardiac modulation during submaximal exercise . However , aerobic exercise training can produce beneficial adaptations in HRV and faster HR kinetics following GBS . Implication s for Rehabilitation The obesity is one of the most important threats to health in developed countries and bariatric surgery is an option for treatment of morbid obesity . Exercise is an effective means of improving health after this procedure due alterations of autonomic nervous system in this population . This study showed that a program of aerobic physical training after bariatric surgery was able to improve the kinetics of heart rate and the cardiac autonomic modulation , both evaluated during submaximal exercise BACKGROUND Our purpose was to evaluate the reliability , validity , and responsiveness of the 6-minute walk test ( 6MWT ) in patients with heart failure ( HF ) enrolled in the R and omized Evaluation of Strategies for Left Ventricular Dysfunction ( RESOLVD ) pilot study . METHODS A total of 768 patients was enrolled in a multicenter r and omized clinical trial evaluating the effect of c and esartan , enalapril , and metoprolol on left ventricular ejection fraction ( LVEF ) , 6MWT distance , neurohormones , and quality of life . The 6MWT was performed once at screening and twice at baseline , 18 weeks , and 43 weeks by a st and ardized method . RESULTS Test-retest reliability at baseline ( intraclass correlation coefficient [ ICC ] = 0.90 ) , 18 weeks ( ICC = 0.88 ) , and 43 weeks ( ICC = 0.91 ) was very good . Baseline 6MWT distance was weakly inversely correlated to the quality -of-life cumulative score ( r = -0.26 , P = .0001 ) and moderately inversely correlated to the New York Heart Association functional classification ( NYHA-FC ) ( r = -0.43 , P = .001 ) . In the RESOLVD study , the 6MWT was not responsive to change when effect sizes and st and ardized response means were used . Disease-specific quality of life was responsive to change in patients treated with c and esartan and enalapril and NYHA-FC was responsive to change in the c and esartan and enalapril combination and for enalapril alone with small effect sizes . The 6MWT , NYHA-FC , and quality of life were not responsive to change during the metoprolol or placebo phase . CONCLUSIONS The 6MWT is highly reproducible in patients with symptoms of HF . It is somewhat correlated to NYHA-FC and quality of life . Overall , quality of life was most responsive to change , whereas 6MWT and NYHA-FC were comparable but less responsive to change in the RESOLVD study Study design : The 10-m walk test ( 10MWT ) and the 6-min walk test ( 6MWT ) have been recommended for assessment of walking in spinal cord injury ( SCI ) patients . The study was design ed on test – retest analysis of the 10MWT and 6MWT . Objectives : The objective of this study was to assess validity/reliability of different methods of performing the tests . Setting : The study was set at an SCI unit of a rehabilitation hospital . Patients and methods : A total of 37 patients ; whose median age was 58.5 years ( interquartile range 40–66 , full range 19–77 ) ; median time since onset of SCI was 24 months ( interquartile range 16.25–70.5 , full range 6–109 ) . Non-traumatic etiology in 20 out of 37 patients ; level : 12C , 14 T and 11L ; American Spinal Injury Association Impairment Scale grade : 35D/2C . Assessment with the 10MWT ( with or without dynamic start ) and the 6MWT ( short or long track ) by two blinded raters to evaluate inter/intra-rater reliabilities . Results : The  10MWT  was performed in a median of 19 s ( 25th–75th interquartile range 13–28 ) with the dynamic start and of 18.4 s ( 25th–75th interquartile range 12.6–29.9 ) with the static start ( P=0.092 ) . The correlation between the results of the two methods was between 0.98 and 0.99 . The inter- and intra-rater reliabilities were between 0.95 and 0.99 for both the methods . The 6MWT showed significant differences according to the track length : patients walked a median of 226.7 m ( 25th–75th interquartile range 123.2–319 ) on the longer track and of 187.6 m ( 25th–75th interquartile range 69.7–240.6 ) on the short one ( P<0.001 ) . The correlation between the results of the two methods was between 0.91 and 0.93 . The inter- and intra-rater reliabilities were between 0.98 and 0.99 . Conclusion : The 10MWT shows high inter/intra-rater reliability and shows comparable results with both dynamic and static start . The different testing conditions of the 6MWT ( track/turns ) results in significant differences that need st and ardization for use in future trials Our objective was to assess the impact of an outpatient physiotherapy-led rehabilitation programme on exercise capacity and anxiety and depression scores in a cohort of adult intensive care survivors . In a prospect i ve study in a teaching hospital , 38 general intensive care survivors following hospital discharge underwent an established physiotherapy-led outpatient rehabilitation programme . The programme involved 2 hours of supervised exercise and education sessions each week and two unsupervised exercise sessions each week for 6 weeks . Assessment s took place 1 week before and 1 week after completing the programme . Primary outcome measures were changes in exercise capacity measured using the 6-minute walk test ( 6MWT ) and incremental shuttle walk test ( ISWT ) . Secondary outcome measures were changes in anxiety and depression scores using the Hospital Anxiety and Depression Scale ( HADS ) . Median distance covered in the 6MWT improved by 160 metres ( p<0.001 ) , and median distance covered in the ISWT also improved by 160 metres ( p < 0.001 ) . Significant improvement in anxiety ( p = 0.001 ) and depression ( p = 0.001 ) scores were also seen . Outpatient , physiotherapy-lead rehabilitation appears to improve both exercise capacity and anxiety and depression scores in a cohort of intensive care survivors . A similar programme should be tested in a r and omised controlled trial
Qualitative analysis indicated moderate evidence for repeatability of the 6MWT in patients undergoing cardiac rehabilitation , for a 2 % to 8 % learning effect between repeated 6MWTs , for a relationship between peak heart rate during the 6MWT and during cycle exercise at the ventilatory threshold , and for moderate-to-high correlation between the 6-minute walk distance and maximum metabolic equivalents achieved on symptom-limited exercise tests .
Strong evidence suggests that the 6MWT is responsive to clinical change following cardiac rehabilitation .
BACKGROUND The  6-minute walk test ( 6MWT ) is a common outcome measurement in cardiac rehabilitation .
However , a search of the literature found no established guidelines for use of the 6MWT in cardiac rehabilitation .
OBJECTIVES Systematic review of the validity , reliability and responsiveness of the 6MWT in cardiac rehabilitation .