[Reference Equations for the 6-Minute Walk Test in Healthy Individuals.] Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Regression equations to predict 6-minute walk distance in middle-aged and elderly adults Lack of Specificity of the 6-Minute Walk Test as an Outcome Measure for Patients with Systemic Sclerosis Course length of 30 metres versus 10 metres has a significant influence on six-minute walk distance in patients with COPD: an experimental crossover study. Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease. Six-minute walking test and the assessment of cardiorespiratory responses during weight-loss programmes in obese children. 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. Impaired 6-min walk test, heart rate recovery and cardiac function post pulmonary embolism in long-term survivors. Peak power estimated from 6-minute walk distance in Asian patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. CPAP Increases 6-Minute Walk Distance After Lung Resection Surgery Relationship between field walking tests and incremental cycle ergometry in COPD. The effects of a "new" walking aid on exercise performance in patients with COPD: a randomized crossover trial. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience Effect of Liuzijue Exercise Combined with Elastic Band Resistance Exercise on Patients with COPD: A Randomized Controlled Trial Six-minute walk test closely correlates to "real-life" outdoor walking capacity and quality of life in patients with intermittent claudication. Alexithymia in respiratory rehabilitation Outcome of pulmonary rehabilitation in patients after acute exacerbation of chronic obstructive pulmonary disease. Two- and 6-minute walk tests assess walking capability equally in neuromuscular diseases Use of the six-minute walk test poststroke: is there a practice effect? The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen Shuttle Walking Test and 6-Minute Walking Test Induce a Similar Cardiorespiratory Performance in Patients Recovering from an Acute Exacerbation of Chronic Obstructive Pulmonary Disease
The six-minute walk test ( 6MWT ) has been broadly used in clinical setting s. Several reference equations for prediction of the total distance walked during the test ( 6MWD ) are available in literature . The present review aim ed to critically discuss studies , published in Portuguese and English ( LILACS , SCIELO , MEDLINE , PUBMED ) , which evaluated normal values and created reference equations for predicting 6MWD in healthy subjects , comparing them with the results that were recently obtained in Brazilian individuals . Age , sex , weight , height and body mass index were the main demographic and anthropometric features more often correlated with 6MWD . The equations derived from these characteristics were able to explain between 25 and 66 % of the total variability in the 6MWD . Unfortunately , the foreign equations were not applicable to the Brazilian population . Even when the 6MWT was performed following strict st and ardization , the difference in 6MWT performance between foreign and Brazilian individuals remains , indicating the necessity of providing specific reference equations for each population and /or ethnic group . Accordingly , these equations developed in Brazil are probably the most appropriate for interpreting 6MWT performance in Brazilian patients with chronic diseases affecting the exercise capacity . Future studies are necessary with larger sample sizes ( e.g. multicentric ones ) and r and omized design for the reference values of the 6MWD to be considered reliable 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 Six-minute walk distance ( 6MWD ) is commonly used as a measure of functional exercise capacity in clinical practice and research . Regression equations to predict 6MWD in healthy individuals are available , but the equations predict distances that vary considerably for an individual . The aims of this study were to 1 ) measure 6MWDs in healthy Caucasian Australians aged 45 - 85 years ; 2 ) determine whether evidence exists for Australian-specific prediction equations for Caucasian individuals by comparing measured 6MWDs with predicted 6MWDs derived by using published regression equations ; and 3 ) develop regression equations for males and females . One hundred nine subjects ( 48 males ) completed the 6-minute walk test ( 6MWT ) . Measurements of height , leg length , weight , habitual physical activity , and peak heart rate ( HR ) achieved during the 6MWT were obtained . 6MWD ( better of two tests ) was 682 ± 73 m ( mean ± SD ) and 643 ± 70 m in the males and females , respectively ( p<0.01 ) . Published regression equations underestimated 6MWDs in female subjects . Gender-specific regression equations using age and anthropometric data explained 40 % and 43 % of the variance in 6MWD in males and females , respectively . Validation of the regression equations in a prospect i ve subject cohort is required Objective . The 6-minute walk test ( 6MWT ) is an important prognostic tool in various cardiovascular diseases and has been considered as a surrogate endpoint . However , conflicting results have been reported in systemic sclerosis ( SSc ) . Our objective was to evaluate the relationships of the 6-min walking distance  ( 6MWD ) and organ damage in SSc . Methods . Eighty-seven consecutive patients with SSc were included and prospect ively investigated ; they underwent 6MWT in addition to conventional assessment of possible lung , heart , kidney , skin , and muscle involvement , and disease activity scoring , severity , and quality of life determination . Results . Twenty-six patients ( 30 % ) had an abnormal 6MWT and the mean 6MWD was 461.8 ± 103.0 m. When considering 6MWT as a binary variable — normal or abnormal — C-reactive protein ( CRP ) was the only independent variable associated with abnormal 6MWT . Considered as a continuous variable , the 6MWD was associated with measures of lung involvement and inflammation , with the activity and severity of disease , and also with quality of life ; nevertheless , calcinosis was the only independent factor associated in multivariate analyses with a trend for an association for CRP . Conclusion . The 6MWD relates to broad factors in SSc and these results raise doubts about the specificity of the 6MWD in this systemic disease , and its relevance to monitoring therapy QUESTIONS Do patients with chronic obstructive pulmonary disease ( COPD ) achieve a different distance on the six minute walk test ( 6MWT ) conducted on a 10 m course versus on a 30 m course ? When assessing the distance on a 6MWT conducted on a 10 m course , is it valid to use existing reference equations that were generated on longer courses ? DESIGN A r and omised double-crossover experimental study . PARTICIPANTS Forty-five patients with COPD in primary physiotherapy care . INTERVENTION All patients performed a 6MWT twice over a 10 m course and twice over a 30 m course . The 6MWTs were performed in accordance with the American Thoracic Society guidelines . OUTCOME MEASURES 6MWD was assessed and predicted distance was calculated based on a range of reference equations . RESULTS The 6MWD on the 10 m course was 49.5 m shorter than on the 30 m course , which was statistically significant ( 95 % CI 39.4 to 59.6 ) . By using existing reference equations for a 6MWT conducted on the 10 m course , the predicted distance is highly overestimated ( with a range of 30 % to 33 % ) and the average distance as a percentage of the predicted value is 8%pred lower compared to a 6MWT conducted on the 30 m course , result ing in a worse representation of a COPD patient 's functional exercise capacity . CONCLUSION This study shows that the impact of course length on the 6MWD and on the use of reference equations in patients with COPD is substantial and clinical ly relevant ( based on the most conservative published minimum clinical ly important difference ) . Therefore , existing reference equations established for a 6MWT conducted over a 30 m ( or longer ) course can not be applied to predict the distance achieved on the 6MWT on a 10 m course , which is frequently used in primary care physiotherapy practice s for patients with COPD Background There is emerging evidence regarding the efficacy of exercise training to improve exercise capacity for individuals with non-small cell lung cancer ( NSCLC ) .  Cardiopulmonary exercise testing ( CPET ) is the gold st and ard measure of exercise capacity ; however this laboratory test has limitations for use in research and clinical practice . Alternative field walking tests are the six-minute walk test ( 6MWT ) , incremental-shuttle walk test ( ISWT ) and endurance-shuttle walk test ( ESWT ) ; however there is limited information about their clinimetric properties in NSCLC . Aims : In NSCLC to determine the 1 ) criterion validity of the 6MWT , ISWT and ESWT against CPET ; 2 ) construct validity of the 6MWT , ISWT and ESWT against measures of function , strength , respiratory function and health-related quality of life ( HRQoL ) ; and 3 ) clinical applicability of the tests . Methods Twenty participants ( 40 % male , mean ± SD age 66.1 ± 6.5 years ) with stage I-IIIb NSCLC completed the 6MWT , ISWT , ESWT and CPET within six months of treatment . Testing order was r and omised . Additional measures included Eastern Cooperative Oncology Group Performance-Status ( ECOG-PS , function ) , respiratory function , h and -grip dynamometry and HRQoL. Correlations and regression analyses were used to assess relationships . Results The ISWT demonstrated criterion validity with a moderate relationship between ISWT distance and CPET peak oxygen consumption ( r = 0.61 , p = 0.007 ) . Relationships between CPET and six minute walk distance ( 6MWD ) ( r = 0.24 , p = 0.329 ) or ESWT time ( r = 0.02 , p = 0.942 ) were poor . Moderate construct validity existed for the 6MWD and respiratory function ( forced vital capacity % predicted r = 0.53 , p = 0.019 ; forced expiratory volume in the first second % predicted r = 0.55 , p = 0.015 ) . There were no relationships between the walking tests and measures of function , strength or HRQoL. The ESWT had a ceiling effect with 18 % reaching maximum time . No floor effects were seen in the tests . The mean ± SD time required to perform the individual 6MWT , ISWT and ESWT was 12.8 ± 2.5 , 14.7 ± 3.7 and 16.3 ± 5.0 min respectively ; in comparison to CPET which was 51.2 ± 12.7 min . Only one assessor was required to perform all field walking tests and no adverse events occurred . Conclusions The ISWT is a promising measure of functional exercise capacity in lung cancer . Findings need to be confirmed in a larger sample prior to translation into practice BACKGROUND Exercise tolerance is an important clinical aspect of chronic obstructive pulmonary disease that can be easily and reliably measured with the 6-minute walking test ( 6MWT ) . To improve the utility of the 6MWT for patient and health care system management , the interpretation of the functional status measure in relation to death and hospitalization should be eluci date d. METHODS Three-year , prospect i ve , multicenter observational study to evaluate the predictive power of 6MWD for death or exacerbation-related hospitalization and to evaluate the factors that help determine 6MWD . RESULTS We measured 6MWD at baseline and annually in 2110 patients with clinical ly stable Global Initiative for Obstructive Lung Disease ( GOLD ) stage II-IV COPD and recorded exacerbation-related hospitalizations and all-cause mortality .  During the study , 200 patients died and 650 were hospitalized .  Using receiver operating characteristics , the best predictive thresholds of the 6MWD were 334 m for increased risk of death and 357 m for exacerbation-related hospitalization ( area under the curve 0.67 and 0.60 respectively ) ; however , the discriminatory thresholds , especially for mortality , were influenced by age . The mean ( SE ) 6MWD declined by 1.6 ( 1.2 ) m per year in GOLD II , 9.8 ( 1.3 ) m per year in GOLD III , and 8.5 ( 2.4 ) m per year in GOLD IV . CONCLUSION The 6MWD provides prognostic information that may be useful for identifying high-risk patients with COPD PURPOSE We assessed the exercise tolerance and cardiorespiratory responses during 2-month weight-loss programmes using the 6-minute walking test ( 6MWT ) in obese children . METHODS Twenty-eight male obese children were r and omly assigned to either a control group ( C ) , an energy restriction group ( R ) , an exercise training at maximum lipid-oxidation ( LIPOXmax ) group ( E ) , or an energy restriction/training group ( RE ) . The body composition , the submaximal incremental cycling exercise , and the 6MWT were performed before and after the 2-month programme . RESULTS . After the programme , RE group showed a significant improvement of body composition ( body weight reduced by 6.3 ± 1.5 kg , p < 0.01 ) , and an increase of 6-minute walking distance ( 6MWD ) ( + 13.7 % , p < 0.01 ) . Similarly , maximum oxygen uptake calculated according to the American College of Science Medicine guideline ( VO(2max ) ACSM ) and VO(2max ) predicted from 6MWD were respectively higher ( + 12.9 % and + 10.0 % , p < 0.01 ) than the R or E groups . Bl and -Altman analysis highlighted an agreement of these two methods of VO(2max ) measurement . Moreover , in all participants the 6MWD was significantly correlated with VO(2max ) ACSM and LIPOXmax ( r = 0.77 , p < 0.001 and r = 0.67 , p < 0.01 ; respectively ) before the programme as well as their changes in percentage over the programme ( r = 0.85 and r = 0.86 , p < 0.0001 ; respectively ) . CONCLUSIONS We concluded that a 2-month weight-loss programme including energy restriction and exercise training targeted at LIPOXmax improved body composition and cardiorespiratory tolerance in obese children . Furthermore , the 6MWT could be considered as a useful and reliable tool for the assessment and the follow-up of cardiorespiratory responses during weight-loss programme in obese children 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 BACKGROUND The functional capacity of long-term survivors of submassive pulmonary embolism ( PE ) is unreported . A six-minute walk distance ( 6MWD ) < 350 m and reduced heart rate recovery ( HRR ) indicate adverse prognosis in various chronic diseases . METHODS Long-term survivors of acute PE ( January 2000-June 2005 ) were invited to undergo prospect ively planned six-minute walk test ( 6MWT ) , transthoracic echocardiogram ( TTE ) , clinical and biochemical evaluation with cardiac biomarkers .  HRR was calculated as the difference between heart rate at 6-min during and at 1-min post 6MWT . RESULTS 120 patients ( 52 males ; mean age [ ±st and ard deviation ] - 65 ± 14 years ) were identified 7.7 ± 1.4 years after PE . 6MWD was significantly lower than that predicted after adjustment for age , sex , and height ( 448 ± 114 m vs 475 ± 89 m , p = 0.005 ) , and 16 % ( 17/104 ) had 6MWD < 350 m. Among patients with no baseline comorbidities at follow-up ( Charlson comorbidity index = 0 ) , 8 % ( 4/52 ) had 6MWD < 350 m. Resting TTE identified 29 % of patients had raised right ventricular ( RV ) pulmonary pressure ( pulmonary arterial systolic pressure [ PASP ] > 36 mmHg ) and 13 % had impaired RV function . Patients with 6MWD < 85 % predicted had significantly greater impairment of RV longitudinal function ( p < 0.001 ) , higher PASP ( p < 0.001 ) and pulmonary vascular resistance ( p < 0.001 ) , elevated NT-proBNP ( p = 0.03 ) and high-sensitivity troponin-T ( HsTropT , p = 0.03 ) , but similar left ventricular systolic and diastolic function , to those with normal 6MWT . CONCLUSIONS Apparently well , long-term survivors of PE demonstrate impaired exercise capacity , heart rate recovery , mild pulmonary hypertension , raised PVR and right ventricular dysfunction associated with elevated NT-proBNP and BACKGROUND AND OBJECTIVE Pulmonary rehabilitation guidelines recommend cycle ergometry training at an intensity that exceeds 60 % of peak power ( P(peak ) ) with the aim of achieving a physiologic response . However , many clinicians do not have access to an incremental cycle ergometry test ( ICET ) to allow prescription of training intensity . No studies have investigated whether the 6MWT can be used to estimate the P(peak ) achieved during an ICET in subjects with IPF or in Asian subjects with COPD . METHODS A total of 90 Japanese subjects ( IPF n = 45 , COPD n = 45 ) undertook a 6MWT and a symptom-limited ICET in r and om order . Anthropometry , quadriceps strength and lung function were measured . RESULTS Exercise tests were prematurely terminated in 10 subjects with IPF due to profound oxygen desaturation ( SpO(2 ) < 80 % ) . The ICET elicited higher peak heart rates , dyspnea and leg fatigue in both subject cohorts ( all P < 0.01 ) . The magnitude of oxygen desaturation was greater during the 6MWT ( P < 0.01 ) . 6MWD was strongly associated with P(peak ) ( r = 0.80 , P < 0.01 ) in both subject cohorts . In subjects with IPF , the predictive equation that accounted for the greatest proportion of variance in P(peak ) included 6MWD and FVC % pred ( R(2 ) = 0.70 ) . In the COPD subjects , 6MWD alone accounted for 64 % of the variance in P(peak ) and the inclusion of other variables did not increase R(2 ) . CONCLUSIONS P(peak ) can be estimated from the 6MWT in Japanese subjects with IPF and COPD . This may allow individualized prescription of the intensity for cycle-based training based on the 6MWT BACKGROUND : The application of CPAP has been used to minimize postoperative pulmonary complications after lung resection surgery . The aim of this study was to quantify both the CPAP effects upon lung function and functional capacity in early postoperative lung resection , as well as to evaluate if CPAP prolongs air leak through the chest drain . METHODS : Thirty patients in the postoperative period of lung resection were allocated into 2 groups : an experimental group , consisting of 15 patients who underwent a 10 cm H2O CPAP  , and a  15 patient control group  , who performed breathing exercises . Arterial blood gas analysis , peak expiratory flow ( PEF ) , respiratory muscle strength , spirometry , and 6-min walk test ( 6MWT ) were assessed in the preoperative period , and repeated postoperatively on the first and on the seventh day ( 6MWT was repeated only on the seventh day ) . RESULTS : Significant increases in PEF , muscle strength , and FEV1 between the first and seventh postoperative day were observed , both in the experimental and in the control group , whereas FVC and PaO2 increased significantly between the first and seventh postoperative day only in the experimental group . The average loss in 6-min walk distance ( 6MWD ) from preoperative to postoperative day 7 in the experimental group was significantly lower than in control group . When comparing the 2 groups , only 6MWD was statistically different ( P < .001 ) . There was no air leakage increase through the drain with the early use of CPAP . CONCLUSION : When compared to breathing exercises , CPAP increases the 6MWD in postoperative lung resection patients , without prolonging air leak through the chest drain BACKGROUND AND OBJECTIVE Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients BACKGROUND Generally , the use of a rollator improves mobility in patients with COPD . Nevertheless , not all patients benefit from its use , and many patients feel embarrassed about using it . Therefore , other walking aids are worthwhile to consider . We compared the direct effects of a " new " ambulation aid ( a modern draisine ) with the effects of a rollator on 6-min walk distance ( 6MWD ) in patients with COPD . METHODS Twenty-one patients with COPD performed two 6-min walk tests ( 6MWTs ) during prerehabilitation assessment ( best 6MWD : 369 ± 88 m ) . Additionally , two extra 6MWTs were performed on two consecutive days in r and om order : one time with a rollator and one time with a modern draisine . Walking pattern ( n = 21 ) was determined using an accelerometer , and metabolic requirements ( n = 10 ) were assessed using a mobile oxycon . RESULTS Walking with the modern draisine result ed in a higher 6MWD compared with walking with the rollator ( 466 ± 189 m vs 383 ± 85 m ) . Moreover , patients had fewer strides ( 245 ± 61 vs 300 ± 49 ) and a greater stride length ( 1.89 ± 0.73 m vs 1.27 ± 0.14 m ) using the modern draisine compared with the rollator  ( all P ≤ .001 ) . Oxygen uptake , ventilation , heart rate , oxygen saturation , and Borg symptom scores were comparable between both walking aids . Ten percent of the patients felt embarrassed using the modern draisine compared with 19 % for the rollator , and a significantly smaller proportion of patients would use the modern draisine in daily life . CONCLUSIONS The mean difference in 6MWD between a modern draisine and a rollator seems clinical ly relevant , with the same metabolic requirements and symptom Borg scores . Therefore , this " new " ambulation aid could be a good alternative to the rollator to improve functional exercise performance in patients with COPD . TRIAL REGISTRY The Netherl and s National Trial Registry ; No. : NTR1542 ; URL : www.trialregister.nl Abstract Background : Multimodal prehabilitation is a preoperative conditioning intervention in form of exercise , nutritional assessment , whey protein supplementation , and anxiety-coping technique . Despite recent evidence suggesting that prehabilitation could improve functional capacity in patients undergoing colorectal surgery for cancer , all studies were characterized by a relatively small sample size . The aim of this study was to confirm what was previously found in three small population trials . Material and methods : Data of 185 participants enrolled in a pilot single group study and two r and omized control trials conducted at the McGill University Health Center from 2010 to 2015 were reanalyzed . Subjects performing trimodal prehabilitation ( exercise , nutrition , and coping strategies for anxiety ) were compared to the patients who underwent the trimodal program only after surgery ( rehabilitation/control group ) . Functional capacity was assessed with the six-minute walk test ( 6MWT ) , a measure of the distance walked over six minutes ( 6MWD ) . A significant functional improvement was defined as an increase in 6MWD from baseline by at least 19 m. Changes in 6MWD before surgery , at four and eight weeks were compared between groups . Results : Of the total study population , 113 subjects ( 61 % ) underwent prehabilitation . Changes in 6MWD in the prehabilitation group were higher compared to the rehabilitation/control group during the preoperative period { 30.0 [ st and ard deviation ( SD ) 46.7 ] m vs. −5.8 ( SD 40.1 ) m , p < 0.001 } , at four weeks [ −11.2 ( SD 72 ) m vs. −72.5 ( SD 129 ) m , p < 0.01 ] , and at eight weeks [ 17.0 ( SD 84.0 ) m vs. −8.8 ( SD 74.0 ) m , p = 0.047 ] . The proportion of subjects experiencing a significant preoperative improvement in physical fitness was higher in those patients who underwent prehabilitation [ 68 ( 60 % ) vs. 15 ( 21 % ) , p < 0.001 ] . Conclusion : In large secondary analysis , multimodal prehabilitation result ed in greater improvement in walking capacity throughout the whole perioperative period when compared to rehabilitation started after surgery Objectives This study aim ed to investigate the effect of Liuzijue exercise combined with elastic b and resistance exercise on patients with chronic obstructive pulmonary disease ( COPD ) to provide a convenient , safe , and cost-effective exercise . Methods Subjects were r and omly divided into the control group ( CG ) , the Liuzijue exercise group ( LG ) , and the Liuzijue exercise combined with elastic b and resistance exercise group ( LEG ) , with 20 patients in each group . The LG performed Liuzijue exercise six times a week ( two exercise sessions in the hospital and four exercise sessions at home ) . The LEG includes Liuzijue exercise similar to the LG and elastic b and resistance exercise three times a week , with elastic b and exercise implemented after Liuzijue exercise .  Spirometry , 6-minute walking test ( 6MWT ) , 30-second sit-to-st and test ( 30 s SST ) , h and grip strength test , and St. George 's Respiratory Question naire ( SGRQ ) were performed at baseline and at the end of intervention . Results After six-month intervention , the forced expiratory volume in 1 second ( % predicted ) , 6-minute walking distance ( 6MWD ) , 6MWD%pred , 30 s SST , and SGRQ were significantly improved in the intervention groups ( p < 0.01 ) and h and grip strength was increased significantly in the LG and LEG ( p = 0.03 and p = 0.001 , respectively ) . Furthermore , improvements in 6MWD and SGRQ were distinguished in the intervention groups compared with the CG ( p < 0.01 ) . No difference was significant in all of the outcomes between the LG and the LEG . Conclusions The intervention program of Liuzijue exercise combined with elastic b and resistance exercise and Liuzijue exercise only has beneficial effects on COPD patients especially in the aspect of exercise capacity and quality of life OBJECTIVE We used outdoor walking distance measured during 40 minutes as " real-life " outdoor walking capacity in 49 patients with intermittent claudication ( IC ) . The outdoor walking distance was measured by a global positioning system application for a smartphone . The relationships of self-reported maximum walking distance ( SR-MWD ) , the MWD on a grade d treadmill test , and the 6-minute maximum walk distance ( 6MWD ) vs outdoors walking capacity were investigated . Also studied were the associations of SR-MWD , MWD , and 6MWD with health-related quality of life assessed with the disease-specific instrument the  Vascular Quality of Life Question naire ( VascuQoL ) . METHODS In this prospect i ve observational cohort study , 49 IC patients underwent an  outdoor walking capacity test for 40 minutes , and MWD and 6MWD were measured . SR-MWD was recorded , and all subjects completed the VascuQoL question naire . Associations between the different walk estimates and outdoor walking capacity and health-related quality of life were investigated by correlation analysis ( Spearman ρ ) . RESULTS Outdoor walking distance during 40 minutes was a median 2495 m ( range , 1110 - 3300 m ) . SR-MWD correlated moderately and MWD correlated strongly to outdoor walking capacity ( r = 0.56 and r = 0.65 ; P < .001 , respectively ) . The 6MWD test showed the largest correlation to the outdoor walking capacity ( r = 0.78 ; P < .001 ) . The 6MWD was the only test that showed correlations with the VascuQoL sum score ( r = 0.53 ; P < .01 ) and all of the domain scores , whereas SR-MWD and MWD showed weak correlations to the VascuQoL. CONCLUSIONS The distance walked during the 6-minute walk test is closely correlated to outdoor walking capacity and health-related quality of life in IC patients . Our data support the use of 6MWD for routine clinical evaluation of walking capacity in IC patients 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 Pulmonary rehabilitation ( PR ) is an evidence -based intervention in patients with chronic obstructive pulmonary disease ( COPD ) which improves the exercise capacity and quality of life ( QoL ) . METHODS We studied 60 patients after an episode of acute exacerbation of COPD ( AE COPD ) . They were r and omised to receive conventional treatment without pulmonary rehabilitation ( CTWPR ) ( n=30 ) or , st and ard treatment plus a 12-week post-exacerbation pulmonary rehabilitation ( PEPR ) programme in addition . Assessment of exercise capacity by six minute walk test ( 6MWT ) and QoL measured by St George 's Respiratory Question naire ( SGRQ ) were carried out initially and at the end of three months . RESULTS The baseline characteristics of both the groups were found to be similar . There was a statistically significant increase in the six minute walk distance ( 6MWD ) ( increase by 37.9 meters , p < 0.001 ) and a significant decline in the total SGRQ score ( by 3.8 units p < 0.001 ) in the PEPR group compared to CTWPR group . CONCLUSION Early pulmonary rehabilitation in patients with an AE COPD has significant benefits on the QoL and exercise capacity Objective : This method ologic study investigates if the 2-minute walk test ( 2MWT ) can be a valid alternative to the 6-minute walk test ( 6MWT ) to describe walking capability in patients with neuromuscular diseases . Methods : Patients ( n = 115 ) with different neuromuscular diseases were invited to participate on 2 test days , each consisting of 1 2MWT and 1 6MWT separated by a minimum 30-minute period of rest . The order of the walk tests was r and omly assigned via sealed envelopes . A group of 38 healthy controls completed 1 6MWT . Results : The mean walking distance for the 2MWT was 142.8 meters and for the 6MWT 405.3 meters . The distance walked in the 2MWT  was highly correlated to the distance walked in the 6MWT ( r = 0.99 , p < 0.001 ) . There was a significant decrease in walking speed from the first to last minute in the 6MWT , both among patients and healthy controls , which was not evident in the 2MWT . Results were consistent across diagnoses and levels of disease severity . Conclusion : The 2MWT is a potential alternative to the 6MWT to describe walking capability among patients with neuromuscular diseases during clinical trials OBJECTIVES To determine whether a practice effect occurs across 2 trials of the six-minute walk test ( 6MWT ) among community-dwelling people within 1 year poststroke and to identify characteristics distinguishing people who show a practice effect from those who do not . DESIGN Secondary analysis of scores on 2 trials of the 6MWT administered approximately 30 minutes apart at baseline in a r and omized controlled trial . SETTING General community . PARTICIPANTS People ( N=91 ) living in the community with a residual walking deficit within the first year of a first or recurrent stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURE Distance walked on the 6MWT .  RESULTS Mean 6MWT scores + /- SD for trials 1 and 2 were 196+/-119 m and 197+/-126 m , respectively ( n=83 ) . The mean difference in 6MWT performance across trials was 0+/-35 m ( 95 % confidence interval [ CI ] , -7 to 8 m ) . The Pearson correlation coefficient between 6MWT distances was .96 ( P<.001 ) , and the intraclass correlation coefficient was .98 ( 95 % CI , .97-.99 ) . The Bl and -Altman plot showed no clear pattern . Participants whose improvement was equal to or greater than the minimal detectable change of 29 m between trials ( 14 % ) did not significantly differ from those in the rest of the study sample ; however , they tended to be younger ( P=.05 ) and more likely to have a mild or moderate gait deficit ( P=.06 ) . CONCLUSIONS Findings do not support a practice effect across 2 trials of the 6MWT in individuals within 1 year poststroke . Thus , a practice walk does not appear necessary . Further research is recommended to evaluate the influence of young age , acute stroke , and mild-to-moderate gait deficit on practice effects 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 incremental shuttle walking test ( SWT ) has recently been proposed as a more valid and reproducible alternative to the conventional 6-min walking test ( 6MWT ) in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease ( COPD ) . Objective : To compare the cardiorespiratory performance obtained during two sessions of SWT with that obtained during two sessions of 6MWT . Methods : We examined 18 patients ( forced expiratory volume in 1 s : 48 ± 14 % ) recovering from an acute exacerbation of COPD that had required hospitalization . In the same afternoon , each patient performed two SWT and two 6MWT , with an interval of at least 30 min between each test ; the sequence of the tests was r and omized . Results : Mean walking distance was greater in the second SWT test than in the first SWT . The changes from baseline in systolic blood pressure , heart rate , respiratory rate , oxygen saturation and dyspnea Borg index at the end of the test were similar between the two 6MWT and the two SWT . There was a highly significant correlation between walking distances measured during SWT and during 6MWT ( ρ : 0.85 , p < 0.0005 ) . Neither SWT nor 6MWT correlated with functional data of COPD . Conclusions : SWT , though being considered to be closer to a submaximal exercise test than 6MWT , does not induce a greater cardiorespiratory performance  than 6MWT in patients recovering from acute exacerbation of COPD
The 6MWD is usually negatively associated with a higher Body Mass Index , increased cigarette consumption , higher doses of antipsychotic medication and lower physical self-worth in individuals with schizophrenia .
The 6MWT demonstrates high reliability .
IMPLICATION S FOR REHABILITATION The Six-Minute Walk Test reliably assesses the functional exercise capacity in patients with schizophrenia .
The impact of therapeutic interventions on patients , as measured by the 6MWT , can not be confirmed .
PURPOSE The six-minute walk test ( 6MWT ) is a sub-maximal exercise test measuring the distance that a patient can walk quickly in a period of 6 minutes ( 6MWD ) .
The objectives of this systematic review are to evaluate the 6MWT 's suitability for measuring the impact of an intervention , to compare the 6MWD walked by patients with schizophrenia with data for the general population or matched controls , to identify the determinants of 6MWD and to examine the measurement properties and quality procedures of the 6MWT .