Which field walking test should be used to assess functional exercise capacity in lung cancer? an observational study Benefits of pulmonary rehabilitation in pediatric asthma 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 endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease. Relation of Longitudinal Changes in Quality of Life Assessments to Changes in Functional Capacity in Patients With Heart Failure With and Without Anemia. Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.] Impact of neuromuscular electrical stimulation on functional capacity of patients with chronic kidney disease on hemodialysis. Reproducibility of the 6-Minute Walk Test for Ambulatory Oxygen Prescription Repeat six-minute walk tests in patients with chronic heart failure: are they clinically necessary?
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 INTRODUCTION There are limited studies evaluating the role of pulmonary rehabilitation ( PR ) in pediatric asthma . METHODS A retrospective chart review was performed of all pediatric patients with a diagnosis of asthma enrolled in PR . Demographics , medications , and clinical records were review ed . In addition , PFTs , 6-min walk test ( 6MWT ) , and patient/parent symptom and quality of life surveys before and after PR were evaluated . RESULTS A total of 38 patients were enrolled in PR ; 18 ( 47 % ) female and 20 ( 53 % ) male . Mean participant age was 11.33 ± 3.37 ( range 4 - 19 ) years . Twenty-two ( 58 % ) were Caucasian and nine ( 24 % ) African American . Chart review was limited by incomplete data sets for many participants . Following PR , significant improvement was noted in mean 6MWT distance ( 1541 vs 1616 feet , P = 0.05 ) and FEV1 ( 89.9 % of predicted versus 96.4 % , P = 0.04 ) . Survey instruments demonstrated improvement in several clinical factors , however , there was no significant change in weight following PR despite scheduled cardiovascular exercise and dietary counseling . CONCLUSIONS Structured PR for pediatric patients with asthma can improve 6MWT distance and FEV1 as well as subjective measures of SOB and QOL , suggesting a role for PR in the chronic management of pediatric asthma . Further prospect i ve investigation is needed to determine if PR has positive effects on other clinical parameters of asthma control and its overall impact on childhood obesity 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 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 OBJECTIVES To investigate the feasibility of an outdoor 6-minute walk test ( 6MWT ) as a measure of functional status among individuals with chronic obstructive pulmonary disease ( COPD ) , and to examine the relationship between performance on an indoor and an outdoor 6MWT . DESIGN An experimental , repeated- measures crossover design . Subjects were studied on 2 separate days in the same week . Two 6MWTs-one indoors and the other outdoors-were performed on each study day , with a rest in between . The test order was r and omly selected on the first day and reversed on the second day . Outdoor tests were performed on days of moderate weather conditions ( mean temperature + /- st and ard deviation , 21 degrees + /-3 degrees C ; mean wind speed , 15+/-7 km/h ; no precipitation ) and on a flat surface ( sidewalk ) . SETTING  Outpatient rehabilitation program in Ontario . PARTICIPANTS Eighteen subjects with COPD ( 10 men , 8 women ; age , 70+/-8y ) , 5 using supplemental oxygen at rest ( forced expiratory volume in 1s , 1.0+/-0.3L ; 42%+/-8 % of predicted ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Distance walked in 6 minutes ( in meters ) , duration of rest ( in seconds ) , and change in rate of perceived dyspnea . RESULTS There was no significant effect of setting ( indoors vs outdoors ) on distance walked ( 394+/-86 m vs 398+/-84 m , P=0.4 ) , duration of rest ( 13+/-28s vs 9+/-20s , P=0.4 ) , or change in rate of perceived dyspnea ( 2.3+/-1.7 vs 2.3+/-2.0 , P=0.8 ) . Testing day had no significant effect on walk test performance ( all P>0.1 ) . CONCLUSIONS The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors Clinical status in heart failure is conventionally assessed by the physician 's evaluation , patients ' own perception of their symptoms , quality of life ( QoL ) tools , and a measure of functional capacity . These aspects can be measured with tools such as the New York Heart Association functional class , QoL tools such as the EuropeanQoL-5 dimension , the Kansas City Cardiomyopathy Question naire , patient global assessment ( PGA ) , and by 6-minute walk test ( 6MWT ) , respectively . The ferric carboxymaltose in patients with heart failure and iron deficiency ( FAIR-HF ) trial demonstrated that treatment with intravenous ferric carboxymaltose in iron-deficient patients with symptomatic heart failure with reduced left ventricular function , significantly improved all 5 outcome measures . This analysis assessed the correlations between the longitudinal changes in the measures of clinical status , as measured by QoL tools and the changes in the measures of functional capacity as measured by the 6MWT . This analysis used the data base from the FAIR-HF trial , which r and omized 459 patients with chronic heart failure ( reduced left ventricular ejection fraction ) and iron deficiency , with or without anemia to ferrous carboxymaltose or placebo .  The degree of correlation between QoL tools and the 6MWT was assessed at 4 , 12 , and 24 weeks . The data demonstrate highly significant correlations between QoL and functional capacity , as measured by the 6MWT , at all time points ( p < 0.001 ) . Changes in PGA , Kansas City Cardiomyopathy Question naire , and EuroQoL-5D correlated increasingly over time with changes in 6MWT performance . Interestingly , the strongest correlation at 24 weeks is for the PGA , which is a simple numerical scale ( r = -0.57 , p < 0.001 ) . This analysis provides evidence that QoL assessment show a significant correlation with functional capacity , as measured by the 6MWT . The strength of these correlations increased over time Background : The responsiveness of the endurance shuttle walk to functional changes following bronchodilation has recently been reported . The current literature suggests that the 6 min walking test ( 6MWT ) is less responsive to bronchodilation than the endurance shuttle walk . Aim : To compare bronchodilator-induced changes in exercise performance with the 6MWT and the endurance shuttle walk . Methods : In a r and omised , double-blind , placebo-controlled , crossover trial , 14 patients with chronic obstructive pulmonary disease ( forced expiratory volume in 1 s ( FEV1 ) 50 (8)% predicted ) completed two 6MWTs and two endurance shuttle walks , each preceded by nebulised placebo or 500 μg ipratropium bromide .  Cardiorespiratory parameters were monitored during each walking test with a portable telemetric gas analyser . Quadriceps twitch force was measured by magnetic stimulation of the femoral nerve before and after each walking test . Results : The 6 min walking distance did not change significantly after bronchodilation despite a significant increase in FEV1 of 0.18 ( 0.09 ) litres ( p<0.001 ) . A similar change in FEV1 ( 0.18 ( 0.12 ) litres , p<0.001 ) was associated with a significant improvement in the distance walked on the endurance shuttle walk ( Δdistance ipratropium bromide – placebo = 144 ( 219 ) m , p = 0.03 ) . Quadriceps muscle fatigue was infrequent ( < 15 % of patients ) after both walking tests . Conclusion : The endurance shuttle walk is more responsive than the 6MWT for detecting changes in exercise performance following bronchodilation 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 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 Introduction Literature shows that patients undergoing hemodialysis present poor physical conditioning and low tolerance to exercise . They may also suffer from respiratory dysfunctions . The purpose of this study was to evaluate the effects of neuromuscular electrical stimulation on pulmonary function and functional capacity of patients with chronic kidney disease on hemodialysis . Methods Forty adult patients with chronic kidney disease on hemodialysis were prospect ively studied and r and omized into two groups ( control n = 20 and treatment n = 20 ) . The treatment group underwent bilateral femoral quadriceps muscles electrical stimulation for 30 minutes during hemodialysis , three times per week , for two months . The patients were evaluated by pulmonary function test , maximum respiratory pressures , maximum one-repetition test , and six-minute walk test ( 6MWT ) , before and after the treatment protocol . Results The treatment group presented increased maximum inspiratory ( MIP ) ( p = 0.02 ) and expiratory pressures ( MEP ) ( p < 0.0001 ) , muscular strength in maximum one-repetition test ( p < 0.001 ) , and distance covered in the 6MWT ( p = 0.03 ) , and decreased systolic blood pressure ( p < 0.001 ) and respiratory frequency ( p < 0.001 ) when compared with the control group . Conclusion Electrical neuromuscular stimulation had a positive impact on pulmonary function and functional capacity , leading to better physical performance in patients on hemodialysis 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 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
Limited evidence to strong evidence was found for reliability in various chronic conditions .
Little evidence was available for responsiveness and measurement error .
Studies showed large variability in test procedures despite existing guidelines for the performance of the 6MWT .
Evidence for measurement properties of the 6MWT  varies largely among chronic pediatric conditions .
BACKGROUND The Six-Minute Walk Test ( 6MWT ) is increasingly being used as a functional outcome measure for chronic pediatric conditions .
Knowledge about its measurement properties is needed to determine whether it is an appropriate test to use .
PURPOSE The purpose of this study was to systematic ally review all published clinimetric studies on the 6MWT in chronic pediatric conditions .