Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: a comparison with cardiopulmonary exercise testing. Relation of Longitudinal Changes in Quality of Life Assessments to Changes in Functional Capacity in Patients With Heart Failure With and Without Anemia. Repeat six-minute walk tests in patients with chronic heart failure: are they clinically necessary? 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Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction A group-based exercise program did not improve physical activity in patients with chronic heart failure and comorbidity: a randomized controlled trial. [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.] A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFÉ-II Study) Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure. 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The Effect of Biofeedback on Function in Patients with Heart Failure Effects of aerobic exercise training on variability and heart rate kinetic during submaximal exercise after gastric bypass surgery – a randomized controlled trial Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency† Lack of Specificity of the 6-Minute Walk Test as an Outcome Measure for Patients with Systemic Sclerosis 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. 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Effect of ivabradine in patients with heart failure with preserved ejection fraction: the EDIFY randomized placebo‐controlled trial Exercise: a “new drug” for elderly patients with chronic heart failure Eccentric training in chronic heart failure: feasibility and functional effects. Results of a comparative study. Testosterone therapy in women with chronic heart failure: a pilot double-blind, randomized, placebo-controlled study. Pentraxin-3 Predicts Functional Recovery and 1-Year Major Adverse Cardiovascular Events After Rehabilitation of Cardiac Surgery Patients Effects of functional electrical stimulation on quality of life and emotional stress in patients with chronic heart failure secondary to ischaemic or idiopathic dilated cardiomyopathy: a randomised, placebo-controlled trial. Regression equations to predict 6-minute walk distance in middle-aged and elderly adults Objective Assessment of the Cardiorespiratory Function of Adolescents With Idiopathic Scoliosis Through the Six-Minute Walk Test Xanthine-oxidase inhibitors and statins in chronic heart failure: effects on vascular and functional parameters. A randomized trial of two home-based exercise programmes to improve functional walking post-stroke Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis. Effects of darbepoetin-alpha on quality of life and emotional stress in anemic patients with chronic heart failure Preliminary report of the 6-minute walk test as a predictor of radiation-induced pulmonary toxicity. No effect of group-based aerobic interval training on N-terminal pro- B-type natriuretic peptide levels in patients with chronic heart failure Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. A randomized study of the effects of exercise training on patients with atrial fibrillation. Randomized clinical trial of an integrated self-care intervention for persons with heart failure and diabetes: quality of life and physical functioning outcomes. The effects of helium-hyperoxia on 6-min walking distance in COPD: a randomized, controlled trial. Heart rate recovery after 6-min walk test predicts survival in patients with idiopathic pulmonary fibrosis. Effect of Bariatric Surgery on the Six-Minute Walk Test in Severe Uncomplicated Obesity Impaired 6-min walk test, heart rate recovery and cardiac function post pulmonary embolism in long-term survivors. Aerobic exercise training improves autonomic nervous control in patients with COPD. Relationship between field walking tests and incremental cycle ergometry in COPD. The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen
AIMS Heart rate recovery ( HRR ) appears to be a robust prognostic marker in heart failure ( HF ) . When using the 6 min walk test ( 6MWT ) in HF , distance ambulated is generally the reference prognostic variable . We hypothesized that HRR after the 6MWT would be a better prognostic measure than distance ambulated . METHODS AND RESULTS A 6MWT and cardiopulmonary exercise testing ( CPX ) were r and omly performed in 258 HF patients [ 216 HF with reduced EF ( HFrEF ) and 42 HF preserved EF ( HFpEF ) ] , after which HRR was measured . HRR was defined as the difference between heart rate at peak exercise and 1 min following test termination . Patients were assessed for major cardiac events during a mean follow-up period of 22.8 ± 22.1 months . There were 50 major cardiac events during the tracking period . Univariate Cox regression analysis results identified HRR after both the 6MWT and CPX as a significant ( P < 0.001 ) predictor of adverse events . Multivariate Cox regression analysis revealed that dichotomized HRR after the 6MWT and CPX was the strongest predictor of survival ( χ(2 ) 61.1 and 53.8 , respectively ; P < 0.001 ) , with LVEF ( residual χ(2 ) 6.1 , P < 0.05 ) adding significant prognostic value to the 6MWT model and ventilatory efficiency ( the VE/VCO2 slope ) ( residual χ(2 ) 6.6 , P < 0 .05 ) adding significant prognostic value to the CPX model . CONCLUSIONS HRR after the 6MWT is a powerful prognosticator that performs similarly to HRR after maximal exercise . If confirmed in subsequent studies , 6MWT HRR should replace 6MWT distance as the reference criterion 6MWT measure to consider when grading cardiovascular risk in HF patients 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 : 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 —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 Abstract Aims Iron deficiency is highly prevalent in Southeast Asians with heart failure ( HF ) and associated with worse outcomes . This trial aim ed to assess the effect of intravenous iron in Southeast Asians hospitalized with decompensated HF . Methods and results Fifty patients hospitalized for acute decompensated HF , regardless of ejection fraction , with iron deficiency ( defined as serum ferritin < 300 ng/mL if transferrin saturation is < 20 % ) were r and omized to receive either one dose of intravenous ferric carboxymaltose ( FCM ) 1000 mg or placebo ( 0.9 % saline ) following HF stabilization and before discharge in two Singapore tertiary centres . The primary endpoint was difference in 6‐min walk test ( 6MWT ) distance over 12 weeks , while secondary endpoints were quality of life assessed using vali date d Kansas City Cardiomyopathy Question naire ( KCCQ ) and Visual Analogue Scale ( VAS ) . Improvement in 6MWT distance at Week 12 was observed in both FCM and placebo groups ( from 252 ± 123 to 334 ± 128 m and from 243 ± 67 to 301 ± 83 m , respectively ) . Unadjusted analysis showed 6MWT distance for FCM exceeded that for placebo , but adjustment for baseline covariates and time attenuated this effect { adjusted mean difference between groups : 0.88 m [ 95 % confidence interval ( CI ) −30.2 to 32.0 , P = 0.956]}. KCCQ overall summary and VAS were similar in both groups [ adjusted mean difference : KCCQ −1.48 ( 95 % CI −8.27 to 5.31 , P = 0.670 ) and VAS 0.26 ( 95 % CI −0.33 to 0.86 , P =  0.386  ) ] . FCM  was well tolerated with no serious treatment‐related adverse events . Conclusions Intravenous FCM administered pre‐discharge in Southeast Asians hospitalized with decompensated HF is clinical ly feasible . Changes in 6MWT distance should be measured beyond Week 12 to account for background therapy effects Background The SENIORS trial demonstrated that nebivolol has beneficial effects in patients with heart failure . However , the role of beta-blocker therapy in patients with heart failure and preserved left ventricular ejection fraction ( HFPEF ) is still unsettled . Objective To assess the long-term effects of administration of nebivolol , compared to placebo , on the clinical symptoms , exercise capacity and parameters of left ventricular ( LV ) function in patients with HFPEF . Methods The Effect of Long-term Administration of Nebivolol on clinical symptoms , exercise capacity and left ventricular function in patients with Diastolic Dysfunction ( EL AND D ) study is a prospect i ve multicenter European trial in 120 patients with HFPEF r and omised to nebivolol or placebo .  HFPEF is defined as symptoms or signs of heart failure , a LV ejection fraction > 45 % and evidence of diastolic LV dysfunction by Doppler echocardiography . Procedures include a baseline clinical examination , 6-min walk test ( 6MWT ) , electrocardiography , Doppler echocardiography and Minnesota QoL question naire . Nebivolol or placebo is started at 2.5 mg/day and gradually uptitrated to 10 mg/day . After initiation of the study , patients are assessed at 1 , 2 , 5 and 6 weeks ( titration phase ) and at weeks 12 and 26 . The primary endpoint is the change from baseline in the 6MWT distance with nebivolol versus placebo . Sample size calculations are based on an anticipated 15 % difference ( 70 m ) in the 6MWT distance between nebivolol and placebo-treated patients . This study will allow the collection of data regarding the possible clinical benefits and the effects on LV function of nebivolol administration in patients with HFPEF Background : The 6-min walk test ( 6MWT ) is increasingly used as an outcome measure in interstitial lung disease ( ILD ) . Aim : To evaluate the usefulness of the 6MWT in a cohort of patients with ILD secondary to systemic sclerosis ( SSc ) and to correlate with established physiological parameters . Methods : 163 patients with SSc-ILD were recruited for a multicentre , r and omised , double-blind clinical trial . Available data at protocol screening included repeated 6MWTs , pulmonary function testing with diffusing capacity , Doppler echocardiography and high-resolution computed tomography of the thorax . Borg Dyspnoea Index was evaluated before and after 6MWT . Results : Mean ( st and ard deviation ( SD ) ) distance walked during walk test 1 was 396.6 ( 84.55 ) m compared with 399.5 ( 86.28 ) m at walk test 2 . The within-subject , intertest correlation as determined by Pearson ’s correlation coefficient testing was 0.95 ( p<0.001 ) . However , only weak correlations of 6MWT with percentage forced vital capacity and the Borg Dyspnoea Index were observed , and no correlation was observed with percentage diffusing capacity . Conclusion : These data confirm the high reproducibility of the  6MWT in patients with SSc-ILD and therefore the validity of the test in this cohort . The lack of correlation of 6MWT with st and ard physiological parameters of ILD suggests a multifactorial basis for limited exercise capacity in patients with SSc and calls into question the utility of the 6MWT as a measure of outcome in future studies on SSc-ILD BACKGROUND The goal of the 6-min walk test ( 6MWT ) is to enable patients to walk " as far as possible " as a measure of their functional ability . The impact of the specific walk instructions on patient 6MWT performance is unknown . METHODS Patients with pulmonary arterial hypertension ( PAH ) , idiopathic pulmonary fibrosis ( IPF ) , and other forms of interstitial lung disease ( ILD ) were recruited to perform four identical 6MWTs with one differing instructional phrase . The st and ard instruction to walk " as far as possible " was substituted in r and om order with " as fast as possible , " " at your normal pace , " or " at a leisurely pace . " RESULTS Twenty-four patients ( 10 with PAH , eight with IPF , six with other ILD ) were enrolled and completed all four 6MWTs . Patients attained the greatest distance with the fast instruction , exceeding the st and ard instruction distance by a mean of 52.7 m ( P < .001 ) . The mean difference between the fast and st and ard walks was 41.5 m in the PAH group , 66.5 m in the IPF group , and 53 m in the other ILD group . CONCLUSIONS Patients do not walk as far as they are able with the st and ard American Thoracic Society instruction for 6MWT . Changing the wording from " far " to " fast " may facilitate a better effort and greater distance during the test . It is possible that this modified 6MWT instruction may result in improved accuracy and reproducibility , thereby enhancing its clinical and research trial usefulness STUDY OBJECTIVES Continuous positive airway pressure ( CPAP ) has been used to improve cardiopulmonary function and reduce pulmonary edema symptoms in patients with congestive heart failure ( CHF ) . The objective of this study was to evaluate the efficacy of CPAP therapy on pulmonary function and exercise tolerance in patients with CHF . DESIGN Prospect i ve blind r and omized clinical study . PARTICIPANTS Twenty-four patients with class II or III CHF and dilated cardiomyopathy were r and omly assigned to 30 min of CPAP therapy and respiratory exercises ( CPAP group ) or respiratory exercise only ( control group ) once a day for 14 days . MEASUREMENTS AND RESULTS Evaluation of pulmonary function was performed measuring FEV1 and FVC . Exercise tolerance was assessed measuring the distance walked during the 6-min walking test ( 6MWT ) . These parameters were measured before treatment and 4 days , 9 days , and 14 days later . CPAP therapy caused a progressive increase ( p < 0.05 ) in both FVC ( maximum of 16 % after 9 days ) and FEV1 ( maximum of 14 % after 14 days ) compared to basal values , without significant changes in the control group . The 6MWT showed a progressive improvement in the distance walked in the CPAP group , reaching approximately 28 % above the basal values in the CPAP group and without significant changes in the control group . CONCLUSIONS These data show that the use of CPAP therapy for 2 weeks on a daily basis is able to enhance pulmonary function and consequently improve the tolerance to physical activities in patients with CHF . The clinical implication of this finding is that CPAP therapy could potentially be used as an adjunct to the treatment of CHF patients OBJECTIVES To investigate cardiorespiratory and dyspnea responses to incremental and self-paced exercise tests in patients with COPD . DESIGN A prospect i ve within-subject design was used . PATIENTS Twenty stable subjects ( 15 men ) , with a mean ( + /- SD ) age of 64.0 + /- 7.5 years and moderate-to-severe COPD ( ie , mean FEV(1 ) , 0.8 + /- 0.3 L and 28.9 + /- 7.9 % predicted ) were studied . METHODS Each subject completed a 6-min walk test ( 6MWT ) , an incremental shuttle walking test ( ISWT ) , and a cycle ergometer test ( CET ) , within a 2-week period . The tests were performed at least 24 h apart . St and ardized encouragement was utilized in each test with the aim of maximizing performance . Heart rate ( HR ) and dyspnea were measured each minute throughout the tests , and pulse oximetric saturation ( Spo(2 ) ) was measured before and immediately after each test . The distances walked in the 6MWT and ISWT were compared to peak oxygen uptake ( Vo(2 ) ) values from the CET . RESULTS HR increased linearly with increasing workload during the CET and ISWT , but increased alinearly with a disproportionate increase early in the 6MWT . In contrast , dyspnea scores increased linearly during the 6MWT , but increased alinearly with a disproportionate increase late during the CET and ISWT . Peak HR and dyspnea were not significantly different between tests . Spo(2 ) was significantly lower at the end of both walking tests compared to that at the end of the CET ( p < 0.001 ) . The distance walked in both the ISWT and 6MWT were related to peak Vo(2 ) values on the CET ( for both tests , r = 0.73 ; p < 0.001 ) . CONCLUSIONS The patterns of response in HR and dyspnea seen during the 6MWT suggest that patients with COPD titrate exertion against dyspnea to achieve a peak tolerable intensity . This strategy is not possible in an externally paced ISWT or CET . However , it is a limited strategy , with performance converging at higher workloads . Similar peak exercise responses were achieved in the 6MWT , ISWT , and CET . Greater oxygen desaturation was observed during the field walking tests , suggesting that both the ISWT and 6MWT are more sensitive than the CET in detecting exercise-induced hypoxemia and in assessing ambulatory oxygen therapy needs Exercise capacity and quality of life ( QOL ) are important outcome predictors in patients with systolic heart failure ( HF ) , independent of left ventricular ( LV ) ejection fraction ( LVEF ) . LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association ( NYHA ) classification ≥II . We hypothesized that the currently used index of diastolic function E/e ' is associated with exercise capacity and QOL , even in optimally treated HF patients with reduced LVEF . This prospect i ve study included 44 consecutive patients aged 55±11 years ( 27 men and 17 women ) , with LVEF<0.50 and NYHA functional class I-III , receiving optimal pharmacological treatment and in a stable clinical condition , as shown by the absence of dyspnea exacerbation for at least 3 months . All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Question naire , followed by the 6-min walk test ( 6MWT ) . In a multivariable model with 6MWT as the dependent variable , age and E/e ' explained 27 % of the walked distance in 6MWT ( P=0.002 ; multivariate regression analysis ) . No association was found between walk distance and LVEF or mitral annulus systolic velocity . Only normalized left atrium volume , a sensitive index of diastolic function , was associated with decreased QOL . Despite the small number of patients included , this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF OBJECTIVE To investigate how group-based exercise affects the levels of physical activity , physical fitness and health- related quality of life ( HRQoL ) in patients with chronic heart failure and comorbidities . DESIGN R and omized controlled trial . PATIENTS A total of 48 patients ( 10 women , 38 men ) , mean age 71 years ( st and ard deviation 8 years ) , ejection fraction 27 % ( st and ard deviation 10 % ) , and New York Heart Association functional class II-III . METHODS A bicycle test , 6-min walk test ( 6MWT ) and muscle endurance tests were performed . Physical activity was assessed with a pedometer and the International Physical Activity Question naire ( IPAQ ) , HRQoL was evaluated with the Short Form-36 ( SF-36 ) . Patients were r and omized to control or intervention groups . Intervention consisted of an individually design ed group-based exercise programme twice a week , for a period of 3 months . Subjects in the control group were asked to continue with their usual lives . RESULTS A total of 42 patients completed the study , and 6 dropped-out .  Steps/day did not increase significantly after intervention ( p = 0.351 ) , but IPAQ score did ( p = 0.008 ) . Exercise tolerance ( p = 0.001 ) , 6MWT ( p = 0.014 ) , shoulder abduction ( p = 0.028 ) , heel lift ( p < 0.0001 ) and HRQoL ( p = 0.018 ) improved significantly in the intervention group compared with the control group . CONCLUSION Group-based exercise did not improve the level of physical activity in patients with chronic heart failure and comorbidity ; however , physical fitness and HRQoL were significantly improved 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 Background : Atrial fibrillation ( AF ) and heart failure ( HF ) often coexist . The aim was to investigate whether restoring sinus rhythm ( SR ) could improve cardiac function , symptoms , exercise capacity and quality of life ( QoL ) in patients with chronic heart failure . Methods : Patients with HF and persistent AF receiving guideline -recommended treatments , including anticoagulants , were eligible for the study . Patients were r and omised to either rhythm ( treated with amiodarone for at least 3 months prior to attempting biphasic external cardioversion and continued amiodarone long-term if SR was restored ) or rate control . Anticoagulants were continued throughout the study regardless of rhythm , unless contraindications developed . Both groups were treated with beta blockers and /or digoxin to reduce the heart rate to < 80 bpm at rest and < 110 bpm after walking . Symptoms , walk distance ( 6-minute corridor walk test , 6MWT ) , QoL and cardiac function were assessed at baseline and 1 year . Results : 61 patients with HF and persistent AF ( median duration 14 months ( IQR 5 to 32 ) ) were r and omly assigned to a rate or rhythm control strategy . Of patients assigned to rhythm control ( n = 30 ) , 66 % were in SR at 1 year , and 90 % of those assigned to rate control ( n = 31 ) achieved the heart rate target . At 1 year , NYHA class ( p = 0.424 ) and 6MWT distance ( p = 0.342 ) were similar between groups but patients assigned to rhythm control had improved LV function ( p = 0.014 ) , NT-proBNP concentration ( p = 0.046 ) and QoL ( p = 0.019 ) compared with those assigned to rate control . Greatest improvement was seen in patients in whom SR was maintained . Conclusion : Restoring SR in patients with AF and heart failure may improve QoL and LV function when compared with a strategy of rate control 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 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 BACKGROUND Providing flexible models and a variety of exercise options are fundamental to supporting long-term exercise participation for patients with heart failure ( HF ) . The aim of this pilot study was to determine the feasibility and efficacy of aquatic exercise training during a maintenance phase for a clinical heart failure population . METHODS In this 2 x 2 crossover design trial , individuals who had previously completed HF rehabilitation were r and omised into either a l and -based or aquatic training program once per week for six weeks , after which time they changed to the alternate exercise training protocol for an additional six weeks . Six-minute walk test ( 6MWT ) , grip strength , walk speed , and measures of balance were compared for the two training protocol s. RESULTS Fifty-one participants ( 43 males , mean age 69.2 yrs ) contributed data for the analysis . Both groups maintained function during the follow-up period , however improvements in 6MWT were greater in the l and -based training group ( 95 % CI : 0.7 , 22.5 ; p=0.038 ) , by a mean difference of 10.8 metres . No significant difference was observed for other parameters when the two training protocol s were compared . CONCLUSION Attending an aquatic exercise program once per week is feasible for patients with stable HF and may provide a suitable option to maintain functional performance in select patients Decreased HRV has been consistently associated with increased cardiac mortality and morbidity in HF patients . The aim of this study is to determine if a 6-week course of heart rate variability ( HRV ) biofeedback and breathing retraining could increase exercise tolerance , HRV , and quality of life in patients with New York Heart Association Class I-III heart failure ( HF ) . Participants ( N = 29 ) were r and omly assigned to either the treatment group consisting of six sessions of breathing retraining , HRV biofeedback and daily practice , or the comparison group consisting of six sessions of quasi-false alpha-theta biofeedback and daily practice . Exercise tolerance , measured by the 6-min walk test ( 6MWT ) , HRV , measured by the st and ard deviation of normal of normal beats ( SDNN ) , and quality of life , measured by the Minnesota Living with Congestive Heart Failure Question naire , were measured baseline ( week 0 ) , post ( week 6 ) , and follow-up ( week 18 ) . Cardiorespiratory biofeedback significantly increased exercise tolerance ( p = .05 ) for the treatment group in the high ( ≥31 % ) left ventricular ejection fraction ( LVEF ) category between baseline and follow-up . Neither a significant difference in SDNN ( p = .09 ) nor quality of life ( p = .08 ) , was found between baseline and follow-up . A combination of HRV biofeedback and breathing retraining may improve exercise tolerance in patients with HF with an LVEF of 31 % or higher . Because exercise tolerance is considered a strong prognostic indicator , cardiorespiratory biofeedback has the potential to improve cardiac mortality and morbidity in HF patients 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 : 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 Aim The aim of this study was to evaluate the benefits and safety of long-term i.v . iron therapy in iron-deficient patients with heart failure ( HF ) . Methods and results CONFIRM-HF was a multi-centre , double-blind , placebo-controlled trial that enrolled 304 ambulatory symptomatic HF patients with left ventricular ejection fraction ≤45 % , elevated natriuretic peptides , and iron deficiency ( ferritin < 100 ng/mL or 100–300 ng/mL if transferrin saturation < 20 % ) . Patients were r and omized 1 : 1 to treatment with i.v . iron , as ferric carboxymaltose ( FCM , n = 152 ) or placebo ( saline , n = 152 ) for 52 weeks . The primary end-point was the change in 6-min-walk-test ( 6MWT ) distance from baseline to Week 24 . Secondary end-points included changes in New York Heart Association ( NYHA ) class , Patient Global Assessment ( PGA ) , 6MWT distance , health-related quality of life ( QoL ) , Fatigue Score at Weeks 6 , 12 , 24 , 36 , and 52 and the effect of FCM on the rate of hospitalization for worsening HF . Treatment with FCM significantly prolonged 6MWT distance at Week 24 ( difference FCM vs. placebo : 33 ± 11 m , P = 0.002 ) . The treatment effect of FCM was consistent in all subgroups and was sustained to Week 52 ( difference FCM vs. placebo : 36 ± 11 m , P < 0.001 ) . Throughout the study , an improvement in NYHA class , PGA , QoL , and Fatigue Score in patients treated with FCM was detected with statistical significance observed from Week 24 onwards . Treatment with FCM was associated with a significant reduction in the risk of hospitalizations for worsening HF [ hazard ratio ( 95 % confidence interval ) : 0.39 ( 0.19–0.82 ) , P = 0.009 ] . The number of deaths ( FCM : 12 , placebo : 14 deaths ) and the incidence of adverse events were comparable between both groups . Conclusion Treatment of symptomatic , iron-deficient HF patients  with FCM over a 1-year period result ed in sustainable improvement in functional capacity , symptoms , and QoL and may be associated with risk reduction of hospitalization for worsening HF ( Clinical Trials.gov number NCT01453608 ) 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 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 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 OBJECTIVES To compare the correlation between the maximum 6 minutes of daily activity ( M6min ) and st and ard measures of functional capacity in older adults with heart failure ( HF ) with that in younger subjects and its prognostic utility . DESIGN Prospect i ve , cohort study . SETTING Tertiary care , academic HF center . PARTICIPANTS Sixty , ambulatory , adults , New York Heart Association ( NYHA ) Class I to III , stratified into young ( 50.9 + /- 9.4 ) and older cohorts ( 76.8 + /- 8.0 ) . MEASUREMENTS Correlation between M6min and measures of functional capacity ( 6-minute walk test ; 6MWT ) and peak oxygen consumption ( VO(2 ) ) according to cardiopulmonary exercise testing in a subset of subjects . Survival analysis was employed to evaluate the association between M6min and adverse events . RESULTS  Adherence  to actigraphy was high ( 90 % ) and did not differ according to age . The correlation between M6min and 6MWT was higher in subjects aged 65 and older than in those younger than 65 ( correlation coefficient ( r=0.702 , P<.001 vs r=0.490 , P=.002 ) . M6min was also significantly associated with peak VO(2 ) ( r=0.612 , P=.006 ) . During the study , 26 events occurred ( 2 deaths , 10 hospitalizations , 8 emergency department visits , and 6 intercurrent illnesses ) . The M6min was significantly associated with subsequent events ( hazard ratio=2.728 , 95 % confidence interval=1.10 - 6.77 , P=.03 ) , independent of age , sex , ejection fraction , NYHA class , brain natriuretic peptide , and 6MWT . CONCLUSION The high adherence to actigraphy and association with st and ard measures of functional capacity and independent association with subsequent morbid events suggest that it may be useful for monitoring older adults with HF 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 Pulmonary hypertension ( PH ) restricts the ability to engage in physical activity and decreases longevity . We examined the impact of aerobic exercise training on function and quality of life in patients with World Health Organization group 1 PH . METHODS Patients were r and omized to a 10-week education only ( EDU ) or education/exercise combined ( EXE ) group . The exercise program consisted of 24 - 30 sessions of treadmill walking for 30 - 45 min per session at 70 % to 80 % of heart rate reserve . Outcome variables included changes in 6-min walk test ( 6MWT ) distance , time to exercise intolerance , peak work rate ( WR ) from a cardiopulmonary treadmill test , and quality -of-life measures , including the Short Form Health Survey , version 2 ( SF-36v2 ) and Cambridge Pulmonary Hypertension Outcome Review ( CAMPHOR ) . RESULTS Data are presented as mean SD . Twenty-three women ( age , 54 11 years ; BMI , 31 7 kg/m 2 ) were r and omized to the EDU ( n 5 13 ) or EXE ( n 5 10 ) groups . Following 10 weeks of intervention , patients in the EXE group demonstrated an improvement in 6MWT distance ( 56 45 m ; P 5 .002 ) , increased time to exercise intolerance ( 1.9 1.3 min ; P 5 .001 ) , and peak WR ( 26 23 W ; P 5 .004 ) . Additionally , the EXE group scored significantly ( P , .050 ) better on six of the eight scales on SF-36v2 , and fi ve of the six scales on CAMPHOR . In contrast , no significant improvement was observed for any of the outcome measures following EDU . No adverse events were noted in either group . CONCLUSION Ten weeks of brisk treadmill walking improved 6MWT distance , cardiorespiratory function , and patient-reported quality of life in female patients with group 1 PH Purpose . To assess if Tai Chi added to endurance training ( ET ) is more effective than ET alone in improving exercise tolerance and quality of life ( QOL ) of elderly patients with chronic heart failure ( CHF ) . Design . Sixty CHF patients , age 73.8 ± 6 years , M/F 51/9 , were enlisted . Thirty pts were r and omized to combined training ( CT ) performing Tai Chi + ET and 30 patients  to ET ( ET only ) . Methods . At baseline and after 12 weeks all patients underwent 6-minute walking test  ( 6MWT ) , assessment of amino terminal probrain natriuretic peptide ( NT-pro BNP ) , quadriceps maximal voluntary contraction ( MVC ) and peak torque ( PT ) , QOL question naire ( MacNewQLMI ) , blood pressure ( BP ) , and heart rate ( HR ) . All patients performed 4 sessions of exercise/week . Results . Distance at 6mwt improved in both groups with significant between-groups differences ( P = .031 ) . Systolic BP and NT-proBNP decreased significant in the CT group compared to ET ( P = .025 ) and P = .015 ) , resp . ) . CT group had a greater significant improvement in physical perception ( P = .026 ) and a significant increase of PT compared to ET group . Conclusions . The association of Tai Chi and ET  improves exercise tolerance and QOL of patients with CHF more efficiently than ET Aim Levosimendan improves central hemodynamics and symptoms in acutely decompensated chronic heart failure ( CHF ) patients . However , its effects on quality of life , emotional stress and functional capacity of patients with advanced CHF have not been properly investigated . Methods and results Sixty-three advanced CHF patients ( NYHA III-IV , LVEF<30 % ) were r and omized ( 2:1 ) to receive either a 24-h levosimendan infusion of 0.1 μg/kg/min or placebo . Question naires addressing quality of life [ Kansas City Cardiomyopathy Question naire ( KCCQ ) , functional and overall , Duke ’s Activity Status Index ( DASI ) ] and emotional stress [ Zung self-rating depression scale ( SDS ) , Beck Depression Inventory ( BDI ) ] , as well as plasma BNP and 6-min walking distance ( 6MWT as a marker of exercise capacity ) were assessed before treatment and at hospital discharge . A significant improvement in NYHA class ( 2.1 ± 0.7 from 3.3 ± 0.7 , p < 0.01 ) , 6 MWT ( 305 ± 152 from 215 ± 142 m , p < 0.01 ) and plasma BNP ( 598 ± 398 from 1,078 ± 756 pg/ml , p < 0.01 ) was observed post-treatment only in levosimendan-treated group . KCCQ functional ( 45 ± 19 from 35 ± 17 % , p < 0.05 ) and overall ( 34 ± 13 from 28 ± 11 % , p < 0.05 ) , DASI ( 26 ± 13 from 22 ± 12 , p < 0.05 ) , Zung SDS ( 38 ± 12 from 42 ± 13 , p < 0.01 ) and BDI ( 11 ± 6 from 14 ± 8 , p < 0.05 ) scores also improved in levosimendan-treated patients , while remained unchanged in the  placebo group . The hospital length stay was shorter in levosimendan group compared to placebo ( 3.2 ± 1.7 versus 5.8 ± 2.1 days , p < 0.01 ) . Levosimendan-induced BNP reduction was significantly correlated with concomitant increase in 6MWT ( r = 0.643 , p < 0.001 ) as well as with the decrease of BDI ( r = 0.30 , p < 0.05 ) and Zung SDS ( r = 0.25 , p = 0.05 ) . Conclusion Levosimendan seems to have a beneficial effect on quality of life , physical activity and emotional stress in advanced CHF patients , reducing concurrently hospitalization length BACKGROUND Heart failure ( HF ) is a complex syndrome characterized by intolerance to exertion and reduced functional capacity . OBJECTIVE To assess the functional capacity of patients with HF and supplemented with creatine .  METHODS Prospect i ve , r and omized , double-blind study . Thirty-three male patients over the age of 18 years with functional class II to IV HF were r and omized into two groups as follows : the experimental group ( CRE , n = 17 ) , supplemented with 5 g/day of creatine for six months ; and the placebo group ( PLA , n = 16 ) , receiving 5 g/day of maltodextrin for that same period . Both groups underwent functional capacity assessment by use of cardiopulmonary exercise test and 6-minute walk test ( 6MWT ) before and after the intervention . The Ancova statistical model and Pearson correlation were used to assess the groups and the treatment . RESULTS Of the variables assessed on the cardiopulmonary exercise test , peak oxygen consumption ( peak VO₂ ) , anaerobic threshold ( AT ) , and oxygen pulse ( O₂ pulse ) showed no significant differences between the groups ( P>0.05 ) . On the 6MWT , no significant difference was observed in the covered distance . CONCLUSION Creatine supplementation in patients with HF did not significantly improve functional capacity AIMS This r and omized , double-blind , placebo-controlled trial assessed whether heart rate ( HR ) reduction with ivabradine improves cardiac function in heart failure with preserved ejection fraction ( HFpEF ) . METHODS AND RESULTS The prEserveD left ventricular ejectIon fraction chronic heart Failure with ivabradine studY ( EDIFY ) included 179 patients in New York Heart Association ( NYHA ) classes II and III , in sinus rhythm , with HR of ≥70 b.p.m . , NT-proBNP of ≥220 pg/mL ( BNP ≥80 pg/mL ) and left ventricular ejection fraction of ≥45 % . Ivabradine ( or placebo ) was titrated to 7.5 mg b.i.d . Patients were followed for 8 months on the change and assessed for three co- primary endpoints : echo-Doppler E/e ' ratio , distance on the 6-min walking test ( 6MWT ) , and plasma NT-proBNP concentration . At baseline , median E/e ' was 12.8 [ interquartile range ( IQR ) : 9.9 - 16.3 ] , median distance on the 6MWT was 320 m ( IQR : 247 - 375 m ) , and median NT-proBNP was 375 pg/mL ( IQR : 253 - 701 pg/mL ) . Baseline median HR was 75 b.p.m . ( IQR : 70 - 107 b.p.m . ) . A total of 171 patients ( 87 in the ivabradine group , 84 in the placebo group ) were evaluated for treatment efficacy . After 8 months of treatment , findings showed a median change in HR of -13.0 b.p.m . ( IQR : -18.0 to -6.0 b.p.m . ) in the ivabradine group and -3.5 b.p.m . ( IQR : -11.5 to 3.0 b.p.m . ) in the placebo group [ estimated between-group difference : 7.7 b.p.m . ; 90 % confidence interval ( CI ) -10 to -5.4 ; P < 0.0001 ] . No evidence of improvement was found in any of the three co- primary endpoints . There was almost no change in median E/e ' in either of the two groups [ median change : + 1.0 ( IQR : -0.8 to 2.9 ) in the ivabradine group ; -0.6 ( IQR : -2.2 to 1.4 ) in the placebo group ; estimated between-group difference : 1.4 , 90 % CI 0.3 - 2.5 ; P = 0.135 ] . There were no meaningful changes in the other co- primary endpoints and no apparent trends . There was no significant safety concern . CONCLUSIONS In patients with HFpEF , HR reduction with ivabradine did not improve outcomes . These findings do not support the use of ivabradine in HFpEF Patients with chronic heart failure ( CHF ) experience progressive deterioration of functional capacity and quality of life ( QoL ) . This prospect i ve , r and omized , controlled trial assesses the effect of exercise training ( ET ) protocol on functional capacity , rehospitalization , and QoL in CHF patients older than 70 years compared with a control group . A total of 343 elderly patients with stable CHF ( age , 76.90±5.67 , men , 195 , 56.9 % ) were r and omized to ET ( TCG , n=170 ) or usual care ( UCG , n=173 ) . The ET protocol involved supervised training sessions for 3 months in the hospital followed by home-telemonitored sessions for 3 months . Assessment s , performed at baseline and at 3 and 6 months , included : ECG , resting echocardiography , NT-proBNP , 6-minute walk test ( 6MWT ) , Minnesota Living with Heart Failure Question naire , and comprehensive geriatric assessment with the InterRAI-HC instrument . As compared to UCG , ET patients at 6 months showed : i ) significantly increased 6MWT distance ( 450±83 vs. 290±97 m , p<0.001 ) ; ii ) increased ADL scores ( 5.00±2.49 vs. 6.94±5.66 , p=0.037 ) ; iii ) 40 % reduced risk of rehospitalisation ( hazard ratio=0.558 , 95%CI , 0.326 - 0.954 , p=0.033 ) ; and iv ) significantly improved perceived QoL ( 28.6±12.3 vs. 44.5±12.3 , p<0.001 ) . In hospital and home-based telemonitored exercise confer significant benefits on the oldest CHF patients , improving functional capacity and subjective QoL and reducing risk of rehospitalisation OBJECTIVES To evaluate , in chronic heart failure ( CHF ) patients , feasibility , safety , compliance and functional improvements of an eccentric ( ECC ) cycle training protocol personalized by the rate of perceived exertion ( RPE ; 9 - 11 Borg Scale ) , compared to concentric ( CON ) training at workload corresponding to the first ventilatory threshold . METHODS Thirty patients were r and omly allocated to ECC or CON training ( 20 sessions ) . Compliance was evaluated with RPE , visual analog scale for muscle soreness and monitoring of heart rate ( HR ) . Functional parameters were measured by the distance walked and the VO(2 ) uptake during the 6-minute walk test ( 6MWT ) before and after training . RESULTS Two patients were excluded due to adverse effects in each group .  RPE was 9 - 11 in ECC training while it reached 12 - 14 in CON training . HR remained stable in ECC group during exercise whereas it increased during CON exercise . 6MWT distance improved in both group ( ECC : + 53 m ; CON : + 33 m ) . 6MWT VO(2 ) uptake remained stable in ECC group whereas it increased in CON group . CONCLUSION ECC training tailored by RPE appears to be an efficient and safe alternative for CHF patients . Indeed , it induces functional improvement similar to conventional CON training with lower dem and on the cardiovascular system during exercise OBJECTIVES The primary objective of this study was to assess the effect of a 6-month testosterone supplementation therapy on functional capacity and insulin resistance in female patients with chronic heart failure ( CHF ) . BACKGROUND Patients with CHF show decreased exercise capacity and insulin sensitivity . Testosterone supplementation improves these variables in men with CHF . No study has evaluated the effects of testosterone supplementation on female patients with CHF . METHODS Thirty-six elderly female patients with stable CHF , ( ejection fraction 32.9 ± 6 ) were r and omly assigned ( 2:1 ratio ) to receive testosterone transdermal patch ( T group , n = 24 ) or placebo ( P group , n = 12 ) , both on top of optimal medical therapy . At baseline and after 6 months , patients underwent  6-min walking test  ( 6MWT ) , cardiopulmonary exercise test , echocardiogram , quadriceps maximal isometric voluntary contraction , dynamic quadriceps isokinetic strength ( peak torque ) , and insulin resistance assessment by homeostasis model . RESULTS Distance walked at 6MWT as well as peak oxygen consumption significantly improved in the T group , whereas they were unchanged in the P group ( p < 0.05 for all comparisons ) . The homeostasis model was significantly reduced in the T group in comparison with the P group ( -16.5 % vs. + 5 % , respectively ; p < 0.05 ) . Maximal voluntary contraction and peak torque increased significantly in the T group but did not change in the P group . Increase in distance walked at 6MWT was related to the increase in free testosterone levels ( r = 0.593 , p = 0.01 ) . No significant changes in echocardiographic parameters were observed in either group . No side effects requiring discontinuation of T were detected . CONCLUSIONS Testosterone supplementation improves functional capacity , insulin resistance , and muscle strength in women with advanced CHF .  Testosterone seems to be an effective and safe therapy for elderly women with CHF 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 Functional electrical stimulation ( FES ) improves exercise capacity and endothelial function in chronic heart failure ( CHF ) patients . This study evaluates the impact of FES on quality of life and emotional stress in patients with moderate to severe CHF . METHODS Thirty patients with stable CHF ( 24 men ; NYHA class II-III ; left ventricular ejection fraction < 35 % ) were r and omly assigned ( 2:1 ) to a 6-week FES training program ( n=20 ) or placebo ( n=10 ) . Question naires addressing quality of life [ Kansas City Cardiomyopathy Question naire ( KCCQ ) , functional and overall ] , and emotional stress [ Zung self-rating depression scale ( SDS ) , Beck Depression Inventory ( BDI ) ] , as well as plasma B-type natriuretic peptide ( BNP ) and 6-min walking distance test ( 6MWT ) were assessed at baseline and after completion of training protocol . RESULTS A significant improvement in KCCQ functional ( F=76.666 , p<0.001 ) , KCCQ overall ( F = 41.508 , p<0.001 ) , BDI ( F = 17.768 , p<0.001 ) and Zung SDS ( F = 27.098 , p<0.001 ) was observed in the FES group compared to placebo . Patients in the FES group had also a significant increase in 6MWT ( F = 19.413 , p<0.001 ) and a trend towards reduction in plasma BNP ( F = 4.252 , p=0.053 ) compared to placebo . CONCLUSION FES seems to have a beneficial effect on quality of life , exercise capacity and emotional stress in patients with moderate to severe CHF 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 Study Design . Clinical prospect i ve , r and om study . Objective . Analyze the results of the six-minute walk test ( 6MWT ) in patients with adolescent idiopathic scoliosis . Summary of Background Data . Although it is widely believed that Adolescent Idiopathic Scoliosis ( AIS ) causes cardiorespiratory dysfunctions , there is no report in literature of objective measurements of this restriction in the ventilatory performance during physical exertion . Methods . One hundred twenty-six adolescents matched by gender and age were prospect ively studied at a tertiary teaching institution : 40 patients without spine deformities ( group I – controls ) , and 86 patients with AIS with a spine curve ranging from 45 ° to 138 ° ( group II ) . All patients underwent radiographic evaluations and the 6MWT . Results . Normal controls presented significantly lower mean heart rate and Borg scores , as well as higher oxygen saturation and walked longer distances on the 6MWT . Conclusion . The 6MWT effectively demonstrated the cardiorespiratory restrictions presented by patients with AIS BACKGROUND Increased oxidative stress in heart failure ( HF ) leads to inflammation and endothelial dysfunction ( ED ) . Both statins and allopurinol have known anti-oxidant properties , but their utility in HF has not been fully assessed . METHODS This investigation was a prospect i ve , double-blind , double-dummy study , performed between March 2007 and June 2009 . Seventy-four HF patients , with New York Heart Association ( NYHA ) Class II or III status and left ventricular ejection fraction ( LVEF ) < 40 % , were included . Patients received placebo during 4 weeks and were then r and omized to receive 4 weeks of either atorvastatin 20 mg/day plus placebo ( ATV+PLA group ) or atorvastatin 20 mg/day orally plus allopurinol 300 mg/day orally ( ATV+ALLO group )  . Malondialdehyde ( MDA ) , extracellular superoxide dismutase ( ecSOD ) activity and uric acid ( UA ) levels , among others , were determined at baseline and after 4 weeks of treatment . ED was assessed by flow-dependent endothelial-mediated vasodilation ( FDD ) , and functional capacity by 6-minute walk test ( 6MWT ) . RESULTS Thirty-two patients were r and omized to ATV+PLA and 38 to ATV+ALLO . Mean age was 59 ± 2 years , 82 % were male , and 22 % had an ischemic etiology . Hypertension was present in 60 % and diabetes in 15 % of those studied . No significant differences were observed between baseline measurements and after placebo . After 4 weeks of treatment , both groups showed a significant decrease on MDA ( 0.9 ± 0.1 to 0.8 ± 0.1 and 1.0 ± 0.5 to 0.9 ± 0.1 μmol/liter , p = 0.88 ) , UA ( 7.4 ± 0.4 to 6.8 ± 0.3 and 7.2 ± 0.4 to 5.0 ± 0.3 mg/dl , p < 0.01 ) and FDD ( 3.9 ± 0.2 % to 5.6 ± 0.4 % and 4.6 ± 0.3 % to 7.1 ± 0.5 % , p = 0.07 ) with increased ecSOD activity ( 109 ± 11 to 173 ± 13 and 98 ± 10 to 202 ± 16 , U/ml/min , p = 0.41 ) and improved 6MWT ( 447 ± 18 to 487 ± 19 and 438 ± 17 to 481 ± 21 m , p = 0.83 ) , with all values for ATV+PLA and ATV+ALLO , respectively ; p-values are for comparison between groups after treatment . CONCLUSION Short-term ATV treatment in heart failure ( HF ) patients  reduces oxidative stress and improves FDD and functional capacity . These beneficial effects are not strengthened by the addition of allopurinol Objective : To estimate the relative effectiveness in improving walking ability and other mobility and health outcomes post-stroke of two home-based exercise programmes – stationary cycling and an exercise and walking programme . Design : An observer-blinded , r and omized , pragmatic , trial with repeated measures . Setting : Hospital centers in two Canadian cities . Subjects : People within 12 months of acute stroke who were able to walk > 10 meters independently and healthy enough to engage in exercise . Interventions : Two dose-equivalent interventions , one involving stationary cycling and the other disability-targeted interventions were tested . Both protocol s required daily moderate intensity exercise at home building up to 30 minutes per day . One group exercised on a stationary bicycle , the second group carried out mobility exercises and brisk walking . Main measures : The primary outcome was walking capacity as measured by the six-minute walk test ( 6MWT ) . Secondary outcomes were physical function , role participation , health-related quality of life exercise adherence , and adverse events . Results : The study failed to meet recruitment targets : 87 participants ( cycle group , n = 43 ; exercise group , n = 44 ) participated . No significant effects of group or time were revealed for the 6MWT , which was approximately 320 m at r and omization . A significant effect for role participation was found in favor of the exercise group ( global odds ratio ( OR ) for cycling vs. exercise was 0.51 ; 95 % confidence interval ( CI ) , 0.27–0.95 ) . Change in the 6MWT between highest and lowest adherence categories was statistically significant ( p = 0.022 ) . Conclusions : Both programmes were equally effective in maintaining walking capacity after discharge from stroke rehabilitation ; or were equally ineffective in improving walking capacity . Clinical Trials Gov number : NCT00786045 PURPOSE To assess the utility of the 6-minute walk test ( 6MWT ) as a predictor of  symptomatic radiation-induced pneumonitis ( RP ) .  METHODS As part of a prospect i ve trial to study radiation-induced lung injury , 53 patients receiving thoracic radiotherapy ( RT ) underwent a pre-RT 6MWT , pulmonary function tests ( PFTs ) , and had > or=3-month follow-up for prospect i ve assessment of Grade 2 or worse RP ( requiring medications or worse ) . Dosimetric parameters ( e.g. , the percentage of lung receiving > or=30 Gy ) were extracted from the lung dose-volume histogram . The correlations between the 6MWT and PFT results were assessed using Pearson 's correlation . The receiver operating characteristic technique was used in patient subgroups to evaluate the predictive capacities for RP of the dosimetric parameters , 6MWT results , and PFT results , or the combination ( using discriminant analysis ) of all three metrics . ROCKIT software was used to compare the receiver operating characteristic areas between each predictive model . The association of the decline in 6MWT with the development of RP was evaluated using Fisher 's exact test . RESULTS The pre-RT PFT and 6MWT results correlated weakly ( r = 0.44 - 0.57 , p < or= 0.001 ) , suggesting that they measure somewhat different physiologic functions . Of the 53 patients , 9 ( 17 % ) developed RP . The dose-volume histogram-based dosimetric parameters were the best single-metric model for predicting RP ( e.g. , percentage of lung receiving > or=30 Gy , receiver operating characteristic area 0.73 , p = 0.03 ) . Including the PFT or 6MWT results with the percentage of lung receiving > or=30 Gy did not improve the predictions . The predictive abilities of dosimetric-based models improved when the analysis was restricted to those patients whose tumors were not causing regional lung dysfunction . No correlation was found between the decline in the 6MWT result and the RP rate ( p = 0.6 ) . CONCLUSION Although the PFTs and 6MWT are related to each other , the correlation coefficients were weak , suggesting that they could be measuring different physiologic functions . In the present data set , the addition of the PFTs or 6MWT did not increase the ability of the dosimetric parameters to predict for acute symptomatic RP . Additional work is needed to better underst and the interaction among the PFT results , exercise tolerance ( 6MWT ) , and the risk of RT-induced  lung dysfunction Objective Anemia is a frequent comorbidity in chronic heart failure ( CHF ) adversely affecting patients ’ prognosis . Erythropoietin seems to improve exercise capacity in CHF patients . This study investigates the effects of recombinant human erythropoietin analog darbepoetin-α on quality of life and emotional stress , evaluated by relevant question naires in patients with CHF and anemia . Methods Forty-one CHF patients [ New York Heart Association class : II-III ; left ventricular ( LV ) ejection fraction ( EF ) ≤40 % ; hemoglobin < 12.5 g/dl ; serum creatinine < 2.5 mg/dl ] were r and omized ( 1:1 ) to receive either 3-month  darbepoietin-α  at 1.5 μg/Kg every 20 days plus iron orally ( n = 21 ) or placebo plus iron orally ( n = 20 ) . Echocardiographic LVEF , question naires addressing quality of life ( Kansas City Cardiomyopathy Question naire , functional and overall , Duke 's Activity Status Index ) and emotional stress [ Zung self-rating depression scale ( SDS ) , Beck Depression Inventory ] , as well as plasma b-type natriuretic peptide and 6-min walking distance ( 6MWT as a marker of exercise capacity ) were assessed at baseline and posttreatment . Results A significant improvement in LVEF ( 32 ± 6 from 26 ± 6 % , P < 0.001 ) , 6MWT ( 274 ± 97 from 201 ± 113 m , P < 0.01 ) , hemoglobin ( 12.8 ± 1.4 from 10.9 ± 1.0 g/dl , P < 0.001 ) and plasma b-type natriuretic peptide ( 517 ± 579 from 829 ± 858 pg/ml , P = 0.002 ) was observed posttreatment only in darbepoetin-treated  group . Kansas City Cardiomyopathy Question naire functional ( 78 ± 14 from 57 ± 24 % , P < 0.01 ) and overall ( 68 ± 20 from 47 ± 22 , P < 0.001 ) , Duke 's Activity Status Index ( 19 ± 11 from 14 ± 9 , P < 0.05 ) , Zung SDS ( 38 ± 10 from 47 ± 11 , P < 0.05 ) and Beck Depression Inventory ( 11 ± 9 from 16 ± 10 , P < 0.05 ) scores also improved in darbepoetin-treated patients , whereas they remain unchanged in the placebo group except for the Zung SDS which worsened ( P≤0.05 ) . A significant correlation between drug-induced percent changes in 6MWT and Zung SDS ( r = –0.627 , P < 0.05 ) was also observed . Conclusions Darbepoetin-α  improves quality of life and emotional stress in CHF patients with anemia , with a parallel increase in exercise capacity PURPOSE To assess the 6-minute walk test ( 6MWT ) as a predictor of  radiation therapy-induced lung injury ( RTLI ) .  METHODS AND MATERIAL S The 6MWT is a simple , economical , and reproducible test that measures both how far a person can walk in 6 min and any associated changes in vital signs . As part of a prospect i ve trial to study RTLI , a pre-RT 6MWT was performed in 41 patients . The predictive capacities of pre-RT 6MWT , forced expiratory volume in 1 s ( FEV1 ) , and single-breath diffusing capacity for carbon monoxide ( DLCO ) for the development of RTLI were assessed with receiver operating curve ( ROC ) techniques . To evaluate the 6MWT , alone or with mean lung dose ( MLD ) of radiation , as a predictor of RTLI , the rates of RTLI in patient subgroups defined by 6MWT results were compared by using Fisher 's exact test . RESULTS Thirty-one patients with > or =3 months ' follow-up were evaluable . The median baseline 6MWT result was 1400 ft . Of 31 patients , 7 developed Grade > or = 2 RTLI . Of 15 patients with an MLD > 18 Gy ( the median ) , 5 developed RTLI , compared with 2 of 16 with MLD < or = 18 Gy ( p = 0.22 ) . Among those with an MLD < or = 18 Gy , the RTLI rates were 0 of 8 and 2 of 8 for 6MWT results > or = 1400 ft or < 1400 ft , respectively , p = 0.46 . The ROC area under the curve for individual metrics was as follows : FEV1 0.66 , MLD 0.70 , DLCO 0.61 , and 6MWT 0.47 . Combining FEV1 with 6MWT increased the ROC to 0.71 , suggesting that the ratio might be a better predictor than the individual values . Patients with a high 6MWT/FEV1 ratio had a lower rate of RTLI than those with a relatively low ratio . CONCLUSIONS The 6MWT might provide prognostic information beyond pulmonary function tests and dosimetric parameters in predicting RTLI . Additional work is needed to better assess the utility of these functional metrics Abstract Objectives . Exercise training might improve cardiac function as well as functional capacity in patients with chronic heart failure ( CHF ) . N-terminal pro-B-type natriuretic peptide ( NT pro-BNP ) , is associated with the severity of the disease , and has been reported to be an independent predictor of outcome in CHF . We evaluated the effect of a four months group-based aerobic interval training program on circulating levels of NT pro-BNP in patients with CHF . We have previously reported improved functional capacity in 80 patients after exercise in this exercise program . Methods . Seventy-eight patients with stable CHF ( 21 % women ; 70±8 years ; left ventricular ejection fraction 30±8.6 % ) on optimal medical treatment were r and omized either to interval training  ( n=39 ) , or to a control group  ( n=39 ) . Circulating levels of NT pro-BNP , a six minute walk test ( 6MWT ) and cycle ergometer test were evaluated at baseline , post exercise , and further after 12 months . Results . There were no significant differences in NT pro-BNP levels from baseline to either post exercise or long-term follow-up between or within the groups . Inverse correlations were observed between NT pro-BNP and 6MWT ( r=−0.24 , p=0.035 ) and cycle exercise time ( r=−0.48 , p<0.001 ) at baseline . But no significant correlations were observed between change in NT pro-BNP and change in functional capacity ( 6MWT ; r=0.12 , p=0.33 , cycle exercise time ; r=0.04 , p=0.72 ) . Conclusion . No significant changes in NT pro-BNP levels were observed after interval training , despite significant improvement of functional capacity STUDY OBJECTIVE We analyzed the effects of the use of a rollator on walking distance and physiologic variables : pulmonary gas exchange , heart rate , minute ventilation ( Ve ) , oxygen saturation , and symptoms during the 6-min walk test ( 6MWT ) in patients with COPD . SETTING Outpatient clinic at university hospital . PATIENTS Fourteen patients with COPD in stable clinical condition . One patient had mild COPD , five patients had moderate COPD , six patients had severe COPD , and two patients had very severe COPD . INTERVENTIONS Two 6MWTs were performed with a portable metabolic system ( VmaxST 1.0 ; Viasys Healthcare ; MEDA ; Aartselaar , Belgium ) with a rollator and without a rollator , in r and om order . In addition , maximal voluntary ventilation ( MVV ) was measured with and without a rollator , r and omly . RESULTS The median 6MWT distance increased significantly with a rollator : 416 m without a rollator ( interquartile range [ IQR ] , 396 to 435 m ) , vs 462 m with a rollator ( IQR , 424 to 477 m ) [ p = 0.04 ] . Significant increases were also seen in oxygen uptake ( 0.04 L/min [ IQR , - 0.002 to 0.09 L/min ] ) ; tidal volume ( 0.06 L/min [ IQR , - 0.001 to 0.11 L/min ] ) ; and Ve ( 0.95 L/min [ IQR , - 0.67 to 7.1 L/min ] ) , recorded in the last minute of the 6MWT ; as well as in MVV ( 3 L/min [ IQR , 0 to 12 L/min ] ) [ p < 0.05 for all ] . Borg dyspnea scores tended to be lower with a rollator : 6 ( IQR , 4 to 7 ) without a rollator , vs 5 ( IQR , 4 to 7 ) with a rollator ( p = 0.10 ) . The variation in the 6MWT was explained by individual changes in walking efficiency ( partial R(2 ) = 0.31 ) and changes in Ve ( partial R(2 ) = 0.36 ) [ p model < 0.04 ] . CONCLUSION The use of a rollator improves walking distance of patients with COPD through an increased ventilatory capacity and /or better walking efficiency BACKGROUND Exercise training is beneficial in ischemic and congestive heart disease . However , the effect on atrial fibrillation ( AF ) is unknown . METHODS Forty-nine patients with permanent AF ( age [ mean ± SD ] , 70.2 ± 7.8 years ; male-to-female ratio , 0.75 ; body mass index [ mean ± SD ] , 29.7 ± 4.3 kg/m(2 ) ) were r and omized to 12-week aerobic exercise training or a control group  . Exercise capacity , 6-minute walk test ( 6MWT ) , cardiac output , quality of life , and natriuretic peptides were measured . Cardiac output was measured at rest and during ergometer testing , and atrial natriuretic peptide and N-terminal pro-B-type natriuretic peptide were measured before and after the training period . Quality of life was evaluated using the Short-Form 36 and Minnesota Living With Heart Failure ( MLHF-Q ) question naires . RESULTS Improved exercise capacity and 6MWT were observed in the active patients ( P < .001 ) , and at study end , there was a significant difference between the active patients and the controls ( P = .002 ) . Resting pulse decreased in the active patients ( 94.8 ± 22.4 to 86.3 ± 22.5 beats/min , P = .049 ) but remained unchanged in the controls . Cardiac output was unchanged from baseline to end-of- study period . The MLHF-Q score improved in the active group ( 21.1 ± 18.0 vs 15.4 ± 17.5 , P = .03 ) . Active patients showed progress in 3 of the 8 Short-Form 36 subscales : physical functioning ( P = .02 ) , general health perceptions ( P = .001 ) , and vitality ( P = .02 ) . Natriuretic peptides were unchanged . CONCLUSION Twelve weeks of exercise training  increased exercise capacity and 6MWT and decreased resting pulse rate significantly in patients with AF . Overall quality of life increased significantly as measured by the cardiology-related MLHF-Q. Cardiac output and natriuretic peptides were unchanged in both groups OBJECTIVES Persons with concomitant heart failure ( HF ) and diabetes mellitus ( DM ) have complicated , often competing , self-care expectations and treatment regimens that may reduce quality of life ( QOL ) . This r and omized controlled trial tested an integrated self-care intervention on outcomes of HF and DM QOL , physical function , and physical activity ( PA ) . METHODS AND RESULTS Participants with HF and DM ( n = 134 ; mean age 57.4 ± 11 years , 66 % men , 69 % minority ) were r and omized to usual care ( control ) or intervention . The control group received st and ard HF and DM educational brochures with follow-up telephone contact . The intervention group received education and counseling on combined HF and DM self-care ( diet , medications , self-monitoring , symptoms , and PA ) with follow-up home visit and telephone counseling . Measures included question naires for HF- and DM-specific and overall QOL , PA frequency , and physical function ( 6-min walk test [ 6MWT ] ) and were obtained at baseline and 3 and 6 months . Analysis included mixed models with a priori post hoc tests . Adjusting for age , body mass index , and comorbidity , the intervention group improved in HF total ( P = .002 ) and physical ( P < .001 ) QOL scores at 3 months with retention of improvements at 6 months , improved in emotional QOL scores compared with control at 3 months ( P = .04 ) , and improved in health status ratings ( P = .04 ) at 6 months compared with baseline . The intervention group improved in 6MWT distance ( 924 ft to 952 ft ; P = .03 ) whereas the control group declined ( 834 ft to 775 ft ; F1,63 = 6.86 ; P = .01 ) . The intervention group increased self-reported PA between baseline and 6 months ( P = .01 ) . CONCLUSIONS An integrated HF and DM self-care  intervention improved perceived HF and general QOL but not DM QOL . Improved physical functioning and self-reported PA were also observed with the integrated self-care intervention . Further study of the HF and DM integrated self-care intervention on other outcomes , such as hospitalization and cost , is warranted BACKGROUND We hypothesized that breathing helium-hyperoxia ( HeO2 ) would significantly improve 6-min walking test ( 6MWT ) distance in COPD subjects . METHODS This was a blinded , r and omized crossover study . At visit 1 , we assessed pulmonary function , exercise capacity , and 6MWT distance . Visits 2 and 3 consisted of four 6MWTs in which the following different inspired gases were used : room air ( RA ) by mask ; 100 % O2 by mask ( mask O2 ) ; 100 % O2 by nasal prongs ( nasal O2 ) ; and 70 % He/30 % O2 by mask ( HeO2 ) .  Walking distance , shortness of breath , leg fatigue , O2 saturation , and heart rate ( HR ) were assessed . RESULTS Sixteen COPD subjects participated ( mean FEV(1)/FVC ratio [ + /- SD ] , 48 + /- 8 % ; mean FEV1 , 55 + /- 13 % predicted ) . Subjects walked farther when breathing HeO2 ( 564 m ) compared to RA ( 497 m ; p < 0.001 ) , mask O2 ( 520 m ; p < 0.001 ) , or nasal O2 ( 528 m ; p < 0.001 ) . Despite the increased distance walked while breathing HeO2 , there was no increase in shortness of breath or leg fatigue . There was desaturation when breathing RA ( 8 % ; p < 0.001 ) and nasal O2 ( 5 % ; p < 0.001 ) , which was reduced when breathing HeO2 ( 3 % ; difference not significant ) and mask O(2 ) ( 0 % ; difference not significant ) . There were no significant differences in HR in the four 6MWTs . CONCLUSIONS The use of HeO2 increased 6MWT distance in COPD subjects more than either mask O2 or nasal O2 compared to RA . The increased walking distance was not associated with increased shortness of breath or leg fatigue . The results suggest that clinical benefit would be obtained by administering HeO2 during exercise , which may have significant clinical implication s for the management of COPD patients BACKGROUND In patients with idiopathic pulmonary fibrosis ( IPF ) , our objectives were to identify predictors of abnormal heart rate recovery ( HRR ) at 1 min after completion of a 6-min walk test ( 6MWT ) [ HRR1 ] and 2 min after completion of a 6MWT ( HRR2 ) , and to determine whether abnormal HRR predicts mortality . METHODS From 2003 to 2008 , we identified IPF patients who had been evaluated at our center ( n = 76 ) with a pulmonary physiologic examination and the 6MWT .  We used logistic regression to identify predictors of abnormal HRR , the product-limit method to compare survival in the sample stratified on HRR , and Cox proportional hazards analysis to estimate the prognostic capability of abnormal HRR . RESULTS Cutoff values were 13 beats for abnormal HRR1 and 22 beats for HRR2 . In a multivariable model , predictors of abnormal HRR1 were diffusing capacity of the lung for carbon monoxide ( odds ratio [ OR ] , 0.4 per 10 % predicted ; 95 % confidence interval [ CI ] , 0.2 to 0.7 ; p = 0.003 ) , change in heart rate from baseline to maximum ( OR , 0.9 ; 95 % CI , 0.8 to 0.97 ; p = 0.01 ) , and having a right ventricular systolic pressure > 35 mm Hg as determined by transthoracic echocardiogram ( OR , 12.7 ; 95 % CI , 2.0 to 79.7 ; p = 0.01 ) . Subjects with an abnormal HRR had significantly worse survival than subjects with a normal HRR ( for HRR1 , p = 0.0007 [ log-rank test ] ; for HRR2 , p = 0.03 [ log-rank test ] ) ; these results held for the subgroup of 30 subjects without resting pulmonary hypertension ( HRR1 , p = 0.04 [ log-rank test ] ) . Among several c and i date variables , abnormal HRR1 appeared to be the most potent predictor of mortality ( hazard ratio , 5.2 ; 95 % CI , 1.8 to 15.2 ; p = 0.004 ) . CONCLUSION Abnormal HRR after 6MWT predicts mortality in IPF patients . Research is needed to confirm these findings prospect ively and to examine the mechanisms of HRR in IPF patients Background : The six-minute walk test ( 6mWT ) is a simple index of functional capacity in healthy people , and it has been used to estimate exercise capacity in obese subjects . The aim of this study was to determine whether weight reduction induced by laparoscopic adjustable gastric b and ing ( LAGB ) improves the functional capacity in the severely obese on the 6mWT . Methods : A prospect i ve 1-year study was carried out at the Hospital Casoria , Naples , involving 15 consecutive severely obese patients who underwent the 6mWT before and 1 year after LAGB .  BMI , walking distance , heart rate , dyspnea , and respiratory function tests were also measured . Patients served as their own controls . Results : 15 patients ( all females ) were evaluated .  Mean BMI decreased from 42.1 ( range 39 - 49 ) before to 31.9 ( range 25 - 38 ) postoperatively . The distance walked increased from 475.7 meters ( range 380 - 580 ) before LAGB to 626.3 meters ( range 435 - 880 ) 1 year postoperatively ( P<0.0001 ) , and the dyspnea score after the 6mWT was significantly reduced postoperatively . All functional variables after the 6mWT showed improvement postoperatively at 1 year study . Conclusion : Weight reduction in the obese increases the functional capacity during walking . The improvements are refected in the patients ' own assessment 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 OBJECTIVES Autonomic modulation is adversely impacted in patients with chronic obstructive pulmonary disease ( COPD ) . The purpose of the present investigation is to assess the effects of a 6-week aerobic exercise training program on autonomic modulation of heart rate in patients with COPD . METHODS Forty patients of both sexes with moderate-to-severe COPD were r and omly allocated to aerobic exercise training ( PT , n=20 ) or to usual care ( Control , n=20 ) . The training program consisted of lower and upper limb stretching and 30 min of treadmill exercise , 3 times per week for a 6-week period . Physiological data during symptom-limited exercise testing and the six-minute walk test ( 6MWT ) were assessed . In addition , R-R intervals were obtained at rest and during the 6MWT . Heart rate variability was analyzed by time ( rMSSD and SDNN index ) and frequency domains ( high frequency -- HF , low frequency -- LF and HF/LF ratio ) . RESULTS Peak oxygen consumption significantly improved in the training group only ( p<0.05 ) . Moreover , the training group demonstrated significant improvements ( p<0.05 ) in blood lactate , minute ventilation , dyspnea at peak exercise , sympathetic activity , and parasympathetic activity at rest and during submaximal exercise . Lastly , a positive and significant correlation was found between change in 6MWT distance and rMSSD index ( r=0.65 and p=0.001 ) . CONCLUSIONS Neural control of heart rate , in addition to other clinical ly valuable measures , is positively altered in moderate-severe COPD patients following 6 weeks of aerobic exercise training . The improvement in submaximal performance after exercise training was associated with parasympathetic activity 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 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
Pharmacological trials including patients with more severe heart failure were more likely to show a significant improvement with therapy than trials of milder heart failure .
Using mean values in these trials , the age of patients appeared a more important determinant of 6MWT distance than New York Heart Association classification .
The 6MWT has not yet been proven to be a robust test for the identification of effective pharmacological interventions although it appears useful for the assessment of cardiac resynchronization therapy .
The results of the 6MWT were concordant with changes in symptoms , suggesting that it may be used as supportive evidence for symptom benefit .
AIMS The 6 min walk test ( 6MWT ) is commonly used in clinical trials to assess treatments for heart failure , but its ability to distinguish between effective and ineffective treatments is question able .
The aim of this study is to investigate , using a systematic literature review , the utility of the 6MWT as a measure of the effectiveness of treatment in r and omized controlled trials of heart failure .