The 6-minute walk is a valid and reliable method of assessing functional ability in a Phase II/III CR population. A learning effect of 6% was observed over the three walks; however, it is unknown if this learning effect will be retained over time. This test may be particularly valuable to smaller CR centers that want to document functional improvements but do not have access to conventional treadmill tests.

This study examined the effects of adaptive rate pacing controlled by closed-loop right ventricular impedance sensing on exercise hemodynamics. Twelve patients in whom Biotronik INOS2+ pacemakers had been implanted 4-6 weeks earlier participated in the study. All patients completed two graded, symptom-limited exercise tests. The pacemaker was programmed to DDDR with an upper rate limit of 75-85% of the age-predicted maximum heart rate and a lower rate limit of 45-60 ppm. Heart rate was recorded continuously. An average of 5 beats during the last 10 seconds of each exercise stage was used in the analysis. Oxygen uptake (VO2) was measured using open circuit spirometry. The VO2 values from the final 15 seconds of each exercise stage were used for analysis. Stroke volume and cardiac output were measured during the last minute of each stage using impedance cardiography. The test-retest reliability of heart rate and cardiac output responses to graded exercise was assessed using repeated measures analysis of variance, for which the reliability coefficients were r = 0.993 and r = 0.954, respectively (P < 0.01). There were significant correlations (P < 0.01) between VO2 and heart rate and between VO2 and cardiac output, with correlation coefficients of r = 0.907 and r = 0.824, respectively. This method of adaptive rate pacing produced reliable, positive hemodynamic responses to graded exercise on a test-retest basis.

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