Repeatability and learning effect in the 6MWT in preoperative cancer patients undergoing a prehabilitation program

Abstract

Objective the main objective was to assess repeatability and learning effect of the six-minute walk test (6MWT) in a cohort of preoperative cancer patients referred to a prehabilitation program. As a secondary objective we aimed to identify determinants of improvement in the second test. Materials and Methodssecondary analysis from a large prospective study on the implementation of a multimodal prehabilitation program in a real-life scenario. Eligible patients were assessed at baseline before starting the prehabilitation program. The 6MWT was conducted according to the American Thoracic Society (ATS)/ European Respiratory Society (ERS) guidelines with two tests being performed under identical conditions separated by 30 minutes. The distance covered (in meters) and the physiological responses (heart rate, oxygen saturation, fatigue and dyspnea) to each test were recorded and compared. Results170 patients (60.9%) were analyzed. Repeatability of the distance covered with the 6MWT was excellent (ICC = 0.98; 95% CI: 0.92 -0.99), but a mean increase of +19.5 meters (95% CI: 15.6 -23.5m; p=<.001) in the second test was found, showing a learning effect with limits of agreement between -31.3 and 70.4m.Coe cient of variation was 4%. No clinical factor was found to be associated with an improvement in the second test. Conclusionsthe 6MWT showed excellent repeatability in preoperative cancer patients, but a signi cant learning effect is present. No associated factors with a clinically meaningful improvement in the second test were identi ed. In light of these ndings, two attempts of the 6MWT should be encouraged in this population.

Cancer survivor inspiratory muscle training: systematic review and Bayesian meta-analysis

“…In our case, from the nine studies included in the meta-analysis, five used the 6MWT. However, the 6MWT seems to have a learning effect for both ptients with COPD56 and patients with cancer 57. In addition, there is heterogeneity in the time when 6MWT was applied before and after the intervention.…”