Six-minute walk distance in healthy young adults

Halliday, Stephen; Wang, Li; Yu, Chang; Vickers, Brian P.; Newman, John H.; Fremont, Richard D.; Huerta, Luis E.; Brittain, Evan L.; Hemnes, Anna R.

doi:10.1016/j.rmed.2020.105933

Cited by 57 publications

(54 citation statements)

References 40 publications

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“…They did not evaluate for Using continuous telemetric ECG measurement, we found a reduction in peak HR, HR expenditure, and HR expenditure adjusted for distance walked (HRE/d) after beginning or intensifying therapy. We hypothesize these changes reflect improved right ventricular function and may be more sensitive to therapy intensification than 6MWD, especially for those walking longer distances (where random variation in walk distance may be more likely) (4,10). Importantly, these HR parameters were unchanged in the stable PAH and healthy control group where we wouldn't expect there to be any changes in RV function.…”

Section: Discussionmentioning

confidence: 93%

“… 10 This was recently confirmed in 56 healthy young adults completing paired 6MWD (median 6MWD difference was 32.5 ± 31.9 m). 4 The variability in 6MWD is a common problem typically encountered in routine clinical practice. The greater random variability among those patients walking longer distances may have contributed to the muted 6MWD benefits seen in combination studies.…”

Section: Discussionmentioning

confidence: 99%

“…We used the MC10 Biostamp nPoint to measure continuous heart rate during 6MWT; the device has FDA 510k clearance, and the cloud storage is fully HIPAA compliant. In the stable groups without planned treatment changes (PAH and healthy control), paired walks were completed within 4 (Figure 1). The treatment intensification (TI) group had testing at baseline and again 2-4 months later ( Figure 1).…”

Section: -Minute Walk With Heart Rate Monitoringmentioning

confidence: 99%

“…The 6-minute walk test (6MWT) is a core component in the evaluation of PAH which appears to reflect RV performance during stress, and it can be serially measured in the clinic. While 6MWT offers a simple, non-invasive and inexpensive measurement, absolute distance walked is likely confounded by several non-cardiopulmonary factors including age, height, weight, (4), effort, and musculoskeletal disease.…”

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confidence: 99%

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Heart rate monitoring improves clinical assessment during 6‐min walk

et al. 2020

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Right ventricular (RV) function is a predictor of outcomes in pulmonary arterial hypertension (PAH). The 6-minute walk test (6MWT) is likely an indirect measure of RV function during exercise, but changes in absolute walk distance can also be influenced by factors like effort and musculoskeletal disease. Paired 6MWT with continuous electrocardiogram monitoring were performed in stable PAH patients, patients adding PAH therapies, and healthy controls. Heart rate expenditure (HRE) was calculated (integrating pulse during 6MWT) and then divided by walk distance (HRE/d). We also evaluated changes in peak heart rate, time above age adjusted maximum predicted heart rate, and heart rate at 6 minutes. HRE/d was compared to invasive hemodynamic measures in patients who had right heart catheterization performed within seven days, WHO functional class assessment, and Emphasis 10 questionnaire. We measured two 6MWT in 15 stable PAH patients, 13 treatment intensification patients, and 8 healthy controls. HRE/d was reproducible in the stable PAH group (median difference, -0.79%), while it decreased (median difference, 23%, p =0.0001) after adding vasodilator therapy. In 11 patients with right heart catheterization, HRE/d correlated strongly with stroke volume, r=-0.72, p=0.01. Peak heart rate decreased after adding vasodilator therapy. HRE/d also correlated with WHO functional class and Emphasis 10 score. Continuous heart rate monitoring during 6MWT provides valuable physiologic data accounting for effort. HRE/d appears to enhance test reproducibility in stable patients while detecting change after adding therapy as compared to walk distance alone.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: -Minute Walk With Heart Rate Monitoringmentioning

confidence: 99%

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confidence: 99%

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Heart rate monitoring improves clinical assessment during 6‐min walk

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“…The 6‐minute walking distance (6MWD) is a commonly used performance‐based measure of mobility in older adults with mobility limitation, chronic obstructive pulmonary disease (COPD), heart failure, and other diseases 2‐4 . Although the CID for 6MWD is often cited to be 50 m, the estimates have varied substantially—from 19 to 63 m—depending on the condition, study population, and the estimation method 5‐12 …”

Section: Introductionmentioning

confidence: 99%

Clinically Important Differences for Mobility Measures Derived from the Testosterone Trials

Stephens‐Shields

Farrar

Ellenberg

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Accurate estimates of clinically important difference (CID) are required for interpreting the clinical importance of treatments to improve physical function, but CID estimates vary in different disease populations. We determined the CID for two common measures of walking ability in mobility‐limited older men. Design Longitudinal, multisite placebo‐controlled trial. Setting/Participants Men enrolled in the Testosterone Trials who had self‐reported mobility limitation and gait speed less than 1.2 m/second (n = 429). Testosterone‐ and placebo‐allocated participants were combined for this study. RESULTS Mean changes from baseline, adjusting for time‐in‐intervention and site, were 29.6, 13.2, 12.5, −2.4, and −32.6 m for 6MWD, and 15.4, 7.2, 2.1, −3.4, and −7.2 for PF10 in men who reported their mobility was “very/much better,” “little better,” “no change,” “little worse,” or “much worse,” respectively. CID estimates using regression, ROC, and eCDF varied from 5.0–29.6 m for 6MWD, and 5.0–15.2 points for PF10. CONCLUSION CID estimates vary by the population studied and by the method and precision of measurement. Increases of 16 to 30 m for 6MWD and 5 to 15 points for PF10 over 12 months appear to be clinically meaningful in mobility‐limited, older hypogonadal men. These CID estimates may be useful in the design of efficacy trials of therapies to improve physical function.

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Development of a Mitochondrial Myopathy‐Composite Assessment Tool

Flickinger

Fan

Wellik

et al. 2021

JCSM Clinical Reports

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Background‘Mitochondrial Myopathy’ (MM) refers to genetically‐confirmed Primary Mitochondrial Disease (PMD) that predominantly impairs skeletal muscle function. Validated outcome measures encompassing core MM domains of muscle weakness, muscle fatigue, imbalance, impaired dexterity, and exercise intolerance do not exist. The goal of this study was to validate clinically‐meaningful, quantitative outcome measures specific to MM.MethodsThis was a single centre study. Objective measures evaluated included hand‐held dynamometry, balance assessments, Nine Hole Peg Test (9HPT), Functional Dexterity Test (FDT), 30 second Sit to Stand (30s STS), and 6‐minute walk test (6MWT). Results were assessed as z‐scores, with < −2 standard deviations considered abnormal. Performance relative to the North Star Ambulatory Assessment (NSAA) of functional mobility was assessed by Pearson's correlation.ResultsIn genetically‐confirmed MM participants [n = 59, mean age 21.6 ± 13.9 (range 7 – 64.6 years), 44.1% male], with nuclear gene aetiologies, n = 18/59, or mitochondrial (mtDNA) aetiologies, n = 41/59, dynamometry measurements demonstrated both proximal [dominant elbow flexion (−2.6 ± 2.1, mean z‐score ± standard deviation, SD), hip flexion (−2.5 ± 2.3), and knee flexion (−2.8 ± 1.3)] and distal muscle weakness [wrist extension (−3.4 ± 1.7), palmar pinch (−2.5 ± 2.8), and ankle dorsiflexion (−2.4 ± 2.5)]. Balance [Tandem Stance (TS) Eyes Open (−3.2 ± 8.8, n = 53) and TS Eyes Closed (−2.6 ± 2.7, n = 52)] and dexterity [FDT (−5.9 ± 6.0, n = 44) and 9HPT (−8.3 ± 11.2, n = 53)] assessments also revealed impairment. Exercise intolerance was confirmed by strength‐based 30s STS test (−2.0 ± 0.8, n = 38) and mobility‐based 6MWT mean z‐score (−2.9 ± 1.3, n = 46) with significant decline in minute distances (slope −0.9, p = 0.03, n = 46). Muscle fatigue was quantified by dynamometry repetitions with strength decrement noted between first and sixth repetitions at dominant elbow flexors (−14.7 ± 2.2%, mean ± standard error, SEM, n = 21). All assessments were incorporated in the MM‐Composite Assessment Tool (MM‐COAST). MM‐COAST composite score for MM participants was 1.3 ± 0.1 (n = 53) with a higher score indicating greater MM disease severity, and correlated to NSAA (r = −0.64, p < 0.0001, n = 52) to indicate clinical meaning. Test–retest reliability of MM‐COAST assessments in an MM subset (n = 14) revealed an intraclass correlation coefficient (ICC) of 0.81 (95% confidence interval: 0.59–0.92) indicating good reliability.ConclusionsWe have developed and successfully validated a MM‐specific Composite Assessment Tool to quantify the key domains of MM, shown to be abnormal in a Definite MM cohort. MM‐COAST may hold particular utility as a meaningful outcome measure in future MM intervention trials.

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Six-minute walk distance in healthy young adults

Cited by 57 publications

References 40 publications

Heart rate monitoring improves clinical assessment during 6‐min walk

Heart rate monitoring improves clinical assessment during 6‐min walk

Clinically Important Differences for Mobility Measures Derived from the Testosterone Trials

Development of a Mitochondrial Myopathy‐Composite Assessment Tool

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