Validity of the 6 min walk test in prediction of the anaerobic threshold before major non-cardiac surgery

Sinclair, R. C. F.; Batterham, Alan M.; Davies, Simon; Cawthorn, Louise; Danjoux, Gerard

doi:10.1093/bja/aer322

Cited by 101 publications

(70 citation statements)

References 27 publications

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“…The anaerobic threshold cannot be identified in some patients and its relationship with cellular lactate generation is unclear [16]. In other studies, the 6 min distance correlated with CPET measures in patients undergoing mixed major non-cardiac surgery [17], as well as patients with cardiac and pulmonary disease [18,19]. These results support walking as an objective measure of functional capacity in surgical populations, which could be used as an alternative to CPET in settings where the latter is not available.…”

Section: Discussionmentioning

confidence: 76%

The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection

et al. 2013

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SummaryWe measured the distance 112 patients walked in 6 min, as well as their peak oxygen consumption pedalling a bicycle, week before scheduled resection of benign or malignant colorectal disease. The distance walked correlated with peak oxygen consumption, the former 'accounting' for about half the variation in the latter, r 2 0.52 (95% CI 0.38-0.64), p < 0.0001. In the first postoperative month, 42/112 patients experienced a complication. In multivariate analysis, complications were less likely with longer walking distances and increasing age: the odds ratio (95% CI) reduced to 0.995 (0.990-0.999) for each metre distance, and to 0.96 (0.93-0.99) with each year of age, p = 0.025 and p = 0.018, respectively. The distance walked in 6 min before surgery can provide prognostic information when cardiopulmonary exercise testing is unavailable.

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Section: Discussionmentioning

confidence: 76%

The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection

et al. 2013

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“…The most frequent complication was pneumonia, which occurred in the first week. Identification of organisms was possible among 24 patients: Gram-negative bacilli (15), gram-pos- Preoperative risk factors for PRCs are shown in Table 3 . There were no significant differences in age, gender, MELD score, Child-Pugh score, international normalized ratio, presence of comorbidities, restrictive syndrome, spirometry, maximal inspiratory pressure, or maximal expiratory pressure between patients who developed PRCs and those who did not.…”

Section: Resultsmentioning

confidence: 99%

“…Also reduced peak V O 2 can help identify patients at risk for mor- bidity and mortality after LT [7,39,40] . In our study, a poor exercise testing (6MWT) results were indeed predictive of PRCs after LT. A possible explanation for the association of poor exercise capacity and PRCs is the ability of this test to determine patients' physiological capacity to cope with the demands placed on the cardiorespiratory system following major surgery [15] . Unlike most organ-specific evaluations of LT candidates, 6MWT and 6MST provide an objective measure of global physical function.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is considerable evidence suggesting that patients with poor exercise test results are at an increased risk for PRCs after major surgery [13][14][15] , probably due to the ability of exercise testing to determine the subject's physiological ability to cope with the demands placed on the cardiorespiratory system following the surgical procedure [16] . A major feature of 6 MWT is the identification of oxyhemoglobin desaturation associated with pulmonary disease, which may not be apparent when the subject is assessed in the resting state.…”

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confidence: 99%

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Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation

Magalhães¹,

Nogueira²,

Marinho³

et al. 2017

Respiration

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Background: Postoperative respiratory complications (PRCs) are common after liver transplantation (LT) and contribute significantly to the related morbidity and mortality. Objective: The aim of this paper was to determine the incidence of PRCs after LT and the value of simple exercise capacity measures as independent predictors of PRCs. Methods: We conducted a prospective cohort study of consecutive adults submitted to LT at a University Hospital in Fortaleza Brazil from March 2013 to March 2015. At baseline, exercise capacity was assessed with the 6-minute walk test (6MWT) and the 6-minute step test (6MST), lung function was tested by spirometry, and respiratory muscle strength was measured by maximal respiratory pressure. Additional relevant pre- and intraoperative data were collected through interview and chart review, and their association with the incidence of PRCs was evaluated. Results: The study included 100 subjects, 44% of whom presented at least 1 of the PRCs. In the univariate analysis, poor 6MST and 6MWT results and a longer preoperative cold ischemia time were associated with PRCs. The logistic regression analysis showed that PRCs were less likely to occur when preoperative walking distances were longer: the odds ratio (95% CI) was reduced to 0.589 (0.357-0.971) for each 50 m walked (p = 0.03). Likewise, PRCs were more likely to occur in patients with longer preoperative cold ischemia times: the odds ratio (95% CI) increased to 1.008 (1.002-1.015) for each minute (p = 0.01). Conclusion: The incidence of PRCs is high in LT patients. A prolonged cold ischemia time and preoperative 6MWT results were independent predictors of PRCs in this patient population.

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“…The DASI questionnaire was developed in medical patients with cardiac disease. Although subjective functional assessment by METs is simple, the entire concept of the MET has been seriously questioned because of numerous limitations [19][20][21][22][23]. Despite numerous validation studies, the validity of physical activity questionnaires for estimation of functional capacity remains unclear [16].…”

Section: Self-reported Functional Capacitymentioning

confidence: 99%

Editorial [Hot Topic Recent Advances in Anesthetic Management (Executive Guest Editors: Ehab Farag and D. John Doyle)]

Farag¹,

Dj²

2012

CPD

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Underlying cardiovascular disease is a potentially modifiable risk factor that contributes significantly to perioperative morbidity and mortality. Reducing perioperative and long-term morbidity and mortality requires risk modifying perioperative management. This, in turn, requires preoperative identification of patients with, or at risk of having cardiovascular disease. Preoperative cardiac evaluation includes, (i) recognition and treatment of active cardiac conditions, (ii) assessment of surgical risk, functional capacity, and clinical risk factors, (iii) identification of candidates for non-invasive cardiac testing, coronary angiography and preoperative coronary revascularization, and (iv) pharmacologic management. A cardiac risk assessment algorithm is useful in guiding systematic evaluation. Although preoperative cardiac evaluation has improved during the past decades, we are not yet in the situation where we can accurately predict individual perioperative risk because the individual stress response to a given stressor, and the individual interactions between pharmacological intervention and intra-and postoperative risk factors are highly variable. Furthermore, preoperative cardiac evaluation is only one aspect of overall perioperative care. There are numerous intra-and postoperative factors which have been shown to affect overall outcome. Not all of them can reliably be predicted or modified in a way which improves outcome. However, recognition of such factors and aggressive attempts at appropriate intervention may reduce overall risk more than preoperative evaluation in isolation. Without defining and subsequently targeting intra-and postoperative risk factors, the benefit of preoperative cardiac evaluation will be limited.

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Validity of the 6 min walk test in prediction of the anaerobic threshold before major non-cardiac surgery

Cited by 101 publications

References 27 publications

The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection

The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection

Exercise Capacity Impairment Can Predict Postoperative Pulmonary Complications after Liver Transplantation

Editorial [Hot Topic Recent Advances in Anesthetic Management (Executive Guest Editors: Ehab Farag and D. John Doyle)]

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