A Qualitative Systematic Overview of the Measurement Properties of Functional Walk Tests Used in the Cardiorespiratory Domain

doi:10.1378/chest.119.1.256

Chest

Volume 119, Issue 1, January 2001, Pages 256-270

https://doi.org/10.1378/chest.119.1.256 Get rights and content

Objective:

To perform a qualitative systematic overviewof the measurement properties of the most commonly utilized walk testsin the cardiorespiratory domain: the 2-min walk test (2MWT), 6-min walktest (6MWT), 12-min walk test (12MWT), self-paced walk test (SPWT), andshuttle walk test (SWT).

Data sources:

MEDLINE(1966 to January 2000) and CINAHL (1982 to December 1999) electronicdatabases were searched. Bibliographies of the retrieved articles werereviewed.

Study selection:

Clinical trials andobservational studies were included if they reported data on thevalidity, reliability, interpretability, or responsiveness of the 2MWT,6MWT, 12MWT, SPWT, or SWT. Only studies conducted on patients withcardiac and/or respiratory involvement wereincluded.

Results:

Fifty-two studies examiningmeasurement properties of the various walk tests were found: 5 studieson the 2MWT, 29 studies on the 6MWT, 13 studies on the 12MWT, 6 studieson the SPWT, and 4 studies on the SWT. Measurement properties were moststrongly demonstrated for the 6MWT. Correlations of 6MWT distance andmaximal oxygen consumption ranged from 0.51 to 0.90. A change indistance walked of at least 54 m was found to be clinicallysignificant for the 6MWT. Reliability was shown to be optimized whenthe administration of walk tests was standardized and at least twopractice walks were performed. Patients with increased likelihood ofpostoperative complications, hospitalization, and death were identifiedby analysis of distance walked.

Conclusions:

Measurement properties of the 6MWT have been the most extensivelyresearched and established. In addition, the 6MWT is easy toadminister, better tolerated, and more reflective of activities ofdaily living than the other walk tests. Therefore, the 6MWT iscurrently the test of choice when using a functional walk test forclinical or research purposes.

Section snippets

Literature Search

A computer search of the English-language medical literatureusing the databases MEDLINE (1966 to January 2000) and CINAHL (1982 to, December 1999) was conducted. Combinations of the following key wordswere used: exercise test, walk,walking, heart diseases, lungdiseases, and cardiopulmonary. A further manual searchexamined the key references provided in each article, and potentialarticles were retrieved. Investigations published only in abstract formwere not included, and no attempt was made to

Literature Search

More than 120 articles were identified through the electronicdatabase and manual searches. Of these, 52 were clinical trials orobservational studies that reported on the measurement properties ofthe 2MWT, 6MWT, 12MWT, SPWT or SWT; the others were reviews or onlyreported the existence or use of the selected or other walk tests.Table 1 summarizes the evidence for thedifferent measurement properties of the selected walk tests.

2MWT

Five studies on the 2MWT were found (Table 2). Of these, two studies

Discussion

The measurement of functional status and capacity has become anintegral component of evaluating the impact of an intervention anddetermining prognosis in patients with cardiorespiratory disease. Thisqualitative systematic review has examined the measurement propertiesof the most commonly used functional walk tests in thecardiorespiratory domain. Most of the literature found evaluatingmeasurement properties of functional walk tests pertained to the 6MWTand 12MWT. Few studies have been conducted

Conclusion

The 2MWT, 6MWT, 12MWT, SPWT, and SWT are functional walk teststhat are used in the assessment of patients with cardiorespiratorydisease. Measurement properties of the 6MWT have been the mostextensively researched and established. In addition, the 6MWT is easyto administer, better tolerated, and more reflective of activities ofdaily living than the other walk tests. Therefore, the 6MWT iscurrently the test of choice when using a functional walk test forclinical or research purposes. The 6MWT

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Performance-based outcome measures for assessing physical capacity in patients with pulmonary embolism: A scoping review
2024, Thrombosis Research
Up to 50 % of patients surviving a pulmonary embolism (PE) report persisting shortness of breath, reduced physical capacity and psychological distress. As the PE population is heterogeneous compared to other cardiovascular patient groups, outcome measures for assessing physical capacity traditionally used in cardiac populations may not be reliable for the PE population as a whole. This scoping review aims to 1) map performance-based outcome measures (PBOMs) used for assessing physical capacity in PE research, and 2) to report the psychometric properties of the identified PBOMs in a PE population.
The review was conducted according to the Joanna Briggs Institute framework for scoping reviews and reported according to the PRISMA-Extension for Scoping Reviews guideline.
The systematic search of five databases identified 4585 studies, of which 243 studies met the inclusion criteria. Of these, 185 studies focused on a subgroup of patients with chronic thromboembolic pulmonary hypertension. Ten different PBOMs were identified in the included studies. The 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) were the most commonly used, followed by the (Modified) Bruce protocol and Incremental Shuttle Walk test. No studies reported psychometric properties of any of the identified PBOMs in a PE population.
Publication of studies measuring physical capacity within PE populations has increased significantly over the past 5–10 years. Still, not one study was identified, reporting the validity, reliability, or responsiveness for any of the identified PBOMs in a PE population. This should be a priority for future research in the field.
Clinimetric Properties of the Steep Ramp Test to Assess Cardiorespiratory Fitness, Its Underlying Physiological Responses, and Its Current Applications: A Scoping Review
2024, Archives of Physical Medicine and Rehabilitation
Providing an overview of the clinimetric properties of the steep ramp test (SRT)—a short-term maximal exercise test—to assess cardiorespiratory fitness (CRF), describing its underlying physiological responses, and summarizing its applications in current clinical and research practice.
MEDLINE (through PubMed), CINAHL Complete, Cochrane Library, EMBASE, and PsycINFO were searched for studies published up to July 2023, using keywords for SRT and CRF.
Eligible studies involved the SRT as research subject or measurement instrument and were available as full text articles in English or Dutch.
Two independent assessors performed data extraction. Data addressing clinimetric properties, physiological responses, and applications of the SRT were tabulated.
In total, 370 studies were found, of which 39 were included in this study. In several healthy and patient populations, correlation coefficients between the work rate at peak exercise (WR_peak) attained at the SRT and oxygen uptake at peak exercise during cardiopulmonary exercise testing (CPET) ranged from .771-.958 (criterion validity). Repeated measurements showed intraclass correlation coefficients ranging from .908-.996 for WR_peak attained with the first and second SRT (test-retest reliability). Physiological parameters, like heart rate and minute ventilation at peak exercise, indicated that the SRT puts a lower burden on the cardiopulmonary system compared to CPET. The SRT is mostly used to assess CRF, among others as part of preoperative risk assessment, and to personalize interval training intensity.
The SRT is a practical short-term maximal exercise test that is valid for CRF assessment and to monitor changes in CRF over time in various healthy and patient populations. Its clinimetric properties and potential applications make the SRT of interest for a widespread implementation of CRF assessment in clinical and research practice and for personalizing training intensity and monitoring longitudinal changes in CRF.
Systematic Review of the Use of the 6-Minute Walk Test in Measuring and Improving Prognosis in Patients With Ischemic Heart Disease
2023, CJC Open
The 6-minute walk test (6MWT) has been used for over 30 years to assess exercise capacity in patients with respiratory disease, and more recently, in those with heart failure. However, despite being a simple and reproducible test of real-world exercise capacity, its use in patients with ischemic heart disease (IHD) is less well accepted. We sought to review systematically the evidence surrounding the 6MWT in IHD.
We searched the Medline, PubMed, Embase, and Scopus databases for the following key terms: “six minute walk test/6 minute walk test/6MWT” and “angina/coronary artery disease/coronary disease/IHD/ischemic heart disease.” We followed Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines to select publications for full-text review and analyzed the collated data.
A total of 1228 unique papers were found, of which 71 were chosen for full-text review and 37 for detailed analysis. Most (23) concerned the effect on 6MWT distance (6MWTd) of cardiac rehabilitation, with measurements commenced after an intervention (acute myocardial infarction, n = 4; open heart surgery (OHS), n = 5; percutaneous coronary intervention (PCI), n = 3; or other, n = 11). The effect on 6MWTd of OHS was investigated in 6 studies and of PCI in one study. The 6MWT is a useful measurement of physical capacity; data are limited on its ability to assess benefit following PCI.
The 6MWT has been studied inconsistently in IHD. The majority of data are on patients before and after CR. Data are limited concerning the effect on 6MWTd of OHS or PCI. The available data support the 6MWT as a measure of change in performance status following coronary intervention. More work is required to confirm this hypothesis.
Le test de marche de 6 minutes (TM6) est utilisé depuis plus de 30 ans pour évaluer la tolérance à l’effort chez les patients atteints de maladies respiratoires, et maintenant également utilisé auprès des patients atteints d’insuffisance cardiaque. Toutefois, bien qu’il s’agisse d’un test simple et facile à reproduire de la tolérance à l’effort en contexte réel, son utilisation est moins bien acceptée auprès des patients présentant une cardiopathie ischémique (CI). Notre objectif était de réaliser une revue systématique des données probantes au sujet du TM6 chez les patients atteints de CI.
Nous avons effectué une recherche dans les bases de données Medline, PubMed, Embase et Scopus en utilisant les mots-clés suivants : « six minute walk test/6 minute walk test/6MWT » [test de marche de six minutes/test de marche de 6 minutes/TM6] et « angina/coronary artery disease/coronary disease/IHD/ischemic heart disease » [angine/coronaropathie/CI/cardiopathie ischémique]. Nous avons suivi les lignes directrices « Preferred Reporting Items for Systematic Reviews and Meta-analysis » pour sélectionner les articles à soumettre à un examen du texte intégral et nous avons analysé les données obtenues.
Au total, 1 228 articles différents ont été repérés; 71 d’entre eux ont été sélectionnés pour un examen du texte intégral, puis 37 ont été soumis à une analyse plus détaillée. La plupart de ces articles (23) portaient sur l’effet de la distance au TM6 (dTM6) sur la réadaptation cardiaque, et les mesures débutaient après une intervention (infarctus aigu du myocarde, n = 4; chirurgie à cœur ouvert [CCO], n = 5; intervention coronarienne percutanée [ICP], n = 3; autre type d’intervention, n = 11). L’effet sur la dTM6 d’une CCO a été évalué dans six études et l’effet d’une ICP a été évalué dans une étude. La dTM6 est une mesure utile de la tolérance à l’effort, mais les données restent limitées sur sa capacité à évaluer les effets bénéfiques d’une ICP.
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Chest

ReviewsA Qualitative Systematic Overview of the Measurement Properties of Functional Walk Tests Used in the Cardiorespiratory Domain

Objective:

Data sources:

Study selection:

Results:

Conclusions:

Section snippets

Literature Search

Literature Search

2MWT

Discussion

Conclusion

J Card Fail

Br J Dis Chest

J Chronic Dis

Physiotherapy

J Chronic Dis

Control Clin Trials

Chest

Chest

Chest

Chest

J Pediatr

Chest

Am Heart J

Am Heart J

Arch Phys Med Rehabil

Am J Cardiol

Br J Dis Chest

Int J Cardiol

Aust J Physiother

Lancet

Control Clin Trials

Reproducibility of walking tests results in chronic obstructive airways disease

Thorax

Estimation of peak oxygen consumption from a sub-maximal half mile walk in obese females

Int J Obes Relat Metab Disord

A 2-km walking test for assessing cardiorespiratory fitness of healthy adults

Int J Sports Med

Validity of a two kilometre walking test for estimating maximal aerobic power in overweight adults

Int J Obes

Assessment of respiratory function in patients with chronic obstructive airways disease

Thorax

Twelve-minute walking test for assessing disability in chronic bronchitis

BMJ

A means of assessing maximal oxygen intake: correlation between field and treadmill testing

JAMA

Two-, six, and 12-minute walking tests in respiratory disease

BMJ

Self-paced walking as a method for exercise testing in elderly and young men

Clin Sci Mol Med

Development of a shuttle walking test of disability in patients with chronic airways obstruction

Thorax

A maximal multistage 20-m shuttle run test to predict VO2max

Eur J Appl Physiol

Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation

Eur Respir J

The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease

Thorax

Field tests in pulmonary disease

Thorax

Systematic reviews: critical links in the great chain of evidence

Ann Intern Med

Systematic reviews: synthesis of best evidence for clinical decisions

Ann Intern Med

Guides for reading and interpreting systematic reviews: III. How did the authors synthesize the data and make their conclusions?

Arch Pediatr Adolesc Med

A systematic overview of the measurement properties of the chronic respiratory questionnaire

Can Respir J

Health status measurement instruments in chronic obstructive pulmonary disease

Can Respir J

Measuring health-related quality of life

Ann Intern Med

Reviews
A Qualitative Systematic Overview of the Measurement Properties of Functional Walk Tests Used in the Cardiorespiratory Domain

A maximal multistage 20-m shuttle run test to predict VO₂max