The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
This presentation will help physiotherapy students for their theory as well as practical purpose for measuring the exercise tolerance level of the individual.
This presentation includes maximal and sub maximal exercise testing with it's VO2 max formula
This presentation gives brief description of the treadmill test, am-strand cycle ergo-meter test, 6MWT, symptom limited testing, shuttle walk test
Exercise Testing in Cardiology : Dr. Akif Baigakifab93
The testing modality and protocol should be selected in accordance with the patient’s estimated functional capacity based on age, estimated physical fitness from the patient’s history, and underlying disease
Several exercise test protocols are available for both treadmill and stationary cycle ergometers
Patients who have low estimated fitness levels or are deemed to be at higher risk because of underlying disease (e.g., recent MI, heart failure) should be tested with a less aggressive exercise protocol
Treadmill and cycle ergometers may use stepped or continuous ramp protocols
Work rate increments (stages) during stepped protocols can vary from 1 to 2.5 METs
Ramp protocols are designed with stages that are no longer than 1 minute and for the patient to attain peak effort within 8 to 12 minutes
This ppt contains all the details about what is obesity, etiology, & mainly focuses on various methods of assessment of obesity from field tests to lab tests.
this ppt contains everything about evaluation in antenatal period by a physiotherapist for proper prescription of exercises. also it has details of contraindications & generalised guidelines for exercises in antenatal period.
this ppt is about therapeutic massage by physiotherapist. includes details like indications, contraindications, effects, preparation of patient & therapist & classification of manipulations.
this PPT contain detailed kinetics & kinematics of ankle joint & all joints of foot complex, muscles of ankle & foot complex, plantar arches & weight distribution during standing.
this PPT contains all the detailed information about walking aids including types, measurements, advantages & disadvantages, gait training with specific aid, etc.
This PPT contains a detailed explanation about resisted exercises, different types of exercise, indications & contraindications, manual & mechanical techniques.
THIS PPT CONTAINS DESCRIPTION ABOUT HISTORY TAKING IN PATIENTS WITH CARDIORESPIRATORY DISEASES, EXPLAINED IN DETAILS ABOUT ALL SYMPTOMS & ITS DETAILED HISTORY.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. • There are several modalities available for the objective evaluation of
functional exercise capacity.
• Some provide a very complete assessment of all systems involved in
exercise performance (high tech), whereas others provide basic
information but are low tech and are simpler to perform.
• The most popular clinical exercise tests in order of increasing complexity
are stair climbing, a 6MWT, a shuttle-walk test, detection of exercise-
induced asthma, a cardiac stress test (e.g., Bruce protocol), and a
cardiopulmonary exercise test.
• Objective measurements are usually better than self-reports.
INTRODUCTION
3. • In the early 1960s, Balke developed a simple test to evaluate the functional
capacity by measuring the distance walked during a defined period of time.
• A 12-minute field performance test was then developed to evaluate the
level of physical fitness of healthy individuals.
• The walking test was also adapted to assess disability in patients with
chronic bronchitis.
• In an attempt to accommodate patients with respiratory disease for whom
walking 12 minutes was too exhausting, a 6-minute walk was found to
perform.
• A recent review of functional walking tests concluded that “the 6MWT is
easy to administer, better tolerated, and more reflective of activities of
daily living than the other walk tests”.
4. • The 6MWT is a practical simple test that requires a 100-ft hallway but no
exercise equipment or advanced training for technicians.
• Walking is an activity performed daily by all but the most severely impaired
patients.
• This test measures the distance that a patient can quickly walk on a flat, hard
surface in a period of 6 minutes (the 6MWD).
• It evaluates the global and integrated responses of all the systems involved
during exercise, including the pulmonary and cardiovascular systems, systemic
circulation, peripheral circulation, blood, neuromuscular units, and muscle
metabolism.
• It does not provide specific information on the function of each of the
different organs and systems involved in exercise or the mechanism of exercise
limitation, as is possible with maximal cardiopulmonary exercise testing.
• The self-paced 6MWT assesses the submaximal level of functional capacity.
5. • Most patients do not achieve maximal exercise capacity during the 6MWT;
instead, they choose their own intensity of exercise and are allowed to stop
and rest during the test.
• However, because most activities of daily living are performed at
submaximal levels of exertion, the 6MWD may better reflect the
functional exercise level for daily physical activities.
• Specifically, it reviews indications, details factors that influence results,
presents a brief step-by-step protocol, outlines safety measures, describes
proper patient preparation and procedures, and offers guidelines for
clinical interpretation of results.
6. • The strongest indication for the 6MWT is for measuring the response to
medical interventions in patients with moderate to severe heart or lung
disease.
• The 6MWT has also been used as a one-time measure of functional status
of patients, as well as a predictor of morbidity and mortality.
• The fact that investigators have used the 6MWT in these settings does not
prove that the test is clinically useful (or the best test) for determining
functional capacity or changes in functional capacity due to an intervention
in patients with these diseases.
INDICATIONS & LIMITATIONS
8. LIMITATIONS :-
• The 6MWT does not determine peak oxygen uptake, diagnose the cause of
dyspnea on exertion, or evaluate the causes or mechanisms of exercise
limitation.
• The information provided should be considered complementary to
cardiopulmonary exercise testing but not a replacement for it.
• 6MWT provides information that may be a better index of the patient’s
ability to perform daily activities than is peak oxygen uptake.
9. Absolute contraindications for the 6MWT
• Unstable angina during the previous month
• Myocardial infarction during the previous month
Relative contraindications
• Resting heart rate of more than 120
• a systolic blood pressure of more than 180 mm Hg
• diastolic blood pressure of more than 100 mm Hg.
CONTRAINDICATIONS
10. • Patients with any of these findings should be referred to the physician
ordering or supervising the test for individual clinical assessment and a
decision about the conduct of the test.
• The results from a resting electrocardiogram done during the previous 6
months should also be reviewed before testing.
• Stable exertional angina is not an absolute contraindication for a 6MWT,
but patients with these symptoms should perform the test after using their
antiangina medication, and rescue nitrate medication should be readily
available.
11. • Testing should be performed in a location where a rapid, appropriate response
to an emergency is possible. ( A crash cart facility)
• Supplies that must be available include oxygen, sublingual nitroglycerine,
aspirin, albuterol (MDI or nebulizer), telephone or other means to call for
help.
• The technician should be certified in cardiopulmonary resuscitation with a
minimum of Basic Life Support. Advanced cardiac life support certification is
desirable. A certified individual should be readily available to respond if
needed.
• Physicians are not required to be present during all tests. The physician
ordering the test or a supervising laboratory physician may decide whether
physician attendance at a specific test is required.
• If a patient is on chronic oxygen therapy, oxygen should be given at their
standard rate or as directed by a physician or a protocol.
SAFETY ISSUES
12. REASONS FOR IMMEDIATELY STOPPING A 6MWT :-
( 1 ) Chest pain
( 2 ) Intolerable dyspnea
( 3 ) Leg cramps
( 4 ) Staggering
( 5 ) Diaphoresis
( 6 ) Pale or ashen appearance
13. • Technicians must be trained to recognize these problems and the
appropriate responses.
• If a test is stopped for any of these reasons, the patient should sit or lie
supine as appropriate depending on the severity or the event and the
technician’s assessment of the severity of the event and the risk of
syncope.
• The following should be obtained based on the judgment of the
technician:
• Blood pressure
• Pulse rate
• Oxygen saturation
• Physician evaluation.
15. • The 6MWT should be performed indoors, along a long, flat, straight,
enclosed corridor with a hard surface.
• If the weather is comfortable, the test may be performed outdoors.
• The walking course must be 30 m in length.
• The length of the corridor should be marked every 3 m.
• The turnaround points should be marked with a cone (such as an orange
traffic cone).
• A starting line, which marks the beginning and end of each 60-m lap,
should be marked on the floor using brightly colored tape.
LOCATION
16. 1. Countdown timer (or stopwatch)
2. Mechanical lap counter
3. Two small cones to mark the turnaround points
4. A chair that can be easily moved along the walking course
5. Worksheets on a clipboard
6. A source of oxygen
7. Sphygmomanometer
8. Pulse oxymeter
9. Telephone
10. Automated electronic defibrillator
EQUIPMENTS NEEDED
17. 1. Comfortable clothing
2. Appropriate shoes for walking
3. Patients should use their usual walking aids during the test (cane, walker,
etc.)
4. The patient’s usual medical regimen should be continued
5. A light meal is acceptable before early morning or early afternoon tests
6. Patients should not have exercised vigorously within 2 hours of beginning
the test.
PATIENT PREPARATION
18. • Repeat testing should be performed about the same time of day to minimize
intraday variability.
• A “warm-up” period before the test should not be performed.
• The patient should sit at rest in a chair, located near the starting position, for
at least 10 minutes before the test starts. During this time, check for
contraindications, measure pulse and blood pressure, and make sure that
clothing and shoes are appropriate.
• Pulse oximetry is optional. If it is performed to measure and record baseline
heart rate and oxygen saturation (SpO2).
• Have the patient stand and rate their baseline dyspnea and overall fatigue using
the Borg scale.
• Set the lap counter to zero and the timer to 6 minutes. Assemble all necessary
equipment and move to the starting point.
MEASUREMENTS
19.
20. Instruct the patient as follows:-
• “The object of this test is to walk as far as possible for 6 minutes. You will
walk back and forth in this hallway. Six minutes is a long time to walk, so you
will be exerting yourself. You will probably get out of breath or become
exhausted. You are permitted to slow down, to stop, and to rest as necessary.
You may lean against the wall while resting, but resume walking as soon as you
are able.
• You will be walking back and forth around the cones. You should pivot briskly
around the cones and continue back the other way without hesitation.
• Demonstrate by walking one lap yourself. Walk and pivot around a cone
briskly. “Are you ready to do that? I am going to use this counter to keep track
of the number of laps you complete. I will click it each time you turn around
at this starting line.
• Remember that the object is to walk AS FAR AS POSSIBLE for 6 minutes,
but don’t run or jog. Start now, or whenever you are ready.”
21. • Position the patient at the starting line. Stand near the starting line during
the test. Do not walk with the patient. As soon as the patient starts to
walk, start the timer.
• Do not talk to anyone during the walk. Use an even tone of voice when
using the standard phrases of encouragement. Watch the patient. Do not
get distracted and lose count of the laps. Each time the participant returns
to the starting line, click the lap counter once (or mark the lap on the
worksheet). Let the participant see you do it. Exaggerate the click using
body language, like using a stopwatch at a race.
22. • Post-test: Record the postwalk Borg dyspnea and fatigue levels. If using a
pulse oximeter, measure SpO 2 and pulse rate from the oximeter and then
remove the sensor.
• Record the number of laps from the counter.
• Record the additional distance covered (the number of meters in the final
partial lap) using the markers on the wall as distance guides. Calculate the
total distance walked, rounding to the nearest meter, and record it on the
worksheet.
• Congratulate the patient on good effort and offer a drink of water.
23. Factors reducing the 6MWD
• Shorter height
• Older age
• Higher body weight
• Female sex
• Impaired cognition
• A shorter corridor (more turns)
• Pulmonary disease (COPD, asthma,
cystic fibrosis, interstitial lung
disease)
• Cardiovascular disease (angina, MI,
CHF, stroke, TIA, PVD, AAI)
• Musculoskeletal disorders (arthritis,
ankle, knee, or hip injuries, muscle
wasting, etc.)
Factors increasing the 6MWD
• Taller height (longer legs)
• Male sex
• High motivation
• A patient who has previously
performed the test
• Medication for a disabling disease
taken just before the test
• Oxygen supplementation in
patients with exercise-induced
hypoxemia
6MWD SOURCE OF VARIABILITY
25. • Most 6MWTs will be done before and after intervention, and the primary
question to be answered after both tests have been completed is whether
the patient has experienced a clinically significant improvement.
• With a good quality-assurance program, with patients tested by the same
technician, and after one or two practice tests, short-term reproducibility
of the 6MWD is excellent.
• A statistically significant mean increase in 6MWD in a group of study
participants is often much less than a clinically significant increase in an
individual patient.
26. • Differences in the population sampled, type and frequency of
encouragement, corridor length, and number of practice tests may account
for reported differences in mean 6MWD in healthy persons. Age, height,
weight, and sex independently affect the 6MWD in healthy adults;
therefore, these factors should be taken into consideration when
interpreting the results of single measurements made to determine
functional status.
• A low 6MWD is nonspecific and nondiagnostic. When the 6MWD is
reduced, a thorough search for the cause of the impairment is warranted.
• The following tests may then be helpful: pulmonary function, cardiac
function, ankle–arm index, muscle strength, nutritional status, orthopedic
function, and cognitive function.
INTERPRETING SINGLE
MEASUREMENTS OF FUNCTIONAL
STATUS
27. APPENDIX
The following elements should be present on the 6MWT worksheet and report:
Lap counter: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Patient name: ____________________ Patient ID# ___________
Walk # ______ Tech ID: _________ Date: __________
Gender: M F Age: ____ Race: ____ Height: ___ft ____in, ____ meters
Weight: ______ lbs, _____kg
Medications taken before the test (dose and time): __________________
Supplemental oxygen during the test: No Yes, flow ______ L/min, type _____
Baseline End of Test
Time ___:___ ___:___
Heart Rate _____ _____
Dyspnea ____ ____ (Borg scale)
Fatigue ____ ____ (Borg scale)
SpO2 ____ % ____%
Blood pressure: _____ _____
Stopped or paused before 6 minutes? No Yes, reason: _______________
Other symptoms at end of exercise: angina dizziness hip, leg, or calf pain
Number of laps: ____ (60 meters) final partial lap: _____ meters
Total distance walked in 6 minutes: ______ meters
Predicted distance: _____ meters Percent predicted: _____%
Tech comments:
Interpretation (including comparison with a preintervention 6MWD):
28. • American Thoracic Society,Am J Respir Crit Care Med Vol 166. pp 111–
117, 2002 DOI: 10.1164/rccm.166/1/111 Internet address:
www.atsjournals.org; ATS STATEMENT: GUIDELINES FOR THE SIX-
MINUTE WALK TEST. This official statement of the american
thoracic society was approved by the ats board of directors march
2002.
REFERENCE