六分钟步行试验与摄氧量的相关性研究

背景:6 min步行试验是一种亚极量水平的运动试验,其操作简便、费用低廉,因而应用较广泛,然而将步行距离转换为最大运动能力是不易的.目的:课题组创新性地在6 min步行实验中引入做功的概念,将无线遥测呼吸气体分析仪同时应用于6 min步行试验和心肺运动试验,分析6 min步行试验中的距离、做功与峰值摄氧量与Bruce方案测得的最大摄氧量之间的相关性.设计、时间及地点:实验于2009-03/05在南京东南大学附属中大医院康复医学科完成.对象:健康受试者来自在中大医院康复医学科实习的学生,共25名,男14名,女11名;年龄(22.0±2.3)岁.方法:25名志愿者先按Bruce方案进行极量心肺运动试验,检测每位受试者极量运动时的最大摄氧量和无氧阈,再接受6 min步行试验,测量每位受试者的6 min步行距离、做功和峰值摄氧量.心肺运动试验和6 min步行试验均采用便携式K4b~2气体分析仪实时检测气体交换参数,以获得最大摄氧量和峰值摄氧量.主要观察指标:①摄氧量、心率、呼吸频率随时间的变化规律.②步行距离、做功、摄氧量、心率、呼吸频率的前后比较.③心肺运动试验中的最大摄氧量、无氧阈与6 min步行试验中的峰值摄氧量比较.④距离、做功与峰值摄氧量、最大摄氧量之间的相关性.结果:心肺运动试验测得的无氧阈与6 min步行试验测得的峰值摄氧量之间差异无显著性意义(P > 0.05).6 min步行距离与峰值摄氧量和最大摄氧量均无明显相关;6 min步行做功与峰值摄氧量呈线性相关(r=0.779 7,P < 0.001);6 min步行做功与最大摄氧量亦呈线性相关(r=0.894 1,P < 0.001).结论:6 min步行试验是一种无氧阈水平的运动试验.6 min步行做功既可反映受试者亚极量运动的能力,也能反映受试者极量运动的能力.     

慢性阻塞性肺疾病患者6分钟步行实验与最大摄氧量关系研究

目的比较慢性阻塞性肺疾病(COPD)患者6分钟步行实验(6MWT)与最大摄氧量(VO2max)关系,进一步评价6分钟步行实验的客观性。方法 27例稳定期COPD(轻到极重度)患者进行心肺运动实验(CPET)测定、6MWT、静态肺功能测定,计算体重指数(BMI)。比较6MWT与VO2max相关性。结果VO2max/kg与6MWD呈正相关(r=0.821,P=0.000),得出与6MWD相关线性回归方程。结论 VO2max作为运动功能评定金标准,它与6MWT有较强相关性,进一步证实6MWT的可靠性。     

中等强度有氧运动对慢性肾病患者峰值摄氧量和无氧阈的影响

目的:探索中等强度有氧运动对慢性肾病患者(chronic kidney disease,CKD)峰值摄氧量和无氧阈的影响,测定以峰值摄氧量百分数表示的无氧阈值(anaerobic threshold,AT)强度,为慢性肾病患者的临床康复运动方案提供依据。方法:70例CKD患者随机分为对照组(n=35)、运动组(n=35)。运动组以50%峰值摄氧量(peak oxygen uptake,VO_(2peak))踏功率自行车,每次30min,每周3次,共12周。12周训练前后,所有患者进行心肺运动试验(cardiopulmonary exercise test,CPET),测定受试者的峰值摄氧量(VO_(2peak)),同时利用简化V-slope法判定每位患者无氧阈值。结果:训练前两组VO_(2peak)、AT以及AT占VO_(2peak)百分比均无明显差异(P0.05);训练后,与对照组相比,运动组的VO_(2peak)、AT以及AT占VO_(2peak)百分比均有显著改善(P0.05)。结论:中等强度的有氧运动对CKD患者VO_(2peak)、AT有改善作用。CKD患者以%VO_(2peak)表示的AT值(73.50±1.31%VO_(2peak))高于未经训练的健康人群(50%—60%VO_(2peak))。     

6min步行试验在心肌梗死后心脏康复中的作用

目的利用6min步行试验(6MWT)来训练心肌梗死恢复期患者的运动耐量,评估预后。方法将80例心肌梗死后4周的患者分成两组。A组40例,每周接受2次6MWT训练;B组40例,进行日常活动;随访6个月,观察两组患者的6MWT和再住院率。结果6个月后,接受训练的A组患者6min步行距离(480±36m)较训练前(380±26m)有显著增加(P<0.001),B组在试验前后6MWT无显著差异。6个月后B组再住院率(30.0)高于A组(8.0)(P<0.001)。结论6MWT训练对心肌梗死后患者的康复有重要的作用,能增加心力衰竭患者的运动能力,改善心脏功能。     

6 min步行试验在老年患者Holter检查中的应用和护理

目的探讨在老年患者行Holter检查时进行6rain步行试验以提高Holter检查阳性率和初步确诊率的效果和护理。方法选择因“胸闷、心悸”住院,常规心电图正常的老年患者73例,分为A组37例,B组36例。住院第3天上午8：30安排Holter检查,其中A组患者在护理工作人员的指导下进行6min步行试验;B组作为对照,不进行6min步行试验。结果A组患者ST段缺血样改变的阳性率为75．7％（28／37）,明显高于B组（P〈0．05）;但心律失常的阳性率为70．3％（26／37）,与B组无统计学差异（P〉0．05）;A组患者与症状有关的ST段缺血样改变和心律失常分别占总阳性人数的75．0％（21／28）和50．0％（13／26）,通过Holter检查初步的确诊率为67．6％（25／37）,与B组比较差异均有统计学意义（P〈0．05）。结论Holter检查时指导患者进行6min步行试验可以提高ST缺血样改变的阳性率,明确症状与疾病的对应关系,提高诊断的准确性。     

慢性阻塞性肺病患者室内与室外6min步行试验结果的比较

慢性阻塞性肺病(chronicobstructivepulmonarydisease,COPD)患者的运动能力和生活质量水平并不常与气道阻塞的严重程度相一致,因此在临床治疗中常将测定其功能水平作为合适治疗的依据之一。在加拿大国家肺康复方案中,98%运动能力检查采取6min或1 2min步行试验,前者更为普遍应用,但该试验通常是在室内走廓中进行,而COPD患者的日常生活活动还包括室外行走,至今,对重症肺疾病患者来说尚无室内和室外活动的文献报导。本文对室外6min步行试验(6minutewalktest,6MWT)作为了解COPD患者功能状态的可行性以及室内与室外6MWT完成情况的相关性…     

6min步行距离和气短指数在城乡COPD患者中的差异性研究

目的探讨6min步行距离和气短指数在城乡COPD患者中的差异。方法 2010年6月至2011年10月,处于缓解期肺功能Ⅱ～Ⅳ级COPD患者108例,按照患者来源(农村或城市)分为城市组和农村组,进行6min步行试验,记录两组患者6min步行距离及步行前后的气短指数评分。结果 6min步行距离,Ⅱ、Ⅲ级COPD患者农村组高于城市组(P<0.05);Ⅳ级COPD患者农村组和城市组之间无明显差异(P>0.05)。同时,6分钟步行试验前后的气短指数评分,Ⅱ、Ⅲ级COPD患者农村组低于城市组(P<0.05);Ⅳ级COPD患者城市组与农村组之间无明显差异(P>0.05)。结论肺功能Ⅱ～Ⅲ级城乡COPD患者进行6min步行试验时6min步行距离和气短指数存在差异,提示COPD患者长期坚持适度体力劳动或运动锻炼有利于提高运动耐力。     

6min步行试验对于慢性阻塞性肺疾病患者的早期筛查意义

目的探讨6 min步行试验(6-MWT)对慢性阻塞性肺疾病(COPD)高危人群的早期筛查意义。方法选择2006年1月~2009年2月在本院呼吸内科就诊的稳定期COPD患者40例,均有长期吸烟史或慢性咳嗽、咳痰症状,其中COPDⅠ级(轻度)患者20例作为COPDⅠ组,Ⅱ级(中度)患者20例作为COPDⅡ组,另选择健康志愿者20例作为对照组。3组均进行6-MWT及肺功能检查,记录并对结果进行比较。结果 COPDⅠ组、Ⅱ组FEV1及6-MWT距离均显著小于对照组,差异有统计学意义。COPDⅡ组6-MWT距离显著小于COPDⅠ组,差异有统计学意义。结论 6 min步行试验可以较好地反映患者的肺功能,并且简便易行,适合在社区诊所或基层医疗单位对长期吸烟或有慢性咳嗽、咳痰症状者进行筛查,以便进一步在专业医疗机构进行肺功能检查和规范治疗。     

基于心肺运动试验峰值摄氧量下渐进式心脏康复运动方案对青年冠心病PCI术后病人的影响

目的:探究基于心肺运动试验峰值摄氧量下渐进式心脏康复运动方案对青年冠心病经皮冠状动脉介入治疗(PCI)术后病人体液因子水平及心肺功能的影响。方法:选取医院2020年1月—2022年10月93例青年冠心病PCI术后病人作为研究对象,按照随机数字表法将其分为对照组46例与观察组47例。对照组根据病人自身耐受程度指导康复运动训练,观察组基于心肺运动试验峰值摄氧量开展渐进式心脏康复运动方案,比较两组病人心肺功能、体液因子水平及运动能力。结果:干预后,观察组病人最大通气量(MVV)、心肺运动试验1 min后心率恢复(HRR1)、左心室射血分数(LVEF)、第1秒用力呼气量(FEV₁)、第1秒用力呼气量与用力肺活量的比值(FEV₁/FVC)较对照组高(P<0.05);同型半胱氨酸(Hcy)、脑利钠肽(BNP)、乳酸(LA)及血管紧张素Ⅱ(AngⅡ)水平低于对照组(P<0.05);最大摄氧量(VO₂max)、最大运动负荷(MWL)、无氧阈(AT)水平高于对照组(P<0.05)。结论:基于心肺运动试验峰值摄氧量下渐进式...     

6 min步行试验提高老年慢性心力衰竭患者活动耐力的效果评价

目的研究应用6 min步行试验提高老年慢性心力衰竭患者活动耐力的效果。方法将60例患者分为观察组和对照组各30例;对照组采用传统方法根据每分钟心脏射血分数(ejection fraction,EF)为依据制定活动计划,观察组采用依据6 min步行试验结果制定的个体化活动计划对患者进行运动锻炼。结果锻炼3周后观察组较对照组6 min步行试验完成率及6 min步行试验距离差异均有统计学意义(P<0.05或P<0.01)。结论应用6min步行试验结果制定运动锻炼计划可较好地提高老年慢性心力衰竭患者的活动耐力。     

6分钟步行试验在肺叶切除术患者术前评估中的应用北大核心CSCD

目的分析术前6分钟步行试验(6MWT)在肺叶切除术前评估应用的可行性及其对术后结局的预测价值。方法回顾性分析2017年5月至2019年5月在本院肺二科住院的580例患者,筛查出符合条件的274例,所有患者均为首次手术且手术方式均为肺叶切除术。通过术前6MWT结果将患者分为两组,6分钟步行距离(6MWD)的临界值通过接受者操作特征曲线(ROC)的曲线下最大面积(AUC)获得,分析两组术后恢复及心肺并发症的发生情况。结果与6MWD>449 m的患者比较,6 MWD≤449 m的患者年龄显著增加(P<0.001),第一秒用力呼气量(FEV1)较小(P<0.05),其他如手术切除部位、病理分期、性别等无显著性差异(P>0.05);术后心肺并发症的发生率明显增加(OR=2.672, 95%CI 1.488~4.798, P=0.002),术后拔管时间和住院天数增加(P<0.05)。6MWD≤449 m是术后心肺并发症的独立危险因素(OR=2.395, 95%CI 1.299~4.415, P=0.005)。结论 6MWT作为一种简易的运动功能测试,可常规应用于肺叶切除术患者术前的生理功能评估。当6MWD≤449 m时,患者术后发生心肺并发症的风险较高。     

Lung function and six-minute walk test performance in individuals with sickle cell disease

Background

Sickle Cell Disease (SCD), which is characterized by a mutation in the gene encoding beta hemoglobin, causes bodily dysfunctions such as impaired pulmonary function and reduced functional capacity.

Objective

To assess changes in pulmonary function and functional capacity in patients with SCD and to identify the relationships between these variables.

Method

We evaluated sociodemographic, anthropometric, lung function (spirometry), respiratory (manovacuometer), peripheral muscle strength (Handgrip strength - HS) and functional capacity (i.e., the six-minute walk test) parameters in 21 individuals with SCD (average age of 29±6 years). Shapiro-Wilk, paired Student''s, Wilcoxon, Pearson and Spearman correlation tests were used for statistical analyses, and the significance threshold was set at p<0.05.

Results

A total of 47.6% of the study subjects exhibited an altered ventilation pattern, 42.8% had a restrictive ventilatory pattern (RVP) and 4.8% exhibited a mixed ventilatory pattern (MVP). The observed maximal inspiratory pressure (MIP) values were below the predicted values for women (64 cmH₂O), and the maximum expiratory pressure (MEP) values, HS values and distance walked during the 6MWT were below the predicted values for both men (103 cmH₂O, 39 Kgf and 447 m, respectively) and women (64 cmH₂O; 27 Kgf; 405 m, respectively). Positive correlations were observed between maximum voluntary ventilation (MVV) and MEP (r=0.4; p=0.046); MVV and BMI (r=0.6; p=0.003); and between HS and MIP (r=0.7; p=0.001), MEP (r=0.6; p=0.002), MVV (r=0.5; p=0.015), distance walked in the 6MWT (r=0.4; p=0.038) and BMI (r=0.6; p=0.004).

Conclusions

SCD promoted changes in lung function and functional capacity, including RVPs and a reduction in the distance walked in the 6MWT when compared to the predictions. In addition, significant correlations between the variables were observed.     

Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery

Abstract

Purpose: We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting.

Methods: Fifty-two patients aged 60.9?±?7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model. Oxygen uptake at steady state, constant time, and mean response time corrected by work rate were analysed. Short-term clinical outcomes were evaluated during the early post-operative of off-pump coronary artery bypass surgery.

Results: Multivariate analysis showed body mass index, surgery time, and mean response time corrected by work rate as independent predictors for short-term outcomes. The optimal mean response time corrected by work rate cut-off to estimate short-term clinical outcomes was 1.51?×?10^?3?min²/ml. Patients with slower mean response time corrected by work rate demonstrated higher rates of hypertension, diabetes, EuroSCOREII, left ventricular dysfunction, and impaired 6-min walk test parameters. The per cent-predicted distance threshold of 66% in the pre-operative was associated with delayed oxygen uptake kinetics.

Conclusions: Pre-operative oxygen uptake kinetics during 6-min walk test predicts short-term clinical outcomes after off-pump coronary artery bypass surgery. From a clinically applicable perspective, a threshold of 66% of pre-operative predicted 6-min walk test distance indicated slower kinetics, which leads to longer intensive care unit and post-surgery hospital length of stay.

• Implications for rehabilitation

• Coronary artery bypass grafting is a treatment aimed to improve expectancy of life and prevent disability due to the disease progression;

• The use of pre-operative submaximal functional capacity test enabled the identification of patients with high risk of complications, where patients with delayed oxygen uptake kinetics exhibited worse short-term outcomes;

• Our findings suggest the importance of the rehabilitation in the pre-operative in order to “pre-habilitate” the patients to the surgical procedure;

• Faster oxygen uptake on-kinetics could be achieved by improving the oxidative capacity of muscles and cardiovascular conditioning through rehabilitation, adding better results following cardiac surgery.

Trial registration: ClinicalTrials.gov identifier: NCT02758600.     

Validity of the 16-metre PACER and six-minute walk test in adults with Down syndrome

Purpose: The purpose was to establish criterion-related validity of the 16-metre PACER and six-minute walk distance (6MWD) tests to VO₂ peak as well as predictors of VO₂ peak in adults with Down syndrome (DS).

Methods: Adults with DS (24 males and 19 females) aged 18–50 years performed the three aerobic tests on non-consecutive days during a one-week period. To assess validity, peak oxygen uptake was measured directly on a motorized treadmill. Pearson–product moment correlations were performed. Predictors of VO₂ peak were assessed with a stepwise multiple regression analysis. Agreement between PACER and VO₂ peak was assessed by Bland–Altman plot.

Results: Linear regression revealed that the PACER (R^2?=^?0.86) and the 6MWD (R^2?=^?0.75) were significantly related to VO₂ peak (p?<?0.05). Both the 16-metre PACER and the 6MWD significantly correlated with VO₂ peak for adults with DS. The relationship was stronger for the 16-metre shuttle run test (r?=?0.87) than the 6MWD (r?=?0.78). The correlation between VO₂ peak and both field tests, controlling for age, gender and BMI, remained significant (r?>?0.7; p?<?0.05). PACER, 6MWD and BMI are significant predictors of VO₂ peak (p?<?0.05).

Conclusion: The 16-metre PACER and 6MWD are valid field tests for predicting aerobic capacity in adults with DS.

• Implications for Rehabilitation

• The 16-metre PACER and 6MWD tests are safe and feasible for use in adults with DS.

• Both tests are valid indicators of cardio-respiratory fitness as assessed by moderate-to-strong coefficients of determination and correlation coefficients.

• Both field tests along with BMI are predictors of aerobic capacity.

     

Post-operative delayed ambulation after thymectomy is associated withpre-operative six-minute walk distance

Objective: Delayed post-operative ambulation is a risk of post-operative complications and increases overall healthcare costs. We investigated pre-operative and intraoperative variables associated with delayed ambulation in patients who underwent thymectomy.

Methods: A total of 57 consecutive patients undergoing thymectomy were included in this study. Pre-operative functional exercise capacity was evaluated by six-minute walk distance. Ambulation was considered to be delayed if the patient could not walk the ward on post-operative day 1. Binary logistic regression analysis was performed to clarify the factors associated with delayed ambulation.

Results: Pre-operative six-minute walk distance was the only significant variable that was associated with delayed ambulation. The area under the receiver operating characteristic curve for predicting delayed ambulation was 0.684 (95% confidential interval: 0.546–0.823, p?=?0.017), and the optimal discriminatory pre-operative six-minute walk distance value was 498 m. Post-operative hospital stay was significantly longer in patients with low six-minute walk distance (<498 m) than those with high six-minute walk distance (≥498 m). In contrast, the presence of myasthenia gravis or adjuvant chemoradiotherapy was not associated with delayed ambulation.

Conclusions: Our results suggest that low pre-operative six-minute walk distance is associated with delayed post-operative ambulation and longer post-operative hospital stay in patients who underwent thymectomy.

• Implications for rehabilitation

• The predictors for delayed ambulation after thymectomy are not fully investigated.

• The presence of myasthenia gravis was not associated with delayed ambulation.

• Low pre-operative six-minute walk distance was associated with delayed ambulation.

     

冠状动脉临界病变患者心肺运动试验的特点及临床意义

目的 回顾性分析冠状动脉临界病变患者心肺运动试验的临床特点和功能能力的变化。方法 回顾分析北京博爱医院2015年1月至2020年1月行冠状动脉造影并同期行心肺运动试验测试的患者,其中冠脉临界病变组184例,非冠心病组73例。比较两组症状、基线资料、实验室和超声心动图数据、心肺运动试验结果,并观察1年内主要心血管事件。结果 与非冠心病组相比,冠脉临界病变组男性比例显著升高(χ2=15.857, P <0.001),有吸烟史(χ2=9.067, P=0.003)、高血压病史(χ2=15.087, P <0.001)、高脂血症病史(χ2=13.507, P <0.001)的比例明显升高;糖化血红蛋白(Z=2.431, P=0.015)和超敏C-反应蛋白(Z=2.108, P=0.035)水平偏高;达到无氧阈比例明显偏低(χ2=10.702, P=0.001);无氧阈时的心率和呼吸交换率降低(Z> 2.156, P <0.05);两组1年后主要心血管事件发生率无显著性差异(P=1.000)。结论 冠脉临界病变患者心肺功能有所降低,应控制吸烟、高血压、高脂血症、糖尿...     

Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis

Purpose.?We hypothesised that six-minute walk (6MWT) distance of patients with ambulatory multiple sclerosis (MS) would differ from age-matched healthy control subjects. We also investigated the contribution of demographic, physical and physiological factors to impaired functional capacity in MS.

Method.?Thirty MS patients and 30 healthy subjects participated in this study. Respiratory muscle strength was measured. Pulmonary function test and 6MWT were performed. The Barthel Index (BI) was used to assess activities of daily living, and the Modified Ashworth Scale was used to determine spasticity. Symptomatic fatigue was measured using the Fatigue Severity Scale (FSS).

Results.?Pulmonary function and respiratory muscle strength of ambulatory MS patients were significantly lower, and baseline heart rate and fatigue perception were significantly higher than were healthy controls (p < 0.05). MS patients reached a significantly higher exercise heart rate, and walked significantly shorter distance than did healthy subjects (p < 0.05). The BI score, baseline heart rate and FSS score together accounted for 81 percent variance in 6MWT distance of MS patients (p < 0.05).

Conclusion.?The shorter distance covered during a 6MWT is determined by the limitations in activities of daily living, resting heart rate and subjective symptomatic fatigue in ambulatory patients with MS. Respiratory muscle weakness, lung function and level of neurological impairment do not contribute to impaired functional exercise capacity in these patients.     

缬沙坦和贝那普利对糖尿病心肌病患者六分钟步行试验的影响

目的探讨缬沙坦和贝那普利联合应用对糖尿病心肌病患者六分钟步行试验的影响。、方法在常规药物治疗的基础上,将98例糖尿病心肌病患者随机分为贝那普利治疗组（贝那普利20mg,每天1次）、缬沙坦治疗组（缬沙坦160mg,每天1次）和缬沙坦与贝那普利联合治疗纽（贝那普利10mg,每天1次和缬沙坦80mg,每天1次）。对比分析各组患者治疗6个月后的6min步行距离、左心室收缩和舒张功能变化情况。结果与治疗前相比,各组6min的步行距离、左心室射血分数和二尖瓣环舒张早期峰值与舒张晚期峰值比值差异均有统计学意义（P〈0．01）。与普利组和沙坦组比较,联合组6min步行距离增加量差异有统计学意义（P〈0．05）。治疗前后血液电解质、血糖变化无统计学意义（P〉0．05）。结论缬沙坦与贝那普利联合应用可以安全有效改善糖尿病心肌病患者的左心室收缩与舒张功能,进而提高糖尿病心肌病患者的运动能力。