Titrating Oxygen Requirements During Exercise: Evaluation of a Standardized Single Walk Test Protocol

Oxygen supplementation for exercise-induced hypoxemia is a common clinical practice that improves exercise tolerance. However, we know of no standardized exercise oxygen titration protocol using a single walk test. We report our experience with a protocol developed in our laboratory.

Our protocol is based on the 6-min walk test (6MWT). Pulse oximetry readings (oxygen saturation [Spo₂]) are monitored, and supplemental oxygen is added in 2 L/min increments to keep Spo₂ > 88%. This continues for at least 6 min of walking with the Spo₂ remaining > 88% for at least 3 min. The records of consecutive patients over 4 months undergoing this procedure were reviewed for test performance, oxygen titration results, and adverse events.

Two hundred twenty-two patients were tested; only two prematurely terminated the protocol because of intractable dyspnea. One hundred fifty-six patients (38%) required oxygen supplementation, with the first titration most commonly occurring between 1 and 2 min of walking. Nine of the patients had the first titration after 5 min of walking. The average test duration was 7 min (maximum, 15 min). The average number of titrations was 2.2 (maximum six). Sixteen patients could not maintain Spo₂ > 88% for 3 min despite administration of 15 L/min of supplemental oxygen (maximal dose).

Our protocol was easily performed as a modification of a standard 6MWT with no serious adverse events. Because it is based on a widely accepted measurement of functional capabilities, and because it determined a stable final oxygen dose for ≥ 3 min of walking in most patients, we believe this protocol can be easily adapted for clinical use.