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Validity and Reliability of the Six-Minute Walking Test Compared to Cardiopulmonary Exercise Test in Individuals with
Garyfallia Pepera1, Varsamo Antoniou1, Eleni Karagianni1
1Clinical Exercise Physiology and Rehabilitation Research Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, 35132 Lamia, Greece.
Insights
The 6-minute walk test (6MWT) is a valid and reliable measure of cardiorespiratory fitness in heart failure (HF) patients, correlating well with cardiopulmonary exercise testing (CPET) and showing excellent test-retest reliability. It serves as a practical alternative or complement to CPET for assessing HF patients.
Area of Science:
- Cardiology
- Exercise Physiology
- Rehabilitation Medicine
Background:
- Reduced cardiorespiratory fitness and exercise tolerance are key predictors of morbidity and mortality in heart failure (HF).
- Cardiopulmonary exercise testing (CPET) is the gold standard but can be complex and poorly tolerated by HF patients.
- The 6-minute walk test (6MWT) offers a simpler, well-tolerated alternative for assessing exercise capacity.
Purpose of the Study:
- To systematically review the validity, reliability, and safety of the 6MWT compared to CPET in patients with heart failure.
- To determine the correlation between 6MWT distance and CPET-derived peak oxygen consumption (VO2).
- To assess the test-retest reliability and learning effect of the 6MWT in HF patients.
Main Methods:
- Systematic review and meta-analysis of studies comparing 6MWT and CPET in HF patients.
- Searched Embase, Medline, and Scopus databases up to November 2023.
- Pooled correlation coefficients (Fisher's z-transformation) and reliability measures (intraclass correlation coefficient) using random-effects models.
Main Results:
- Twenty studies involving 5379 HF participants were included.
- A moderately strong positive correlation was found between 6MWT distance and CPET peak VO2 (r = 0.62).
- Excellent test-retest reliability (ICC = 0.93) and a small learning effect (15.5 m) were observed for the 6MWT, with no serious adverse events reported.
Conclusions:
- The 6MWT is a valid measure of cardiorespiratory fitness in HF, correlating well with CPET peak VO2.
- The 6MWT demonstrates excellent reliability and is safe for use in HF patients.
- The 6MWT can serve as a practical complementary or alternative assessment to CPET when CPET is not feasible.
Abstract:
Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability issues among HF patients mean that the 6 min walk test (6MWT) is a cost-saving and well-tolerated complementary assessment. We aimed to systematically review the validity, reliability, and safety of the 6MWT compared to CPET for patients with HF. Methods: This study is a systematic review and meta-analysis. Embase, Medline, and Scopus were searched from inception to November 2023. We applied Fisher's z-transformation to correlation coefficients and pooled effects under a random-effects model; heterogeneity (I2), leave-one-out sensitivity, and Egger's test were reported. Results: Twenty studies were finally included, involving 5379 HF participants. A significant moderately strong positive correlation was shown between the 6MWT distance and CPET peak oxygen consumption: (r) = 0.62, 95% CI 0.58-0.66; I2 = 56.95%; p < 0.001. The results showed an excellent test-retest reliability, with a pooled intraclass correlation coefficient of 0.93 (95% CI 0.89-0.95; I2 = 92.06%; p < 0.001). A pooled weighted mean difference of 15.5 m (95% CI 10.2-20.8) was found for the learning effect between the first and second 6MWT. Although some patients required rest stops or reported symptoms such as fatigue or dyspnea, no 6MWTs were terminated due to serious adverse events. Conclusions: Compared with CPET, the 6MWT distance demonstrated a moderately strong correlation with peak VO2, excellent test-retest reliability, and a small learning effect. The 6MWT can therefore complement CPET or serve as a pragmatic alternative when CPET is not feasible; it does not replace comprehensive CPET assessment.
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