The six-minute walk test in outpatients with obesity: Reproducibility and known group validity
To assess the reproducibility and validity of the six-minute walk test (6MWT) in men and women with obesity in order to facilitate evaluation of treatment outcome.
A test--retest design was used to test reproducibility and a comparative design to test known group validity. Forty-three obese outpatients (16 male), mean age 47 (21-62) years, mean body mass index (BMI) 40 (3-62)kg-m(-2) performed the 6MWT twice within one week. Intraclass correlation (ICC1.1) and measurement error (S(w)) were calculated from the mean square values derived from a one-way repeated-measures ANOVA (fixed effect model). The reproducibility was also analysed by means of coefficient of variation (CV) and the Bland Altman method including 95% limits of agreement. The variance of the distance walked was analysed by means of regressions. The known group validity of the 6MWT (distance walked and the work of walking) in obese participants was shown by comparisons with 41 lean participants (18 male), mean age 47 (24-65) years, mean BMI 22.7 kg-m(-2) (19-25).
The obese group walked 534 m (confidence interval [CI] 508-560 the first and 552 m (CI 523-580) the second walk (p < 0.001). S(w) was 25 m, CV 4.7%, ICC1.1 was 0.96. The limits of agreement were -46 m+80 m. The validity tests showed that they walked 162 m shorter (p < 0.001) and performed much heavier work (p < 0.001) than the lean group. In the obese group, BMI alone explained 38% of the variance of the distance walked.
The 6MWT showed good reproducibility and known group validity and can be recommended for evaluating walking ability in subjects with obesity. For individual evaluation, however, an improved walking distance of at least 80 m was required to make the difference clinically significant. Despite shorter walking distance the obese participants performed heavier work than the lean.
Available from: Aurelie Baillot
- "BMI was also significantly associated with 6MWTD in our study as reported in numerous studies[10,33,36,40]. Significant 6MWTD difference between women and men were found in obese individuals in our study, with a trend in the primary care population (p = 0.07). The assumption that females have a shorter 6MWTD is equivocal in the literature with studies showing significant differences[10,11,19,20,23,34]and others none[12,17,33]. This sex difference may be explained mainly by the difference in height[12,18], as found in our results. "
- "Although the 'gold standard' measure of cardiorespiratory fitness is peak VO 2 obtained during CPX,the performance of functional field tests are attractive due to their low costs and simplicity to adminis- ter.[20,29,30]The ISWT and 6MWT have been validated to evaluate functional capacity in obese adults[12,13,20]and in this current study, we add to this body of literature by demonstrating both were in agreement with CPX responses in both studied groups andfurthermore elicited comparable responses in obese but not in eutrophic women. The obese volunteers walked lower distances during the ISWT compared to the 6MWT, even though the self-paced functional test had lasted only 6 min compared to 6.4 min for the externally paced test. "
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To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals.
Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20-45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland-Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables.
There was an agreement between CPX and both the 6MWT [oxygen uptake (VO2 mL kg(-1) min(-1)) = 6.9 (CI: 5.7-8.1), and heart rate (bpm) = 37.0 (CI: 33.3-40.7)] and ISWT [VO2 (mL kg(-1) min(-1)) = 6.1 (CI: 4.9-7.3), and heart rate (bpm) = 36.2 (CI: 32.1-40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO2 ( r = 0.70); dyspnoea (r = 0.80); and leg fatigue (r = 0.70).
6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited. Implications for Rehabilitation Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk. Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing. Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.
- "Lean tissue mass and body fat were assessed by DXA (Lunar Prodigy , General Electric, Madison WI, USA). Physical function was assessed using the 6 min walk test . Quality of life was assessed using the self-report short-form 36 health survey (SF-36v2), which was scored using Health Outcomes Scoring Software. "
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ABSTRACT: Maintenance of muscle mass and strength into older age is critical to maintain health. The aim was to determine whether increased dairy or soy protein intake combined with resistance training enhanced strength gains in older adults.
179 healthy older adults (age 61.5 ± 7.4 yrs, BMI 27.6 ± 3.6 kg/m(2)) performed resistance training three times per week for 12 weeks and were randomized to one of three eucaloric dietary treatments which delivered >20 g of protein at each main meal or immediately after resistance training: high dairy protein (HP-D, >1.2 g of protein/kg body weight/d; ∼27 g/d dairy protein); high soy protein (HP-S, >1.2 g of protein/kg body weight/d; ∼27 g/d soy protein); usual protein intake (UP, <1.2 g of protein/kg body weight/d). Muscle strength, body composition, physical function and quality of life were assessed at baseline and 12 weeks. Treatments effects were analyzed using two-way ANOVA.
83 participants completed the intervention per protocol (HP-D = 34, HP-S = 26, UP = 23). Protein intake was higher in HP-D and HP-S compared with UP (HP-D 1.41 ± 0.14 g/kg/d, HP-S 1.42 ± 0.61 g/kg/d, UP 1.10 ± 0.10 g/kg/d; P < 0.001 treatment effect). Strength increased less in HP-S compared with HP-D and UP (HP-D 92.1 ± 40.8%, HP-S 63.0 ± 23.8%,UP 92.3 ± 35.4%; P = 0.002 treatment effect). Lean mass, physical function and mental health scores increased and fat mass decreased (P ≤ 0.006), with no treatment effect (P > 0.06).
Increased soy protein intake attenuated gains in muscle strength during resistance training in older adults compared with increased intake of dairy protein or usual protein intake. Clinical Trial Registration: ACTRN12612000177853 www.anzctr.org.au.
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