COMPLEX ESTIMATE OF THE TEST OF A 6-MINUTE WALK IN PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE

Author(s):  
Андрей Петрович Бабкин

Одним из важных проявлений большинства хронических легочных заболеваний является одышка, которая, в свою очередь, становится основной причиной ограничения переносимости физических нагрузок. Снижение физической толерантности у больных, страдающих хроническими легочными заболеваниями, обусловлено неспособностью организма обеспечивать необходимое поступление кислорода во время нагрузки, а в клиническом отношении - с невозможностью для пациента выполнять ту физическую работу, которую мог выполнять ранее. Среди методов оценки переносимости физических нагрузок используют кардиопульмонарное тестирование на велоэргометре, тредмиле, которое требует обязательного присутствия врача, что не всегда возможно в амбулаторных условиях. В ряде работ показана достаточная эффективность для диагностики состояния больного и оценки переносимости нагрузки использование для этой цели теста 6-минутный ходьбы. Это тест с ходьбой в произвольном темпе в течение 6 мин. Результатом теста является расстояние, которое больной может быстро пройти по ровной твердой поверхности за 6 мин. Расстояние, пройденное в тесте 6-минутной ходьбы, имеет прогностическое значение при многих заболеваниях, включая ХОБЛ. В данной статье оценивается комплексная оценка модифицированного теста 6-минутной ходьбы у больных ХОБЛ с использованием динамической пульcоксиметрии, которая расширяет диагностические возможности нагрузочного тестирования. Показано, что параллельно нарастанию выраженности одышки у больных снижается сатурация кислорода с постепенным восстановлением в покое. В контрольной группе, несмотря на сопоставимую с больными ХОБЛ одышку, оцениваемую по шкале Борга, насыщение крови кислородом не менялось. Комплексная оценка теста 6-минутной ходьбы поможет объективизировать эффективность проводимых лечебных и профилактических мероприятий у больных с ХОБЛ One of the important manifestations of most chronic pulmonary diseases is a shortness of breath, which, in turn, becomes the main reason for the restability of physical exertion. A decrease in physical tolerance in patients suffering from chronic pulmonary diseases is due to the inability of the body to provide the necessary flow of oxygen during the load, and in the clinical terms - with the impossibility of the patient to carry out that physical work that could be performed earlier. Among the methods for estimating the tolerability of physical loads, cardiopulmonary testing on the bikergometr, tredmil, which requires the mandatory presence of a doctor, which is not always possible in the outpatient conditions. A number of work shows sufficient efficiency for the diagnostic of the patient's condition and the use of load portability to use for this purpose a 6-minute walk. This is a walking speed in an arbitrary pace for 6 minutes. The result of the test is the distance that the patient can quickly go through a smooth solid surface for 6 minutes. The distance traveled in a 6-minute walk test is prognostic in many diseases, including COPD. This article is estimated to be an integrated assessment of a 6-minute walk test using a dynamic pulse oximetry, which expands the diagnostic capabilities of load testing. It has been shown that in parallel increasing the severity of shortness of breath in patients decreases the saturation of oxygen with gradual restoration alone. In the control group, despite comparable with sickness patient with COPD, the oxygen saturation estimated on the Borg scale did not change. A comprehensive test assessment of a 6-minute walk will help to facility the effectiveness of therapeutic and preventive measures to patients with COPD

2019 ◽  
Vol 27 (1) ◽  
pp. 49-58 ◽  
Author(s):  
Vladimir N. Abrosimov ◽  
Aleksey V. Kosyakov ◽  
Maria N. Dmitrieva

Aim. To study the relationship between parameters of cardiointervalometry and ergoreflex, and 6-minute walk test data in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods. The study included 103 men, of them 63 patients with COPD, 40 patients of the control group. Functional assessment of external respiration and a 6-minute walk test were performed using Spiropalm 6MWT equipment (Cosmed, Italy). The autonomic status and the influence of the ergoreflex on it were assessed by the method of cardiointervalometry before, during and after the test with external peripheral vascular occlusion using Varicard hardware and software complex (LLC Ramena, Ryazan, Russia). Results. When performing a 6-minute walk test, significant differences were obtained between the groups of patients with COPD and of the control group in the majority of the studied parameters (p0.01). In 18 of 63 patients with COPD, the level of SpO2 in 6-minute walk test decreased by 4% (p0.01). The obtained result is of considerable importance for assessment of exercise tolerance in patients with COPD. In tests with external peripheral vascular occlusion in patients with COPD and of the control group, the index of activity of regulatory systems (IARS) increased in both groups. However, after completion of the test, the index in patients with COPD decreased below the initial values (p0.05), and in patients of the control group the changes were even more pronounced (p0.01). Patients with COPD were divided into groups depending on the distance covered in 6-minute walk test. Analysis of the data revealed a moderate positive correlation between the covered distance and the forced expiratory volume in the 1st second (FEV1, R=0.45, p0.01).The maximum level of the total effect of the autonomic regulation of blood circulation was recorded in patients who covered the minimum distance (227.7748.13 m) in 6-minute walk test. Besides, a moderate negative correlation between IARS and the results of 6-minute test was recorded (R=-0.34, p0.01). Conclusions. 1. For assessment of the functional status of patients in 6-minute walk test it is important to take measurement of saturation throughout the whole test. 2. The change in IARS values in the test with external peripheral vascular occlusion can be regarded as a reduction of the influence of reflex from the lower limb ergoreceptors on the functional condition of patients. 3. Patients with COPD showed a marked autonomic imbalance. IARS showed a moderate negative correlation with the distance covered in 6-minute walk test. 4. Maximum value of IARS was obtained in patients with the minimal distance covered in 6-minute walk test.


World Science ◽  
2018 ◽  
Vol 2 (8(36)) ◽  
pp. 26-35
Author(s):  
Гетман О. А. ◽  
Крахмалова О. О.

Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung associated with progressive airflow limitation. There is growing recognition that the inflammatory state associated with COPD is not confined to the lungs but also involves the systemic circulation and can impact nonpulmonary organs. However, there is insufficient data on the potential role of systemic inflammation in the formation of pulmonary hypertension, secondary to COPD. Thus, our goal was to investigate the degree of systemic inflammation that is reflected in the level of interleukin-4 and interleukin (IL-2) exchange in patients with COPD and coronary artery disease (IHD) with and without pulmonary hypertension. METHODS: 121 patients with COPD and stable coronary heart disease (mean age [M +/- SD], 60.7 ± 9.7 years, mean FEV1, 46.2 ± 18.1%) were screened into the study, mean pulmonary artery preasure was measured using echocardiography. Osteopontin and IL-2 levels in the serum were evaluated using ELISA kits. Patients were divided into 2 groups: 1 group with signs of pulmonary hypertension (68 patients); and 53 patients without Pulmonary hypertension (2-group). RESULTS: IL-2 concentrations were in 1 group - 9.8 [7.3; 13.1] and 2.2 [0.9; 3.0] in 2 group respectively. For IL-4, the levels were 2.5 [1.8; 2.9] – 1 group, and in the control group (without PH) 3.5 [0.59; 10.0] does not exceed the values of healthy donors. Correlation analysis shows that in the first group there was a positive correlation between the duration of COPD and the level of IL-2 (r = 0.33, p = 0.04) and the negative correlation between osteopontin, IL -2 with a FEV1 (r = -0.84); FLC (r = -0.55). There is a high correlation between osteopontin (r = -0.45), IL-2 (r = -0.60), and a 6-minute walk test and IL-2 and the Borg dyspnea scale (r = 0, 42) after a 6-minute walk test. Pulmonary hypertension is associated with increased levels of systemic inflammatory markers which may have important pathophysiological and therapeutic implications for subjects with stable COPD and CAD.


2020 ◽  
Vol 28 (3) ◽  
pp. 290-299
Author(s):  
Kira A. Ageeva ◽  
Evgenii V. Filippov

Aim. To study the prognostic value of the results of dynamic capnography in the complex assessment of parameters of the respiratory system in 6-minute walk test in patients with chronic heart failure (CHF). Materials and Methods. 73 Patients were examined: the group of study included 48 patients with IIA or IIB stage CHF (mean age 57.94.6 years, 23 men), the control group included 25 practically healthy volunteers (mean age 47.63.5 years, 9 men). The patients were conducted complex determination of parameters of the respiratory system: clinical scaling before and after 6-minute walk test (6MWT), instrumental examinations including spirometry, capnography and pulse oximetry before, during and after physical activity. The analysis of survival was conducted on the basis of the dynamic follow-up of patients within 5 years (60 months). Results. In the analysis of parameters of dyspnea at rest, all the parameters were higher in the group of patients with CHF (р0.05). The distance walked by the patients with CHF in 6 minutes was 488.2390.84 m, which was significantly less than in the control group (815.6053.89 m, р=0.009). Dyspnea as the cause of stoppage/slowing down of walking in 6MWT, was also more often recorded in patients with CHF (93.83.0% and 48.05.1%, р=0.049). Besides, in 6MWT the patients noted: weakness in legs (50.15.0% in the group of CHF and 40.05.0% in the control group, р=0.014), palpitation (29.04.6% and 20.04.1%, respectively, р=0.004). Worsening of dyspnea parameters in 6MWT was more evident in patients with CHF than in the control group (р0.01). In the CHF group, hypocapnic type of ventilation was revealed in 6MWT, analysis of РЕТСО2 trend graphs revealed a wave-like increase in the parameters, the so called periodic breathing (PB). CO2 trend was recorded in CHF group in 58.31.0% of cases (the difference with the control group with р=0.046), the trend of heart rate in 18.80.3% of cases (р=0.027). Cox proportional hazards regression analysis of mortality in patients with CHF showed a prognostic significance of a complex model comprising the following parameters of a patient: body mass index (р=0.005), left ventricular end-diastolic dimension (р=0.034), left ventricular end-systolic dimension (р=0.002), left ventricular ejection fraction (р=0.041), 6MWT distance (р=0.004), desaturation (р=0.009), and the presence of signs of PB during 6MWT (р=0.005). Model coefficients were statistically significant at р0.0001. Conclusions. Dynamic capnography and pulse oximetry allow to identify signs of PB in patients with CHF during 6MWT which may deepen a complex assessment of parameters of the cardio-respiratory system in patients with CHF in order to determine tolerance to physical exercise as well as the effectiveness of the conducted treatment. Complex assessment of survival of patients with CHF showed prognostic significance of the following parameters of a patient: body mass index, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, 6MWT distance, desaturation, PB during 6MWT.


2000 ◽  
Vol 80 (1) ◽  
pp. 8-16 ◽  
Author(s):  
Mary B King ◽  
James O Judge ◽  
Robert Whipple ◽  
Leslie Wolfson

Abstract Background and Purpose. The reliability and responsiveness of 2 physical performance measures were assessed in this nonrandomized, controlled pilot exercise intervention. Subjects. Forty-five older individuals with mobility impairment (mean age=77.9 years, SD=5.9, range=70–92) were sequentially assigned to participate in an exercise program (intervention group) or to a control group. Methods. The intervention group performed exercise 3 times a week for 12 weeks that targeted muscle force, endurance, balance, and flexibility. Outcome measures were the 8-item Physical Performance Test (PPT-8) and the 6-minute walk test. Test-retest reliability and responsiveness indexes were determined for both tests; interrater reliability was measured for the PPT-8. Results. The intraclass correlation coefficient for interrater reliability for the PPT-8 was .96. Intraclass correlation coefficients for test-retest reliability were .88 for the PPT-8 and .93 for the 6-minute walk test. The intervention group improved 2.4 points and the control group improved 0.7 point on the PPT-8, as compared with baseline measurements. There was no change in 6-minute walk test distance in the intervention group when compared with the control group. The responsiveness index was .8 for the PPT-8 and .6 for the 6-minute walk test. Conclusion and Discussion. Measurements for both the PPT-8 and the 6-minute walk test appeared to be highly reliable. The PPT-8 was more responsive than the 6-minute walk test to change in performance expected with this functional training intervention.


2003 ◽  
Vol 17 (8) ◽  
pp. 659-663
Author(s):  
Eduardo Bruera ◽  
Catherine Sweeney ◽  
Jie Willey ◽  
J Lynn Palmer ◽  
Florian Strasser ◽  
...  

Context: The symptomatic benefits of oxygen in patients with cancer who have nonhypoxic dyspnea are not well defined. Objective: To determine whether or not oxygen is more effective than air in decreasing dyspnea and fatigue and increasing distance walked during a 6-minute walk test. Patients and methods: Patients with advanced cancer who had no severe hypoxemia (i.e., had an O2 saturation level of] / 90%) at rest and had a dyspnea intensity of] / 3 on a scale of 0–10 (03/4/no shortness of breath, 103/4/worst imaginable shortness of breath) were recruited from an outpatient thoracic clinic at a comprehensive cancer center. This was a double-blind, randomized crossover trial. Supplemental oxygen or air (5 L/min) was administered via nasal cannula during a 6-minute walk test. The outcome measures were dyspnea at 3 and 6 minutes, fatigue at 6 minutes, and distance walked. We also measured oxygen saturation levels at baseline, before second treatment phase, and at the end of study. Results: In 33 evaluable patients (31 with lung cancer), no significant differences between treatment groups were observed in dyspnea, fatigue, or distance walked (dyspnea at 3 minutes: P = 0.61; dyspnea, fatigue, and distance walked at 6 minutes: P = 0.81, 0.37, and 0.23, respectively). Conclusions: Currently, the routine use of supplemental oxygen for dyspnea during exercise in this patient population cannot be recommended.


2013 ◽  
Vol 8 ◽  
Author(s):  
Antonello Nicolini ◽  
Federico Merliak ◽  
Cornelius Barlascini

Background: The six-minute walk test (6MWT) is widely used because it is both simple and reliable as a measure of exercise capacity. Individuals with chronic obstructive pulmonary disease (COPD) usually show a limited capacity to perform exercise. Methods: Our study is a prospective, randomized controlled trial which uses the 6MWT in one hundred consecutive in and out- patients with moderate to severe COPD to assess the benefit of a simple positive expiratory pressure (PEP) device. PEP device consisted of a PEP valve 5 cmH2O connected to 1-meter tube and a mouthpiece. All the enrolled patients performed a 6MWT before randomization. The following day PEP group patients performed the 6MWT using PEP device. Control group patients performed the 6MWT without this device. The primary outcome was the difference in distance (meters) walked. Results: Functional capacity assessed by the distance covered during 6MWT improved in the PEP group more than in the control group. The difference was statistically significant (p < 0.001).Oxygen saturation improved to a statistically significant level during 6MWT (p < 0.01). Heart rate was also reduced (p < 0.03). Conclusions: There are few studies demonstrating that PEP devices enhance exercise capacity in COPD patients. Our results has been obtained using only a low positive expiratory pressure (5 cmH2O). In our opinion the strength of this study is the simplicity and the lower cost when compared to other devices and approaches. The study was registered as Chi CTR-ORC-12002173 at www.chictr.org.


2021 ◽  
Vol 9 (4) ◽  
pp. 553-558
Author(s):  
Aleksey V. Kosyakov ◽  

BACKGROUND: Considering the economic costs of managing patients with chronic obstructive pulmonary disease (COPD), as well as the high mortality and disability rate, it is necessary to improve the diagnosis of the disease, to look for new approaches to assessing the functional status of patients. AIM: Is to study the functional status of patients with COPD. MATERIALS AND METHODS: A comprehensive approach was applied to assess the functional status of patients: the data of the 6-minute walk test (6MWT), heart rate variability (HRV) was studied, ergoreflex was assessed according to HRV data. 64 patients with COPD and 41 male volunteers without respiratory diseases older than 40 years were examined. Statistical processing of the obtained results was carried out using the licensed package of applied statistical programs Excel 2010 and Statistica 10. RESULTS: The group of patients with COPD and the respondents of the control group were comparable in terms of body mass index, heart rate, respiratory rate, index of indicators of activity of regulatory systems (p > 0.05). As expected, during the 6MWT, differences were obtained between the studied groups in terms of the distance covered (p < 0.01). Similarly, the results of the study of the function of external respiration showed a statistically significant difference in all the studied parameters (p < 0.01). The results obtained confirmed the presence of impaired respiratory function in the group of patients with COPD. Analysis of HRV values, when conducting a test with external peripheral vascular occlusion, confirmed ergoreflex hyperactivity in patients with COPD. CONCLUSION: The integration of methods for routine clinical diagnostics of patients condition (spirometry, 6-minute walk test, assessment of autonomic status) and the introduction of the study of ergoreflex activity made it possible to expand the understanding of the functional state of patients with COPD and is of great interest for further research.


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