To evaluate the feasibility, tolerability, and adherence with wearable actigraphy devices among infants and children with pulmonary arterial hypertension (PAH).
This multi-center, prospective, ...observational study included children ages 0-6 years with and without PAH. Participants wore the ActiGraph wGT3X-BT on the hip and FitBit Inspire on the wrist during waking hours for 14 days. Steps, vector magnitude counts per minute (CPM), activity intensity, heart rate, and heart rate variability (HRV) were compared between groups.
Forty-seven participants (18 PAH, 29 control) were enrolled from 10 North American sites. PAH patients were mostly functional class II (n=16, 89%) and treated with oral medications at the time of enrollment. The number of wear days was not significantly different between the groups (ActiGraph: 10 95% CI 5.5, 12.2 in PAH vs. 8 4, 12 in control, p=0.20; FitBit 13 10, 13.8 in PAH vs. 12 8, 14 in control, p=0.87). Complete data were obtained in 81% of eligible ActiGraph participants and 72% of FitBit participants. PAH participants demonstrated fewer steps, lower vector magnitude CPM, more sedentary activity, and less intense physical activity at all levels compared with control participants. No statistically significant differences in HRV were demonstrated between the two groups.
Measurement of physical activity and other endpoints using wearable actigraphy devices was feasible in young children with PAH. Larger studies should determine associations between physical activity and disease severity in young PAH patients to identify relevant endpoints for pediatric clinical trials.
Wearable sensors are becoming increasingly popular for complementing classical clinical assessments of gait deficits. The aim of this review is to examine the existing knowledge by systematically ...reviewing a large number of papers focusing on the use of wearable inertial sensors for the assessment of gait during the 6-minute walk test (6MWT), a widely recognized, simple, non-invasive, low-cost and reproducible exercise test. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 28 full-text articles. Then, the available knowledge was summarized regarding study design, subjects enrolled (number of patients and pathological condition, if any, age, male/female ratio), sensor characteristics (type, number, sampling frequency, range) and body placement, 6MWT protocol and extracted parameters. Results were critically discussed to suggest future directions for the use of inertial sensor devices in the clinics.
New Findings
What is the central question of this study?
Are chronotropic responses to a 6‐minute walk test different in women with post‐acute coronavirus disease 2019 (COVID‐19) syndrome compared ...with control subjects?
What is the main finding and its importance?
Compared with control subjects, the increase in heart rate was attenuated and recovery delayed after a 6‐minute walk test in participants after infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Women reporting specific symptoms at time of testing had greater impairments compared with control subjects and SARS‐CoV‐2 participants not actively experiencing these symptoms. Such alterations have potential to constrain not only exercise tolerance but also participation in free‐living physical activity in women during post‐acute recovery from COVID‐19.
The short‐term cardiopulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are well defined. However, the implications of cardiopulmonary sequelae, persisting beyond acute illness, on physical function are largely unknown. Herein, we characterized heart rate responses to and recovery from a 6‐minute walk test (6MWT) in women ∼3 months after mild‐to‐moderate SARS‐CoV‐2 infection compared with non‐infected control subjects. Forty‐five women (n = 29 SARS‐CoV‐2; n = 16 controls; age = 56 ± 11 years; body mass index = 25.8 ± 6.0 kg/m2) completed pulmonary function testing and a 6MWT. The SARS‐CoV‐2 participants demonstrated reduced total lung capacity (84 ± 8 vs. 93 ± 13%; P = 0.006), vital capacity (87 ± 10 vs. 93 ± 10%; P = 0.040), functional residual capacity (75 ± 16 vs. 88 ± 16%; P = 0.006) and residual volume (76 ± 18 vs. 93 ± 22%; P = 0.001) compared with control subjects. No between‐group differences were observed in 6MWT distance (P = 0.194); however, the increase in heart rate with exertion was attenuated among SARS‐CoV‐2 participants compared with control subjects (+52 ± 20 vs. +65 ± 18 beats/min; P = 0.029). The decrease in heart rate was also delayed for minutes 1–5 of recovery among SARS‐CoV‐2 participants (all P < 0.05). Women reporting specific symptoms at the time of testing had greater impairments compared with control subjects and SARS‐CoV‐2 participants not actively experiencing these symptoms. Our findings provide evidence for marked differences in chronotropic responses to and recovery from a 6MWT in women several months after acute SARS‐CoV‐2 infection.
Resumen: En pacientes en hemodiálisis crónica (HC), se ha demostrado que ejercicios aeróbicos y de resistencia mejoran la capacidad física, parámetros metabólicos y cardiovasculares. Objetivo: ...evaluar en pacientes en HC, el impacto de una rutina de ejercicios de resistencia sobre fuerza muscular, calidad de vida y parámetros metabólicos. Pacientes y método: treinta y un pacientes del centro de diálisis realizaron rutina de ejercicios dinámicos y estáticos de resistencia progresiva para tren inferior y abdomen y aeróbico a baja carga con pedalera, 45 minutos de duración, 3 sesiones/semana por 20 semanas. Se midió al inicio y final: peso, glicemia, perfil lipídico, test de marcha de 6 minutos y cuestionario de calidad de vida SF36. En siete de ellos se evaluó fuerza extensora de rodilla mediante la máxima contracción voluntaria. La escala de Borg se utilizó para graduar la progresión de la carga. Resultados: diecinueve pacientes (11 hombres/8 mujeres), completaron 47 ± 6,4 sesiones. No hubo diferencias significativas entre la medición basal y final en los parámetros evaluados. La escala de Borg aumentó significativamente a las semanas 10 (p < 0,05) y 20 (p < 0,01) respecto del basal. Este aumento en la percepción del esfuerzo concuerda con el aumento en la progresión de intensidad programada para los ejercicios. En 5/8 pacientes se observó un incremento >30 metros en el test de marcha. Conclusión: aunque esta rutina de ejercicios no determinó cambios estadísticamente significativos en los parámetros evaluados, el aumento en algunos pacientes en su capacidad de marcha es relevante. Más estudios son necesarios para establecer el tipo de rutina de ejercicios que beneficiará a estos pacientes. Abstract: In patients in chronic hemodialysis (CH), aerobic and resistance exercises have been shown to improve fitness, metabolic and cardiovascular parameters. Objective: to evaluate in patients in CH, the impact of a resistance training routine on muscle strength, quality of life and metabolic parameters. Patients and method: thirty one patients from the dialysis unit performed a routine of dynamic and static progressive resistance training for lower body and abdomen, and low-load aerobics with a pedal board in 45 minute sessions, 3 sessions/week for 20 weeks. Weight, glycemia, lipids, 6-minute walk test and SF36 quality of life questionnaire were measured at the beginning and at the end. In seven patients, knee extensor strength was evaluated by means of the maximum voluntary contraction. The Borg scale was used to evaluate load progression. Results: nineteen patients (11 M/8F), completed 47 ± 6.4 sessions. There were no significant differences between baseline and final measurements for the evaluated parameters. The Borg scale increased significantly at weeks 10 (p < 0.05) and 20 (p < 0.01) compared to baseline, indicating that the perception of exercise intensity increased in accordance with increases in intensity in the exercise routines. In 5/8 patients, an increase over 30 meters in the 6-minute walk test was observed. Conclusion: although this exercise routine did not statistically determine significant changes in the evaluated parameters, the increase in walk capacity in some patients is relevant. More studies are needed to establish the type of exercise routine that will benefit these patients.
ABSTRACT
Introduction: Duchenne muscular dystrophy (DMD) subjects ≥5 years with nonsense mutations were followed for 48 weeks in a multicenter, randomized, double‐blind, placebo‐controlled trial of ...ataluren. Placebo arm data (N = 57) provided insight into the natural history of the 6‐minute walk test (6MWT) and other endpoints. Methods: Evaluations performed every 6 weeks included the 6‐minute walk distance (6MWD), timed function tests (TFTs), and quantitative strength using hand‐held myometry. Results: Baseline age (≥7 years), 6MWD, and selected TFT performance are strong predictors of decline in ambulation (Δ6MWD) and time to 10% worsening in 6MWD. A baseline 6MWD of <350 meters was associated with greater functional decline, and loss of ambulation was only seen in those with baseline 6MWD <325 meters. Only 1 of 42 (2.3%) subjects able to stand from supine lost ambulation. Conclusion: Findings confirm the clinical meaningfulness of the 6MWD as the most accepted primary clinical endpoint in ambulatory DMD trials. Muscle Nerve 48: 343–356, 2013
ABSTRACT
Introduction: An international clinical trial enrolled 174 ambulatory males ≥5 years old with nonsense mutation Duchenne muscular dystrophy (nmDMD). Pretreatment data provide insight into ...reliability, concurrent validity, and minimal clinically important differences (MCIDs) of the 6‐minute walk test (6MWT) and other endpoints. Methods: Screening and baseline evaluations included the 6‐minute walk distance (6MWD), timed function tests (TFTs), quantitative strength by myometry, the PedsQL, heart rate–determined energy expenditure index, and other exploratory endpoints. Results: The 6MWT proved feasible and reliable in a multicenter context. Concurrent validity with other endpoints was excellent. The MCID for 6MWD was 28.5 and 31.7 meters based on 2 statistical distribution methods. Conclusions: The ratio of MCID to baseline mean is lower for 6MWD than for other endpoints. The 6MWD is an optimal primary endpoint for Duchenne muscular dystrophy (DMD) clinical trials that are focused therapeutically on preservation of ambulation and slowing of disease progression. Muscle Nerve 48: 357–368, 2013
The 6-Minute Walk Test (6MWT) is frequently used for the assessment of walking distances in several conditions, as knee osteoarthritis, but it can be both time-consuming for the researcher or ...clinician, and exhausting of painful for the subject suffering from this condition. The objective of our study was to analyze the concurrent validity of the 2-Minute Walk Test (2MWT) for patients with knee osteoarthritis compared to the 6-Minute Walk Test (6MWT).
Cross-sectional validation study. Scores from the 6MWT of 42 ambulatory patients affected by knee osteoarthritis were compared to those from the shorter 2MWT. An initial correlation test was used to assess correlation between both measures, and a subsequent univariate regression analysis was performed with the aim of comparing the estimated outcomes of the 6MWT versus the actual 6MWT.
The scores from the 2MWT and 6MWT showed excellent correlation (Pearson's correlation coefficient r = 0.976; p-value < 0.001); the predictive equation based on the scores from the 2MWT (R2 = 0.952, p-value < 0.001) estimates the 6MWT scores with a relative error of 3.23%.
The 2MWT may be a practical assessment tool in replacement for the 6MWT in clinical assessment due to its low burden on patients and as a means of improving efficiency in a timely manner.
The effect of prehabilitation in patients with frailty undergoing colorectal cancer surgery remains controversial. This meta-analysis aimed to assess the impact of prehabilitation before colorectal ...surgery on the functional outcomes and postoperative complications in patients with frailty undergoing colorectal cancer surgery.
PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for articles published up to November 9, 2022. We included randomized and non-randomized trials in which the effects of prehabilitation in patients with frailty undergoing colorectal cancer surgery were investigated against a control group. Data extracted for our meta-analysis included the 6-minute walk test (6MWT), postoperative incidence of complications (Clavien-Dindo classification ≥IIIa), comprehensive complication index (CCI), and length of stay (LOS) in the hospital.
Compared with the control group, we found a significant improvement in the incidence of postoperative complications and shorter LOS in the hospital in the prehabilitation group. However, the 6MWT and CCI results showed no significant differences between the 2 groups.
Prehabilitation in patients with frailty who underwent colorectal cancer surgery improved the incidence of postoperative complications and LOS in the hospital. Hence, clinicians should consider conducting or recommending prehabilitation exercises prior to colorectal cancer surgery in patients with frailty.
Abstract
BACKGROUND
It remains unclear whether systolic (SBP) and diastolic (DBP) pressure and BP response after six-minute walk test (6MWT) are associated with adverse outcomes in patients with ...acute heart failure (AHF).
METHODS
We investigated these associations in 98 AHF patients (24.5% women; mean age, 70.5 years) enrolled in the ROSE trial (The Low-dose Dopamine or Low-dose Nesiritide in Acute Heart Failure with Renal Dysfunction). The primary endpoint consisted of any death or rehospitalization within 6 months after randomization. We computed hazard ratios (HRs) of the risks associated with 1-SD increase in post-exercise BP levels and BP ratios, calculated as BP immediately after 6MWT divided by BP before 6MWT.
RESULTS
The BP before and after 6MWT averaged 110.6/117.5 mm Hg for SBP and 61.9/64.7 mm Hg for DBP. In multivariable-adjusted analyses including clinic BP measured at the same day of 6MWT, higher DBP after 6MWT was associated with lower risk of the primary endpoint (HR, 0.49; 95% confidence interval CI, 0.26–0.95; P = 0.034). Both higher SBP and DBP immediately after 6MWT were associated with lower risk of 6-month mortality (HRs, 0.39/0.16; 95% CI, 0.17–0.90/0.065–0.40; P ≤ 0.026). The post-exercise SBP ratio was associated with the risk of 6-month mortality in multivariable-adjusted analyses (HR, 0.44; P = 0.023).
CONCLUSIONS
Higher BP levels and BP ratios immediately after 6MWT conferred lower risk of adverse health outcomes. Our observations highlight that 6MWT-related BP level and response may refine risk estimates in patients hospitalized AHF and may help further investigation for the development of HF preventive strategies.
Graphical Abstract
Graphical Abstract
Introduction
Ambulatory individuals with spinal muscular atrophy (SMA) experience muscle weakness, gait impairments, and fatigue that affect their walking ability. Improvements have been observed in ...motor function in children treated with nusinersen, but its impact on fatigue has not been studied.
Methods
Post hoc analyses were used to examine changes in 6‐minute walk test (6MWT) distance and fatigue in children and adolescents with SMA type II and III who received their first dose of nusinersen in the phase Ib/IIa, open‐label CS2 study and were ambulatory during CS2 or the extension study, CS12.
Results
Fourteen children performed the 6MWT. Median (25th, 75th percentile) distance walked increased over time by 98.0 (62.0, 135.0) meters at day 1050, whereas median fatigue changed by −3.8% (−19.7%, 1.4%).
Discussion
These results support previous studies demonstrating clinically meaningful effects of nusinersen on motor function in children and adolescents with later‐onset SMA.
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