The six-minute walk distance is a marker of hemodynamic-related functional capacity in hypertension: a case–control study

This study investigated the association between hemodynamic variables and the 6-minute walk distance (6MWD) in adults with and without hypertension and explored the role of hemodynamic variables as predictors of 6MWD. Patients undergoing antihypertensive medication therapy (n=41) and sex-matched healthy subjects (n=41) were evaluated for their clinical status and cardiovascular risk factors. Two 6-minute walk tests were performed along an 18-m corridor with a 30-minute rest interval. The intraclass correlation (ICC) was high among patients (ICC=0.984 (0.965; 0.992), P<0.001) and controls (ICC=0.987 (0.832; 0.996), P<0.001). The patients presented 6MWD values that were significantly lower than those of healthy controls (338.8±112.8 vs. 388.0±66.7 m, P=0.010). In patients, the 6MWD was significantly and positively correlated with sex (0.737; P<0.001), height (0.502; P<0.001) and weight (0.303; P=0.027). In addition, negative and significant correlations were observed between 6MWD and the mean (−0.577; P<0.001), systolic (−0.521; P<0.001), diastolic (−0.505; P=0.001) and pulse (−0.353; P=0.015) pressures after simultaneous adjustment for age, body height and weight. The same behavior was observed in healthy controls (except for pulse pressure), albeit with lower correlation values. A regression model with sex, age, height and weight explained 52.2% (P<0.001) of the variance. The highest explained variance in patients (64.8%; P<0.001) and controls (56.5%; P<0.001) was observed after replacing the body weight with mean pressure in the model. The 6MWD is inversely associated with hemodynamic variables in both groups and is lower in patients with hypertension compared with healthy controls. Hemodynamic variables, particularly the mean pressure, should be included in prediction equations for 6MWD.

[1]  Tomas Faresjö,et al.  To Match or Not to Match in Epidemiological Studies—Same Outcome but Less Power , 2010, International journal of environmental research and public health.

[2]  B. Celli,et al.  The 6-min walk distance in healthy subjects: reference standards from seven countries , 2010, European Respiratory Journal.

[3]  R. Goldstein,et al.  Has my patient responded? Interpreting clinical measurements such as the 6-minute-walk test. , 2011, American journal of respiratory and critical care medicine.

[4]  S. Lewington.  Prospective studies collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies (vol 360, pg 1903, 2002) , 2003 .

[5]  S. P. Gupta,et al.  Twelve-minute walking test for assessing disability in chronic bronchitis. , 1976, British medical journal.

[6]  R G Haennel,et al.  Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population. , 2000, Journal of cardiopulmonary rehabilitation.

[7]  M. Falvo,et al.  Six-minute walk distance in persons with Parkinson disease: a hierarchical regression model. , 2009, Archives of physical medicine and rehabilitation.

[8]  D. Brooks,et al.  A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. , 2001, Chest.

[9]  R. Britto,et al.  Teste de caminhada de seis minutos em diferentes faixas etárias e índices de massa corporal , 2007 .

[10]  A. M. Ponte,et al.  ANÁLISE MIOELÉTRICA E DE FORÇA DE PREENSÃO MANUAL EM DIFERENTESPOSICIONAMENTOS DO PUNHO E ANTEBRAÇO , 2007 .

[11]  Bittner,et al.  Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. , 1993, JAMA.

[12]  R. Carleton,et al.  Short stature and cardiovascular disease among men and women from two southeastern New England communities. , 1998, International journal of epidemiology.

[13]  P. A. D. M. S. Nogueira,et al.  Correlação entre capacidade funcional e qualidade de vida em idosas hipertensas submetidas a treinamento resistido , 2011 .

[14]  T. Araújo,et al.  QUESTIONÁRIO INTERNACIONAL DE ATIVIDADE FÍSICA (IPAQ): ESTUPO DE VALIDADE E REPRODUTIBILIDADE NO BRASIL , 2001 .

[15]  L. Adams,et al.  Repeated six-minute walk tests for outcome measurement and exercise prescription in outpatient cardiac rehabilitation: a longitudinal study. , 2011, Archives of physical medicine and rehabilitation.

[16]  R. Arena,et al.  Cardiac rehabilitation and cardiovascular disability: role in assessment and improving functional capacity: a position statement from the American Association of Cardiovascular and Pulmonary Rehabilitation. , 2013, Journal of cardiopulmonary rehabilitation and prevention.

[17]  R. Pedrosa,et al.  Correlação entre os testes da caminhada, marcha estacionária e TUG em hipertensas idosas , 2009 .

[18]  Jeroen J. Bax,et al.  2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, Blood pressure.

[19]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[20]  William J. Rogers,et al.  Prediction of Mortality and Morbidity With a 6-Minute Walk Test in Patients With Left Ventricular Dysfunction , 1993 .

[21]  V. Dourado,et al.  The six-minute walk test and body weight-walk distance product in healthy Brazilian subjects. , 2009, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[22]  Six-minute walk test: an effective and necessary tool in modern cardiac rehabilitation. , 2013, Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese.

[23]  G. Pickering.  Hyperpiesis: high blood-pressure without evident cause: essential hypertension. , 1965, British medical journal.

[24]  R. Britto,et al.  Exercício aeróbico no controle da hipertensão arterial na pós-menopausa , 2011 .

[25]  M. Falvo,et al.  Reference equation for 6-minute walk in individuals with Parkinson disease. , 2009, Journal of rehabilitation research and development.

[26]  Hirofumi Tanaka,et al.  Age-predicted maximal heart rate revisited. , 2001, Journal of the American College of Cardiology.

[27]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context , 1990, The Lancet.

[28]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias , 1990, The Lancet.

[29]  T. Araújo,et al.  Validação do questionário internacional de nível de atividade física (IPAQ- Versão 6): Estudo piloto em adultos jovens brasileiros , 2008 .

[30]  W. Elliott.  Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research , 2009 .

[31]  L. Lipsitz,et al.  Association Between Concurrent and Remote Blood Pressure and Disability in Older Adults , 2007, Hypertension.

[32]  K. Reynolds,et al.  Worldwide prevalence of hypertension: a systematic review , 2004, Journal of hypertension.

[33]  Peter R Eastwood,et al.  Six minute walk distance in healthy subjects aged 55-75 years. , 2006, Respiratory medicine.

[34]  R. Pedrosa.  Correlação entre os testes da caminhada, marcha estacionária e tug em hipertensas idosas Correlation between the walk, 2-minute step and tug tests among hypertensive older women , 2009 .

[35]  C. Pereira,et al.  Teste de caminhada de seis minutos: valores de referência para adultos saudáveis no Brasil , 2011 .

[36]  S. Kritchevsky,et al.  Relation of Pulse Pressure to Long-Distance Gait Speed in Community-Dwelling Older Adults: Findings from the LIFE-P Study , 2012, PloS one.

[37]  Brian H Willis,et al.  Spectrum bias--why clinicians need to be cautious when applying diagnostic test studies. , 2008, Family practice.

[38]  A. Dominiczak,et al.  2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) , 2007, European heart journal.

[39]  A. S. Ferreira.  Integrative medicine for hypertension: the earlier the better for treating who and what are not yet ill , 2013, Hypertension Research.

[40]  Activity level predicts 6-minute walk distance in healthy older females: an observational study. , 2013, Physiotherapy.

[41]  N Hernández,et al.  Capillary changes in skeletal muscle of patients with essential hypertension , 1999, The Anatomical record.

[42]  F. Fuchs,et al.  Trends in Prevalence of Hypertension in Brazil: A Systematic Review with Meta-Analysis , 2012, PloS one.

[43]  P. Enright,et al.  The 6‐min Walk Test: A Quick Measure of Functional Status in Elderly Adults. , 2003, Chest.

[44]  G. Guyatt,et al.  The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. , 1985, Canadian Medical Association journal.

[45]  B BALKE,et al.  A SIMPLE FIELD TEST FOR THE ASSESSMENT OF PHYSICAL FITNESS. REP 63-6. , 1963, [Report]. Civil Aeromedical Research Institute.

[46]  V. Dourado.  [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.] , 2011, Arquivos brasileiros de cardiologia.

[47]  A. Woodcock,et al.  Two-, six-, and 12-minute walking tests in respiratory disease. , 1982, British medical journal.

[48]  V. Dourado,et al.  Reference equations for the performance of healthy adults on field walking tests. , 2011, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[49]  Victor Zuniga Dourado,et al.  Equações de referência para os testes de caminhada de campo em adultos saudáveis , 2011 .

[50]  SIX-MINUTE WALK TEST AT DIFFERENT AGES AND BODY MASS INDEXES , 2007 .