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European Heart Journal Advance Access originally published online on April 14, 2005
European Heart Journal 2005 26(17):1742-1751; doi:10.1093/eurheartj/ehi259
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

The reproducibility and sensitivity of the 6-min walk test in elderly patients with chronic heart failure

Lee Ingle*, Rhidian J. Shelton, Alan S. Rigby, Samantha Nabb, Andrew L. Clark and John G.F. Cleland

Department of Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull HU16 5JQ, UK

Received 2 September 2004; revised 10 February 2005; accepted 15 March 2005; online publish-ahead-of-print 14 April 2005.

* Corresponding author. Tel: +44 148 262 3732; fax: +44 148 262 4071. E-mail address: l.ingle{at}hull.ac.uk

Aims The 6-min walk test (6-MWT) is used to estimate functional capacity. However, in elderly patients with chronic heart failure (CHF): (i) 1 year reproducibility of the 6-MWT; (ii) sensitivity of the 6-MWT to self-perceived changes in symptoms of heart failure; and (iii) implications for patient numbers required for studies using the 6-MWT as an endpoint have not been described.

Methods and results One thousand and seventy-seven patients with CHF, aged>60, with NYHA Class ≥II were recruited. Heart failure symptom assessment was determined using a questionnaire related to aspects of physical function, and patients performed a baseline 6-MWT, with follow-up 1 year later. Seventy-four patients with unchanged symptoms had an unchanged 6-MWT distance, with an overall intraclass correlation coefficient of 0.80 (95% CI=0.69–0.87). Four hundred and twenty-three patients reported an improvement in symptoms during follow-up. There was a negative correlation (r=–0.55; P=0.0001) between {Delta} symptoms and {Delta} 6-MWT (i.e. a reduced 6-MWT distance is associated with reduced symptom severity at follow-up). Five hundred and sixteen patients reported worsening symptoms of heart failure, a moderate inverse correlation (r=–0.53; P=0.0001) was displayed between {Delta} symptoms and {Delta} 6-MWT. For all patients, irrespective of symptom status, a high inverse correlation (r=–0.75; P=0.0001) was evident. On the basis of the data for patients with unchanged symptoms, it is calculated that to detect an increase in 6-MWT of 50 m, with 90% power, a study size of approximately 120 is required.

Conclusion In elderly patients with CHF, the 6-MWT shows satisfactory agreement when repeated 1 year later. Change in 6-MWT distance is sensitive to change in self-perceived symptoms of heart failure.

Key Words: Symptoms of heart failure • Elderly patients • 1 year follow-up • Power curves


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