European Heart Journal Advance Access originally published online on August 16, 2005
European Heart Journal 2005 26(20):2209-2210; doi:10.1093/eurheartj/ehi453
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Six minute walk test: reply
Department of Medicine
Viborg Hospital
Heibergs Allé 4
8800 Viborg
Denmark
Tel: +45 8660 2860
Fax: +45 8927 3494
E-mail address: jensrefsgaard{at}post.tele.dk
I want to thank the Editor for giving me the opportunity to answer the letter by Dr Swedberg et al. First of all I have to say that as an author it was difficult to discuss the article by Ingle et al.1 as it was not published when my Editorial2 was submitted to The European Heart Journal. However, in the article by Ingle et al.,1 the six minute walk test (6MWT) distance is shown to be sensitive to changes in self-perceived symptoms of heart failure. Moreover, the 6MWT test shows satisfactory agreement when repeated 1 year later in 74 patients with congestive heart failure and with unchanged symptoms [intraclass correlation coefficient (ICC)=0.80 (95% CI=0.69–0.87)] performed in a 15 m long corridor. What the ICC would have been if the 6MWT had been repeated is unknown from this study, and whether an ICC of 0.80 is an argument for not repeating the test, can be discussed.
Dr Swedberg et al. also refer to the work by Demers et al.3 They assessed the 6MWT in 768 patients with heart failure (NYHA II–IV) at baseline, after 18 and 43 weeks in the RESOLVD study, and they found a high reproducibility from screening to baseline (baseline 3 weeks after screening) (ICC=0.90), after 18 weeks (ICC=0.88) and 43 weeks (ICC=0.91). However, in the study by Demers et al.,3 they did not compensate for changes in the patients clinical conditions over time, which is important as shown and discussed by Ingle et al.1
I think that a variance in distance from 0 to 17% from the first to the second walk4 as noticed by Dr Swedberg et al. in their letter is important enough to attempt to minimize, for example by repeating the test as shown by Guyatt et al.5 And why not, when you have this simple, safe, and inexpensive method? I am therefore still convinced that if the 6MWT is performed in a strict standardized manner in an uncrowded area with a well-prepared instruction without encouragement of the patient during the test, then the test will give valid supplementary information on the treatment effect and the physical status of the patient. The test should be standardized in a strict manner,4 however, further standardization to make the test more reliable is most welcome.
Finally, I fully agree with Dr Swedberg et al., that the peak oxygen uptake is not a ‘golden standard’ of heart failure assessment, which I have never stated it is.
Conflict of interest: none declared.
References
- Ingle L, Shelton RJ, Rigby AS, Nabb S, Clark AL, Cleland JG. The reproducibility and sensitivity of the 6-min walk test in elderly patients with chronic heart failure. Eur Heart J 2005. Published online ahead of print April 14, 2005; doi:10.1093/eurheartj/ehi259.
- Refsgaard J. "This is a walking test, not a talking test": the six minute walking test in congestive heart failure. Eur Heart J 2005;26:749–750.
[Free Full Text] - Demers C, McKelvie RS, Negassa A, Yusuf S; RESOLVD Pilot Study Investigators. Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure. Am Heart J 2001;142:698–703.[CrossRef][Web of Science][Medline]
- ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:1111–1117.
- Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 1985;132:919–923.[Abstract]
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