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Vol. 86, No. 5, 2013
Issue release date: December 2013
Respiration 2013;86:384-392

Is an Individual Prediction of Maximal Work Rate by 6-Minute Walk Distance and Further Measurements Reliable in Male Patients with Different Lung Diseases?

Ochmann U. · Kotschy-Lang N. · Raab W. · Kellberger J. · Nowak D. · Jörres R.A.
aInstitute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital of Munich, Munich, bRehabilitation Clinic Falkenstein, Berufsgenossenschaftliche Klinik für Berufskrankheiten, Falkenstein, and cRehabilitation Clinic Bad Reichenhall, Klinik für Berufskrankheiten der Verwaltungs-Berufsgenossenschaft, Bad Reichenhall, Germany

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Background: In patients with chronic lung diseases, the work rate for endurance training is calculated by the maximal work rate (Wmax). Because the assessment bears side effects, a prediction by easier accessible tests would be of practical use. Objective: We addressed the reliability of predicting Wmax on the basis of the 6-min walk distance (6MWD) test and a set of further parameters in patients with different lung diseases. Methods: Baseline data of a longitudinal study including 6MWD, Wmax, peripheral muscle force, lung function, fat-free mass and dyspnea (Modified Medical Research Council score) of 255 men with occupational lung diseases (104 asthma, 69 asbestosis, 42 silicosis, 40 chronic obstructive pulmonary disease) were evaluated. Results: 6MWD correlated with Wmax (r = 0.51, p < 0.05). The product of 6MWD and body weight, in particular fat-free mass, led to an improvement in the correlation of Wmax with 6MWD. Muscle force, lung function and Modified Medical Research Council score correlated moderately but significantly with Wmax (p < 0.05 each). The maximum correlation gained by including 6MWD and further parameters in the prediction equations was r = 0.76 in patients with obstructive lung function impairment and r = 0.61 in asbestosis patients. The residual standard deviations of Wmax predicted by the calculated equations ranged between 20 and 28 W, and the 95% prediction intervals of Wmax ranged between ±47 and ±65 W. Conclusions: A reliable prediction of individual Wmax by 6MWD or related measures and therefore a replacement by other tests is not possible. Nevertheless, it may be useful for the comparison of average values in epidemiological and clinical studies.

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  1. Grunig E, Ehlken N, Ghofrani A, Staehler G, Meyer FJ, Juenger J, Opitz CF, Klose H, Wilkens H, Rosenkranz S, Olschewski H, Halank M: Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration 2011;81:394-401.
  2. Ferrazza AM, Martolini D, Valli G, Palange P: Cardiopulmonary exercise testing in the functional and prognostic evaluation of patients with pulmonary diseases. Respiration 2009;77:3-17.
  3. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntyre N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S, Troosters T: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006;173:1390-1413.
  4. Cavalheri V, Hernandes NA, Camillo CA, Probst VS, Ramos D, Pitta F: Estimation of maximal work rate based on the 6-minute walk test and fat-free mass in chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2010;91:1626-1628.
  5. Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR: Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2008;89:1782-1787.
  6. Kozu R, Jenkins S, Senjyu H, Mukae H, Sakamoto N, Kohno S: Peak power estimated from 6-minute walk distance in Asian patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Respirology 2010;15:706-713.
  7. Luxton N, Alison JA, Wu J, Mackey MG: Relationship between field walking tests and incremental cycle ergometry in COPD. Respirology 2008;13:856-862.
  8. Sillen MJ, Vercoulen JH, Hul AJ, Klijn PH, Wouters EF, van Ranst D, Peters JB, van Keimpema AR, Franssen FM, Otten HJ, Molema J, Jansen JJ, Spruit MA: Inaccuracy of estimating peak work rate from six-minute walk distance in patients with COPD. COPD 2012;9:281-288.
  9. Ochmann U, Kotschy-Lang N, Raab W, Kellberger J, Nowak D, Jörres RA: Long-term efficacy of pulmonary rehabilitation in patients with occupational respiratory diseases. Respiration 2012;84:396-405.
  10. ATS/ACCP: ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211-277.
  11. Clini EM, Crisafulli E: Exercise capacity as a pulmonary rehabilitation outcome. Respiration 2009;77:121-128.
  12. Carter R, Holiday DB, Nwasuruba C, Stocks J, Grothues C, Tiep B: 6-minute walk work for assessment of functional capacity in patients with copd. Chest 2003;123:1408-1415.
  13. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA: Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54:581-586.
  14. Nishiyama O, Taniguchi H, Kondoh Y, Kimura T, Ogawa T, Watanabe F, Arizono S: Quadriceps weakness is related to exercise capacity in idiopathic pulmonary fibrosis. Chest 2005;127:2028-2033.
  15. Cooper CB: The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function. Am J Med 2006;119:21-31.
  16. O'Donnell DE: Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2006;3:180-184.
  17. Callens E, Graba S, Gillet-Juvin K, Essalhi M, Bidaud-Chevalier B, Peiffer C, Mahut B, Delclaux C: Measurement of dynamic hyperinflation after a 6-minute walk test in patients with COPD. Chest 2009;136:1466-1472.
  18. Marin JM, Carrizo SJ, Gascon M, Sanchez A, Gallego B, Celli BR: Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;163:1395-1399.
  19. Gosselink R, Troosters T, Decramer M: Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996;153:976-980.
  20. Seymour JM, Spruit MA, Hopkinson NS, Natanek SA, Man WD, Jackson A, Gosker HR, Schols AM, Moxham J, Polkey MI, Wouters EF: The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J 2010;36:81-88.
  21. Franssen FM, Broekhuizen R, Janssen PP, Wouters EF, Schols AM: Limb muscle dysfunction in COPD: effects of muscle wasting and exercise training. Med Sci Sports Exerc 2005;37:2-9.
  22. Eiser N, Willsher D, Dore CJ: Reliability, repeatability and sensitivity to change of externally and self-paced walking tests in COPD patients. Respir Med 2003;97:407-414.
  23. Chatterjee AB, Rissmiller RW, Meade K, Paladenech C, Conforti J, Adair NE, Haponik EF, Chin R Jr: Reproducibility of the 6-minute walk test for ambulatory oxygen prescription. Respiration 2010;79:121-127.
  24. Noseda A, Carpiaux JP, Prigogine T, Schmerber J: Lung function, maximum and submaximum exercise testing in COPD patients: reproducibility over a long interval. Lung 1989;167:247-257.
  25. Covey MK, Larson JL, Alex CG, Wirtz S, Langbein WE: Test-retest reliability of symptom-limited cycle ergometer tests in patients with chronic obstructive pulmonary disease. Nurs Res 1999;48:9-19.
  26. Marciniuk DD, Watts RE, Gallagher CG: Reproducibility of incremental maximal cycle ergometer testing in patients with restrictive lung disease. Thorax 1993;48:894-898.
  27. Ross RM, Murthy JN, Wollak ID, Jackson AS: The six minute walk test accurately estimates mean peak oxygen uptake. BMC Pulm Med 2010;10:31.
  28. Holland AE, Hill K, Alison JA, Luxton N, Mackey MG, Hill CJ, Jenkins SC: Estimating peak work rate during incremental cycle ergometry from the 6-minute walk distance: differences between reference equations. Respiration 2011;81:124-128.
  29. Pretto JJ, Braun GW, Guy PA: Using baseline respiratory function data to optimize cycle exercise test duration. Respirology 2001;6:287-291.

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