The 6-minute walk test can replace the cardiopulmonary exercise test! Chinese experts agree

The 6-minute walk test can better replicate the daily physiological state of elderly patients and evaluate their overall activity ability and functional reserve. It is a non-invasive, safe, simple, easy, well-tolerated, reliable and effective clinical trial that can better reflect daily activities.

Recently, the Geriatrics Branch of the Chinese Medical Association organized experts in related fields to formulate the Chinese Expert Consensus on the Clinical Application of the 6-Minute Walk Test in Elderly Patients.

The consensus points out that in hospitals (especially grassroots hospitals) or departments that lack professional equipment and personnel for cardiopulmonary examinations, the 6-minute walk test is a suitable alternative for assessing exercise tolerance for elderly people with moderate to severe functional impairment and multiple chronic diseases.

The 6-minute walk test is indicated for the following:

However, contraindications to the 6-minute walk test in elderly patients must be strictly evaluated before the test:

The consensus strongly recommends that test operators follow standardized test procedures and all operators must be familiar with the test procedures, because consistency in test procedures and conditions is crucial to ensuring the quality of 6-minute walk test results.

The 6MWT is very sensitive to changes in methodology, including the use of encouraging language, provision of supplemental oxygen, changes in walking track layout and length, and use of wheeled walkers, and the consensus emphasizes that these factors should remain constant in repeated trials (evidence quality A, recommendation strength 2).

The consensus points out that the reference value of the 6-minute walk distance should, as far as possible, use a formula generated and verified in the local population, and it is recommended to use the 6-minute walk distance calculation formula for the healthy elderly population in China.

Regarding the 6-minute walk test to evaluate cardiopulmonary function or exercise endurance in the elderly, the consensus suggests that a 6-minute walk distance of 450 meters is normal.

The consensus also pointed out that the 6-minute walk test can be an important predictive tool for survival and prognosis in the elderly population.

The consensus states that the 6-minute walk test should be terminated in the following circumstances:

(1) Chest pain suspected to be angina pectoris;

(2) unbearable dyspnea;

(3) lower limb cramps or extreme leg muscle fatigue;

(4) gait imbalance;

(5) Pale complexion and sweating;

(6) Dizziness or fainting;

(7) SpO2 decreases and remains below 85%;

(8) a decrease in systolic blood pressure ≥20 mmHg, accompanied by an increase in heart rate;

(9) systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥100 mmHg;

(10) The patient cannot tolerate the trial further.

In addition, the 6-minute walk test, as a method for assessing cardiopulmonary and motor function capacity, can also be an important tool for early screening, diagnostic evaluation, and early prevention and treatment of frailty in the elderly. It can also be a simple, economical, and easy-to-manage alternative method for assessing the exercise endurance and functional capacity of elderly patients. Personalized walking exercise prescriptions can be formulated for elderly patients based on the 6-minute walk distance.

Source: Chinese Medical Association Geriatrics Branch. Chinese expert consensus on the clinical application of the 6-minute walk test in elderly patients. Chinese Journal of Geriatrics, 2020, 39 (11): 1241-1250.

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