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Int J Sports Med 2013; 34(07): 631-636
DOI: 10.1055/s-0032-1323746
Training & Testing
© Georg Thieme Verlag KG Stuttgart · New York

Validity of the Six-Minute Walk Test in Cancer Patients

K. Schmidt
1   Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
,
L. Vogt
1   Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
,
C. Thiel
1   Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
,
E. Jäger
2   Department of Hematology and Oncology, Krankenhaus Nordwest, Frankfurt am Main, Germany
,
W. Banzer
1   Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
› Author Affiliations
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Publication History



accepted after revision 31 July 2012

Publication Date:
26 February 2013 (online)

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Abstract

The present study evaluated the validity of the six-minute walk test (6MWT) in cancer patients. 50 subjects (36 f, 14 m; 57.4±10.2 years; during (56%) or off (44%) cancer treatment) performed a 6MWT and a spiroergometry on a cycle ergo­meter (0+25 W, 3 min) to evaluate maximum exercise capacity (VO2peak). A subsample (n=30) completed a retest of the 6MWT within 2–7 days. Patients covered a distance of 594±81 m during 6MWT at an average intensity of 86.3±9.6% of HRmax and achieved a VO2peak of 21.2±4.86 ml · kg − 1 · min − 1 during cycle ergometry. The distance walked correlated significantly (p<0.001) with VO2peak (r=0.67) and perceived physical function (EORTC QLQ-C30 physical function subscale) (r=0.55). Concerning reliability the intraclass correlation coefficient was r=0.93 (95%CI: +0.86;+0.97; p<0.001) and the coefficient of variation 3%. During retest participants walked 3.1% (95%CI: +1.1; +5.2) farther and achieved a higher RPE (+1.0; 95%CI: +0.3;+1.8). Limits of agreement were between  − 43.1 and 76.4 m. In cancer patients the 6MWT seems to be as valid and reliable as in healthy elderly, cardiac and pulmonary patients. Thus, it can be recommended for use in cancer patients.

Key words

reliability - validity - 6MWT - cancer - evaluation of physical ­function
 

  • References

  • 1 Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes CJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F. for the European Organization for Research and Treatment of Cancer Study Group on Quality of Life . The European Organization for Research and Treatment of Cancer QLQ-C30: A Quality-of-Life Instrument for Use in International Clinical Trials in Oncology. J Natl Cancer Inst 1993; 85: 365-376
    CrossrefPubMedSearch in Google Scholar
  • 2 American College of Sports Medicine . Health-Related Physical Fitness Testing and Interpretation. In: American College of Sports Medicine. Thompson WR, Gordon NF, Pescatello LS. (eds.). ACSM’s Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo: Lippincott Williams & Wilkins; 2010: 60-104
    Search in Google Scholar
  • 3 American Thoracic Society, American College of Chest Physicians . ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003; 167: 211-277
    CrossrefPubMedSearch in Google Scholar
  • 4 Atkinson G, Davison RCR, Nevill AM. Performance characteristics of gas analysis systems: what we know and what we need to know. Int J Sports Med 2005; 26 (Suppl) 2-10
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Atkinson G, Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 1998; 26: 217-238
    CrossrefPubMedSearch in Google Scholar
  • 6 ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories . ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111-117
    CrossrefPubMedSearch in Google Scholar
  • 7 Banzer W, Vogt L, Hübscher M, Thiel C. Sports Medical Assessment in Oncology. Dtsch Z Sportmed 2012; 63: 20-22
    PubMedSearch in Google Scholar
  • 8 Beriault K, Carpentier AC, Gagnon C, Ménard J, Baillargeon J, Ardilouze J, Langlois M. Reproducibility of the 6-minute walk test in obese adults. Int J Sports Med 2009; 30: 725-727
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8: 135-160
    CrossrefPubMedSearch in Google Scholar
  • 10 Brown JC, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, Johnson BT. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2011; 20: 123-133
    CrossrefPubMedSearch in Google Scholar
  • 11 Camarri B, Eastwood PR, Cecins NM, Thompson PJ, Jenkins S. Six minute walk distance in healthy subjects aged 55–75 years. Respir Med 2006; 100: 658-665
    CrossrefPubMedSearch in Google Scholar
  • 12 Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008; (02) CD006145
    PubMedSearch in Google Scholar
  • 13 Gibbons WJ, Fruchter N, Sloan S, Levy RD. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil 2001; 21: 87-93
    CrossrefPubMedSearch in Google Scholar
  • 14 Harriss D, Atkinson G. Update – ethical standards in sport and exercise science research. Int J Sports Med 2011; 32: 819-821
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Jehn M, Halle M, Schuster T, Hanssen H, Weis M, Koehler F, Schmidt-Trucksäss A. The 6-min walk test in heart failure: is it a max or sub-maximum exercise test?. Eur J Appl Physiol 2009; 107: 317-323
    CrossrefPubMedSearch in Google Scholar
  • 16 Jenkins S, Cecins N, Camarri B, Williams C, Thompson P, Eastwood P. Regression equations to predict 6-minute walk distance in middle-aged and elderly adults. Physiother Theory Pract 2009; 25: 516-522
    PubMedSearch in Google Scholar
  • 17 Jones LW, Cohen R, Mabe SK, West MJ, Desjardins A, Vredenburgh JJ, Friedman AH, Reardon DA, Wander E, Friedman HS. Assessment of physical functioning in recurrent glioma: preliminary comparison of performance status to functional capacity testing. J Neurooncol 2009; 94: 79-85
    CrossrefPubMedSearch in Google Scholar
  • 18 Jones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR. Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol 2009; 10: 598-605
    CrossrefPubMedSearch in Google Scholar
  • 19 Jones LW, Eves ND, Haykowsky M, Joy AA, Douglas PS. Cardiorespiratory exercise testing in clinical oncology research: systematic review and practice recommendations. Lancet Oncol 2008; 9: 757-765
    CrossrefPubMedSearch in Google Scholar
  • 20 Jones LW, Eves ND, Mackey JR, Peddle CJ, Haykowsky M, Joy AA, Courneya KS, Tankel K, Spratlin J, Reiman T. Safety and feasibility of cardiopulmonary exercise testing in patients with advanced cancer. Lung Cancer 2007; 55: 225-232
    CrossrefPubMedSearch in Google Scholar
  • 21 Jones LW, Hornsby WE, Goetzinger A, Forbes LM, Sherrard EL, Quist M, Lane AT, West M, Eves ND, Gradison M, Coan A, Herndon JE, Abernethy AP. Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer. Lung Cancer [Epub ahead of print] 2011; [cited 2012 Jan 05]. Available from http://dx.doi.org/10.1016/j.lungcan.2011.10.009
    PubMedSearch in Google Scholar
  • 22 Jones LW, Peddle CJ, Eves ND, Haykowsky MJ, Courneya KS, Mackey JR, Joy AA, Kumar V, Winton TW, Reiman T. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 2007; 110: 590-598
    CrossrefPubMedSearch in Google Scholar
  • 23 Kasymjanova G, Correa JA, Kreisman H, Dajczman E, Pepe C, Dobson S, Lajeunesse L, Sharma R, Small D. Prognostic value of the six-minute walk in advanced non-small cell lung cancer. J Thorac Oncol 2009; 4: 602-607
    CrossrefPubMedSearch in Google Scholar
  • 24 Kervio G, Carre F, Ville NS. Reliability and intensity of the six-minute walk test in healthy elderly subjects. Med Sci Sports Exerc 2003; 35: 169-174
    CrossrefPubMedSearch in Google Scholar
  • 25 Kervio G, Ville NS, Leclercq C, Daubert J, Carré F. Intensity and daily reliability of the six-minute walk test in moderate chronic heart failure patients. Arch Phys Med Rehabil 2004; 85: 1513-1518
    CrossrefPubMedSearch in Google Scholar
  • 26 Ligibel JA, Meyerhardt J, Pierce JP, Najita J, Shockro L, Campbell N, Newman VA, Barbier L, Hacker E, Wood M, Marshall J, Paskett E, Shapiro C. Impact of a telephone-based physical activity intervention upon exercise behaviors and fitness in cancer survivors enrolled in a cooperative group setting. Breast Cancer Res Treat 2012; 132: 205-213
    CrossrefPubMedSearch in Google Scholar
  • 27 Mustian KM, Katula JA, Zhao H. A pilot study to assess the influence of tai chi chuan on functional capacity among breast cancer survivors. J Support Oncol 2006; 4: 139-145
    PubMedSearch in Google Scholar
  • 28 Pollentier B, Irons SL, Benedetto CM, Dibenedetto AM, Loton D, Seyler RD, Tych M, Newton RA. Examination of the six minute walk test to determine functional capacity in people with chronic heart failure: a systematic review. Cardiopulm Phys Ther J 2010; 21: 13-21
    PubMedSearch in Google Scholar
  • 29 Riesenberg H, Lübbe AS. In-patient rehabilitation of lung cancer patients – a prospective study. Support Care Cancer 2010; 18: 877-882
    CrossrefPubMedSearch in Google Scholar
  • 30 Rostagno C, Gensini GF. Six minute walk test: a simple and useful test to evaluate functional capacity in patients with heart failure. Intern Emerg Med 2008; 3: 205-212
    CrossrefPubMedSearch in Google Scholar
  • 31 Ruden E, Reardon DA, Coan AD, Herndon 2nd JE, Hornsby WE, West M, Fels DR, Desjardins A, Vredenburgh JJ, Waner E, Friedman AH, Friedman HS, Peters KB, Jones LW. Exercise behavior, functional capacity, and survival in adults with malignant recurrent glioma. J Clin Oncol 2011; 29: 2918-2923
    CrossrefPubMedSearch in Google Scholar
  • 32 Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz A. American College of Sports Medicine . American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42: 1409-1426
    CrossrefPubMedSearch in Google Scholar
  • 33 Sciurba F. Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length. Am J Respir Crit Care Med 2003; 167: 1522-1527
    CrossrefPubMedSearch in Google Scholar
  • 34 Shelton ML, Lee JQ, Morris GS, Massey PR, Kendall DG, Munsell MF, Anderson KO, Simmonds MJ, Giralt SA. A randomized control trial of a supervised versus a self-directed exercise program for allogeneic stem cell transplant patients. Psychooncology 2009; 18: 353-359
    PubMedSearch in Google Scholar
  • 35 Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86: 420-428
    CrossrefPubMedSearch in Google Scholar
  • 36 Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest 2001; 119: 256-270
    CrossrefPubMedSearch in Google Scholar
  • 37 Temel JS, Greer JA, Goldberg S, Vogel PD, Sullivan M, Pirl WF, Lynch TJ, Christiani DC, Smith MR. A structured exercise program for patients with advanced non-small cell lung cancer. J Thorac Oncol 2009; 4: 595-601
    CrossrefPubMedSearch in Google Scholar
  • 38 Thiel C, Vogt L, Himmelreich H, Hübscher M, Banzer W. Reproducibility of muscle oxygen saturation. Int J Sports Med 2011; 32: 277-280
    Thieme ConnectPubMedSearch in Google Scholar
  • 39 Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J 1999; 14: 270-274
    PubMedSearch in Google Scholar
  • 40 Winters-Stone KM, Nail L, Bennett JA, Schwartz A. Bone Health and Falls: Fracture risk in breast cancer survivors with chemotherapy-induced amenorrhea. Oncol Nurs Forum 2009; 1: 315-325
    PubMedSearch in Google Scholar
  • 41 Wu G, Sanderson B, Bittner V. The 6-minute walk test: How important is the learning effect?. Am Heart J 2003; 146: 129-133
    CrossrefPubMedSearch in Google Scholar
  • 42 Yuen HK, Sword D. Home-based exercise to alleviate fatigue and improve functional capacity among breast cancer survivors. J Allied Health 2007; 36: 257-275
    PubMedSearch in Google Scholar