6mwt Guidelines Brochure Abs3103

8/9/2019 6mwt Guidelines Brochure Abs3103

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THE 6MINUTE WALK TEST 6MWT is one of the most widely used

tests for assessing the functional status of patients with pulmonary arterial

hypertension (PAH).1,2Along with the symptom-based WHO functional

classification and other elements of the clinical picture, results of baseline

and serial 6-minute walk testing have prognostic value and may suggest

approaches to treatment.3,4

ALTHOUGH SIMPLE IN CONCEPT,the 6MWT requires adherence to a

standardized protocol to produce consistent results. Elimination of variability

allows comparisons over time for a single patient, as well as across patients

and across PAH centers.5This summary of the American Thoracic Society (ATS)

guidelines for the 6MWT is provided by Gilead Sciences, Inc. as an educational

service to help encourage Best Practices in PAH care.

F U N C T I O N A L A S S E S S M E N T I N P A H

Guidelines for the 6-Minute Walk Test


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THE 6MWT MEASURES THE DISTANCE A PATIENT CAN WALK ON A

FLAT, HARD SURFACE IN A PERIOD OF 6 MINUTES5

The 6MWT, a submaximal exercise test, is:

Easy to administer, well tolerated, and reflective of activities of daily living6

Reproducible3,7

Technically simple and inexpensive to perform1,7

The 6-minute walk distance (6MWD) is a primary endpoint in many PAH clinical studies because it

is correlated to clinical outcomes and to other markers of disease severity1-3

INTERPRETING 6MWT RESULTS

The 6MWD correlates3,8:

Inversely with WHO functional status severity and pulmonary vascular resistance

Directly with cardiac output, peak oxygen consumption, and other measures of pulmonary

gas exchange

MEAN 6MWD OF HEALTHY VOLUNTEERS VS. PATIENTS WITH PAH

IN NYHA FUNCTIONAL CLASSES II, III, AND IV 7

SERIAL DETERMINATIONS OF FUNCTIONAL CLASS AND EXERCISE CAPACITY

ASSESSED BY THE 6MWT PROVIDE BENCHMARKS FOR DISEASE SEVERITY,

RESPONSE TO THERAPY, AND PROGRESSION.3

Performance on the 6MWT is predictive of survival in patients with idiopathic PAH (IPAH)3:

Patients walking 10% during 6MWT increases mortality risk by a factor of 2.9

(median follow-up 26 months)1

Functional Assessment in PAH :

The 6-Minute Walk Test

ATS GUIDELINES FOR THE 6MWT 5

Published in 2002, the ATS statement provides practical guidelines for the 6MWT with the aim of

encouraging Best Practices and uniformity of results

Covered topics include indications and limitations, contraindications, safety issues, technical aspects of

the test, required equipment, patient preparation, measurements, quality assurance, and interpretation

of results; standardized phrases for instructing the patient are also provided

GUIDELINE HIGHLIGHTS5

SAFETY

Trained emergency personnel and resuscitation equipment should be readily available

The test should be stopped immediately for any of the following: chest pain, intolerable dyspnea,

leg cramps, staggering, diaphoresis, and pale or ashen appearance

COURSE LAYOUT

Recommended: a long, at, straight, enclosed corridor with a hard surface, 30 m in length, with

turnaround points at each end clearly marked with cones

A permanent, dedicated course is ideal

Notrecommended: a continuous course or treadmill

PARAMETERS TO BE RECORDED

Primary:

Distance in meters completed in 6 minutes

Secondary:

Pre-test blood pressure

Pre- and post-test heart rate and SpO2(no intra-test measurements)

Pre- and post-test patient perception of fatigue and dyspnea (Borg scale)

PATIENT PREP

The patient should:

Wear comfortable clothes and walking shoes and use his or her regular walking aid (e.g., cane or walker)

Continue his or her usual medical regimen, including supplemental oxygen

CONDUCTING THE TEST

There is no warm-up period; the patient should be seated for at least 10 minutes before the test

The person conducting the test should not walk with the patient or oer any physical or verbal

encouragement other than pre-scripted phrases

Instructions to the patient should be delivered in an even tone of voice and limited to set phrases

described in the guidelines

Any supplemental oxygen source should be carried or pulled by the patient in his or her usual fashion

The 6-minute timer should continue to run even if the patient stops to rest

Practice tests are unnecessary but may be considered; typically, they improve performance by increasing the

distance walked. Allow at least 1 hour between a practice test and follow-up test; report the highest 6MWD

STANDARDIZATION OF THE 6MWT IS CRITICAL: A STANDARDIZED APPROACH

REDUCES VARIABILITY, WHICH CAN MARKEDLY INFLUENCE TEST RESULTS.5

P


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6MWT

COURSE MARKERS

Thecoursemarkers areanexcellent way to aid in trackingpatient progress duringthetest.

Simply placea marker every3meters in your 30-metercourse.Seetheguidelines for

completedetails.

ME TE RS

Printed on recycled paper 50TRF/25PCW(50% totally recycled fiber, 25% post-consumer waste)

6MWT COURSE

References: 1.Gali N, Torbicki A, Barst R, et al, for the Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. ESC guidelines:

guidelines on diagnosis and treatment of pulmonary arterial hypertension. Eur Heart J. 2004;25(24):2243-2278. 2.Snow JL, Kawut SM. Surrogate end points in pulmonary arterial

hypertension: assessing the response to therapy. Clin Chest Med. 2007;28(1):75-89. 3.McGoon M, Gutterman D, Steen V, et al. Screening, early detection, and diagnosis of pulmonary

arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004;126(1, suppl):14S-34S. 4.Lee SH, Rubin LJ. Current treatment strategies for pulmonary arterial

hypertension.J Intern Med. 2005;258(3):199-215. 5.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(1):111-117. 6.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(1):256-270. 7.Miyamoto S, Nagaya N, Satoh T, et al. Clinical correlates and prognostic significance of six-minute walk test in

patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing.Am J Respir Crit Care Med. 2000;161(2, pt 1):487-492. 8.Barst RJ, McGoon M, Torbicki A,

et al. Diagnosis and differential assessment of pulmonary arterial hypertension.J Am Coll Cardiol. 2004;43(12, suppl S):40S-47S.

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6mwt Guidelines Brochure Abs3103