Cardiac Rehabilitation Increases the Reliability of the 6-Minute Walk Test in Patients After Coronary Artery Bypass Graft Surgery
Background: Few data are available on the capacity for functional exercise after cardiac rehabilitation in patients who have undergone coronary artery bypass graft (CABG) surgery. The aim of this study was to determine the clinical and biochemical factors that affect the 6-minute walk test (6MWT) results in patients who have undergone CABG.
Methods: Data were prospectively collected from
56 patients consecutively admitted at our hospital between January 2013 and May 2015 for a 3-month cardiac rehabilitation program. Data were analysed retrospectively up to
90 days after cardiac surgery. In addition to clinical and biochemical parameters, the functional capacity of patients was evaluated by an exercise 6-minute walking test and echocardiography. Functional capacity was evaluated at baseline and after three months of cardiac rehabilitation.
Results: Before cardiac rehabilitation, the 6MWT values were negatively correlated with Body Mass Index (BMI) and abdominal and buttock diameters (r = -0.375, -0.386, and -0.370, respectively; P < .05), and were positively correlated with metabolic equivalent (MET) values (r = 0.493, P < .05). After cardiac rehabilitation, the 6MWT values were negatively correlated with body mass index (BMI) and abdominal and buttock diameters (r = -0.382, -0.274, and -0.405, respectively; P < .05) and were positively correlated with MET and VO2 max values (r = 0.456 and 0.573, respectively; P < 0.05). Before cardiac rehabilitation, VO2 max and FEV1/FEVC values were found as factors that significantly increased 6MWT values (P < .05). After cardiac rehabilitation, VO2 max values were found as factors that significantly increased 6MWT values (P < .05).
Conclusion: Overall, in current clinical settings, cardiac rehabilitation increases the reliability of the 6MWT. Improvement in pulmonary function after cardiac rehabilitation reduces the impact of pulmonary function on 6MWT values. The functional capacity of patients may be more reliably determined by 6MWT after cardiac rehabilitation.
Ainsworth BE, Haskell WL, Whitt MC, et al. 2000. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):498-504.
Anderson L, Oldridge N, Thompson DR, et al. 2016. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol 67:1-12.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. 2002. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111-117.
Bellet RN, Adams L, Morris NR. 2012. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness a systematic review. Physiotherapy 98:277-286.
Cacau LA, Santana-Filho VJ, Maynard LG, et al. 2016. Reference Values for the Six-Minute Walk Test in Healthy Children and Adolescents: a Systematic Review. Braz J Cardiovasc Surg 31:381-388.
Cacciatore F, Abete P, Mazzella F, et al. 2012. Six-minute walking test but not ejection fraction predicts mortality in elderly patients undergoing cardiac rehabilitation following coronary artery bypass grafting. Eur J Prev Cardiol 19:1401-1409.
Fiorina C1, Vizzardi E, Lorusso R, et al. 2007. The 6-min walking test early after cardiac surgery. Reference values and the effects of rehabilitation programme. Eur J Cardiothorac Surg 32:724-729.
Fu TC, Huang SC, Hsu CC, et al. 2014. Cardiac Rehabilitation in Patients with Heart Failure. Acta Cardiol Sin 30:353-359.
Goel K, Pack QR, Lahr B, et al. 2015. Cardiac rehabilitation is associated with reduced long-term mortality in patients undergoing combined heart valve and CABG surgery. Eur J Prev Cardiol 22:159-168.
Haeffener MP, Ferreira GM, Barreto SS, et al. 2008. Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery. Am Heart J 156:900.e1-900.e8.
Hamilton DM, Haennel RG. 2000. Validity and reliability of the 6-minute walk test in cardiac rehabilitation population. J Cardiopulm Rehabil 20:156-164.
Haykowsky MJ, Daniel KM, Bhella PS, et al. 2016. Heart Failure: Exercise-Based Cardiac Rehabilitation: Who, When, and How Intense? Can J Cardiol 32:382-387.
Højskov IE, Moons P, Hansen NV, et al. 2016. Early physical training and psycho-educational intervention for patients undergoing coronary artery bypass grafting. The SheppHeart randomized 2 × 2 factorial clinical pilot trial. Eur J Cardiovasc Nurs 15:425-437.
King M, Bittner V, Josephson R, et al. 2012. Medical director responsibilities for outpatient cardiac rehabilitation/secondary prevention programs: 2012 update: a statement for health care professionals from the American Association for Cardiovascular and Pulmonary Rehabilitation and the American Heart Association. J Cardiopulm Rehabil Prev 32:410-419.
Kulik A. 2016. Secondary prevention after coronary artery bypass graft surgery: a primer. Curr Opin Cardiol 31:635-643.
McKee G. 2009. Are there meaningful longitudinal changes in health related quality of life—SF36, in cardiac rehabilitation patients? Eur J Cardiovasc Nurs 8:40–47.
Mendes M. 2016. Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? There is No Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting. Circulation 133:2538-2543.
Pack QR, Goel K, Lahr BD, et al. 2013. Participation in cardiac rehabilitation and survival after coronary artery bypass graft surgery: a community-based study. Circulation 128:590-597.
Parmley WW. 1986. Position report on cardiac rehabilitation: Recommendations of the American College of Cardiology. J Am Coll Cardiol 7:451-453.
Rasekaba T, Lee AL, Naughton MT, et al. 2009. The six-minute walk test: a useful metric for the cardiopulmonary patient. Intern Med J 39:495-501.
Rauch B, Davos CH, Doherty P, et al. 2016. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol 23:1914-1939.
Strong PC, Lee SH, Chou YC, et al. 2012. Relationship between quality of life and aerobic capacity of patients entering phase II cardiac rehabilitation after coronary artery bypass graft surgery. J Chin Med Assoc 75:121-126.
Wright DJ, Khan KM, Gossage EM, et al. 2001. Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test. Clin Rehabil 15:119-124.
Yamamoto S, Yamaga T, Sakai Y, et al. 2016. Association between physical performance and cardiovascular events in patients with coronary artery disease: protocol for a meta-analysis. Syst Rev 5:32.
Yerokun BA, Williams JB, Gaca J, et al. 2016. Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes. Coron Artery Dis 27:319-326.
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