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Effectiveness of Supervised Exercise Based Cardiac Rehabilitation versus Unsupervised Exercise Training Following Coronary Artery Bypass Graft Surgery View project
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without hesitation.” Demonstrate by walking one lap 12. Record the number of laps from the counter (or tick
yourself. Walk and pivot around a cone briskly. “Are marks on the worksheet).
you ready to do that? I am going to use this counter to 13. Record the additional distance covered (the number of
keep track of the number of laps you complete. I will meters in the final partial lap) using the markers on the
click it each time you turn around at this starting line. wall as distance guides. Calculate the total distance
Remember that the object is to walk as far as possible walked, rounding to the nearest meter, and record it
for 6 minutes, but don’t run or jog. Start now or on the worksheet.
whenever you are ready.” 14. Congratulate the patient on good effort and offer a drink
8. Position the patient at the starting line. You should of water.
also stand near the starting line during the test. Do not
Clinical Application:
walk with the patient. As soon as the patient starts to
walk, start the timer. Initially, SMWT was used as field test to monitor the
outcomes of therapy specifically in pulmonary conditions;
9. Do not talk to anyone during the walk. Use an even
Later was used to assess the exercise tolerance in patients
tone of voice when using the standard phrases of
with low work capacity and high risk group for graded,
encouragement. Watch the patient. Do not get
maximal exercise testing. Thus, gradually SMWT was used
distracted and lose count of the laps. Each time the
in cardiac rehab programs with validation with standard
participant returns to the starting line, click the lap
testing protocols and self-reported measures.[15, 16, 17] The
counter once (or mark the lap on the worksheet). Let
6MWT data guides the exercise prescription in cardiac
the participant see you do it. Exaggerate the click using
Rehabilitation by making use of American College of Sports
body language, like using a stopwatch at a race.
Medicine (ACSM) working equation.[13]
After the first minute, tell the patient the following (in
even tones): “You are doing well. You have 5 minutes Example of Using 6-Min Walk Data for Exercise Prescription
to go.” When the timer shows 4 minutes remaining, Distance walked by the patient: 420 metres in 6
tell the patient the following: “Keep up the good work. min.Calculate walking speed: Calculate speed in m/min:
You have 4 minutes to go.” When the timer shows 3 420 m/6 min = 70m/min Calculate metabolic value for
minutes remaining, tell the patient the following: “You walking without grade:1 MET = 3.5ml/kg/min; 0.1 is the
are doing well. You are halfway done.” When the timer constant for converting m/min to ml/kg/min Estimated
shows 2 minutes remaining, tell the patient the oxygen consumption(V)2) = 3.5ml/kg/min+O2 consumed
following: “Keep up the good work. You have only 2 in 6MWT(in ml/kg/min)Thus, VO2 = 3.5ml/kg/min +70m/
minutes left.” When the timer shows only 1 minute min×0.1 = 3.5+7ml/kg/min = 10.5 ml/kg/min.MET level
remaining, tell the patient: “You are doing well. You achieved: 10.5 ml/kg/min/3.5 = 3 METs. Metabolic value
have only 1 minute to go.” Do not use other words of can be used for exercise prescription on apparatus other
encouragement (or body language to speed up). If the than treadmill MET, metabolic equivalent.
patient stops walking during the test and needs a rest, Using the cahalin formula [VO2 MAX = 0.006 X
say this: “You can lean against the wall if you would 6MWD (FEET) +3.38 also can be used Walter villobos et
like; then continue walking whenever you feel able.” al., have concluded in their study that 6MWT is more reliable
Do not stop the timer. If the patient stops before the 6 in cardiac rehabilitation and have better correlation in term
minutes are up and refuses to continue (or you decide of Vo2 Max.[16, 17] In their study they also concluded patients
that they should not continue), wheel the chair over with a 6MWD of less than 360 have low level exercise
for the patient to sit on, discontinue the walk, and capacity and those with 6MWD great than 546 have moderate
note on the worksheet the distance, the time stopped, to high level of exercise capacity. They also use an equation
and the reason for stopping prematurely. When the to find the predicated value for 6MWT equation 218+ (5.14
timer is 15 seconds from completion, say this: “In a X HT IN CM – 5.32 X AGE) – (1.80 X WT + 51.31). It is
moment I’m going to tell you to stop. When I do, just observed that in healthy individuals will have a predicted
stop right where you are and I will come to you.” When 6MWD of 631 ±93meter.
the timer rings (or buzzes), say this: “Stop!” Walk over
Widening Horizons:
to the patient. Consider taking the chair if they look
exhausted. Mark the spot where they stopped by placing Six-minute walk test is a universally accepted field
a beanbag or a piece of tape on the floor. test. It is safe, simple and well tolerated by most patients,
even by frail elderly. It is reliable and feasible for many
10. Post-test: Record the post walk Borg dyspnea and fatigue
patient populations including the renal patients. The six-
levels and ask this: “What, if anything, kept you from
minute walk test (SMWT) is a simple, safe, and inexpensive
walking farther?”
test that uses an exercise mode relevant to everyday
11. If using a pulse oximeter, measure SpO 2 and pulse activities. The SMWT is a good measure of functional
rate from the oximeter and then remove the sensor. exercise ability because it is self-paced and sub maximal
32 Sri Ramachandra Journal of Medicine, Jan. June 2011, Vol. 4, Issue 1
Review Article
in nature. The SMWT is also well-accepted by patients, tolerance and predictive values in those patients. Thus,
easily administered, and easily reproduced.[15-20] Recent SMWT could serve as a clinically useful tool facilitating
studies indicate that Six minute walk distance predicts the efficient method of estimating an individual’s physical
mortality in different groups of patients. The SMW distance capacity with a functional test. The SMWT should be
was found to be correlated with mortality prediction considered as useful complementary information about
inpatients with colon cancer and lung transplant.[21, 22] It is the functional status of patients with cardiovascular or
quite interesting to note that a recent study have found the pulmonary disease, while the utility needs further testing
prediction ability of the SMWT in patients waiting for liver in other groups of patients.
transplant, which was equivalent to predictability as that
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