A more effective alternative to the 6-minute walk test for the assessment of functional capacity in patients with pulmonary hypertension.

BACKGROUND: The prognosis of Pulmonary Hypertension (PH) is directly correlated with the functional capacity (FC). The most common FC test is the 6-Minute Walk Test (6MWT), however, there is evidence to suggest that the 6MWT does not reflect the real FC in PH patients. AIM: To compare physiological responses among three field walk tests and cardiopulmonary exercise testing (CPET) in patients with pulmonary hypertension (PH), and to determine the determinants of distance walked in the field walk tests. DESIGN: Cross sectional study. SETTING: Outpatient clinic. POPULATION: 26 volunteers (49.8±14.6 years), WHO functional class II-III and a mean pulmonary artery pressure of 45 mmHg. METHODS: Patients underwent three field walk test: 6MWT, incremental shuttle walk test (ISWT), and endurance shuttle walk test (ESWT) and CPET on different, non-consecutive days. The main outcome measures were heart rate and perception of effort at the peak of exercise. RESULTS: The ISWT achieved maximum levels of effort without significant difference in any physiologic response compared to CPET. The physiological responses during ISWT were significantly higher than 6MWT and ESWT responses. CONCLUSIONS: The ISWT produced the greatest physiologic response of the field tests safely for which reason it appears to be the most effective test to assess FC of PH patients. CLINICAL REHABILITATION IMPACT: The self-paced characteristic of the 6MWT and lower physiologic responses compared to the CPET were the main reason for this test to be classified as submaximal in PH patients. The physiological responses during the ESWT were significantly lower than other field tests highlighting the need for more research on this test and other field test in PH patients.

Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed. METHODS: Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks. RESULTS: There was a significant difference in the distance covered on the six-minute walk test (p < 0.05) and BODE index (p < 0.001) in the outpatient and at-home groups after participating in the rehabilitation program compared to baseline. CONCLUSION: A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.