Development of a multivariate model of the six-minute walked distance to predict functional exercise capacity in hypertension.

BACKGROUND: Hypertension is associated with deterioration of musculoskeletal function and functional capacity. Existing prediction models for assessment of the 6-min walk test (6MWT) do not capture the disease-related functional capacity. This study developed a multivariate prediction model of the measured 6-min walked distance (6MWDM) in hypertension and proposed target-values based on optimal therapeutic aims. METHODS: Seventy-six patients (38 men, 56.1 ±â€¯14.3 years, systolic pressure 156.7 ±â€¯17.5 mmHg, diastolic pressure 92.9 ±â€¯6.9 mmHg) underwent anamnesis, physical examination, and laboratory analysis. Functional capacity was assessed using the 6MWT, being the 6MWDM considered as the dependent variable. Independent variables included sex (S, coded 'male' = 1, 'female' = 0), age (A), body height (H), body mass, mean blood pressure (MBP), and physical activity (IPAQ, coded 1-5). Target-values were derived from theoretical scenarios of optimal blood pressure and physical activity, separately and combined. RESULTS: Patients walked 324.5 ±â€¯10.1 m in the average of two trials 30-min apart. Pearson's correlation coefficient showed moderate-to-weak significant associations between 6MWDM and all independent variables. The final multivariate model was 6MWDP = 611.347-4.446 × MBP + 267.630 × H - 1.511 × A + IPAQcode + Scode (adjusted R2 = 0.680, SE of bias = 6.3 m), suggesting that clinical, anthropometric, and hemodynamic information determines functional capacity. Predicted values yielded a group-average of 325 ±â€¯87 m. Target-values under the optimal scenario resulted in 420 ±â€¯60 m. CONCLUSIONS: Sex (men), higher body height, higher physical activity, lower mean blood pressure, and lower age are independently correlated with higher 6MWDM in patients with hypertension. Target-values can be estimated for therapeutic aims related to hemodynamics and lifestyle.

Functional capacity in adults with hypertension as assessed by the six-minute walk distance test: systematic review / Capacidad funcional de adultos con hipertensión evaluada por el test de caminada de seis minutos: revisión sistemática / Capacidade funcional de adultos com hipertensão avaliada pelo teste de caminhada de seis minutos: revisão sistemática

This study systematically reviewed the six-minute walk test (6MWT) for assessment of functional capacity of adults with hypertension subjected or not to physical rehabilitation, focusing in walked distance (6MWD) and blood pressure. A literature search was conducted in PubMed, SciELO, LILACS, PEDro, Cochrane, Redalyc, and national journals of physiotherapy using the keywords "hipertensão" (hypertension) and "teste de caminhada de seis minutos" (six-minute walk test) without language or period constraints. Six studies were included: one case-control, one clinical trial, two quasi-experimental and two series of cases. Results from cross-sectional studies suggest preservation of the 6MWD in the mild stage of hypertension, whereas significant lower values in the more severe stage of hypertension or in the presence of comorbidities. Longitudinal studies suggest that the 6MWT is sensitive to the increase in functional capacity due to adaptations from physical rehabilitation programs. Two major limitations compromise the external validity of the included studies: samples with specific phenotypes (same sex; same hypertension stage; narrow age group) and the small sample size (range 8 to 32). The low methodological quality reinforces the need for researches with larger samples and different phenotypes of hypertension.

Eso trabajo revisó sistemáticamente los estudios referentes al test de caminada de seis minutos (TC6) para evaluación de la capacidad funcional de adultos con hipertensión que fueron o no sometidos a la rehabilitación física, con foco en la distancia caminada (DC6) y en la presión arterial. Una búsqueda en la literatura fue conducida en PubMed, SciELO, LILACS, PEDro, Cochrane, Redalyc y en periódicos brasileños de fisioterapia con las palabras clave "hipertensión" (hypertension) y "test de caminada de seis minutos" (six-minute walking test) sin restricciones de lengua y periodo. Fueron inclusos uno estudio caso-control, un ensayo clínico, dos casi-experimentales y dos reportos de casos. Los estudios transversales sugieren preservación de la DC6 en los estadios leves de la hipertensión, pero reducciones significativas en los estadios más severos y/o en la presencia de comorbidades. Los estudios longitudinales sugieren que el TC6 es sensible al aumento de la capacidad funcional porque hay adaptaciones advenidas de programas de rehabilitación física. Dos importantes limitaciones comprometen la validad externa de los estudios: muestras con fenotipos específicos (mismo sexo; mismo estadio de HAS; edad estrecha) y pequeño tamaño de la muestra (entre 8 y 32 participantes). La baja cualidad metodológica de los estudios resalta la necesidad de investigaciones con muestras mayores y espectro más amplio de fenotipos de hipertensión.

Este trabalho revisou sistematicamente os estudos sobre teste de caminhada de seis minutos (TC6) para avaliação da capacidade funcional de adultos com hipertensão submetidos ou não à reabilitação física, com foco na distância caminhada (DC6) e pressão arterial. Uma busca na literatura foi conduzida no PubMed, SciELO, LILACS, PEDro, Cochrane, Redalyc e em periódicos nacionais de fisioterapia com as palavras-chave "hipertensão" (hypertension) e "teste de caminhada de seis minutos" (six-minute walk test) sem restrição de idioma e período. Foram incluídos um estudo caso-controle, um ensaio clínico, dois quase-experimentais e duas séries de casos. Os estudos seccionais sugerem preservação da DC6 nos estágios leves da hipertensão, mas reduções significativas nos estágios mais graves e/ou na presença de comorbidades. Os estudos longitudinais sugerem que o TC6 é sensível ao aumento da capacidade funcional em razão das adaptações oriundas dos programas de reabilitação física. Duas importantes limitações comprometem a validade externa dos estudos incluídos: amostras com fenótipos específicos (mesmo sexo; mesmo estágio de HAS; faixa etária estreita) e pequeno tamanho amostral (entre 8 e 32 participantes). A baixa qualidade metodológica dos estudos reforça a necessidade de pesquisas com amostras maiores e espectro mais amplo de fenótipos de hipertensão.