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      Comparison between the six-minute walk test and the six-minute step test in post stroke patients

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          Abstract

          Background

          The Stroke remains one of the major chronic diseases worldwide, and is considered a major cause of disability, which results not only in persistent neurological deficits, but also in the high physical deconditioning, nevertheless there are not many forms of assessing functional capacity in this population. We aimed to investigate the feasibility of the Six Minute Walk Teste and the Six-Minute Step Test (6MST) in post-stroke patients and compare the behavior of physiological variables during the 6MST and the Six-Minute Walk Test (6MWT), by correlating the functional performance obtained in both tests.

          Method

          The 6MWT was carried out according to the American Thoracic Society (ATS) and the 6MST was performed in six minutes in order to compare it to the 6MWT in a 20 cm step. Was included post-stroke individuals able to walk without aid. All of them did the 6MWT and the 6MST.

          Results

          12 patients participated in the study. There was no statistical difference in the parameters analyzed when tests were compared. There was poor correlation between the functional performance in both tests.

          Conclusion

          The 6MWT and the 6MST is feasible for post-stroke patients and physiological responses are equal during the performance of both tests. However, there was no correlation with respect to functional performance, which was assessed by the distance walked in the 6MWT and by the number of steps climbed in the 6MST.

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          Most cited references11

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          A step test to assess exercise-related oxygen desaturation in interstitial lung disease.

          A 6-min step test (6MST) may constitute a practical method for routinely assessing effort tolerance and exercise-related oxyhaemoglobin desaturation (ERD) in the primary care of patients with interstitial lung disease. In total, 31 patients (19 males) with idiopathic pulmonary fibrosis (n = 25) and chronic hypersensitivity pneumonia were submitted, on different days, to two 6MSTs. Physiological responses were compared with those found on maximal and submaximal cycle ergometer tests at the same oxygen uptake (V'(O(2))). Chronic breathlessness was also determined, as measured by the baseline dyspnoea index (BDI). Responses to 6MST were highly reproducible: 1.3+/-2.0 steps x min(-1), +/-5 beats x min(-1) (cardiac frequency), +/-50 mL x min(-1) (V'(O(2))), +/-7 L x min(-1) (minute ventilation) and +/-2% (arterial oxygen saturation measured by pulse oximetry (S(p,O(2)))). The number of steps climbed in 6 min was correlated to peak V'(O(2)) and the BDI. There were significant associations among the tests in relation to presence (change in S(p,O(2)) between rest and exercise > or = 4%) and severity (S(p,O(2)) <88%) of ERD. Four patients, however, presented ERD only in response to 6MST. Resting diffusing capacity of the lung for carbon monoxide and alveolar-arterial oxygen tension difference were the independent predictors of the number of steps climbed. A single-stage, self-paced 6-min step test provided reliable and reproducible estimates of exercise capacity and exercise-related oxyhaemoglobin desaturation in interstitial lung disease patients.
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            Functional walk tests in individuals with stroke: relation to perceived exertion and myocardial exertion.

            Functional walk tests such as the 6- and 12-Minute Walk Test (ie, 6MWT and 12MWT, respectively) are submaximal measures used to determine functional capacity in individuals with compromised ability. The purpose of this study was to determine the relationship between these walk tests and measures of exertion (perceived and myocardial), in addition to impairment in individuals with stroke. The relationship among the 6MWT, 12MWT, and the more traditionally assessed measure of self-paced gait speed (generally assessed over a short distance, eg, 10 m) was also evaluated. Twenty-five community-dwelling individuals with stroke were evaluated for the following: 12MWT distance, 6MWT distance, self-paced gait speed over 8 m, plantarflexion strength, Berg Balance Scale, Ashworth Scale of Spasticity, and Chedoke-McMaster Stroke Assessment. Heart rate (HR), rate-pressure product (RPP), and perceived exertion were assessed during the functional walk tests. Correlational analysis quantified the relationship between gait, impairment measures, and physiological responses during the functional walk tests. HR reached a steady state after 6 minutes and reflected a moderate exercise intensity of 63% of age-predicted maximum HR. The 6MWT, 12MWT, and self-paced gait speed were all highly correlated with one another (r>0.90) and were all also related to the severity of impairments. The functional walk distances did not relate either to perceived exertion or actual exertion (increase in the myocardial oxygen demand as measured by RPP). Stroke-specific impairments are the major limitations to the distance walked in individuals with stroke. If the functional walk test is used to assess performance of an individual over time (eg, in response to an intervention), we recommend that both exertion (eg, increase in RPP or HR) and distance be measured.
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              Exercise rehabilitation after stroke.

              Stroke is a leading cause of disability that results not only in persistent neurological deficits, but also profound physical deconditioning that propagates disability and worsens cardiovascular risk. The potential for exercise-mediated adaptations to improve function, fitness, and cardiovascular health after stroke has been underestimated: it represents an emerging arena in neurotherapeutics. To define the health rationale for cardiovascular (aerobic) exercise, we first outline the impact of debilitating secondary biological changes in muscle and body composition on fitness and metabolic health after stroke. We provide an overview of evidence-based advances in exercise therapeutics, with a focus on task-oriented models that combine a progressive aerobic conditioning stimulus with motor learning to improve multiple physiological domains that determine longitudinal outcomes after stroke. Although progress in development of safe and effective exercise strategies is advancing, fundamental questions regarding dose intensity, prescription to optimize central and peripheral neuromuscular adaptations, and the public health value of exercise in secondary stroke prevention remain unanswered. Key issues steering future research in exercise neurotherapeutics are discussed within the context of initiatives to facilitate translation to community-based studies, requisite for dissemination.
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                Author and article information

                Contributors
                Journal
                Int Arch Med
                Int Arch Med
                International Archives of Medicine
                BioMed Central
                1755-7682
                2013
                7 August 2013
                : 6
                : 31
                Affiliations
                [1 ]Universidade Federal de São Paulo, UNIFESP, R. Botucatu, SP 740, 03828-000, Brazil
                [2 ]Escola de Educação Física e Esporte da Universidade de São Paulo, EEFE/USP, Av. Prof. Mello de Morais, 65, 05508-030 SP, Brasil
                [3 ]Escola de Artes, Ciências e Humanidades da Universidade de São Paulo EACH/USP, Rua Arlindo Béttio, SP 1000,03828-00 SP, Brasil
                [4 ]Faculdades Metropolitanas Unidas, FMU, Rua Taguá 150 - Prédio 1, 01508-010 SP, Brasil
                [5 ]Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, UNESP, Rua Roberto Simonsen, 305,19060-900 Presidente Prudente, SP, Brasil
                [6 ]Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821 09060-650 Santo André, SP, Brasil
                [7 ]Departamento de Saúde da Coletividade, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP, Brasil
                [8 ]Faculdade Mario Schenberg, Estrada do Espigão, SP, 06710540 Cotia, Brasil
                Article
                1755-7682-6-31
                10.1186/1755-7682-6-31
                3750617
                23924407
                96c19398-9129-47f9-a26f-e33f2625099a
                Copyright © 2013 da Silva et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 December 2012
                : 5 August 2013
                Categories
                Original Research

                Medicine
                exercise test,mobility limitation,stroke
                Medicine
                exercise test, mobility limitation, stroke

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