The influence of the pre-test instruction content on the result of the six-minute walk test in schoolchildren with congenital heart defects

Background. The 6-minute walk test (6MWT) is a widely used instrument for assessing the patient’s functional status and selecting parameters of physical training. The distance covered in 6 minutes is the main result of 6MWT, however, this indicator is influenced by many factors: age, gender, weight, height of the patient, the methodology of the test. Objective. To assess the influence of various pre-test instructions on the distance value covered during the 6MWT by schoolchildren with congenital heart defects. Material and methods. 67 patients with corrected congenital heart defects and congestive heart failure aged 12.8 (7–16) years were included, 59.5 % were boys. Everyone underwent two 6MWT with different instructions for implementation. Test 1: the patient was given the goal to walk the maximum possible distance in 6 minutes (the “Further” test — FT). Test 2: The patient was instructed to walk as fast as possible in order to cover the maximum possible distance in 6 minutes (the “Faster and Further” test — FFT). The sequence of tests was random. Results. The distance covered in FFT was greater than in FT in 79.2 % of the surveyed, amounting to 505 [439; 570] meters and 580 [507; 648] meters (p < 0.0001) or 69 [57; 79] % and 79 [70; 87] % of the required values (p < 0.0001) respectively for FT and FFT tests. The heart rate measured in the first 10 seconds after physical activity in 89.6 % of patients was higher in FFT — 126 [110–139] BPM, in FT — 104 [92–120] BPM (p < 0.0001) or 60.2 [53.2; 67.5] % and 50.3 [44.5; 56.7] % of the maximum calculated heart rate (220-age). The increase in heart rate was 40 [25; 48] BPM and 15 [10; 28] BPM or 31.1 [20.1; 41.7] % and 12.9 % [8.8; 22.8] of the heart rate reserve, respectively, in the FT and FFT groups, p < 0.0001. Conclusion. The instruction to walk “as fast as possible in order to cover as much distance as possible” increases the distance of the 6MWT by increasing the intensity of physical effort without reducing the safety of the study. This increases the informativeness of the test in assessment the patient’s functional status and the formation of a physical rehabilitation program.

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