Brief report| Volume 98, ISSUE 3, P600-603, March 2017

Association Between 6-Minute Walk Test Distance and Objective Variables of Functional Capacity After Exercise Training in Elderly Heart Failure Patients With Preserved Ejection Fraction: A Randomized Exercise Trial

Published:September 27, 2016DOI:



      To evaluate the change in the 6-minute walk test (6-MWT) distance relative to changes in key functional capacity measures after 16 weeks of exercise training in older patients (≥65y) who have heart failure with preserved ejection fraction (HFpEF).


      Prospective, randomized, single-blinded (by researchers to patient group) comparison of 2 groups of HFpEF patients.


      Hospital and clinic records; ambulatory outpatients.


      Participants (N=47) randomly assigned to an attention control (AC) (n=24) or exercise training (ET) (n=23) group.


      The ET group performed cycling and walking at 50% to 70% of peak oxygen uptake ( V ˙ o2peak) intensity (3d/wk, 60min each session).

      Main Outcome Measures

      V ˙ o2peak, ventilatory threshold (VT), and 6-MWT distance were measured at baseline and after the 16-week study period.


      At follow-up, the 6-MWT distance was higher than at the baseline in both the ET (11%, P=.005) and AC (9%, P=.004) groups. In contrast, V ˙ o2peak and VT values increased in the ET group (19% and 11%, respectively; P=.001), but decreased in the AC group at follow-up (2% and 0%, respectively). The change in V ˙ o2peak versus 6-MWT distance after training was also not significantly correlated in the AC group (r=.01, P=.95) or in the ET group (r=.13, P=.57). The change in 6-MWT distance and VT (an objective submaximal exercise measure) was also not significantly correlated in the AC group (r=.08, P=.74) or in the ET group (r=.16, P=.50).


      The results of this study challenge the validity of using the 6-MWT as a serial measure of exercise tolerance in elderly HFpEF patients and suggest that submaximal and peak exercise should be determined objectively by VT and V ˙ o2peak in this patient population.


      List of abbreviations:

      6-MWT (6-minute walk test), AC (attention control), ET (exercise training), HF (heart failure), HFpEF (heart failure with preserved ejection fraction), HFrEF (heart failure with reduced ejection fraction), V˙o2peak (peak oxygen uptake), VT (ventilatory threshold)
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        • Haykowsky M.J.
        • Brubaker P.H.
        • John J.M.
        • Stewart K.P.
        • Morgan T.M.
        • Kitzman D.W.
        Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction.
        J Am Coll Cardiol. 2011; 58: 265-274
        • Kitzman D.W.
        • Brubaker P.H.
        • Herrington D.M.
        • et al.
        Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial.
        J Am Coll Cardiol. 2013; 62: 584-592
        • Forman D.E.
        • Fleg J.L.
        • Kitzman D.W.
        • et al.
        6-min walk test provides prognostic utility comparable to cardiopulmonary exercise testing in ambulatory outpatients with systolic heart failure.
        J Am Coll Cardiol. 2012; 60: 2653-2661
        • Rich M.W.
        • Beckham V.
        • Wittenberg C.
        • Leven C.L.
        • Freedland K.E.
        • Carney R.M.
        A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.
        N Engl J Med. 1995; 333: 1190-1195
        • Kitzman D.W.
        • Brubaker P.H.
        • Morgan T.M.
        • Stewart K.P.
        • Little W.C.
        Exercise training in older patients with heart failure and preserved ejection fraction/clinical perspective.
        Circ Heart Fail. 2010; 3: 659-667
        • Maldonado-Martin S.
        • Brubaker P.H.
        • Kaminsky L.A.
        • Moore J.B.
        • Stewart K.P.
        • Kitzman D.W.
        The relationship of a 6-min walk to VO(2 peak) and VT in older heart failure patients.
        Med Sci Sports Exerc. 2006; 38: 1047-1053
        • Gary R.A.
        • Sueta C.A.
        • Rosenberg B.
        • Cheek D.
        Use of the 6-minute walk test for women with diastolic heart failure.
        J Cardiopulm Rehabil. 2004; 24: 264-268
        • Kitzman D.W.
        • Upadhya B.
        Heart failure with preserved ejection fraction: a heterogenous disorder with multifactorial pathophysiology.
        J Am Coll Cardiol. 2014; 63: 457-459
        • Baba R.
        • Nagashima M.
        • Goto M.
        • et al.
        Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise.
        J Am Coll Cardiol. 1996; 28: 1567-1572
        • Marburger C.T.
        • Brubaker P.H.
        • Pollock W.E.
        • Morgan T.M.
        • Kitzman D.W.
        Reproducibility of cardiopulmonary exercise testing in elderly patients with congestive heart failure.
        Am J Cardiol. 1998; 82: 905-909