The association of six-minutes walking test (6MWT) with cardiovascular disease risk among older women with type 2 diabetes mellitus in a rural primary health care: a pilot observational study

https://doi.org/10.22146/jcoemph.47599

Rakhmat Ari Wibowo(1), Arum Tri Wahyuningsih(2), Rio Jati Kusuma(3), Wahyu Pamungkasih(4), Denny Agustiningsih(5*)

(1) Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada
(2) Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(3) Department of Health Nutrition, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(4) Puskesmas Banguntapan II Bantul, Yogyakarta, Indonesia
(5) Department of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


The recent systematic review found that cardiovascular events contributed to approximately half of all deaths among patients with type 2 diabetes mellitus (T2DM). Several studies suggested that the six-minutes walking test (6MWT) could be a valuable prognostic tool for predicting cardiovascular disease (CVD) events in particular diseases. However, less is known concerning the role of 6MWT in predicting CVD events among patients with T2DM. Thus, this pilot observational study aimed to test the feasibility of conducting the 6MWT and to examine the association of measures collected during 6MWT with ASCVD risk estimator parameters for predicting CVD events among T2DM patients. Fourteen older women with T2DM in a rural primary health care were enrolled in this cross-sectional study. Blood pressure measurement, heart rate measurement, and blood sampling for HDL, LDL, and total cholesterol measurements were carried out during rest. Both heart rate and distance were measured at the end of the following 6MWT. Feasibility data were collected. Recruitment rate and measurement completion rate were 85.7% and 40% respectively. No adverse events during the 6MWT were reported. Patient’s heart rate at the end of 6MWT was correlated with diastolic blood pressure (r=0.5 p=0.48). Multivariate analyses suggested that every one-meter increase in distance of 6MWT, there is a decrease in diastolic blood pressure of -0.9 mmHg (p=0.01; 95% CI= -1.6 to -0.2). In conclusion, 6MWT is a feasible simple test which could provide a valuable prediction of ASCVD risk among older women with T2DM. Thus, this test should be considered to be conducted as a part of routine examination. Cohort study with a larger sample could be suggested to establish the usefulness of the 6MWT in predicting CVD risk.


Keywords


6MWT; cardiorespiratory fitness; cardiovascular disease risk; diabetes mellitus; older adults

Full Text:

PDF


References

  1. North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circ. Res. 2012; 110:1097–1108
  2. Garcia M, Mulvagh SL, Merz CN, Buring JE, Manson JE. Cardiovascular disease in women: clinical perspectives. Circ. Res. 2016; 118:1273–1293
  3. World Health Organization. Global Health Observatory (GHO) data: Life expectancy. Geneva, Swiss. 2020
  4. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol. 2018;17:83.
  5. Ross R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134(24):e653–e699.
  6. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166:111–117.
  7. Beatty AL, Schiller NB, Whooley MA. Six-minute walk test as a prognostic tool in stable coronary heart disease: data from the Heart and Soul Study. Arch Intern Med. 2012; 172:1096–1102.
  8. Mänttäri A, Suni J, Sievänen H, et al. Six‐minute walk test: a tool for predicting maximal aerobic power (vo2 max) in healthy adults. Clin Physiol Funct Imaging. 2018; 38(6): 1038–1045
  9. Iyriboz Y, Powers S, Morrow J, Ayers D, Landry G. Accuracy of pulse oximeters in estimating heart rate at rest and during exercise. Br J Sports Med. 1991;25:162–4
  10. Dehghan M, Merchant AT. Is bioelectrical impedance accurate for use in large epidemiological studies? Nutr J. 2008;7:26.
  11. Razi F, Forouzanfar K, Bandarian F, Nasli-Esfahani E. LDL-cholesterol measurement in diabetic type 2 patients: a comparison between direct assay and popular equations. J Diabetes Metab Disord. 2017;16:43.
  12. Chahine MN, Topouchian J, Zelveian P, et al. Validation of BP devices QardioArm® in the general population and Omron M6 Comfort® in type II diabetic patients according to the European Society of Hypertension International Protocol (ESH-IP). Med Devices. 2017;11:11–20.
  13. Prasad VK, Hand GA, Sui X, et al. Association of exercise heart rate response and incidence of hypertension in men. Mayo Clin Proc. 2014;89(8):1101–1107.
  14. Aladin A, Al Rifai M, Rasool S, et al. The association of resting heart rate and incident hypertension: The Henry Ford Hospital Exercise Testing (FIT) project. American Journal of Hypertension. 2016; 29(2): 251-257.
  15. Christofaro DGD, Casonatto J, Vanderlei LCM, Cucato GG, Dias RMR. Relationship between resting heart rate, blood pressure and pulse pressure in adolescents. Arq Bras Cardiol. 2017;108(5):405–410.
  16. Liu L, Mizushima S, Ikeda K, Nara Y, Yamori Y. Resting heart rate in relation to blood pressure: results from the World Health Organization-Cardiovascular Disease and Alimentary Comparison study. Int J Cardiol. 2010;145:73–74.
  17. Ferreira I, Twisk J, Stehouwer C, Van Mechelen, W, Kemper H. Longitudinal changes in &vo2max: associations with carotid imt and arterial stiffness. Med Sci Sports Exerc. 2003; 35(10): 1670-1678.
  18. Liu J, Sui X, Lavie CJ, Zhou H, Park YM, Cai B, et al. Effects of cardiorespiratory fitness on blood pressure trajectory with aging in a cohort of healthy men. J Am Coll Cardiol. 2014; 64:1245–53.
  19. Buñag RD, Eriksson L, Krizsan D. Baroreceptor reflex impairment and mild hypertension in rats with dietary-induced obesity. Hypertension. 1990; 15(4): 397-406
  20. Church TS, Kampert JB, Gibbons LW, Barlow CE, Blair SN. Usefulness of cardiorespiratory fitness as a predictor of all-cause and cardiovascular disease mortality in men with systemic hypertension. Am J Cardiol. 2001; 88(6):651-6.
  21. Watanabe N, S Sawada S, Shimada K, et al. Relationship between cardiorespiratory fitness and non-high-density lipoprotein cholesterol: a cohort study. J Atheroscler Thromb. 2018; 25(12):1196-1205.



DOI: https://doi.org/10.22146/jcoemph.47599

Article Metrics

Abstract views : 3307 | views : 1824

Refbacks

  • There are currently no refbacks.


Copyright (c) 2020 Rakhmat Ari Wibowo

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.