A moderate 500-m treadmill walk for estimating peak oxygen uptake in men with NYHA class I-II heart failure and reduced left ventricular ejection fraction

Gianni Mazzoni; Biagio Sassone; Giovanni Pasanisi; Jonathan Myers; Simona Mandini; Stefano Volpato; Francesco Conconi; Giorgio Chiaranda; Giovanni Grazzi

doi:10.1186/s12872-018-0801-9

A moderate 500-m treadmill walk for estimating peak oxygen uptake in men with NYHA class I-II heart failure and reduced left ventricular ejection fraction

BMC Cardiovasc Disord. 2018 Apr 16;18(1):67. doi: 10.1186/s12872-018-0801-9.

Authors

Gianni Mazzoni^{1

2}, Biagio Sassone³, Giovanni Pasanisi⁴, Jonathan Myers^{5

6}, Simona Mandini⁷, Stefano Volpato⁸, Francesco Conconi⁹, Giorgio Chiaranda¹⁰, Giovanni Grazzi^{1

2}

Affiliations

¹ Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
² Public Health Department, AUSL Ferrara, Ferrara, Italy.
³ Department of Medicine, Division of Cardiology, Cento Hospital, AUSL Ferrara, Ferrara, Italy.
⁴ Department of Medicine, Division of Cardiology, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy.
⁵ Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
⁶ Stanford University School of Medicine, Stanford, CA, USA.
⁷ Center of Biomedical Studies Applied to Sport, University of Ferrara, via Gramicia 35 -, 44123, Ferrara, Italy. simona.mandini@unife.it.
⁸ Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
⁹ Center of Biomedical Studies Applied to Sport, University of Ferrara, via Gramicia 35 -, 44123, Ferrara, Italy.
¹⁰ General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy.

Abstract

Background: Maximal cardiopulmonary exercise testing (CPX) is the gold-standard for cardiorespiratory fitness assessment in chronic heart failure (CHF) patients. However, high costs, required medical supervision, and safety concerns make maximal exercise testing impractical for evaluating mobility-impaired adults. Thus, several submaximal walking protocols have been developed and currently used to estimate peak oxygen consumption (VO₂peak) in CHF patients. However, these tests have to be performed at close to maximum exercise intensity. The aim of this study was to examine the validity of a 500-m treadmill-walking test carried out at moderate intensity for estimating VO₂peak in community-dwelling adult and elderly patients with CHF and reduced left ventricular ejection fraction (HFrEF).

Methods: Forty-three clinically stable men with HFrEF (age 67.7 ± 9.2 years, and left ventricular ejection fraction, LVEF 38% ± 6%) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patients completed a CPX, and a moderate and self-paced (11-13/20 on the Borg scale) 500-m treadmill-walking test. Age, weight, height, walk time, and heart rate during the 500-m test were entered into prediction equations previously validated for VO₂peak estimation from a 1000-m walking test in patients with cardiovascular disease and preserved LVEF.

Results: Directly measured and estimated VO₂peak values were not different (21.6 ± 4.9 vs 21.7 ± 4.6 mL/kg/min). The comparison between measured and estimated VO₂peak values yielded a correlation of R = 0.97 (SEE = 0.7 mL/kg/min, P < 0.0001). The slope and the intercept coincided with the line of identity (Passing and Bablock analysis, P = 0.50). Residuals were normally distributed, and the examination of the Bland-Altman analysis do not show systematic or proportional error.

Conclusions: A moderate and self-regulated 500-m treadmill-walking test is a valid tool for VO₂peak estimation in patients with HFrEF. These findings may have practical implications in the context of transitioning from clinically based programs to fitness facilities or self-guided exercise programs in adults and elderly men with HFrEF.

Keywords: Cardiorespiratory fitness; Heart failure; Left ventricular dysfunction; Walking test.

Publication types

Validation Study

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Cardiorespiratory Fitness*
Exercise Test / methods*
Exercise Tolerance*
Health Status
Heart Failure / diagnosis*
Heart Failure / physiopathology
Humans
Male
Middle Aged
Oxygen Consumption*
Predictive Value of Tests
Reproducibility of Results
Sex Factors
Stroke Volume*
Ventricular Dysfunction, Left / diagnosis*
Ventricular Dysfunction, Left / physiopathology
Ventricular Function, Left*
Walking*