Walking And Moving Around - Heart Failure

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Outpatient Therapy

Skilled Nursing Facility

Home Care Setting

Meredith Miller, SPT; Michael Johnson, SPT

The Six Minute walk test is found on the rehabmeasures.org website under the Functional Mobility area of assessment 1. Rehabmeasures.org indicates that this test can be used to measure all systems involved in exercise: muscular strength, endurance, circulation, and aerobic capacity for geriatric patients that have experienced heart failure 1. The Six Minute Walk Test it is a good starting point for geriatric patients two weeks s/p Myocardial Infarction because there is no cost associated with the test and there are minimal equipment requirements (only a stop watch and a way to measure distance are needed 1. These two characteristics allow the test to be performed at home. The outcome measures are easy to capture and interpret: distance walked, RPE (Borg Scale), and vitals 2. All of which give an indication of muscular strength and endurance, and cardiopulmonary function including circulation, and perfusion 3.

The 200MWT
Gremeaux et all assert that the 200 M Walk Test may be a better test for some patients that have recently experienced an acute coronary episode. In a study comparing the two, Gremeaux asserts that the 200 M WT has many of the same benefits of the 6 MWT, but found that the 200 MWT allows patients to enter into higher levels of exercise intensity 3. High intensity levels for shorter durations have been shown to have more beneficial effects in rehabilitation settings 3. Researchers and clinicians prescribe exercise intensity extrapolated from HR measurements taken after the completion of the walk tests. The exercise prescriptions created on the basis of these measurements have lead to better walking ability and maximum exercise capacity in patients 3.

The 200MWT vs The 6MWT
Both the 6-minute and 200M Walk Tests are relatively inexpensive and easy to administer. Both can be performed within the home, which may put the patients more at ease. The 200 MWT, however, may logistically and psychologically be easier to perform than the 6 MWT. Logistically speaking, it may be easier to find an obstacle free space consisting of 200 meters rather than one that would allow for 6 minutes of continuous, obstacle free movement within the home. As the test is supposed to be taken inside, in a well lit space, on a hard and flat surface, the patient may have to retrace his or her route multiple times. Perform the test outside is not recommended by the authors of the test. Psychologically speaking, it may seem less daunting and easier to walk as fast as he or she is able if the distance appears to be shorter and/or an “end is in sight.” For these reasons, and the ability to allow patients to achieve higher levels of exertion, I would utilize the 200MWT in the home health care plan for patients 2 weeks status post MI.

Title of Assessment: 200 Meter Walk Test

Link to instrument: the same as the 6MWT condensed to 200m
Test Instructions: Have the patient walk the specified distance the fastest the patient can walk. Time the speed and take vitals.
Purpose: Assesses the distance walked over 200 M as a sub-maximal test of aerobic capacity and endurance.

Acronym: 200MWT

Instrument Reviewer(s): Meredith Miller SPT; Michael Johnson SPT

Summary Date: 1/30/13

Description : To be performed at the fastest speed possible with or without the use of assistive devices.
Documentation should include the speed tested if fastest speed is not used (preferred vs. fast).
Assistive devices can be used but kept consistent from test to test.Individual should be able to ambulate without physical assistance.

ICF Domain: Activity

Time to Administer: The time it takes the patient to finish the test

Number of Items: N/A

Equipment Required: Stop Watch, A stretch of hard, flat surface that measures to 200m

Training Required: None

Actual Cost: Free (minus the cost of stop watch & distance measuring tools)

Populations Tested:
Pulmonary disease
Heart failure
Spinal cord injury
Multiple sclerosis
Parkinson’s Disease

Reliability: ICC =.97
Construct Validity: strong correlation to physical component of SF-36 (r=-.77; p< 0.01)
Responsiveness: mean = 1.11 (strong)

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