A comparison of informative between 6-minute walking test and sit-to-stand test in patients with fibrosing interstitial lung diseases

Physical intolerance is an important sign of many chronic respiratory diseases. The most useful tool for clinical evaluation of physical status is six-minute walking test (6-MWT), but sometimes its technical requirements are not feasible. By this reason, a search for alternative field tests have being going on in the last years, but the diagnostic yield of the new exercise tests for most chronic bronchopulmonary diseases is not clear.

The aim of this study was to compare results of 6-MWT and 30-seconds sit-to-stand (30-s-STS) test in patients with fibrosing interstitial lung diseases (ILDs) and restrictive abnormalities of lung function.

Methods. This was a cross-sectional non-randomized open comparative study. Patients with ILDs were asked to perform 6-MWT and 30-s-STS test with 30 min interval. We also analyzed medical history, lung function, and dyspnea assessed with Medical Research Council (MRC).

Results. The study included 25 ILD patients (11 males; 14 women); 75% of patients had restrictive lung function disorders. The mean distance walked in 6-MWT (6MD) was 380.4 ± 111.9 m (M ± SD), 14 (56%) patients desaturated during the test. The mean number of repetitions in 30-s-STS test was 12 (10 – 13) during 30 s; 5 (20%) patients desaturated during the test. 6MD showed moderate correlation with the number of repetitions in 30-s-STS test and to dyspnea on exertion. The number of repetitions in the 30-s-STS test was not associated with any clinical or functional parameters. To the end of exercise, the number of patients who desaturated increased, the desaturation was greater, and post-exercise SpO2 was lower in 6-MWT compared to 30-s-STS test.

Conclusion. 30-s-STS test was less informative in terms of reduced physical tolerance and desaturation on exertion compared to 6-MWT in patients with fibrosing ILDs and restrictive abnormalities of lung function.

1. Chuchalin A.G., Avdeev S.N., Aisanov Z.R. et al. [Diagnosis and treatment of idiopathic pulmonary fi rosis: Federal guidelines]. Pul’monologiya. 2016: 26 (4): 399–419. DOI: 10.18093/0869-0189-2016-26-4-399-419 (in Russian).

2. Avdeev S.N. [Idiopatic pulmonary fibrosis: A new paradigm]. Terapevticheskiy arkhiv. 2017; 89 (1): 112–122. DOI: 10.17116/terarkh2017891112-122 (in Russian).

3. Avdeev S.N., Chikina S.Yu., Nagatkina O.V. [Idiopathic pulmonary fibrosis: a new international clinical guideline]. Pul’monologiya. 2019; 29 (5): 525–552. DOI: 10.18093/0869-0189-2019-29-5-525-552 (in Russian).

4. Singh S.J., Puhan M.A., Andrianopoulos V. et al. An official systematic review of the European Respiratory Society, American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur. Respir. J. 2014; 44 (6): 1447–1478. DOI: 10.1183/09031936.00150414.

5. Brown A.W., Nathan S.D. The value and application of the 6-minute-walk test in Idiopathic pulmonary fibrosis. Ann. Am. Thorac. Soc. 2018; 15 (1): 3–10. DOI: 10.1513/AnnalsATS.201703-244FR.

6. Eaton T., Young P., Milne D., Wells A.U. Six-minute walk, maximal exercise tests: reproducibility in fibrotic interstitial pneumonia. Am. J. Respir. Crit. Care Med. 2005; 171 (10): 1150–1157. DOI: 10.1164/rccm.200405-578OC.

7. Lama V.N., Flaherty K.R., Toews G.B. et al. Prognostic value of desaturation during a 6-minute walk test in idiopathic interstitial pneumonia. Am. J. Respir. Crit. Care Med. 2003; 168 (9): 1084–1090. DOI: 10.1164/rccm.200302-219OC.

8. du Bois R.M., Albera C., Bradford W.Z. et al. 6-minute walk distance is an independent predictor of mortality in patients with idiopathic pulmonary fibrosis. Eur. Respir. J. 2014; 43 (5): 1421–1429. DOI: 10.1183/09031936.00131813.

9. Holland A.E., Spruit M.A., Troosters T. et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur. Respir. J. 2014; 44 (6): 1428–1446. DOI: 10.1183/09031936.00150314.

10. Singh D.K., Pillai S.G., Tan S.T. et al. Association between physiological falls risk and physical performance tests among community-dwelling older adults. Clin. Interv. Aging. 2015; 10: 1319–1326. DOI: 10.2147/CIA.S79398.

11. Liu M., Chen J., Fan W. еt al. Eff of modifi d sit-to-stand training on balance control in hemiplegic stroke patients: a randomized controlled trial. Clin. Rehabil. 2016; 30 (7): 627–636. DOI: 10.1177/0269215515600505.

12. Wang J., Siddicky .F., Oliver T.E. et al. Biomechanical changes following knee arthroplasty during sit-to-stand transfers: systematic review J. Arthroplasty. 2019; 34 (10): 2494–2501. DOI: 10.1016/j.arth.2019.05.028.

13. Helbostad J.L., Sturnieks D.L., Menant J. еt al. Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: a systematic literature review. BMC Geriatr. 2010; 10: 56. DOI: 10.1186/1471-2318-10-56.

14. Bisca G.W., Morita A.A., Hernandes N.A. et al. Simple lower limb functional tests in patients with chronic obstructive pulmonary disease: a systematic review. Arch. Phys. Med. Rehabil. 2015; 96 (12): 2221–2230. DOI: 10.1016/j.apmr.2015.07.017.

15. Zhang Q., Li Y.X., Li X.L. et al. A comparative study of the five-repetition sit-to-stand test and the 30-second sit-to-stand test to assess exercise tolerance in COPD patients. Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 2833–2839. DOI: 10.2147/COPD.S173509.

16. Briand J., Beha l.H., Chenivesse C. et al. The 1-minute sit-tostand test to detect exercise-induced oxygen desaturation in patients with interstitial lung disease. Ther. Adv. Respir. Dis. 2018; 12: 1753466618793028. DOI: 10.1177/1753466618793028.

17. Raghu G., Remy-Jardin M., Myers J.L. et al. Diagnosis of idiopathic pulmonary fi osis: An offi ial ATS/ERS/JRS/ALAT clinical practice guideline. Am. J. Respir. Crit. Care Med. 2018; 198 (5): e44–68. DOI: 10.1164/rccm.201807-1255ST.

18. Fletcher C.M. The clinical diagnosis of pulmonary emphysema – an experimental study. Proc. R. Soc. Med. 1952; 45 (9): 577–584. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1987525/?page=2

19. Miller M.R., Hankinson J., Brusasco V. et al. Standardisation of spirometry. Eur. Respir. J. 2005; 26 (2): 319–338. DOI: 10.1183/09031936.05.00034805.

20. Wanger J., Clausen J.L., Coates A. et al. Standardisation of the measurement of lung volumes. Eur. Respir. J. 2005; 26 (3): 511–522. DOI: 10.1183/09031936.05.00035005.

21. Graham B.L., Brusasco V., Burgos F. et al. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur. Respir. J. 2017; 49 (1): 1600016. DOI: 10.1183/13993003.50016-2016.