Short- and Long-Term Reliability of the 6-Minute Walk Test in People With Idiopathic Pulmonary Fibrosis

BACKGROUND: The aim of this work was to investigate the short- and long-term test-retest reliability of the 6-min walk distance (6MWD), peak heart rate, and nadir oxygen desaturation in idiopathic pulmonary fibrosis (IPF).

METHODS: A reliability study of 70 adults with IPF was undertaken within out-patient pulmonary rehabilitation programs at 2 tertiary hospitals. Participants completed 2 baseline 6-min walk tests using a standard protocol, with continuous measures of percutaneous S_pO2 and heart rate via pulse oximetry. The 6-min walk test was completed immediately following an intervention period and 6 months after. Reproducibility was assessed by intraclass correlation coefficient and Bland-Altman analysis.

RESULTS: Participants with a mean ± SD diffusing capacity of the lung for carbon monoxide of 48 ± 14% were included. The reliability of the 6MWD was high (intraclass correlation coefficient = 0.96) with a mean learning effect of 21 m (95% CI 12-30 m). The learning effect persisted at 8 weeks (mean 14 m, 95% CI 5-23 m) but not 6 months (mean 15 m, 95% CI −1 to 30 m). Using the best (greatest) 6MWD significantly reduced the proportion of participants who were classified as having a clinically important response to rehabilitation compared with using the first 6MWD (40% vs 54%, P = .002). Nadir S_pO2 was reproducible, with a mean difference of 0.7 ± 2.2%, and limits of agreement of −4 to 5%. Peak heart rate was more variable, with mean difference 5 ± 9 beats/min and limits of agreement of −12 to 20 beats/min.

CONCLUSIONS: The 6MWD is a reproducible measure of exercise capacity in people with IPF. Whereas the nadir S_pO2 may be accurately determined from one test, evaluating change in 6MWD with interventions may require 2 tests on each occasion.