Exercise Testing

I'm not exactly sure of what you're asking. We assess functional capacity originally on their first billable session. They complete the 6MWT and we start them off on two different modalities, one being the treadmill. By the 3rd session, we measure their MET level. As they progress through the program, we use the same modality, ie the treadmill, to measure their MET level showing their percentage of increase. They use this modality throught their program. We specifically use the treadmill because we try to incorporate a HIIT program on the treadmill for all patients, if appropriate. As far as RPE, patients should be exercising between somewhat hard to hard, around 12 to 16.

One thing that I borrowed from Duke was 6MWT interpretation based on predicted values that take into account age, gender and height/weight. It has transformed how I look at that data and how I anticipate expected improvements.

Here is the online calculator and it has a link to the journal article it is based on. 6 Minute Walk Distance CalculatorThere are also references to quantifying impairment (mild, moderate or severe) and ACSM provides guidance on what constitutes a clinically significant improvement (98.4 ft) for example.

Hope this helps!

Kim Smith

ECU Health Medical Center

Amy - I'd love to hear more about your process/protocol. Is this the first/second/third time the patient is getting on this modality? What RPE do you have them target? I want my team to be more intentional going forward so wanting to get an understanding of what everyone else is doing. Thanks!

Megan,

We do both 6mwt increase of 10% and MET by 40% from the 3rd session. These are parameters the AACVPR recommends for certification for measuring functional capacity. Also, in response to your question regarding patients switching modalities throughout the program and assessing Met level. Whatever modality the patient originally had MET measured on, should be the same modality that is remeasured at the end of their program. This is also an AACVPR recommendation. We usually always measure on the treadmill. If the patient does not use the treadmill due to mobility issues, then we will use the NuStep.

We try to get pre and post functional GXT for everyone who is capable. We’re in the process of figuring out better practices to get metrics for everyone else. I want to follow this discussion to see what other folks do.

How does everyone assess increase in functional capacity? Currently we are looking at either an increase in 6MWT by 10% OR an increase in peak METs from 3rd session and discharge by 40%.

Does anyone actually look at symptom limited GXT pre and post? If so, what protocols do you use?

For those who look at increase in peak METs from 3rd session and discharge, how do you navigate all the "issues" that come up - such as, pt changing modality throughout the course of the program, etc?

Thank you!