6 Minute Walk Test
The 6 Minute Walk Test (6MWT) is one of the most widely used and validated outcome measures in cardiac rehabilitation. 6MWT measures the distance a patient can walk in six minutes, reflecting their ability to perform physical activities of daily living particularly for assessing functional capacity, exercise tolerance, and overall cardiovascular fitness. It is simple, non-invasive, and requires minimal equipment, making it a practical tool in both clinical and rehabilitation settings.
Procedure:
- The patient should be dressed in comfortable clothing and footwear suitable for walking.
- Resting vitals (e.g., blood pressure, heart rate) be taken before the test. Stopwatch to record the time.
- The patient is instructed to walk as far as they can in 6 minutes, but they can stop and rest if needed.
- They should walk continuously at a comfortable pace without running or jogging.
- A chair should be available for the patient to sit and rest.
- A 30-meter (or 20-meter) flat corridor is commonly used, marked clearly at both ends with tape or cones.
- Heart rate, blood pressure, and perceived exertion may be monitored during and after the test to assess the patient’s response to the exercise.
After the test, the patient’s recovery is monitored for a few minutes, and their heart rate and blood pressure may be measured again. The test result is the total distance walked in six minutes.Interpretation depends on age, sex and functional status. If a patient is able to walk longer distance compared to first record indicate their progression improves on functional capacity, exercise tolerance and overall cardiovascular fitness.
Modified Borg Dyspnoea Scale
The Borg scale is a tool to measure a person’s perception of their effort and exertion, breathlessness, and fatigue during physical work. Therapist able to prescribe exercise as well as having individuals self-monitor their symptoms allowing for a safe increase or decrease of the aerobic exercise intensity.
Timed Up and Go Test (TUG)
The Timed Up and Go Test (TUG) assesses mobility, balance, walking ability, and fall risk in older adults.
Procedure:
- The patient sits in the chair with his/her back against the chair back.
- On the command “go,” the patient rises from the chair, walks 3 meters at a comfortable and safe pace, turns, walks back to the chair and sits down.
- Timing begins at the instruction “go” and stops when the patient is seated.
- The patient should have one practice trial that is not included in the score.
- Patients must use the same assistive device each time he/she is tested to be able to compare scores.
An older adult who takes ≥12 seconds to complete the TUG is at risk for falling. By routinely assessing the TUG test, clinicians can monitor patient progress, tailor exercise interventions, and ensure safe participation in rehab programs, ultimately improving physical function and quality of life for cardiac patients.
30 Second Sit To Stand
This test is a highly effective outcome measure in cardiac rehabilitation to evaluate lower body strength and functional endurance, which are key components of overall mobility and functional capacity, especially for individuals with heart disease.
Procedure:
- The 30-Second Chair Test is administered using a folding chair without arms and placed against the wall for safety.
- The patient is seated in the middle of the chair, back straight; feet approximately shoulder width apart and placed on the floor at an angle slightly back from the knees, with one foot slightly in front of the other to help maintain balance. Arms are crossed at the wrists and held against the chest.
- Demonstrate the task both slowly and quickly.
- Have the patient practice a repetition or 2 before completing the test.
- The patient is encouraged to complete as many full stands as possible within 30 seconds. The patient is instructed to fully sit between each stand.
- While monitoring the performance to ensure proper form, the tester silently counts the completion of each correct stand.
If a patient must use their arms to complete the test they are scored 0. The score is the total number of stands within 30 seconds (more than halfway up at the end of 30 seconds counts as a full stand). Incorrectly executed stands are not counted.
Spirometer
A spirometer is a device that measures lung function by assessing the volume and flow of air that can be inhaled and exhaled which is beneficial in cardiac rehabilitation. It provides visual cues to the patients that the desired flow or volume has been achieved and facilitates a sustained slow deep breath to improve both cardiovascular fitness and respiratory capacity. There are typically two types of incentive spirometer, namely:
- Flow-oriented incentive spirometer (Triflow Device) – Has three chambers with one ball in each chamber. Capacity up to 1200ml.
- Volume-oriented incentive spirometer – Has one-way valve with capacity up to 4000ml.
Procedure:
- Therapist demonstrates using a separate device and provides an information sheet regarding technique, prescription of use and cleaning advice based on manufacturers instructions.
- Patient should be in a relaxed position suitable for deep breathing (e.g. sitting upright in a chair.
- Patient creates a tight seal around the mouthpiece and inhales deeply and slowly. The patient watches the flow meter for visual feedback. If possible the patient sustains the inhalation to create an end-inspiratory hold. Ideally, the inhalation is sustained for 4-5 seconds.
- Patient relaxes seal around the mouthpiece and exhales; normal breathing is resumed with relaxed shoulder girdle.
- Advise patient to take approximately ten incentive spirometry breaths per waking hour.
Cardiac patients that may experience shortness of breath (dyspnea) can affect how well a person tolerates physical activity. Patients with heart disease may have weakened respiratory muscles due to deconditioning. Regular monitoring with spirometry can help assess improvements in lung volumes and airflow, indicating better respiratory muscle performance.
Prepared by
Tan Jia Li
Your Physio Kota Kemuning