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Comparing 6-minute walk versus treadmill walking distance as outcomes in randomized trials of peripheral artery disease.
- Source :
- Journal of Vascular Surgery; Mar2020, Vol. 71 Issue 3, p988-1001, 14p
- Publication Year :
- 2020
-
Abstract
- Randomized trials of people with peripheral artery disease (PAD) and intermittent claudication have traditionally used maximal treadmill walking distance as the primary outcome, but the 6-minute walk test is increasingly used as a primary outcome in randomized trials of PAD. This study compared relative changes in maximal treadmill walking distance versus 6-minute walk distance in response to a therapeutic intervention or control in randomized trials of participants with PAD. Data from four randomized trials of therapeutic interventions in participants with PAD that measured both 6-minute walk and treadmill walking performance at baseline and the 6-month follow-up were combined. Two trials studied supervised treadmill exercise, one studied home-based walking exercise, and one studied resveratrol. Of 467 participants (mean age, 69.8; standard deviation, 9.7), the mean ankle-brachial index was 0.66 (standard deviation, 0.17). At the 6-month follow-up, participants with PAD randomized to control or placebo significantly declined in 6-minute walk distance (−10.2 m; 95% confidence interval, −18.2 to −2.2; P =.013), but improved maximal treadmill walking distance (+25.7 m; 95% CI, +6.0 to +45.3 m; P =.010; difference between change in 6-minute walk versus maximal treadmill walking distance: −37.3 m; 95% CI, −56.4 to −18.2; P <.001). Home-based exercise improved the 6-minute walk distance by 43.2 m (95% CI, +28.4 to +57.9), and supervised treadmill exercise improved the 6-minute walk distance by 25.0 m (95% CI, +14.7 to +35.2; mean difference, +18.2 m favoring home-based exercise [95% CI, +0.2 to +36.2 m; P =.048]). Among all participants, the presence (vs absence) of treadmill exercise training was associated with a 141.3-m greater improvement in maximal treadmill walking distance compared to 6-minute walk distance (95% CI, 88.2-194.4; P <.001), suggesting a benefit from treadmill training on the treadmill outcome. Maximal treadmill walking distance and the 6-minute walk distance are not interchangeable outcomes in participants with PAD. Participants with PAD randomized to control groups improved treadmill walking distance but simultaneously meaningfully declined in 6-minute walk distance. Supervised treadmill exercise training amplified improvement in treadmill walking distance because of a training to the outcome measure phenomenon. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 07415214
- Volume :
- 71
- Issue :
- 3
- Database :
- Supplemental Index
- Journal :
- Journal of Vascular Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 141730822
- Full Text :
- https://doi.org/10.1016/j.jvs.2019.05.058