RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the candidate and Address /
NOBLE SUNNY,
SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTER,
PANDESHWAR,
MANGALORE-575001.
2 /

Name of the Institute

/ SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTER, MANGALORE.
3 /

Course of study and Subject

/ Master of Physiotherapy (MPT)
2 years Degree Course.
“Physiotherapy in Cardio Respiratory disorders and Intensive Care”
4 /

Date of Admission

/ 11/07/2013
5 /

Title of the topic

/ ‘‘NORMATIVE VALUE OF SIX MINUTEWALK TEST IN HEALTHY ADOLESCENTS IN INDIA.”
6.
7.
8. / Brief resume of the intended work:
6.1 Need for the study:
Most of the daily activities are performed at sub maximal levels of exertion, and it has been proposed that sub maximal functional tests are a better reflection of physical capability.1
The six-minute walk test (6MWT) is a simple, low tech, safe and well established self-paced assessment tool to quantify functional exercise capacity in individuals with various cardio respiratory diseases.2
This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD).3
The 6MWT is increasingly being used in routine clinical practice because it provides useful information on the daily physical performance of healthy individuals and those with pulmonary diseases.2
The 6MWT has become a standard tool in clinical practice and research to assess exercise performance, function and response to treatment within cardio respiratory disorders.4
Normal values for 6MWT and the effects of anthropometric measurements BP, HR, Heart rate recovery, SpO2 and dyspnoea on the distance walked in Indian population differ when comparing with other population.6
Normal value of six minute walk distance (6MWD) in children and adult in Indian population are available in which anthropometrics like weight, height and other factors like BMI, gender, sex and waist height may affect normative data of six minute walk distance in adolescent, whichposes problems for clinicians wishing to provide patients with a measure of their expected 6MWD in the absence of disease.
To determine the normative value of six minute walk distance in healthy adolescent population of age group from 10-19 and its application in Cardio Pulmonary assessment.
6.2 Review of Literature:
1. Morinder G et al.(2009) did a study on six-minute walk test in obese children and adolescents for reproducibility and validity in Sweden to determine the value from normal children and finally describe the correlation between distance walked, estimate oxygen uptake and reproducibility was determined by a test–retest design and known group by validity a comparative design thereby mean (standard deviation) six-minute walk distance (6MWD) in the obese children was 571 m (65.5), and in the normal-weight children,663 m (61.1) and concludedthat 6MWT showed good reproducibility and known groupvalidity, and can be recommended for use in clinical practice in the studied population.10
2. A E Lammeret al.(2008) did a study to provide normal values of 6MWD for healthy children between 4 and 11 years and they concluded that performing a 6MWT is feasible and practical in young children and this study provides data on normal children against which the performance of sick children and the response to therapeutic intervention can be judged.15
3.D’silva C et al.(2007) did a study to provide normal value of 6MWT for School Children Aged 7–12 Y in India and they concluded that mean distance walked increased from 625.4±120.22 m in children of 7 y to 667.45±181.73 m at 12 y with significant difference between boys and girls( p<0.001)in which boys covered more distance than girls and in this study provides data on normal values of 6MWT in normal children, which may help to evaluate functional capacity and to know the effects of therapeutic intervention in the diseased children. 6
4.Silvia Ulrich et al.(2007) did a study to evaluate the reference values for the six minute walk test in healthy children and adolescents in Switzerlandto influence of age, anthropometrics, heart rate, blood pressure and physical activity. The normal value of 6MWT is 618 ± 79 m in which boys covered more distance than girls. and they concluded that age is the best single predictor and mostly influenced walk distance.6MWT helps to better assess and compare outcomes in young patients with cardiovascular and respiratory diseases and are for different populations.2
5. Li AM, et al.(2007) did a study to evaluate standard reference for the six-minute walk test in healthy children aged 7 to 16 yr in Hong Kong. The anthropometric data, spirometric lung function in the group are prospectively measured using standardized protocols. The findings were used to construct height-specific standards for the 6MWT. The least mean square (LMS) method using maximum penalized likelihood was used to facilitate model fitting. Factors significantly associated with 6MWD were also determined and they concluded that an estimation of individual response to incremental maximal exercise and accurately reflects physical capacity of patients with pulmonary disease and provide useful references.1
6. Enright P, et al.(2003) did a study on six minute walk test in healthy individual in U.S. The standardized 6-min walk test was administered to the Cardiovascular Health Study cohort during their seventh annual examination. The mean 6MWD was 344 m and they concluded the test may be used clinically to measure the impact of multiple comorbidities including cardiovascular disease, lung disease, arthritis, diabetes, and cognitive dysfunction and depression, on exercise capacity and endurance in older adults.4
7. Troosters et al.(2001) did a study on physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease and concludedstudy have identified the 6-min walking test as a strenuous protocol that imposes a significant, but sustainable, load to the exercising body. The 6-min walking test differs from incremental cycling exercise protocols in that it evaluates steady state exercise performance and encouraged 6-min walking test generates a high but sustainable oxygen uptake. Since the oxygen uptake plateau reflects the integrated response of the system, it may explain the high prognostic value of the 6-min walkingtest.7
8.Guyatt G Het al.(1985) did a study on 6-minute walk test that is a new measure of exercise capacity in patients with chronic heart failure in Canada which is highly acceptable to patient and reproducible result are achieved after the first two walks. The result here correlates the functional status and exercise capacity then concluded that the 6-minute walk is a tool to measure functional exercise capacity and a suitable measure of outcome for heart failure.12
6.3 Objectives of the study:
  • To measure the distance walked using 6MWT in healthy adolescent subjects.
  • To determine the cardiovascular responses by measuring the vitals at baseline, before starting and immediately after completion at 2 and 5 minutes of the test.
6.4 Hypothesis:
Not applicable to this study as this study intend to measure normal data.
Material and Methods:
7.1 Source of data: Healthy individuals of age group 10-19 years from schools and colleges in Mangalore.
7.2 Method of collection of data:
200 healthy subjects will be recruited for the study.
Sampling: Purposive sampling
Procedure:
  • A Written consent (approved by institution) will be obtained stating voluntary acceptance to be the subject of this study.
  • Subjects will be informed to avoid caffeine, alcohol and consumption of heavy meal for at least 2 hrs prior to testing and strenuous physical exercise in the previous 24 hrs.
  • The subjects will go for the six minute walk test in accordance to American Thoracic Society (ATS) guidelines.
SIX MINUTE WALK TEST:
The six minute walk test will be performed over a 10 m long straight course within an enclosed level corridor. The length of the corridor will be marked every 3 m. The turnaround points should be marked with a cone (such as an orange traffic cone). A starting line, which marks the beginning and end of each 60-m lap, will be marked on the floor using brightly coloured tape.3
SUBJECT PREPARATION
  1. Comfortable clothing should be worn.
  2. Appropriate footgear for walking should be worn.
  3. A light meal is acceptable before early morning or early afternoon tests
  4. Individual should not have exercised vigorously within 2 hours of beginning the test.
MEASUREMENT:
  1. The patient should sit in a chair, located near the starting position and rest for at least 10 minutes before the test starts. During this time, baseline measurement of vitals which includes heart rate, blood pressure, Spo2 and respiratory rate will be recorded.
  2. The therapist set the lap counter to zero and the timer to 6 minutes. Assemble all necessary equipments (lap counter, timer, clipboard, worksheet) and move to the starting point.
Instruction for subjects to follow:
The subject of this test is to walk as far as possible for 6 minutes. Six minutes is a long time to walk, so subject will be exerting. Subject will probably get out of breath or become exhausted. Subjects are permitted to slow down, stop and rest as necessary. Individual may lean against the wall while resting, but resume walking as soon as they are able to. Subjects will be walking back and forth around the cones. Subjects should pivot briskly around the cones and continue back the other way without hesitation. I am going to use this counter to keep track of the number of laps you complete. I will click it each time they turn around at this starting line. The subject is supposed to inform therapist any difficulties such as chest pain, intolerable dyspnoea, leg cramps, staggering, diaphoresis and pale or ashen appearance which will be considered as criteria for termination.
Remember that the aim is to walk as far as possible for 6 minutes, but don’t run or jog.
  • The therapist should position the subject at the starting line. As soon as the subject starts to walk, start the timer and lap counter.
  • After completion of six minute, subject will be asked to stop and mark the spot where subject will stop by placing a bright tap on the floor.
  • The therapist should measure the cardiovascular and respiratory responses (Heart Rate, Blood pressure respiratory rate and Spo2) immediately after completion and after 2 and 5 minutes of the test.
  • Therapist record the number of laps from the counter (or tick marks on the worksheet).
  • Then record the distance covered (the number of meters in the final partial lap). Calculate the total distance walked, and record it on the worksheet.
All the readings will be taken and cumulated for analyses of data.
Materials to be used:
  1. Chair
  2. Stop watch
  3. Lap counter
  4. Two small cones to mark turn around the points
  5. Work sheet on a clip board
  6. Pulse oxymeter
  7. Sphygmomanometer
INCLUSION CRITERIA:
  1. Healthy subjects
  2. Age between 10 to 19 years
EXCLUSION CRITERIA:
  1. Hypertension>150/100 mmHg
  2. Recent illness including Upper respiratory tract infection.
  3. Presence of any factors that may limit ability to participate in 6MWT e.g.: impaired cognition function , neuromuscular disease, claudication, severe musculoskeletal problems affecting lower extremity or spine cardiopulmonary disorders.3
SATISTICAL ANALYSIS:
STUDY DESIGN: cross sectional study.
DATA ANALYSIS: Collected data will be analysed by ANOVA.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe briefly.
YES, the study is done on human which is intended to measure the six minute walk distance and cardio respiratory parameter before and after the test.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
YES.
LIST OF REFERENCE
  1. Albert M. Li, Jane Yin, Jun T. Au, Hung K. So, Tony Tsang, Eric
Wong, et al. Standard reference for the six-minute walk test in healthy children aged 7 to 16 y. Am J Respire Crit Care Med. 2007; 176: 174–80.
  1. Silvia Ulrich, Florian F Hildenbrand, Ursula Treder, Manuel Fischler,
Stephan Keusch, Rudolf Speich, et al. Reference values for the 6-minute walk test in healthy children and adolescents in Switzerland. Ulrich et al. BMC Pulmonary Medicine 2013, 13:49.
  1. American Thoracic Society. ATS statement. Guidelines for the six minute walk test. Am J Respire Crit Care Med. 2002; 166: 111–117.
  2. Paul L. Enright, Mary Ann McBurnie, Vera Bittner, Russell P. Tracy,
Robert McNamara, Alice Arnold,et al. The six minute walk test. Respire Care. 2003; 48: 783–5.
  1. A.M. Li, J. Yin, C.C.W. Yu, T. Tsang, H.K. So, E. Wong. The six—minute walk test in healthy children: reliability and validity. EurRespir J. 2005; 25: 1057–60.
  2. CherishmaD’silva, Vaishali K,PremVenkatesan. Six-Minute Walk Test-Normal Values of School Children Aged 7–12 Y in India: A Cross-Sectional Study . Indian journal of paediatrics.2012;79:97-102.
  3. Troosters T, J. Vilaro, R. Rabinovich, A. Casas, J.A. Barbera, R. Rodriguez-Roisin, J. Roca. Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease.EurRespir J 2002; 20: 564–569.
  4. Carol A. Maherab, Marie T. Williamsa and Tim S Oldsa. The six-minute walk test for children with cerebral palsy. International Journal of Rehabilitation Research 2008; 31: 185–188.
  5. Solway S, Brooks D, Thomas S. A qualitative systematicoverview of the measurement properties of functional walk tests used in the cardio respiratory domain. Chest 2001; 119: 256–70.
  6. GunillaMorinder, Eva Mattsson, Clara Sollander,Claude Marcus, Ullas Evers Larasson.Six-minute walk test in obese children and adolescents: reproducibility and validity. Physiotherapy Research InternationalPhysiother. Res. Int. 14(2): 91–104 (2009).
  7. Gordon H Guyatt, Stewart 0 Pugsley, Michael J Sullivan, Penelope J Thompson, Leslie B Berman, Norman L Jones. Effect of encouragement on walking test performance. Thorax 1984; 39: 818-822.
  8. Gordon H Guyatt, Michael J. Sullivan, Penelope J. Thompson, Ernest L. Fallen, Stewart 0. Pugsley, D. Wayne Taylor et al; The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J, Vol. 1985; 132: 919-923.
  9. Victor Zuniga Dourado Departamento de Ciências da Saúde, Reference Equations for the 6-Minute Walk Test in Healthy Individuals Universidade Federal de São Paulo (UNIFESP), Campus Baixada Santista, Santos, São Paulo – Brazil.
  10. Paul L. Enright, McBurnie MA, Bittner V, Tracy RP, McNamara R,Arnold A et al; The 6 minute walk test: a quick measure of functional status in elderly adults. Chest 2003; 123(2): 387–398.
  11. A E Lammers, A Hislop, Y Flynn, S G Haworth. The 6- minute walk test: normal values for children of 4–11 years of age. Arch. Dis. Child. 2008; 93: 464-468.

9 /
Signature of the candidate
10 /
Remarks of the guide
/
Study is feasible to conduct and
highly valid
11 /
Name & Designation of:
11.1 Guide’s name
Designation of the Guide
11.2 Signature
/
DR. C.H. SHIVAKUMAR
Associate Professor in Physiotherapy
11.3 Co-Guide (If Any)
11.4 Signature /
DR. SREEDEVI M
Assistant Professor in Physiotherapy
11.5 Head of the Department
11.6 Signature /
DR. RAJASEKAR
Associate Professor in Physiotherapy
and P.G Coordinator
12 /
12.1 Remarks of Chairman and Principal
12.2 Signature /
DR. RAJASEKAR
AssociateProfessor in Physiotherapy andPrincipal
Accepted by scientific and ethical
committee reviewers

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