Jehn, Melissa

Trucksäss, Arno

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REPLYResponse to letter to the editor by Dr. Vitor Oliveira Carvalhoand Guilherme Veiga Guimaraes: Is the 6-min walking testa submaximal exercise test in heart failure patients?Melissa L. Jehn • Arno Schmidt Trucksa¨ssAccepted: 22 September 2009 / Published online: 16 October 2009 Springer-Verlag 2009We thank Carvalho and Guimaraes (2009) for their interestin our article (Jehn et al. 2009). The primary purpose of ourstudy was to measure the cardio-respiratory responseduring a constant load exercise test (6-min walk test) inpatients with heart failure and compare peak values withan incremental exercise test (ramp protocol). We agreewith Carvalho et al. that a treadmill test would have been amore direct comparison to the 6-min walk test regardingexercise mode. However, treadmill tests are rarely donein patients with heart disease in many European countries,in particular Germany. Thus, we wanted our test outcometo be as closely related to its clinical applicability aspossible.In support of our data, it has been previously shownthat the cardio-respiratory response and its prognosticutility are not greatly impacted by the mode of exercise inpatients with heart failure, and that test outcome of theCPET can be applied globally, irrespective of exercisemodality (i.e. treadmill vs. cycle ergometry) (Arena et al.2005). The importance in eliciting a maximal exerciseresponse lies predominately in the nature of the preferredexercise test, in other words, what the patient feels morecomfortable with (Albouaini et al. 2007; Piepoli et al.2006). This goes for walking versus cycling as well asconstant load versus incremental exercise stress test(CPET). The main reason why cycle ergometry often isavoided as means of CPET testing in many westerncountries is usually due to the general inability of indi-viduals in riding a bike, albeit it offers more stability andtechnically better ECG data which is of particular perti-nence in cardiac patients during exercise testing. Withinour study population, however, the use of a bicycle actsas a widespread mode of transportation within the generalcommunity and most patients felt more comfortable on acycle ergometer than the treadmill.Carvalho et al. raise an important aspect by pointing outthat the use of prognostic cut-off values for VO2 peak(14 ml/kg per min) provided in the literature (Frankensteinet al. 2007; Parikh et al. 2009) would have added to theclinical importance of our findings. However, consider-ing our small study population size, we wanted to ensurethat the groups were as closely matched in size (N) aspossible.Likewise, we do agree that both the use of the Borgscale and the respiratory exchange ratio (RER) areimportant aspects of ensuring an adequate maximal exer-cise response during exercise testing, as they offer bothsubjective and objective measures of exertion, respectively(Carvalho et al. 2009). Both, the Borg scale (C18) andRER C 1.05, were used as measures of maximal perfor-mance in our study, and patients not meeting these criteriawere excluded from the analyses.Our main prerogative was to show that the value ineliciting a maximal exercise response in patients with heartfailure lies predominately in choosing the appropriateexercise test and is dependent on the functional status andexercise limitations of that particular patient. Moreover,our findings indicate a constant load exercise test (in whichindividuals choose their own workload and thus exerciseintensity) to elicit higher peak respiratory parameters thanincremental stress testing in patients with limited exercisecapacity.Communicated by Susan Ward.M. L. Jehn (&)  A. S. Trucksa¨ssDepartment of Sports Medicine, Institute of Exerciseand Health Sciences, University of Basel, Bierstrasse 320B,St. Jacobs Turm, 4052 Basel, Switzerlande-mail: melissa.jehn@unibas.ch123Eur J Appl Physiol (2010) 108:631–632DOI 10.1007/s00421-009-1227-yReferencesAlbouaini K, Egred M, Alahmar A, Wright DJ (2007) Cardiopulmo-nary exercise testing and its application. Heart 93(10):1285–1292Arena R, Guazzi M, Myers J, Ann PM (2005) Prognostic character-istics of cardiopulmonary exercise testing in heart failure:comparing American and European models. Eur J CardiovascPrev Rehabil 12(6):562–567Carvalho VO, Guimaraes GV (2009) Is the 6-min walking test asub-maximal exercise test in heart failure patients? Eur J ApplPhysiolCarvalho VO, Bocchi EA, Guimaraes GV (2009) The Borg Scale asan important tool of self-monitoring and self-regulation ofexercise prescription in heart failure patients during hydrother-apy. Circ JFrankenstein L, Nelles M, Hallerbach M, Dukic D, Fluegel A,Schellberg D, Katus HA, Remppis A, Zugck C (2007) Prognosticimpact of peak VO2-changes in stable CHF on chronic beta-blocker treatment. Int J Cardiol 122(2):125–130Jehn M, Halle M, Schuster T, Hanssen H, Weis M, Koehler F, Schmidt-Trucksass A (2009) The 6-min walk test in heart failure: is it a maxor sub-maximum exercise test? Eur J Appl PhysiolParikh MN, Lund LH, Goda A, Mancini D (2009) Usefulness of peakexercise oxygen consumption and the heart failure survival scoreto predict survival in patients[65 years of age with heart failure.Am J Cardiol 103(7):998–1002Piepoli MF, Corra U, Agostoni PG, Belardinelli R, Cohen-Solal A,Hambrecht R, Vanhees L (2006) Statement on cardiopulmonaryexercise testing in chronic heart failure due to left ventriculardysfunction. Recommendations for performance and interpreta-tion. Eur J Cardiovasc Prev Rehabil 13(1):10–12632 Eur J Appl Physiol (2010) 108:631–632123

Response to letter to the editor by Dr. Vitor Oliveira Carvalho and Guilherme Veiga Guimaraes: Is the 6-min walking test a submaximal exercise test in heart failure patients?

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Response to letter to the editor by Dr. Vitor Oliveira Carvalho and Guilherme Veiga Guimaraes: Is the 6-min walking test a submaximal exercise test in heart failure patients?

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