Rufus Adesoji ADEDOYIN, Gregory Efosa ERHABOR, Oluwatobi Daniel OJO, Chidozie Emmanuel MBADA, Taofeek Oluwole AWOTIDEBE, Daniel Osagbemworhue OBASEKI, Olayinka Omotesho AWOFOLU

Assessment of cardiovascular fitness of patients with pulmonary tuberculosis using six minute walk test

AMAÇ: Akciğer tüberkülozu hastaları, azalmış egzersiz toleransı ve günlük yaşamsal aktivitelerini gerçekleştirmede yetersizlik yaşamaktadırlar. Bu hastalar incelenirken egzersizin önemi yeterince araştırılmamıştır. Bu çalışma, akciğer tüberkülozlu hastalarinin alti dakikalik yürüme testi (6-MWT) kullanilarak kardiyovasküler sağlıklarının değerlendirilmesi amacıyla gerçekleştirilmiştir. YÖNTEM: Altmış beş gönüllü akciğer tüberkülozu hastası çalışmaya dahil edilmiştir. Katılımcılar, 6-MWT testini 30 metrelik yürüme parkurunda yapabildikleri kadar hızlı yürüyerek uygulamışlardır. Katılımcılardan toplanan veriler; fiziksel karakteristikleri, egzersiz öncesi-sonrası kan basıncı ve kalp hızı ölçümleri ve maksimum oksijen tüketimi şeklindedir. Elde edilen bulgular, tanımlayıcı analizler, ortalama ve standart sapma ve bağımlı gruplarda t testi kullanılarak analiz edilmiştir. BULGULAR: Yürüyüş sonu kardiyovasküler bulguların dinlenme sırasındaki bulgulardan anlamlı bir şekilde yüksek oldukları bulunmuştur. Ortalama VO2 max ve katılımcıların MET değerleri sırasıyla; 11,7±0,97 (ml O2kg -1min-1) ve 3,35±0,28 (mL/Kg). Ortalama 6-MWT uzaklığı erkeklerde ve kadın katılımcılarda sırasıyla, 502.0±43.0 m. ve 481.7±68.3 m. bulunmuştur. SONUÇ: 6-MWT testi sonuçlarına gore, akciğer tüberkülozu hastalarında anlamlı kardiyovasküler değişimler olduğu değerlendirilmiştir. 6-MWT testi akciğer tüberkülozu hastaların fonksiyonel kapasitelerini değerlendirmek açısından kullanışlı olabilir.

Akciğer tüberkülozlu hastaların kardiyovasküler sağlıklarının, altı dakikalık yürüme testi kullanılarak değerlendirilmesi

AIM: Patients with pulmonary tuberculosis (TB) tends to have limited exercise tolerance and a significant disability affecting their activities of daily living. The importance of exercise in the management of these patients has not been well investigated. This study was designed to assess the cardiovascular fitness of patients with pulmonary TB using the six-minute walk test (6-MWT). METHOD: Sixty five consented patients with Pulmonary TB were consecutively recruited into the study. The patients performed 6-MWT over a 30 meter course on a level walkway at a speed as fast as they could. Data were obtained on participants’ physical characteristics, pre and post exercise blood pressure and heart rate, and maximum oxygen consumption. Data were analyzed using descriptive statistics of mean and standard deviation and paired t-test. RESULTS: The post walk test cardiovascular parameters were significantly higher than the resting cardiovascular parameters. The mean VO2 max and MET of the participants were 11.7±0.97 (ml O2kg -1min-1) and 3.35±0.28 (mL/Kg) respectively. The means 6-MWT distance for male and female participants were 502.0±43.0m 481.7±68.3m respectively. CONCLUSION: The result implies that the 6-MWT is capable of evoking a significant cardiovascular change among patients with pulmonary TB. The 6-MWT may be useful in the assessment of functional capacity of patients with pulmonary TB.

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1. Loachimescu O, Tomford JW. 2004. Tuberculosis._The_Cleveland_clinic._www.clevel andclinicmeded.com/medicalpubs/diseasemanag ement/pulmonary/tb/tb.htm. [Accessed date 05.08.2008].
2. World Health Organization (WHO). WHO/ Tuberculosis: Infection and transmission. Fact sheet N 140, revised. 2005.
3. Igbuzor EJ. Phage amplification technology in the disease of pulmonary tuberculosis. Applicability in Nigeria. Afr J Clinical and Experimental Microbiology. 2002; 3(2): 55-63.
4. World Health Organization (WHO). Global Report: Global Tuberculosis Control. WHO Report. 2006.
5. Salami AK, Oluboyo PO. Hospital prevalence of pulmonary tuberculosis and co-infection with human immunodeficiency virus in Ilorin; a review of nine years 1991–1999. West Afr J Med. 2002; 21(1): 24–27.
6. James L, Diana B. 2006 Tuberculosis. www.emedicine.com/emerg/topic618. [Accessed date 05.08.2008].
7. Comstock GW. Frost revisited: the modern epidemiology of tuberculosis. Am J Epidemiol. 1975; 5: 363–382.
8. Grzybowski S, Barnett GD, Styblo K. Contacts of cases of active pulmonary tuberculosis. Bull Int Union Tuberc Lung Dis. 1975; 5: 90–106.
9. Styblo K. State of the art: epidemiology of tuberculosis. Bull Int Union Tuberc. 1978; 53: 141–152.
10. Elegbe IA, Salawu L, Adeyemo AO. Pulmonary Tuberculosis in Nigeria. The Journal of the Royal Society for the Promotion of Health. 1986; 6(2): 69-71.
11. Murray CJ, Styblo K, Rouillon A. Tuberculosis in developing countries: burden, intervention and cost. Bull Int Union Tuberc Lung Dis. 1990; 65: 6– 24.
12. Smith PG. Epidemiology of tuberculosis. In: Bloom B, ed. Tuberculosis: pathogenesis, protection and control. Washington, DC. American Society for Microbiology, 1994, p. 13- 24.
13. Lienhardt C, Bennett S, Del Prete G, Bah-Sow O, Newport M, Gustafson P, at al. Investigation of Environmental and Host-related Risk Factors for Tuberculosis in Africa. I. Methodological Aspects of a Combined Design. Am J. Epidemiol. 2002; 155(11): 1066-1073.
14. Enwuru CA, Idigbe EO, Ezeobi NV, Otegbeye AF. Care-seeking behavioural patterns, awareness and diagnostic processes in patients with smearand culture-positive pulmonary tuberculosis in Lagos, Nigeria. Trans R Soc Trop Med Hyg. 2002; 96: 614–616.
15. Needham DM, Godfrey-Faussett P, Foster SD. Barriers to tuberculosis control in urban Zambia: the economic impact and burden on patients prior to diagnosis. Int J Tuberc Lung Dis. 1998; 2: 811– 817.
16. Odusanya OO, Babafemi. JO. Patterns of delays amongst pulmonary tuberculosis patients in Lagos, Nigeria. BMC Public Health. 2004; 4: 18.
17. Ando M, Atsushi M, Hiroshi E. The effect of pulmonary rehabilitation in patients with posttuberculosis lung disorder. Chest. 2003; 123: 1988-1995.
18. Brannon FJ, Foley MW, Starr JA, Saul LM. Additional components of pulmonary rehabilitation. In: Cardiopulmonary Rehabilitation: Basic Theory and Application, edited by Brannon FJ, Foley MW, Starr JA, and Saul LM. Philadelphia. FA. Davis, 1993, p. 430-432.
19. Mador MJ, Rodis A, Magalang UJ. Reproducibility of Borg scale measurements of dyspnea during exercise with patients with COPD. Chest. 1995; 107: 1590-1597.
20. Humberstone N, Tecklin JS. Respiratory evaluation: Respiratory assessment and respiratory treatment. In; Irwin, S. and Tecklin J: Cardiopulmonary physical therapy. 3. ed. St Loius. Mosby-Year Book, 1995, p. 356.
21. Phillips MS, Kinner WJM, Shaw D, Shneerson JM. Exercise responses in patients treated for pulmonary tuberculosis by thoraco-plasty. Thorax. 1989; 44(4): 268-274.
22. DeCesare JA, Graybill-Tucker CA, Gould AL. Physical therapy for child with respiratory dysfunction. In: Irwin S and Tecklin JS eds. Cardiopulmonary physical therapy, 3. ed. St Loius. Mosby-Year Book, 1995, p. 357-360.
23. Glaskell DV, Webber BA. The Brompton Hospital Guide to Chest Physiotherapy. 4th ed. Oxford. Blackwell Scientific Publications, 1980, p. 13-30.
24. Sadowsky HS. Pulmonary diagnostic tests and procedures. In: Hillegas EA, and Sadowsky HS. Essentials of Cardiopulmonary Physical Therapy. 2nd ed. Philadelphia. WB. Saunders, 2001, p. 421-449.
25. Kisner C, Colby LA. Critical analysis of exercise programs: In: Therapeutic exercise: Foundations and techniques. FA. Davis Company, 1996, p. 711-726.
26. Steel B. Timed walking test of exercise capacity in chronic cardiopulmonary illness. J. Cardiopulm Rehabil. 1996; 16: 25-33.
27. Cooper CB. Exercise in chronic pulmonary disease: Aerobic exercise prescription. Med sciences Sports Exerc. 2001; 33: 5671-5679.
28. Solway S, Brooks D, Lacasce Y. A qualitativ systemic overview of measurement of properties of functional walk test used in cardiorespiratory domain. Chest. 2001; 119: 256-270.
29. Turner SE, Eastwood PR, Cecins NM, Hillman DR, Jenkins SC. Physiological response to incremental and self paced exercise in COPD. A comparison of three tests. Chest. 2004;126: 766- 773.
30. American Thoracic Society (ATS). Standard for diagnosis and care of patients with COPD: Comprehensive outpatient management of patients with COPD. Am J. Respir Crit Care Med. 2002; 152 (suppl): 84s-96s.
31. American College of Sport Medicine (ACSM). Prediction of maximum oxygen consumption VO2 max during level walking. 1995.
32. Cooper KH. A means of assessing maximum oxygen uptake. Correlation between field and treadmill testing. JAMA. 1968; 203, 201-204.
33. Enright PL, Sherrill DL. Reference equation for the six minute walk test in healthy adults. Am J Respir Crit Care Med. 1998; 158: 1384-1387.
34. Cooper CB, Storer TW. Exercise testing and interpretation. A Practical Approach. Cambridge, UK. Cambridge University Press, 2001, p. 69.
35. Reybrouck T. Clinical usefulness and limitation of six-minute walk test in patients with cardiovascular or pulmonary disease. Chest. 2003; 123: 325-327.
36. Nobuyuki M, Mikio A, Kazuhisa M, Ikuharu M, Tatsuo S, Ichiro N. Blood response to heart rate during exercise test and risk of future hypertension. Hypertension. 2002; 39; 761-777.
37. Astrand PO and Rodahl K. Textbook of work physiology. New York. McGraw-Hill, 1977, p. 617
38. Astrand PO, Rodahl K. Circulation, cardiac output and transportation of oxygen. Textbook of work physiology. 3rd ed. New York. McGraw-Hill, 1986, p. 191-194.
39. Laughlin, MH. Cardiovascular response to exercise. Advances in physiology education. 1999; 277(6): 244-259s.
40. Banner NR, Lloyd MH, Hamilton RD, Innes JA, Guz A, Yacoub MH. Cardiopulmonary response to dynamic exercise after heart and combined heart-lung transplantation. Br Heart J. 1989; 61(3): 215-23.
41. American College of Sports Medicine (ACSM). Resource manual for Guidelines for Exercise Testing and Prescription. 2. ed. Philadelphia. Lea and Fabiger, 1993.
42. Wenger NK Hellerstein HK. Rehabilitation of the coronary patient. 2nd ed. New York. Wiley, 1984, p. 197-284.
43. Chung EK. Exercise Electrocardiography practical Approach. 2nd Ed. Baltimore. Williams and Wilkins, 1983, p. 66-76.
44. Szlachic J, Massic BM, Framer BL, Topic N, Tubau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol. 1985; 55: 1037-42.
45. Prentice WE. Fitness for college and Life. 5th ed. St. Louis. MO Mosby, 1994, p. 182-183.
46. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr. Compendium of physical activities: Classification of energy costs of human physical activities. Med Sci Sport Exerc. 1993; 25: 71-80.
47. Stelken AM, Younis LT, Jennisons H, Miller DD, Miller LW, Shaw LJ. Prognostic value of cardiopulmonary exercise testing using percent achieved in predicated peak oxygen intake for patients with Ischemic and dilated cardiomyopathy. J Am Coll Cardiol. 1996; 27: 345-52.
48. American College of Sports Medicine (ACSM). Guidelines for exercise testing and prescription. 4. ed. Philadelphia. Lea and Fabiger, 1991.
49. Pollock M.L. Ayres J. and Ward A. Cardiorespiratory fitness: response to differing intensities and duration and duration of Training. Arch Phys Med Rehabil. 1977; 58: 467-473.
50. Burnett CN, Glenn TM. Principle of aerobic exercise. In: Exercise Therapeutic Exercise. 1996, p. 111-142.
51. Tsang RCC. Reference value for 6-Minute walk test and hand-grip strength in healthy Hong Kong Chinese adults. Hong Kong Physiotherapy Journal. 2005; 23: 6-12.
52. Gibbons W, Fruchter N, Sloan S et al. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopul Rehabil. 2001; 21: 87-93.
53. Lipkin DP, Scriven AJ, Crake T, Poole-Wilson PA. Six minute walking test for assessing exercise capacity in chronic heart failure. BMJ. 1986; 292: 653-655.
54. Guyatt GH. Use of 6-minute walk as an outcome measure in clinical trials in chronic heart failure. Heart Failure. 1987; 211-217.
55. Morales FJ, Matinez A, Mendez M, Agarrado A, Ortega F. A shuttle walk Test for Assessment of Functional Capacity in Chronic Heart failure. Am Heart J. 1999; 138(2): 292-298.
56. Lucas C, Stevenson LW, Johnson W, Harthy H, Hamilton MA, Walden J. The 6-minute walk and peak oxygen consumption in advanced Heart Failure: Aerobic capacity and survival. Am Heart J. 1999;138(4) : 633-640.
57. Opasich C, Pinna GD, Mazza A, Febo O, Richard R, Richard PG, Capomolla S. Six-minute walking performance in patients with moderate to severe heart failure; is it a useful indicator in clinical practice? Eur Heart J. 2001; 22(6): 488-496.
58. Mc Kelvie RS, Teo KK, Robert R, Mc cartneu K, Yusuf S. Effects of Exercise Training in Patients with Heart failure: The Exercise Rehabilitation Trial (EXERT). Am Heart J. 2002; 144: 23-30.