Functional capacity in patients with congestive heart failure

Background: Six-minute walk distance (6MWd) is related to activities of daily living and is also an independent predictor of prognosis in patients with congestive heart failure (CHF). Therefore, it is important to determine factors that contribute to the variability of this test. Methods and Results: We assessed the relationship between 6MWd and peak aerobic capacity (V̇O2) and dynamic muscle strength in 180 patients with CHF (age, 66 ± 10 years; 146 men, 34 women; ejection fraction,.29 ± 0.08). We also hypothesized that a measure of work performed during the walk test (6MWw) would be a better indicator of exercise capacity than 6MWd. The 6MWd had weak to moderate correlations with dynamic muscle strength (r = 0.33 to 0.41) and peak V̇O2 (r = 0.48). However, 6MWw was strongly related to dynamic muscle strength (r = 0.63 to 0.70) and peak V̇O2 (r = 0.77). Multivariate analysis indicated that a model combining dynamic muscle strength and peak V̇O2 explained 69% of the variance in 6MWw, more than with peak V̇O2 alone (R2 = 0.59). Conclusions: Compared with 6MWd, 6MWw correlates significantly better with peak V̇O2 and dynamic muscle strength, suggesting that 6MWw may be a better reflection of a patient's exercise capacity. Furthermore, these results suggest that an exercise program combining both aerobic and strength training in patients with CHF may improve 6MWw and therefore 6MWd.