Vol. 18 Issue 1
Subacute and Long-term Care
Endurance Testing in Long-Term Care Patients
In my last column, I discussed ways to measure cardiovascular fitness or endurance in the frail older person. Some of those measures include determining maximum heart rate (HRmax), maximal oxygen consumption (VO2 max) or measuring subjective ratings of perceived exertion (RPE) using the Borg scale.1
The goal of measuring these parameters is to determine an optimal level at which the patient should exercise. This month's column will focus on three functional assessment tools that are easy to use in testing a patient's level of cardiovascular conditioning. These tests include the Six-Minute Walk Test, the March Test and the Seated Step Test.
Six-Minute Walk Test
The Six-Minute Walk Test (6MWT) was originally developed as an alternative to treadmill testing. The 6MWT is a good test when ambulation is an improvement goal and when endurance is a functional issue. Throughout the literature, the 6MWT has been used on sample populations including the healthy elderly, elderly with Alzheimer's disease and people with cardiac, pulmonary and orthopedic problems. The procedure for performing this test is as follows:
A designated number of feet or walking loop is marked out;
Vitals including BP, HR and O2 Sats at rest are taken;
The patient is asked to walk for six minutes. If the patient can only walk for less than six minutes, then the test ends;
Record number of feet, BP, HR and O2 Sats when exercise stops;
Record recovery time back to baseline.
Table 1 shows norms found in the normal, healthy elderly population ranging in age from 60 to 94. With the frail elderly, I use this test in an effort to get a baseline endurance level during ambulation. Also, VO2 max can be estimated using the following formula:
Convert feet to meters by multiplying by .3048 (Example: 1378 feet x .3048 = 420 meters);
Distance walked = 420 m; Time = 6 min;
Speed = 420 m/ 6 min = 70 meters/min;
VO2max = 0.1 (speed) + 3.5;
VO2max = 0.1 (70 m/min) + 3.5;
VO2max = 7 + 3.5 = 10.5 ml/kg/min.
The Two-Minute March Test2
For patients who may be challenged in ambulation but are able to stand, the March Test may be an alternative to the 6MWT. With a measuring tape, measure the distance from the ASIS of the patient's pelvis to the medial condyle of the knee. Measuring up from the floor, make a mark on the wall that represents half of the distance measured between the ASIS and medial condyle of the knee. This is the stepping height. The patient is then instructed to march in place for two minutes with the knees at least reaching the stepping height. A full step is counted each time the right knee reaches the stepping height. Table 2 shows norms established for men and women between the ages of 60 and 94.
Seated Step Test3
For patients who may be wheelchair-bound or have difficulty standing, a seated step test may be an effective endurance test. A patient may be placed in four cardiovascular stages or conditions beginning with the least taxing stage.
Stage 1–Alternate placement of feet on edge of step or raised bar (six inches high) at a rate of one step per second.
Stage 2–Alternate placement of feet on edge of step or raised bar (12 inches) at a rate of one step per second.
Stage 3–Alternate placement of feet on edge of step or raised bar (18 inches) at a rate of one step per second.
Stage 4–Alternate placement of feet on edge of step or raised bar (18 inches) at a rate of one step per second with alternating arms.
Heart rate and blood pressure are monitored initially and at two minutes. If heart rate remains under 75 percent (60 percent for more frail patients) of age predicted maximum at two minutes, continue an additional five minutes. If heart rate remains under 75 percent of age predicted maximum for the additional five minutes, the next stage can be attempted.
1. Borg, G. (1982). Psychophysical bases of perceived exertion. Medical Science and Sports Exercise, 14(5), 377-381.
2. Rikli, R., & Jones, C. (2001). The Senior Fitness Test. Human Kinetics (www.humankinetics.com).
3. Smith & Gilligan. (1983). Physical activity for the older adult. Physician and Sportsmedicine, 11(8), 91-101.
Bob Thomas is a geriatric physical therapist who presently serves as president of Infinity Rehab, a provider of rehab in subacute, long-term care and outpatient settings in the Northwest and Midwest. He lectures for Great Seminars on rehab for the frail older population and is an adjunct faculty member at Pacific University in Oregon.