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Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/757
Title: Resting Hemodynamics and Response to Exercise Using the 6-Minute Walk Test in Late Pregnancy: An International Prospective Multicentre Study
Authors: Dennis AT
Salman M
Paxton E
Flint M
Leeton L
Roodt F
Yentis S
Dyer RA
ANZCA/FPM Author: Dennis, AT
Keywords: pregnancy
hemodynamics
walk test
Citation: 2018 Oct 8. [Epub ahead of print]
Abstract: BACKGROUND: Cardiac disease is the leading cause of maternal death. Assessment of cardiovascular fitness is important in pregnant women because it is linked to increased risk of cardiac disease but is rarely undertaken or studied. The 6-Minute Walk Test (6MWT) is a safe exercise test but is not used in pregnancy. We determined the 95% reference interval for resting heart rate (HR) and distance walked for the 6MWT, as well as hemodynamic recovery variables, and quantified expectations and actual experiences of exertion and breathlessness with exercise in late pregnancy. METHODS: After institutional research board approval (Australian and New Zealand Clinical Trials Registry Number: 12615000964516), 300 healthy term nulliparous pregnant women performed the 6MWT at 3 tertiary referral obstetric hospitals using a standardized protocol. Each woman underwent two 6MWT with maximum 15-minute recovery period after each test. Hemodynamic variables were measured at rest and after exercise. Participants were asked 4 questions, 2 regarding expectation and 2 regarding actual experience, using the Rating of Perceived Exertion scale and Modified Borg Dyspnea scale. RESULTS: Participant characteristics and resting variables were mean (standard deviation [SD]); age, 31 years (4.2 years); body mass index, 27 kg/m (2.9 kg/m); gestational age, 37 weeks (1.3 weeks); HR, 85 bpm (10.8 bpm) with 95% reference interval 64-106 bpm; systolic blood pressure, 112 mm Hg (10.2 mm Hg); diastolic blood pressure, 72 mm Hg (8.6 mm Hg); oxygen saturation, 98% (0.9%); and respiratory rate, 18 breaths/min (5.7 breaths/min). The mean (SD) average distance walked was 488 m (94.9 m) with a speed of 3.0 mph (0.64 mph) with a 95% reference interval of 302-674 m. The mean (SD) HR increase with exercise was 12 bpm (11.0 bpm) with a median [quartile] recovery time of 5.0 minutes [1-8 minutes]. A lower resting HR was associated with increased distance walked (r = -0.207; 95% confidence interval, -0.313 to -0.096; P < .001). A greater HR change with exercise was associated with increased recovery time from exercise (r = 0.736; 95% confidence interval, 0.697-0.784; P < .001). Sixty-three percent and 83% of participants, respectively, expected to be more exerted and breathless than they actually were with exercise. CONCLUSIONS: The 6MWT is feasible and applicable in term pregnant women. The reference intervals for resting HR and distance walked in the 6MWT have been generated. HR increases by approximately 12 bpm with submaximal exercise, and half of the women recovered within 5 minutes of submaximal exercise. Women expected to be more exerted and breathless than they actually were with exercise.
URI: http://hdl.handle.net/11055/757
DOI: doi: 10.1213/ANE.0000000000003818
Study Name: Australian and New Zealand Clinical Trials Registry Number: 12615000964516
Journal Title: Anesthseia and Analgesia
Type: Journal Article
Affiliates: Department of Anaesthesia, Royal Women's Hospital, Parkville, Australia
Departments of Pharmacology, Obstetrics and Gynaecology, and Medicine and Radiology, The University of Melbourne, Parkville, Australia
Department of Anaesthesia, Guy's & St Thomas' Hospital, Lambeth, United Kingdom
Groote Schuur Hospital, Cape Town, South Africa
Mowbray Maternity Hospital, Cape Town, South Africa
Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
Department of Anaesthesia, Chelsea and Westminster Hospital, London, United Kingdom
Imperial College London, London, United Kingdom
Study/Trial: Prospective Cohort Study
Appears in Collections:Scholarly and Clinical

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