Aerobic

Aerobic or cardiorespiratory training is an important component of exercise cancer rehabilitation.

Before commencing aerobic training, it is recommended you calculate your patient’s maximum heart rate. The Tanaka equation is a useful way to assess this:

 HR max= 208-(0.7 x age)  

It is important to consider what treatment (if any) before setting your starting exercise prescription.

It is optimal to set your starting exercise intensity using heart rate reserve (HRR) or using the ACSM metabolic equation for treadmill walking. However, people receiving cardiotoxic chemotherapy such as doxirubicin will have a variable resting heart rate throughout the course of their chemotherapy. People receiving chemotherapy may also struggle to achieve their target heart rate within an exercise session. Therefore, a combination of methods to prescribe and monitor aerobic exercise intensity such as using heart rate and BORG RPE is recommended.

The 6 Minute Walk Test informs clinicians regarding walking endurance and cardiovascular strength.

It is important to ensure that the test is performed in a standardised manner on each occasion.

  • Walking track: can be continuous (oval or rectangular) or point-to-point (stop, turn around, go)
  • Should be flat, with minimal blind turns or obstacles.
  • The minimum recommended length for a centre-based walking track is 25m and could be marked in metre increments.
    • If you cannot access a 25m track, you may use a different track as long as you use the same track for all tests. A shorter test may produce a lower total distance as patients are required to turn more often in the 6 minutes

Equipment:

  • A chair positioned at one end of the walking track (you may choose to have more chairs)
  • BORG RPE Scale
  • Pulse oximeter
  • Sphygmomanometer (blood pressure)
  • Stopwatch
  • Access to oxygen and telephone/emergency button in case of emergency
  • Portable supplemental oxygen if required by the patient to perform the test
  • Clipboard with reporting sheet and pen
  • Pre-measured marks along the track are preferable

Prior to Assessment: 

  • Inform the patient to dress comfortably and with appropriate footwear for the test
  • Record: blood pressure, HR, oxygen saturation and base dyspnoea score (BORG RPE)
  • Attached oximeter to patient so it can be read during the test without disruption
  • Describe the walking track and the procedure of the test (these instructions must be standardised):
    • The aim of this test is to walk as far as possible for 6 minutes. You will walk along this hallway between the markers, as many times as you can in 6 minutes.
    • I will let you know as each minute goes past, and then at 6 minutes I will ask you to stop where you are.
    • 6 minutes is a long time to walk, so you will be exerting yourself. You are permitted to slow down, to stop, and to rest as necessary, but please resume walking as soon as you are able.
    • Remember that the objective is to walk AS FAR AS POSSIBLE for 6 minutes, but don’t run or jog.
    • Do you have any questions?

During the test:

  • Remain behind the patient so that you do no affect their pace of ambulation.
  • Monitor patient for signs and symptoms of distress.
  • Use the following standard encouragements during the test:
    • 1 min “You are doing well. You have 5 minutes to go.”
    • 2 min “Keep up the good work. You have 4 minutes to go.”
    • 3 min “You are doing well. You are halfway.”
    • 4 min “Keep up the good work. You have only 2 minutes left.”
    • 5 min “You are doing well. You have only 1 minute to go.”
    • 6 min “Please stop where you are.”
  • At every minute record the SpO2 and HR
  • If the patient stops during the test, instruct them that they can resume whenever they feel able if their SpO2 is >85%

Following the test:

  • Place a marker on the distance walked
  • Allow the patient to rest (seated/standing)
  • Immediately record SpO2, HR and BORG RPE Dyspnoea score

To calculate your starting intensity:

Treadmill speed = %intensity x 6MWT average speed

6MWT average speed = (6MWT distance x 10) ÷ 1000 km / hr

(NB You may start with a lower speed if patient is unfamiliar with the treadmill. Once patient is confident and safe, walking speed can be increentally increased)

For walking laps:

Six-minute walk distance (6MWD) ÷ 6 = Distance in one minute

For distance in 20 minutes = one minute distance x 20

Patients may not be able to keep up their average walking pace achieved in the 6MWT throughout the aerobic training session. Therefore multiply calculated distance by 80%

 

Instructions adapted from the Lung Foundation Pulmonary Rehab Toolkit. See website for normative measures.

For a printable version of the above protocol and test recording sheets see Pulmonary Rehab Toolkit Resources .

There may be some instances where there is a ceiling effect to using the 6-minute walk test for example younger patients or those preparing for treatment.

In this instance you may choose to do an alternative test such as an incremental shuttle walk test or treadmill test.

Common treadmill tests for this population are the UNCCRI Treadmill protocol or Modified Bruce protocol