Six-minute walk test in cardio-oncology rehabilitation: a review

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Abstract

Breast cancer treatment often involves drugs with significant cardiotoxicity. One of the novel approaches to preventing and managing heart failure and reduced exercise tolerance in patients with breast cancer is cardio-oncology rehabilitation. A submaximal exercise test allows for the assessment of physical load tolerance and the effectiveness of rehabilitation programs.

The aim of this review was to evaluate the feasibility of using the six-minute walk test for prescribing and assessing the effectiveness of cardiac training programs in patients with breast cancer through the analysis of randomized clinical trials.

The six-minute walk test has demonstrated reliability and validity when performed in oncology patients, although its results may be influenced by numerous factors.

The maximum heart rate obtained during the six-minute walk test can be used to determine training intensity, and the test results can assess the effectiveness of rehabilitation programs. Changes in health status can be monitored using treadmill testing, while wearable medical devices enable the use of the six-minute walk test in remote rehabilitation. Actual testing is necessary to determine exercise tolerance: the six-minute walk test can be utilized for dynamic monitoring of patients’ health both in conventional settings and on a treadmill.

About the authors

Ksenia A. Blinova

Ivanovo State Medical University

Author for correspondence.
Email: xenny7@yandex.ru
ORCID iD: 0000-0002-2896-8764
SPIN-code: 4959-7018

MD, Cand. Sci. (Medicine)

Russian Federation, Ivanovo

Irina E. Mishina

Ivanovo State Medical University; Saint-Petersburg State University

Email: mishina-irina@mail.ru
ORCID iD: 0000-0002-7659-8008
SPIN-code: 2549-1182

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Ivanovo; Saint Petersburg

Galina E. Ivanova

The Russian National Research Medical University named after N.I. Pirogov

Email: reabilivanova@mail.ru
ORCID iD: 0000-0003-3180-5525
SPIN-code: 4049-4581

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Elena N. Kopysheva

Saint-Petersburg State University

Email: enk9@yandex.ru
ORCID iD: 0009-0003-9067-1317
SPIN-code: 7245-1066

MD, Cand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg

Alexander K. Kostrygin

Ivanovo State Medical University

Email: onko@ivreg.ru
ORCID iD: 0000-0003-1840-8111
SPIN-code: 3112-0170

MD, Cand. Sci. (Medicine)

Russian Federation, Ivanovo

Anna S. Pugacheva

Ivanovo State Medical University

Email: anutserovka07@gmail.com
ORCID iD: 0009-0009-5046-7083
SPIN-code: 2542-4288
Russian Federation, Ivanovo

References

  1. Malignant neoplasms in Russia in 2023 (morbidity and mortality). Kaprin AD, et al., editors. Moscow: National Medical Research Radiological Center; 2024. 276 р. (In Russ.)
  2. Khajoei R, Ilkhani M, Azadeh P, et al. Breast cancer survivors-supportive care needs: Systematic review. BMJ Support Palliat Care. 2023;13(2):143–153. doi: 10.1136/spcare-2022-003931 EDN: IIESYP
  3. Fernández-Casas A, Leirós-Rodríguez R, Hernandez-Lucas P, González-Represas A. Protective effects of exercise on cardiotoxicity induced by breast cancer treatments: A systematic review and meta-analysis. Maturitas. 2024;183:107932. doi: 10.1016/j.maturitas.2024.107932 EDN: TPBSIL
  4. Scalia IG, Gheyath B, Tamarappoo BK, et al. Chemotherapy related cardiotoxicity evaluation: A contemporary review with a focus on cardiac imaging. J Clin Med. 2024;13(13):3714. doi: 10.3390/jcm13133714 EDN: KFCDPI
  5. Valiyaveettil D, Joseph D, Malik M. Cardiotoxicity in breast cancer treatment: Causes and mitigation. Cancer Treat Res Commun. 2023;37:100760. doi: 10.1016/j.ctarc.2023.100760 EDN: LSIFNC
  6. Chung WP, Yang HL, Hsu YT, et al. Real-time exercise reduces impaired cardiac function in breast cancer patients undergoing chemotherapy: A randomized controlled trial. Ann Phys Rehabil Med. 2022;65(2):101485. doi: 10.1016/j.rehab.2021.101485 EDN: LNQUUA
  7. Naaktgeboren WR, Binyam D, Stuiver MM, et al. Efficacy of physical exercise to offset anthracycline-induced cardiotoxicity: A systematic review and meta-analysis of clinical and preclinical studies. J Am Heart Assoc. 2021;10(17):e021580. doi: 10.1161/JAHA.121.021580 EDN: UQDZSK
  8. Werner C, Hanhoun M, Widmann T, et al. Effects of physical exercise on myocardial telomere-regulating proteins, survival pathways, and apoptosis. J Am Coll Cardiol. 2008;52(6):470–482. doi: 10.1016/j.jacc.2008.04.034 EDN: VZPSFN
  9. Scott JM, Zabor EC, Schwitzer E, et al. Efficacy of exercise therapy on cardiorespiratory fitness in patients with cancer: A systematic review and meta-analysis. J Clin Oncol. 2018;36(22):2297–2305. doi: 10.1200/JCO.2017.77.5809
  10. Akyol M, Tuğral A, Arıbaş Z, Bakar Y. Assessment of the cardiorespiratory fitness and the quality of life of patients with breast cancer undergoing chemotherapy: A prospective study. Breast Cancer. 2023;30(4):617–626. doi: 10.1007/s12282-023-01453-6 EDN: LEEBNG
  11. Mishina IE, Sarana AM, Mikhailovskaia TV, Ivanova GE. Principles for the appointment of aerobic physical training during outpatient cardiac rehabilitation. Bulletin of rehabilitation medicine. 2020;97(3):83–95. doi: 10.38025/2078-1962-2020-97-3-83-95 EDN: NAPBEE
  12. Foulkes SJ, Howden EJ, Pituskin E, et al. A review on the role of exercise training to prevent a decline in cardiorespiratory fitness and cardiac function in breast cancer survivors. J Cardiopulm Rehabil Prev. 2024;44(1):5–14. doi: 10.1097/HCR.0000000000000834 EDN: FBOHGR
  13. Bonikowske AR, Taylor JL, Larson KF, et al. Evaluating current assessment techniques of cardiorespiratory fitness. Expert Rev Cardiovasc Ther. 2024;22(6):231–241. doi: 10.1080/14779072.2024.2363393 EDN: BHGKYN
  14. Li H, Liu H, Wang B, et al. Exercise interventions for the prevention and treatment of anthracycline-induced cardiotoxicity in women with breast cancer: A systematic review. J Sci Sport Exercise. 2025;7:14–27. doi: 10.1007/s42978-023-00256-7 EDN: IVFVTI
  15. Moreno-Cabañas A, Ortega JF, Morales-Palomo F, et al. Importance of a verification test to accurately assess VO2 max in unfit individuals with obesity. Scand J Med Sci Sports. 2020;30(3):583–590. doi: 10.1111/sms.13602
  16. Midgley AW, Earle K, McNaughton LR, et al. Exercise tolerance during VO2max testing is a multifactorial psychobiological phenomenon. Res Sports Med. 2017;25(4):480–494. doi: 10.1080/15438627.2017.1365294
  17. Roberts DE, Futrell EE, Toole E. Submaximal walking tests: A review of clinical use. J Clin Exercise Physiol. 2022;11(2):62–74. doi: 10.31189/2165-6193-11.2.62
  18. ATS committee on proficiency standards for clinical pulmonary function laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–117. doi: 10.1164/ajrccm.166.1.at1102. Erratum in: Am J Respir Crit Care Med. 2016;193(10):1185. doi: 10.1164/rccm.19310erratum
  19. Scrutinio D, Guida P, La Rovere MT, et al. Incremental prognostic value of functional impairment assessed by 6-min walking test for the prediction of mortality in heart failure. Sci Rep. 2024;14(1):3089. doi: 10.1038/s41598-024-53817-3 EDN: PPLIWM
  20. Wegrzynowska-Teodorczyk K, Rudzinska E, Lazorczyk M, et al. Distance covered during a six-minute walk test predicts long-term cardiovascular mortality and hospitalisation rates in men with systolic heart failure: An observational study. J Physiother. 2013;59(3):177–187. doi: 10.1016/S1836-9553(13)70182-6
  21. Schmidt K, Vogt L, Thiel C, et al. Validity of the six-minute walk test in cancer patients. Int J Sports Med. 2013;34(7):631–636. doi: 10.1055/s-0032-1323746
  22. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 2020;201(3):393. doi: 10.1164/rccm.v201erratum1 EDN: YSTTIZ
  23. But-Hadzic J, Dervisevic M, Karpljuk D, et al. Six-minute walk distance in breast cancer survivors: A systematic review with meta-analysis. Int J Environ Res Public Health. 2021;18(5):2591. doi: 10.3390/ijerph18052591 EDN: HZNJBB
  24. Ortiz A, Tirado M, Hughes DC, et al. Relationship between physical activity, disability, and physical fitness profile in sedentary Latina breast cancer survivors. Physiother Theory Pract. 2018;34(10):783–794. doi: 10.1080/09593985.2018.1424978
  25. Mascherini G, Tosi B, Giannelli C, et al. Breast cancer: Effectiveness of a one-year unsupervised exercise program. J Sports Med Phys Fitness. 2019;59(2):283–289. doi: 10.23736/S0022-4707.18.08131-8
  26. Ying L, Yahng JJ, Fisher M, et al. Walking the boundaries: Using the 6-min walk test for accurate assessment of the level of fitness in breast clinic outpatients. ANZ J Surg. 2020;90(6):1141–1145. doi: 10.1111/ans.15637
  27. Howard FM, Olopade OI. Epidemiology of triple-negative breast cancer: A review. Cancer J. 2021;27(1):8–16. doi: 10.1097/PPO.0000000000000500 EDN: ICBMXB
  28. Mikhailovskaya TV, Nazarova OA, Dovgalyuk YuV, et al. Methodological issues of assessment of sixminute walk test in patients with coronary artery disease. Bulletin of rehabilitation medicine. 2021;20(3):37–44. doi: 10.38025/2078-1962-2021-20-3-37-44 EDN: ZRXBCM
  29. Hansen D, Abreu A, Ambrosetti M, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: Why and how. A position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2022;29(1):230–245. doi: 10.1093/eurjpc/zwab007 EDN: OPKECN
  30. Tubiana-Mathieu N, Cornette T, Mandigout S, et al. Can the six-minute walk test be used to individualize physical activity intensity in patients with breast cancer? Cancers (Basel). 2021;13(22):5851. doi: 10.3390/cancers13225851 EDN: BQQMTI
  31. Milecki P, Hojan K, Ozga-Majchrzak O, Molińska-Glura M. Exercise tolerance in breast cancer patients during radiotherapy after aerobic training. Contemp Oncol (Pozn). 2013;17(2):205–209. doi: 10.5114/wo.2013.34453
  32. Cornette T, Vincent F, Mandigout S, et al. Effects of home-based exercise training on VO2 in breast cancer patients under adjuvant or neoadjuvant chemotherapy (SAPA): A randomized controlled trial. Eur J Phys Rehabil Med. 2016;52(2):223–232.
  33. Foley MP, Hasson SM. Effects of a community-based multimodal exercise program on health-related physical fitness and physical function in breast cancer survivors: A pilot study. Integr Cancer Ther. 2016;15(4):446–454. doi: 10.1177/1534735416639716
  34. Leclerc AF, Foidart-Dessalle M, Tomasella M, et al. Multidisciplinary rehabilitation program after breast cancer: Benefits on physical function, anthropometry and quality of life. Eur J Phys Rehabil Med. 2017;53(5):633–642. doi: 10.23736/S1973-9087.17.04551-8
  35. Cerulli C, Parisi A, Sacchetti M, et al. Dancing with health: A new dance protocol to improve the quality of life of breast cancer survivors. Med Sport. 2019;72:295–304. doi: 10.23736/S0025-7826.19.03530-0
  36. Hojan K, Procyk D, Horyńska-Kęstowicz D, et al. The preventive role of regular physical training in ventricular remodeling, serum cardiac markers, and exercise performance changes in breast cancer in women undergoing trastuzumab therapy: An REH-HER study. J Clin Med. 2020;9(5):1379. doi: 10.3390/jcm9051379 EDN: ZROQWE
  37. Soucy C, Bouchard DR, Hrubeniuk T, Sénéchal M. Variability in physical function for patients living with breast cancer during a 12-week exercise program. Support Care Cancer. 2022;30(1):69–76. doi: 10.1007/s00520-021-06394-4 EDN: RMXVSI
  38. Mulero Portela AL, Colón Santaella CL, Rogers LQ, Missaghian Vissepo M. Effect of low- and moderate-intensity endurance exercise on physical functioning among breast cancer survivors: A randomized controlled trial. Support Care Cancer. 2024;33(1):49. doi: 10.1007/s00520-024-09100-2 EDN: BUHBKP
  39. Araquib AK, Salah SS, El Missiri AM, Kamal KA. The effect of cardiac rehabilitation on quality of life and 6-minute walk test in breast cancer patients during ongoing anthracycline based therapy. Egypt J Hospital Med. 2024;96(1):3346–3351.
  40. Araquib AK, Haddad MM, Kamal KA, Raymond R. The effect of cardiac rehabilitation on quality of life and 6-minute walk test in breast cancer survivors. Int J Cardiol Res. 2024;6(2):36–42.
  41. Ngueleu AM, Barrette S, Buteau C, et al. Impact of pathway shape and length on the validity of the 6-minute walking test: A systematic review and meta-analysis. Sensors. 2025;25(1):17. doi: 10.3390/s25010017 EDN: QIXPXM
  42. Semaan MB, Wallard L, Ruiz V, et al. Is treadmill walking biomechanically comparable to overground walking? A systematic review. Gait Posture. 2022;92:249–257. doi: 10.1016/j.gaitpost.2021.11.009 EDN: PXXKNG
  43. Nevelikova M, Dosbaba F, Pepera G, et al. Validity and reliability of automated treadmill six-minute walk test in patients entering exercise-based cardiac rehabilitation. Ann Med. 2023;55(2):2304664. doi: 10.1080/07853890.2024.2304664 EDN: RJBHBL
  44. Vickery-Howe DM, Bonanno DR, Dascombe BJ, et al. Physiological, perceptual, and biomechanical differences between treadmill and overground walking in healthy adults: A systematic review and meta-analysis. J Sports Sci. 2023;41(23):2088–2120. doi: 10.1080/02640414.2024.2312481 EDN: WLFWCQ
  45. Al Maghraby MA, Alshami AM, Muaidi QI, et al. Corridor and real-time 6-minute walk tests in healthy young adults: A randomized cross-over study. J Taibah Univ Med Sci. 2024;19(3):637–643. doi: 10.1016/j.jtumed.2024.05.005 EDN: OJVTRB
  46. Cantarero-Villanueva I, Postigo-Martin P, Granger CL, et al. The minimal clinically important difference in the treadmill six-minute walk test in active women with breast cancer during and after oncological treatments. Disabil Rehabil. 2023;45(5):871–878. doi: 10.1080/09638288.2022.2043461 EDN: DNULII
  47. Mak J, Rens N, Savage D, et al. Reliability and repeatability of a smartphone-based 6-min walk test as a patient-centred outcome measure. Eur Heart J Digit Health. 2021;2(1):77–87. doi: 10.1093/ehjdh/ztab018 EDN: TNSOAB
  48. Chow R, Drkulec H, Im JH, et al. The use of wearable devices in oncology patients: A systematic review. Oncologist. 2024;29(4):e419–e430. doi: 10.1093/oncolo/oyad305 EDN: QFUEMN
  49. Douma JA, Verheul HM, Buffart LM. Feasibility, validity and reliability of objective smartphone measurements of physical activity and fitness in patients with cancer. BMC Cancer. 2018;18(1):1052. doi: 10.1186/s12885-018-4983-4 EDN: BUFUTX

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