ABC | Volume 114, Nº3, March 2020

Short Editorial Carvalho Exercise and Six-Minute Walk Test Arq Bras Cardiol. 2020; 114(3):493-495 2006 Practice Guidelines state that there was no evidence to support the recommendation for the patient “to go home to walk”. However, since 2011, successful clinical trials with home-based exercise interventions that included much more than recommendations like “go home to walk”, such as the instructions for patients to stablish exercise goals and monitor their exercises, thereby promoting a change of focus. Even adding behavior change techniques, home-based exercises require fewer resources and less cost compared with supervised treadmill exercise, and thus are more accessible and probably more acceptable by many patients, which may ultimately lead to higher treatment compliance. 13 In functional assessment of patients with LE-OPAD, six- minute walk test has gained popularity as a validated measure and better related to physical activity levels compared with the treadmill test, with no association with the learning effect of repeated tests. 13 In patients with LE-OPAD, compared with treadmill tests, changes in the performance on six-minute walk test have been more associated with outcomes as mortality and loss of mobility. 14 In the paper “Exercise Intensity During 6-min Test in Patients with Peripheral Artery Disease”, 1 AT was reached 1. Farah BQ, Ritti-Dias RM, Montgomery P, Cucato GG, Gardner A. Exercise Intensity during 6-Minute Walk Test in Patients with Peripheral Artery Disease. Arq Bras Cardiol. 2020; 114(3):486-492 2. Neder JA, Nery LE. Teste de Exercício Cardiopulmonar. J Pneumol. 2002; 28(Supl 3): 166-206. 3. Song P, Rudan D, Zhu Y, Fowkes FJI, Rahimi K, Fowkes FGR, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health. 2019;7(8): e1020–e1030. 4. Beckman JA, DuncanMS, Damrauer SM, Wells QS, Barnett JV, Wasserman DH, et al. Microvascular disease, peripheral artery disease, and amputation. Circulation. 2019;140(6):449–58. 5. Matsushita K, Kwak L, Yang C, Pang Y, Ballew SH, Sang Y, et al. High- sensitivity cardiac troponin and natriuretic peptide with risk of lower extremity peripheral artery disease: the Atherosclerosis Risk inCommunities (ARIC) Study. Eur Heart J. 2018;39(25):2412–9. 6. Aboyans V, Ricco JB, BartelinkMEL, BjorckM, BrodmannM, Cohnert T, et al; ESC ScientificDocument Group. 2017 ESCGuidelines on theDiagnosis and Treatment of Peripheral Arterial Diseases, in collaborationwith the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763–816. 7. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e686-e725. 8. Tóth-Vajna Z, Tóth-Vajna G, Gombos Z, Szilágyi B, Járai Z, Berczeli M, Sótonyi P. Screening of peripheral arterial disease in primary health care. Vascular Health Risk Manag. 2019 Aug 20;15:355-63. 9. Arya S, Khakharia A, Binney ZO, DeMartino RR, Brewster LP, Goodney PP, et al. Association of Statin Dose With Amputation and Survival in Patients With Peripheral Artery Disease. Circulation. 2018;137(14):1435-46. 10. Klaphake S, Buettner S, Ultee KH, van Rijn MJ, Hoeks SE, Verhagen HJ. Combination of endovascular revascularization and supervised exercise therapy for intermittent claudication: a systematic reviewandmeta-analysis. J Cardiovasc Surg (Torino). 2018;59(2):150-7. 11. Saratzis A, Paraskevopoulos I, Patel S, Donati T, Biasi L, Diamantopoulos A, et al. Supervised Exercise Therapy and Revascularization for Intermittent Claudication: Network Meta-Analysis of Randomized Controlled Trials. JACC Cardiovasc Interv. 2019;12(12):1125-36. 12. Fakhry F, van de Luijtgaarden KM, Bax L, denHoed PT, HuninkMG, Rouwet EV, Spronk S. Supervised walking therapy in patients with intermittent claudication. J Vasc Surg. 2012;56(4):1132-42. 13. McDermott MM, Polonsky T. Home-based exercise: a therapeutic option for peripheral artery disease. Circulation. 2016; 134(16):1127–9. 14. McDermott MM, Guralnik JM, Criqui MH, Liu K, Kibbe MR, Ferrucci L. Six-minute walk is a better outcome measure than treadmill walking tests in therapeutic trials of patients with peripheral artery disease. Circulation. 2014; 130(1):61–8. 15. Temfemo A, Chlif M, Mandengue SH, Lelard T, Choquet D, Ahmaidi S. Is there a beneficial effect difference between age, gender, and different cardiac pathology groups of exercise training at ventilatory threshold in cardiac patients? Cardiol J. 2011;18(6):632-8. References in 60% of patients, and peak oxygen consumption and ABI during treadmill test were higher in the other 40% patients. The six-minute walk test was more difficult for women and patients with low cardiorespiratory fitness, indicating a higher relative intensity of exercise effort for these patients. This is relevant in practice, since it is recommended that exercise training be performed above the AT aiming at improving cardiovascular function. 15 Therefore, the study corroborates the use of overground walking as the exercise mode of choice for women and patients with low cardiorespiratory fitness. More intense exercise training should be considered for men and patients with better cardiovascular fitness including cycle and elliptical ergometers, and even treadmills, to reach the AT and consequently improve physical fitness. Finally, it is worth pointing out that the article “Exercise Intensity During 6-min Test in Patients with Peripheral Artery Disease” provides original and interesting results, but since it is an observational, monocentric study, it has limitations that prevent firm conclusions being drawn. Therefore, the study provides important information that are applicable to clinical practice and should be considered as the subject of future research. 494