Study of correlation of efficacy in six-minute walk test among overweight, normal weight and underweight MBBS students.
- Dr. Vinodh R.S. , Associate Professor, Department of Physiology,VIMS&RC.
Article Information:
Abstract:
Background: Alarming increase in prevalence of obesity in young medicos is putting them at the risk of poor health 6-minute walk test is an easy test for functional fitness. It helps to discover robustness among overweight, normal, and underweight groups Objective: To study the correlation of cardiorespiratory parameters distance in underweight, normal weight and overweight medical trainees using 6-minute walk test Method: 6-minute walk test was carried out in 15 underweight, normal and overweight individuals. before and after test cardio and respiratory variables were compared in the above three groups Result: showed a significant relation in borg scale in underweight, normal weight and overweight medical trainees Conclusion: 6 – minute walk test study showed prevention of overweight and underweight by resorting to lifestyle modifications such as inculcating fitness and practicing balanced diet thereby preventing possible cardiovascular risks
Keywords:
Article :
INTRODUCTION:
Assessing the risk for the presence of major CVD risk factors in young adults is of particular importance since it would allow us to promptly identify persons at high risk for development of clinical CVD later in life (1). Young adults between the ages of 18–25 are in a period of 'transition' from adolescence to adulthood (2). Until recently, it was perceived that obesity mostly affected middle age adults. However, a steadily increasing trend of obesity among young adults, especially college and university students, is becoming evident (3). Modest associations between improvement in weight status by indulging in physical fitness and academic achievement are noteworthy. Fitness is defined as a physiological state of well-being that reduces the risk of hypokinetic disease and enables one to complete the task of daily living (4). A converging body of literature indicates that markers of aerobic exercise capacity, both maximal and submaximal, are positively related to children's academic achievement as well as intellectual and cognitive abilities (5) Interventions promoting physical activity and reducing sedentary behaviours are considered crucial for addressing childhood obesity and improving overall health outcomes in children, even if long-term studies on hard endpoints are lacking (6). Efforts to encourage healthy lifestyle changes for youth are imperative to combat the rise in childhood obesity and promote better health. The six-minute walk test (6MWT) is a sub-maximal exercise test used to assess aerobic exercise capacity and functional performance. It measures the distance an individual can walk in ix minutes and is commonly used to assess the impact of various conditions on physical function (7).
It has demonstrated significant prognostic value in various medical conditions, such as chronic heart failure (8) or primary pulmonary hypertension (9(. The 6MWT is widely utilised, even in school-aged children (10, 11, & 12). It has also been employed in obese patients, where it is associated with body composition (13, 14) and performance after a weight reduction programme (15) or bariatric surgery (16). Even in obese children, 6MWT showed good reproducibility (17). Interestingly, the 6MWT distance (6MWT-D) performed by obese children was, on average, 14% less than the distance that normal-weight children walked (18). In haemodynamics, the Rate Pressure Product (RPP) is an index of myocardial oxygen consumption and is proportional to the workload of the heart. It is calculated by multiplying the systolic blood pressure (SBP) by the heart rate (HR). This measure is used to estimate the myocardial (heart muscle) work and reflects the energy consumption of the myocardial muscle. It has been shown to have prognostic value in various adult populations, including in predicting cardiovascular events and mortality (19)
OBJECTIVE:
1.To observe 6-minute walk distance in underweight, normal weight and overweight medical trainees.
To study the correlation of cardiorespiratory parameters distance in underweight, normal weight and overweight medical trainees using 6-minute walk test.
MATERIALS AND METHODS:
Study Design: Medical students from first to final year MBBS of Vydehi institute of Medical Sciences who are willing to participate will be briefed about the study. The study will be an Observational cross-sectional study
Inclusion criteria:
· Adults aged above 18 years
· Medical students willing to provide informed consent
Exclusion criteria:
· Medical students who are not willing to provide informed consent
Study protocol
We designed a preliminary Questionnaire tailored to the study objectives. The study began only after obtaining clearance from Vydehi Institutional Ethics committee
Anthropometric measurements weretaken in clinical physiology lab. A Stadiometer and calibrated balance were used to measure height and weight. Body mass index was calculated as weight/height2(kg/m2). Students were classified as overweight, normal weight and underweight using Indian height weight chart of global health care India (20). Rest brachial blood pressure and heart rate were determined. Students were invited to perform six-minute walk test where they will be encouraged to walk at normal pace for six minutes aiming to cover as much distance as possible After completion of six-minute walk test BP and heart rate were measured. The RPP were calculated by multiplying SBP and HR.
Statistical analysis
Data was entered MS Excel and analysed using SPSS version 23
Independent Sample t-test
The sample size was calculated by using G* power software for independent sample t-test.
The formula is:
Where:
· Z1−α/2=1.96Z1−α/2=1.96 (Standard normal score at 95% level of confidence)
· Z1−β=PowerZ1−β=Power
· σ= Standard deviation of average of both the groups (from related article)
· d= Clinically significant difference: Minimum mean difference between 2 groups
Based on the findings from previous literature by Iais Lima Pelouze et al.
(2023):
The mean and standard deviation of both the groups is 10.99 ± 3.89 and 7.95 ± 2.20
At 95% level of confidence and 90% power with standard effect size is 1.26, so the minimum sample size in each group is 15, overall, 45.
Descriptive analysis of all the explanatory and outcome parameters werebe done using mean and standard deviation for quantitative variables, frequency, and proportions for categorical variables. The level of significance will be set at p<0.05.The relationship between categorical data was examined using one way ANOVA test. The statistical analyses was performed using SPSS (version 23; IBM Corp, Armonk, NY, USA) and R (version 4.2.0 R Foundation For statistical Computing)
RESULTS:
The study was undertaken for assessing the correlation of cardiorespiratory parameters distance in underweight, normal weight and overweight medical trainees using 6-minute walk test yielded the following results:
Age distribution of study subjects with mean age+- SD ranges in normal weight group 4.5+/-2.69(18-23 years), in over weight group 4+/-3.6(18-23 years) and underweight group 3.5+/1.7(18-23 years) respectively (in table no.1 and 2).
• In Table no 3 Comparison of baseline values of hemodynamic parameters between underweight, overweight, and Normal weight at baseline showed p value greater than 0.05 indicated there is no significant difference among the groups
Table no. 1: Age distribution of study subjects
|
Age in Years |
category |
Total |
||||||
|
Normal |
Overweight |
Underweight |
||||||
|
N |
% |
N |
% |
N |
% |
N |
% |
|
|
18-19 |
5 |
10.4% |
6 |
12.5% |
5 |
10.4% |
16 |
33.3% |
|
20-21 |
7 |
14.6% |
8 |
16.7% |
5 |
10.4% |
20 |
41.7% |
|
|
|
|
|
|
|
|
|
|
|
22-23 |
6 |
12.5% |
2 |
4.2% |
3 |
6.3% |
11 |
22.9% |
|
>23 |
0 |
0.0% |
0 |
0.0% |
2 |
2.1% |
1 |
2.1% |
|
Total |
18 |
37.5% |
16 |
33.3% |
15 |
29.2% |
48 |
100.0% |
|
4.5+/-2.69(18-23 years) |
4+/-3.6(18-23 years) |
3.5+/1.7(18-23 years) |
|
|
||||
Table no. 2 Gender wise distribution of study subjects
|
|
category |
Total |
|||||||
|
Normal |
Overweight |
Underweight |
|||||||
|
N |
% |
N |
% |
N |
% |
N |
% |
||
|
gender |
F |
7 |
14.6% |
6 |
12.5% |
12 |
25.0% |
25 |
52.1% |
|
M |
11 |
22.9% |
10 |
20.8% |
3 |
4.2% |
23 |
47.9% |
|
|
Total |
18 |
37.5% |
16 |
33.3% |
15 |
29.2% |
48 |
100.0% |
|
Table no 3: Comparison of baseline values of hemodynamic parameters between underweight, overweight, and Normal weight at baseline
|
Parameter |
Underweight |
Normal weight |
Overweight |
P value |
|||
|
Mean |
SD |
Mean |
SD |
Mean |
SD |
||
|
SBP |
115 |
5.82 |
109 |
7.92 |
111 |
8.97 |
0.071 |
|
DBP |
78 |
4.73 |
75 |
5.15 |
76 |
8.02 |
0.441 |
|
HEART RATE |
79 |
8.02 |
78 |
9.92 |
73 |
6.14 |
0.103 |
|
Spo2(%) |
98.6 |
0.90 |
97.9 |
0.77 |
98.2 |
1.12 |
0.095 |
Table no 4: Comparison of mean heart rate between underweight, overweight, and Normal weight at different time point
|
time |
Underweight |
Normal weight |
Overweight |
P value |
|||
|
Mean |
SD |
Mean |
SD |
Mean |
SD |
||
|
baseline |
115 |
5.82 |
109 |
7.92 |
111 |
8.97 |
0.071 |
|
immediate |
99 |
8.47 |
100.9 |
13.24 |
101.3 |
9.12 |
0.798 |
|
30 sec |
89.9 |
7.90 |
93.5 |
11.18 |
91.5 |
8.90 |
0.635 |
|
1 min |
84.1 |
9.09 |
88.6 |
13.13 |
84.2 |
9.09 |
0.514 |
|
2 min |
85.2 |
13.17 |
83.3 |
13.20 |
85.6 |
13.17 |
0.832 |
|
5 min |
85.1 |
11.83 |
83.6 |
11.41 |
85.15 |
11.84 |
0.051 |
· In Table no 4 comparison of mean heart rate between underweight, overweight, and Normal weight at different time point showed p value greater than 0.05 indicated there is no significant difference among the groups
· In Table no 5 Comparison of mean SBP, DBP and Spo2 between underweight, overweight, and Normal weight at baseline and immediately after 6-minute walk test using ANOVA TEST showed p value greater than 0.05 indicated there is no significant difference among the groups
Table no. 6 comparison of Borg scale and 6 min walk distance between underweight, normal weight and overweight at baseline
|
underweight |
Normal weight |
Over weight |
P value |
||||
|
Mean |
SD |
Mean |
SD |
Mean |
SD |
||
|
Borg Scale |
6.4 |
0.87 |
6 |
2.17 |
7.6 |
1.29 |
0.0021 |
|
6 min walk distance |
418.7 |
56.59844 |
474.2 |
56.59284 |
422.8 |
56.59284 |
0.0249 |
In Table no. 6 comparison of Borg scale and 6 min walk distance between underweight, normal weight and overweight medicos at baseline showed highly significant p value 0.021 and 6-minute walk distance showed 0.0249 among underweight, normal weight and overweight medicos which was highly significant at the baseline
DISCUSSION:
Productive association of cardiorespiratory health and intellectual strength especially thinking ability and study performance has been documented in preadolescent children’s groups. (5) Nonetheless such studies in young adult medical population have been a rarity. In a study by Sonali Uikey et al showed functional activity of overweight children is less in comparison to normal weight children in consistent with results of our study. (21) The main findings of the study by giontella A et al(22) showed that obese children group covered lesser distance when compared to normal counterparts in 6- minute walk test whereas in our study we included an underweight group in addition to normal weight along with overweight groups and maximum distance was covered by normal weight group in comparison with underweight and overweight groups. In a study by Dehghan H et al (23).RPE was higher in overweight and obese participants than those with normal participants similar to the findings in our study
CONCLUSION:
Young medicos with overweight and underweight covered less distance in comparison to their normal counterparts indicating corrective mediation to improve physique thereby preventing possible later complications
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