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Is there a Place for the Fullerton Test in Evaluation of Heart Failure Patients? The Relationship between Exertional Gas Exchange Parameters and Functional Fitness in Patients with Heart Failure: A Pilot Study

Background: To minimize the effect of heart failure (HF) on quality of life and to reduce the economic burden, it is necessary to provide means of rehabilitation and prognosis evaluation for patients. Patients with severe HF might not be able to perform the most commonly used cardiopulmonary exercise test (CPET), even using the easiest protocols. The Fullerton functional fitness test, developed for the elderly, might be suitable for evaluation of such patients. Our aim was to determine relationship between functional fitness and exertional gas exchange parameters in HF patients, and if they performed worse in functional fitness tests than patients without HF.

Methods: Twenty-one male patients were included in this prospective registry; twelve with HF and nine without. They underwent the standard Fullerton test; the six-minute-walk test (6MWT; patient walks for six minutes along a corridor, and the distance covered is measured; it is a submaximal exercise test for healthy individuals) was modified by using a portable CPET device to record exertional gas exchange parameters.

Results: The HF patients had lower left ventricular ejection fraction and were younger; they presented significantly worse “chair sit-and-reach” results (-0.18 vs. 1.81 cm, p=0.041) and 6-minute walking distance (334.8 vs. 508.4 m, p=0.002), less exercise repetitions in “chair stand” (10.7 vs. 15.1, p<0.001) and “arm curl” (13 vs. 16.8, p<0.001), longer time to perform “8-foot up-and-go” (7.1 vs. 5.6 s, p=0.030), higher VE/VCO2 slope (34.1 vs. 29, p=0.005), and tended to present lower peak oxygen uptake parameters (VO2/kg 11.8 vs. 14, p=0.13; VO2 0.99 vs. 1.22, p=0.10; VO2 as percentage of predicted 43.1 vs. 55.4, p=0.14). 6 MWT, “chair stand” and “arm curl” showed the strongest correlations with AT VE/VCO2 (r=-0.58, p=0.006; r=-0.57, p=0.007; r=-0.62, p=0.003 respectively) and VE/VCO2 slope (r=-0.60, p=0.004; r=-0.52, p=0.015; r=-0.50, p=0.021 respectively) and VO2 as percentage of predicted (r=0.59, p=0.005; r=0.55, p=0.009; r=0.47, p=0.031 respectively); 6MWT correlated strongly with VO2/kg (r=0.61, p=0.004).

Conclusion: HF patients perform worse in the Fullerton test than patients without HF. Physical fitness is related to CPET parameters taken during 6MWT. Lower physical fitness is related to lower exercise capacity and worse ventilatory efficiency. The Fullerton test may be useful in complex evaluation of HF patients.


Michalina Cieslowska, Jacek Migaj, Marta Kaluzna-Oleksy, Magdalena Mróz and Ewa Straburzynska-Migaj

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