Physiotherapy - Original Articles
8 September 2025
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Investigation of different field tests in relation to balance, daily living activities, and quality of life in pulmonary hypertension
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Assessment of exercise capacity is useful in monitoring patients and planning a rehabilitation program for subjects with pulmonary hypertension (PH). No study has investigated the relationship of different field tests, except for the six-minute walk test (6MWT), with balance, activities of daily living (ADL), and quality of life (QoL) in subjects with PH. This study aimed to investigate the relationship of different field tests with balance, ADL, and QoL in subjects with PH. This study was a prospective cross-sectional study. A total of 27 subjects who were diagnosed as having PH were included in the study. Field tests were the 6MWT, the Incremental Shuttle Walk Test (ISWT), and the Endurance Shuttle Walk Test (ESWT). Balance assessment was performed using the Timed Up and Go Test (TUG). ADL was evaluated using the London Chest Activities of Daily Living Scale, and QoL was evaluated using emPHasis-10. TUG was the significant predictor of 6MWD and ISWT walking distance (ß=-0.590, p=0.001, ß=-0.600, p=0.001). The emPHasis-10 score significantly predicted ESWT time (ß=-0.667, p<0.001). Submaximal and maximal exercise capacity were related to balance in subjects with PH, and lower endurance capacity was related to decreased QoL. This study suggests that submaximal and maximal exercise capacity were related to dynamic balance in subjects with PH, and lower endurance capacity was related to decreased QoL. ISWT can be considered a safe and practical tool to assess maximum exercise capacity.
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Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022;43:3618-731. DOI: https://doi.org/10.1093/eurheartj/ehac237
Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 2019;53:1801913. DOI: https://doi.org/10.1183/13993003.01913-2018
Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2016;37:67-119. DOI: https://doi.org/10.1093/eurheartj/ehv317
Tran DL, Lau EMT, Celermajer DS, et al. Pathophysiology of exercise intolerance in pulmonary arterial hypertension. Respirology 2018;23:148-59. DOI: https://doi.org/10.1111/resp.13141
Babu AS, Myers J, Arena R, et al. Evaluating exercise capacity in patients with pulmonary arterial hypertension. Expert Rev Cardiovasc Ther 2013;11:729-37. DOI: https://doi.org/10.1586/erc.13.33
Demir R, Küçükoğlu MS. Six-minute walk test in pulmonary arterial hypertension. Anadolu Kardiyol Derg 2015;15:249-54. DOI: https://doi.org/10.5152/akd.2015.5834
Halank M, Einsle F, Lehman S, et al. Exercise capacity affects quality of life in patients with pulmonary hypertension. Lung 2013;191:337-43. DOI: https://doi.org/10.1007/s00408-013-9472-6
Miyamoto S, Nagaya N, Satoh T, et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Am J Respir Crit Care Med 2000;161:487-92. DOI: https://doi.org/10.1164/ajrccm.161.2.9906015
Batt J, Ahmed SS, Correa J, et al. Skeletal muscle dysfunction in idiopathic pulmonary arterial hypertension. Am J Respir Cell Mol Biol 2014;50:74-86. DOI: https://doi.org/10.1165/rcmb.2012-0506OC
Mainguy V, Provencher S, Maltais F, et al. Assessment of daily life physical activities in pulmonary arterial hypertension. PLoS One 2011;6:e27993. DOI: https://doi.org/10.1371/journal.pone.0027993
Kahraman BO, Ozsoy I, Savci S, et al. Static and dynamic balance performance and balance confidence in individuals with and without pulmonary hypertension. J Cardiopulm Rehabil Prev 2018;38:259-63. DOI: https://doi.org/10.1097/HCR.0000000000000299
Wootton SL, Cindy Ng LW, McKeough ZJ, et al. Ground-based walking training improves quality of life and exercise capacity in COPD. Eur Respir J 2014;44:885-94. DOI: https://doi.org/10.1183/09031936.00078014
Evans RA, Singh SJ, Collier R, et al. Generic, symptom based, exercise rehabilitation; Integrating patients with COPD and heart failure. Respir Med 2010;104:1473-81. DOI: https://doi.org/10.1016/j.rmed.2010.04.024
Billings CG, Hurdman JA, Condliffe RA, et al. Incremental shuttle walking test distance and autonomic dysfunction predict survival in pulmonary arterial hypertension. J Hear Lung Transplant 2017;36:871-9. DOI: https://doi.org/10.1016/j.healun.2017.04.008
Irisawa H, Takeuchi K, Inui N, et al. Incremental shuttle walk test as a valuable assessment of exercise performance in patients with pulmonary arterial hypertension. Circ J 2013;78:215-21. DOI: https://doi.org/10.1253/circj.CJ-13-0238
Marsico A, Dal Corso S, de Carvalho EF, et al. A more effective alternative to the 6-minute walk test for the assessment of functional capacity in patients with pulmonary hypertension. Eur J Phys Rehabil Med 2021;57:645-52. DOI: https://doi.org/10.23736/S1973-9087.21.06561-8
Prajapati B, Dunne M, Armstrong R. Sample size estimation and power analysis. Optom Today 2010;16:10-8.
Podsiadlo D, Richardson S. The timed ”up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142-8. DOI: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
Kahraman BO, Ozsoy I, Akdeniz B, et al. Test-retest reliability and validity of the timed up and go test and 30-second sit to stand test in patients with pulmonary hypertension. Int J Cardiol 2020;304:159-63. DOI: https://doi.org/10.1016/j.ijcard.2020.01.028
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;166:111-7. DOI: https://doi.org/10.1164/ajrccm.166.1.at1102
Singh SJ, Morgan MDL, Scott S, et al. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992;47:1019-24. DOI: https://doi.org/10.1136/thx.47.12.1019
Singh S, Morgan MDL, Hardman AE, et al. Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Eur Respir J 1994;7:2016-20. DOI: https://doi.org/10.1183/09031936.94.07112016
Revill SM, Morgan MDL, Singh SJ, et al. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax 1999;54:213-22. DOI: https://doi.org/10.1136/thx.54.3.213
Garrod R, Estall JC, Paul EA, et al. Development and validation of a standardized measure of activity of daily living in patients with severe COPD : the London Chest Activity of Daily Living scale (LCADL). Respir Med 2000;94:589-96. DOI: https://doi.org/10.1053/rmed.2000.0786
Saka S, Savcı S, Calik-Kutukcu E, et al. Validity and reliability of the Turkish version of the London chest activity of daily living scale in obstructive lung diseases. Turk Thorac J 2019;21:116-21. DOI: https://doi.org/10.5152/TurkThoracJ.2019.18155
Ödevoglu P, Demir R, Okumuş G, et al. Evaluation of the validity and reliability of the Turkish translation of the emphasis-10 questionnaire In patients with pulmonary hypertension. J Eval Clin Pract 2019;25:896-902. DOI: https://doi.org/10.1183/13993003.congress-2018.PA3113
Yorke J, Corris P, Gaine S, et al. emPHasis-10: development of a health-related quality of life measure in pulmonary hypertension. Eur Respir J 2013;43:1106-13. DOI: https://doi.org/10.1183/09031936.00127113
Ozemek C, Berry MJ, Arena R. A review of exercise interventions in pulmonary arterial hypertension and recommendations for rehabilitation programing. J Cardiopulm Rehabil Prev 2019;39:138-45. DOI: https://doi.org/10.1097/HCR.0000000000000402
Satyamurthy A, Poojary G, Dibben G, et al. Exercise training in pulmonary hypertension: an updated systematic review with meta-analysis. J Cardiopulm Rehabil Prev 2023;43:237-44. DOI: https://doi.org/10.1097/HCR.0000000000000765
Marques A, Cruz J, Quina S, et al. Reliability, agreement and minimal detectable change of the timed up & go and the 10-meter walk tests in older patients with COPD. COPD 2016;13:279-87. DOI: https://doi.org/10.3109/15412555.2015.1079816
Zamboti CL, Gonçalves AFL, Garcia T, et al. Functional performance tests in interstitial lung disease: Impairment and measurement properties. Respir Med 2021;184:106413. DOI: https://doi.org/10.1016/j.rmed.2021.106413
Montgomery G, McPhee J, Pääsuke M, et al. Determinants of performance in the timed up-and-go and six-minute walk tests in young and old healthy adults. J Clin Med 2020;9:1561. DOI: https://doi.org/10.3390/jcm9051561
Oliveira CC, Annoni R, Lee AL, et al. Falls prevalence and risk factors in people with chronic obstructive pulmonary disease: a systematic review. Respir Med 2021;176:106284. DOI: https://doi.org/10.1016/j.rmed.2020.106284
Hakamy A, Bolton CE, Gibson JE, McKeever TM. Risk of fall in patients with COPD. Thorax 2018;73:1079-80. DOI: https://doi.org/10.1136/thoraxjnl-2017-211008
Loughran KJ, Emerson J, Avery L, et al. Exercise-based interventions targeting balance and falls in people with COPD: a systematic review and meta-analysis. Eur Respir Rev 2024;33:240003. DOI: https://doi.org/10.1183/16000617.0003-2024
Matura LA, Shou H, Fritz JS, et al. Physical activity and symptoms in pulmonary arterial hypertension. Chest 2016;150:46-56. DOI: https://doi.org/10.1016/j.chest.2016.02.633
Okumus G, Aslan GK, Arseven O, et al. The role of an activity monitor in the objective evaluation of patients with pulmonary hypertension. Clin Respir J 2016;12:119-25. DOI: https://doi.org/10.1111/crj.12495
Fernandes CJCS, Martins BCS, Jardim CVP, et al. Quality of life as a prognostic marker in pulmonary arterial hypertension. Health Qual Life Outcomes 2014;12:130. DOI: https://doi.org/10.1186/s12955-014-0130-3
Mereles D, Ehlken N, Kreuscher S, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 2006;114:1482-9. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.618397
Ethics approval
The study was approved by the Istanbul University Ethics Committee (number: 2018/285) and conducted by the Helsinki Declaration.How to Cite
“Investigation of Different Field Tests in Relation to Balance, Daily Living Activities, and Quality of Life in Pulmonary Hypertension”. 2025. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2025.3308.
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