Comparison of master two-step exercise stress test versus six-min walk test in patients tested positive for SARS-CoV-2

Ankit Kumar; Naveen Hegde; J Kumaravel; Ritin Mohindra; Roop Kishor Soni; Ramya Rathod; Mohan Kumar; Valliappan Muthu; Nanda Gamad; Amol N Patil; P L Sharma

doi:10.4103/jfmpc.jfmpc_1111_22

Comparison of master two-step exercise stress test versus six-min walk test in patients tested positive for SARS-CoV-2

J Family Med Prim Care. 2022 Nov;11(11):7008-7014. doi: 10.4103/jfmpc.jfmpc_1111_22. Epub 2022 Dec 16.

Authors

Affiliations

¹ Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
² Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
³ Department of Otorhinolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
⁴ Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Abstract

Background and aim: There has been a lack of uniformity on how to triage coronavirus disease 2019 (COVID-19) patients visiting the emergency units of hospitals. Triage tools are themselves spreading the pandemic in hospital areas. The present study compared a master two-step (M2ST) exercise stress test versus a 6-min walk test (6MWT) in COVID-19-positive patients visiting the emergency unit of a hospital.

Materials and methods: Thirty-nine patients underwent 6MWT followed by M2ST, while another set of 38 patients underwent M2ST followed by 6MWT in this randomized, crossover, open-label, and noninferiority study. The exercise tests assessed the change from baseline in SpO₂, heart rate (HR), respiratory rate, blood pressure, exertion, and dyspnea on the modified-Borg scale.

Results: Noninferiority was established for SpO₂ (P < 0.05), systolic blood pressure (SBP; P < 0.001), and diastolic blood pressure (DBP; P < 0.05), but not for HR (P = 0.3) and respiratory rate (P = 0.6). The difference between the pretest and posttest (delta change) values for the parameters SpO₂, respiratory rate, HR, SBP, and DBP correlated significantly (P < 0.001) with Pearson correlation coefficient (r = 0.764, 0.783, 0.473, 0.838, and 0.783, respectively). The delta change values of modified-Borg scale for dyspnea (P = 0.291) and exertion (P = 0.208) were statistically insignificant between the two exercise tests. However, the correlation between the tests was statistically significant (P < 0.001).

Conclusion: M2ST, a timesaving, cost-effective, and easy to perform exercise stress test, has been identified as a reliable alternative for 6MWT.

Keywords: COVID-19; Six-min walk distance; exercise stress test; hospitalization; master two-step test; six-min walk test; triage.