Huiyun Du

A Review of the Six-Minute Walk Test: Its Implication as a Self-Administered Assessment Tool:

Background: Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD) management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity. Aim: The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test. Method: The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review The 6MWT is a simple, safe and inexpensive sub-maximal exercise test. The 6MWT distance is strongly associated with functional capacity, and it is a useful prognostic tool. To date, the capacity for self-administration of the 6MWT has not been investigated. Conclusions: Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity.

An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: study protocol for a randomized controlled trial

BackgroundChronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF.Methods/DesignA randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain).All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months. The primary outcome of the trial is the physical functioning domain of quality of life, measured by the physical functioning subscale of the Medical Outcome Study Short Form -36. Secondary outcomes include physical functional capacity measured by the standard six minute walk test, self-management capacity, health related quality of life measured by Medical Outcome Study Short Form -36 and Minnesota Living With Heart Failure Questionnaire, self-efficacy and self-care behaviour.DiscussionA self-monitoring intervention that can improve individuals exercise self-efficacy, self-management capacity could have potential significance in improving the management of people with chronic heart failure in community settings.Trial RegistrationAustralian New Zealand Clinical Trial Registry 12609000437268

Self‐efficacy: a useful construct to promote physical activity in people with stable chronic heart failure

AIM To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention. BACKGROUND The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individuals level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal. DESIGN Discursive. METHODS Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status. CONCLUSIONS Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term. RELEVANCE TO CLINICAL PRACTICE The increasing burden of chronic disease and the emphasis on self-management strategies underscore the importance of promoting adherence to recommendations, such as physical activity.

Cardiovascular disease in Chinese women: an emerging high-risk population and implications for nursing practice.

Background: Globally, cardiovascular disease (CVD) is the leading cause of death among women. In China, the burden of CVD is increasing at an alarming rate; yet, it is underestimated and has important primary, secondary, and tertiary prevention issues. Aim: This article seeks to document the issues surrounding the increased rate of CVD among Chinese women and describe the etiological factors and potential strategies to decrease the burden of disease. Methods: The Medline, Current Information in Nursing and Allied Health Literature, Ovid, Science Direct, and Government Reports were searched using the key words heart disease, cardiovascular, ischemic heart disease, coronary, women, and Chin (China, Chinese). Articles were selected if they described epidemiological factors and/or interventions to address heart disease in Chinese women. Findings: Rapid industrialization and urbanization in China have extended the life expectancy of the population, particularly among women. Social, political, and economic factors have caused lifestyle changes that have a direct bearing on health. Heart disease has become the most common cause of death among Chinese women and the second most common cause among men. Paradoxically, prevention and management strategies are sparse in relation to the high prevalence. A number of modifiable risk factors have been identified as major contributors of CVD and should be a focus of primary, secondary, and tertiary prevention. Conclusion: Cardiovascular disease is already a leading cause of death and disability among Chinese women. The high prevalence of risk factors and low rate of awareness, treatment, and control signal an urgent need for focusing on this issue in Chinese women. Strategies on individual, community, and government levels are recommended. Involving Chinese nurses in these strategies is essential.

Health-seeking beliefs of cardiovascular patients: A qualitative study

OBJECTIVES The study aims were to (a) describe the experiences of Chinese Australians with heart disease following discharge from hospital for an acute cardiac event; (b) identify patterns and cultural differences of Chinese Australians following discharge from hospital; and (c) illustrate the illness/health seeking behaviors and health beliefs of Chinese Australians. DESIGN Qualitative study. METHODS Interview data were obtained from the following sources: (a) focus groups of Chinese community participants without heart disease; (b) interviews with patients recently discharged from hospital following an admission for an acute cardiac event; and (c) interviews with Chinese-born health professionals working in Australia. Qualitative thematic analysis was undertaken. RESULTS Study themes generated from the data were: (1) linking traditional values and beliefs with Western medicine; (2) reverence for health professionals and family; and (3) juxtaposing traditional beliefs and self-management. CONCLUSIONS Considering the influence of cultural values in developing health care plans and clinical decision making is important.

Assessment of a Self‐administered Adapted 6‐Minute Walk Test

PURPOSE This study assessed the reliability and viability of the Home-Heart-Walk (HHW) test, adapting a standardized 6-minute walk test protocol for self-administration. METHODS Twenty-nine volunteers with documented coronary heart disease (CHD) undertook a structured 7-day program using the HHW. RESULTS The intervention was well received by participants. The intraclass correlation coefficient of the test distance over 7 days was 0.98, and the correlations between investigator and participant measures were high (r = 0.99 for day 1 [first test], r = 0.99 for day 1 [second test], and r = 0.99 on day 7). CONCLUSION These data demonstrate the potential of the HHW as a tool to promote and monitor physical activity in community-based settings. These observations require further investigation and testing in other populations.

Value of web-based learning activities for nursing students who speak english as a second language

There is an increasing need to address the educational needs of students with English as a second language. The authors assessed the value of a Web-based activity to meet the needs of students with English as a second language in a bioscience subject. Using telephone contact, we interviewed 21 Chinese students, 24 non-Chinese students with English as a second language, and 7 native English-speaking students to identify the perception of the value of the intervention. Four themes emerged from the qualitative data: (1) Language is a barrier to achievement and affects self-confidence; (2) Enhancement intervention promoted autonomous learning; (3) Focusing on the spoken word increases interaction capacity and self-confidence; (4) Assessment and examination drive receptivity and sense of importance. Targeted strategies to promote language acculturation and acquisition are valued by students. Linking language acquisition skills to assessment tasks is likely to leverage improvements in competence.

Correlation between a self-administered walk test and a standardised Six Minute Walk Test in adults.

This study was undertaken to assess the correlation between a self-administered, adapted Six Minute Walk Test (the Home-Heart-Walk) and the standard Six Minute Walk Test based on the American Thoracic Society guideline. A correlational study was conducted at a university campus in Sydney, Australia. Thirteen healthy volunteers underwent the Home-Heart-Walk and the standard Six Minute Walk Test on a single occasion. The distance that participants walked during the two tests was assessed using Pearsons correlation. The correlation between the Home-Heart-Walk and the Six Minute Walk Test distance was 0.81. The Home-Heart-Walk distance was highly correlated to the standard Six Minute Walk Test distance in this study. This relationship provides confidence for further research in populations to facilitate monitoring and evaluation.

Cardiac rehabilitation: Unraveling the complexity of referral and current models of delivery

Background: Evidence-based guidelines recommend strategies for reducing risk factors for secondary prevention of acute coronary syndromes, yet referral to and completion of programs to deliver this advice are poor. Purpose: In this article we describe the complexity of factors that influence referral and delivery of evidence-based cardiac rehabilitation (CR) programs through an Australian context and provide direction for solutions for clinicians and policy makers to consider. The Ecological Approach is used as a framework to synthesize evidence. The approach has 5 categories, the characteristics of which may act as barriers and enablers to the promotion and adoption of health behaviors and includes (a) interpersonal factors, (b) interpersonal factors, (c) institutional factors, (d) community networks, and (e) public policy. Conclusions: Despite the context of strong evidence for efficacy, this review highlights systematic flaws in the implementation of CR, an important intervention that has been shown to improve patient outcomes and prevent cardiac events. Recommendations from this review include standardization of program delivery, improvement of data capture, use of technological innovations and social networks to facilitate delivery of information and support, and establishment of a cohesive, consistent message through interorganizational collaboration involved in CR. Clinical Implications: These avenues provide direction for potential solutions to improve the uptake of CR and secondary prevention.

Chinese nurses' perceptions of heart health issues facing women in China: a focus group study.

Background:China is in a state of rapid economic growth and epidemiological transition. Morbidity and mortality relating to heart disease in women have increased dramatically. Objectives:The aim of this study was to obtain the views of nurses regarding heart health issues for women in contemporary China. Design:This study used focus group interviews. Settings:Convenience sampling was used to recruit nurses working in acute care hospitals in metropolitan China. Methods:Five focus groups containing 28 female participants were conducted. Focus groups were moderated by 2 bilingual Chinese nurses, audiotaped, and analyzed using thematic analysis. Results:Four themes emerged from the focus group data: (1) mixed perceptions of disease burden in women, (2) modern life impacts upon womens health, (3) need for focus on prevention and coordination, and (4) education and support are keys to driving healthcare improvements. Conclusions:Heart disease, as a significant health issue for women in China, is underappreciated among Chinese nurses.