{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T03:40:26Z","timestamp":1788579626533,"version":"build-2803163510"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":1436,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T00:00:00Z","timestamp":1640822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardiopulmonary exercise test (CPET) and 6 min walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self-selected constant load test usually considered a submaximal, and therefore safer, exercise, but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath-by-breath measurement of cardiorespiratory parameters. HF patients were grouped according to their CPET peak oxygen uptake (peakV\u0307O2). One hundred and fifty-five subjects were enrolled, of whom 40 were healthy (59 \u00b1 8 years; male 67%) and 115 were HF patients (69 \u00b1 10 years; male 80%; left ventricular ejection fraction 34.6 \u00b1 12.0%). CPET peakV\u0307O2 was 13.5 \u00b1 3.5 mL\/kg\/min in HF patients and 28.1 \u00b1 7.4 mL\/kg\/min in healthy subjects (P &amp;lt; 0.001). 6MWT-V\u0307O2 was 98 \u00b1 20% of the CPET peakV\u0307O2 values in HF patients, while 72 \u00b1 20% in healthy subjects (P &amp;lt; 0.001). 6MWT-V\u0307O2 was &amp;gt;110% of CPET peakV\u0307O2 in 42% of more severe HF patients (peakV\u0307O2 &amp;lt; 12 mL\/kg\/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V\u0307O2 at 6MWT, reported as a percentage of CPET peakV\u0307O2 vs. 6MWT V\u0307O2 reported as the absolute value, progressively increased as exercise limitation did.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conclusion, the last minute of 6MWT must be perceived as a maximal or even supramaximal exercise activity in patients with more severe HF. Our findings should influence the safety procedures needed for the 6MWT in HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13781","type":"journal-article","created":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T23:31:16Z","timestamp":1640907076000},"page":"812-821","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Brisk Walking can be a Maximal Effort in Heart Failure Patients: A Comparison of Cardiopulmonary Exercise and 6 Min Walking Test Cardiorespiratory Data"],"prefix":"10.1093","volume":"9","author":[{"given":"Massimo","family":"Mapelli","sequence":"first","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Milan ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan , Via Parea, 4-20138, Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Salvioni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Paneroni","sequence":"additional","affiliation":[{"name":"Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Gugliandolo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Bonomi","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simonetta","family":"Scalvini","sequence":"additional","affiliation":[{"name":"Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Raimondo","sequence":"additional","affiliation":[{"name":"Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate , Varese ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Sciomer","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, \u2018Sapienza\u2019 Rome University , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mattavelli","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Teresa","family":"La Rovere","sequence":"additional","affiliation":[{"name":"Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano , Pavia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piergiuseppe","family":"Agostoni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Milan ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan , Via Parea, 4-20138, Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,30]]},"reference":[{"key":"2026012114165199800_ehf213781-bib-0001","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1164\/rccm.167.2.211","article-title":"ATS\/ACCP statement on cardiopulmonary exercise testing","volume":"167","author":"American Thoracic Society","year":"2003","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012114165199800_ehf213781-bib-0002","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/CIR.0b013e31829b5b44","article-title":"Exercise standards for testing and training: a scientific statement from the American Heart Association","volume":"128","author":"Fletcher","year":"2013","journal-title":"Circulation"},{"key":"2026012114165199800_ehf213781-bib-0003","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ijcard.2019.04.053","article-title":"How to perform and report a cardiopulmonary exercise test in patients with chronic heart failure","volume":"288","author":"Agostoni","year":"2019","journal-title":"Int J Cardiol"},{"key":"2026012114165199800_ehf213781-bib-0004","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1016\/j.apmr.2003.11.037","article-title":"Cardiorespiratory requirements and reproducibility of the six-minute walk test in elderly patients with coronary artery disease","volume":"85","author":"Gayda","year":"2004","journal-title":"Arch Phys Med Rehabil"},{"key":"2026012114165199800_ehf213781-bib-0005","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2466-14-136","article-title":"Cardiorespiratory responses to 6-minute walk test in interstitial lung disease: not always a submaximal test","volume":"14","author":"Holland","year":"2014","journal-title":"BMC Pulm Med"},{"key":"2026012114165199800_ehf213781-bib-0006","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s00421-009-1128-0","article-title":"The 6-min walk test in heart failure: is it a max or sub-maximum exercise test?","volume":"107","author":"Jehn","year":"2009","journal-title":"Eur J Appl Physiol"},{"key":"2026012114165199800_ehf213781-bib-0007","doi-asserted-by":"crossref","DOI":"10.1177\/1753944719870084","article-title":"6-minute walking test: a useful tool in the management of heart failure patients","volume":"13","author":"Giannitsi","year":"2019","journal-title":"Ther Adv Cardiovasc Dis"},{"key":"2026012114165199800_ehf213781-bib-0008","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.ejheart.2004.06.007","article-title":"Work-rate affects cardiopulmonary exercise test results in heart failure","volume":"7","author":"Agostoni","year":"2005","journal-title":"Eur J Heart Fail"},{"key":"2026012114165199800_ehf213781-bib-0009","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1164\/ajrccm.166.1.at1102","article-title":"ATS statement: guidelines for the six-minute walk test","volume":"166","author":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012114165199800_ehf213781-bib-0010","first-page":"300","article-title":"Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation part II: how to perform cardiopulmonary exercise testing in chronic heart failure","volume":"13","author":"Piepoli","year":"2006","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"2026012114165199800_ehf213781-bib-0011","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1002\/ejhf.989","article-title":"Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison","volume":"20","author":"Agostoni","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"2026012114165199800_ehf213781-bib-0012","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1080\/15412555.2017.1394285","article-title":"Classification of chronic obstructive pulmonary disease (COPD) according to the new Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017: comparison with GOLD 2011","volume":"15","author":"Marcoa","year":"2018","journal-title":"COPD"},{"key":"2026012114165199800_ehf213781-bib-0013","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.euje.2005.12.014","article-title":"Recommendations for chamber quantification","volume":"7","author":"Lang","year":"2006","journal-title":"Eur J Echocardiogr"},{"key":"2026012114165199800_ehf213781-bib-0014","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.119.006541","article-title":"Comparison of BNP and NT-proBNP in patients with heart failure and reduced ejection fraction","volume":"13","author":"Rorth","year":"2020","journal-title":"Circ Heart Fail"},{"key":"2026012114165199800_ehf213781-bib-0015","first-page":"137","volume-title":"Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications","author":"Wasserman","year":"2005"},{"key":"2026012114165199800_ehf213781-bib-0016","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2018.01764","article-title":"Accuracy and precision of the COSMED K5 portable analyser","volume":"9","author":"Perez-Suarez","year":"2018","journal-title":"Front Physiol"},{"key":"2026012114165199800_ehf213781-bib-0017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0226290","article-title":"Accuracy of the Cosmed K5 portable calorimeter","volume":"14","author":"Crouter","year":"2019","journal-title":"PLoS ONE"},{"key":"2026012114165199800_ehf213781-bib-0018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0209925","article-title":"Validity, reliability and minimum detectable change of COSMED K5 portable gas exchange system in breath-by-breath mode","volume":"13","author":"Guidetti","year":"2018","journal-title":"PLoS ONE"},{"key":"2026012114165199800_ehf213781-bib-0019","first-page":"23","article-title":"Perceived exertion as an exercise intensity indicator in chronic heart failure patients on beta-blockers","volume":"3","author":"Levinger","year":"2004","journal-title":"J Sports Sci Med"},{"key":"2026012114165199800_ehf213781-bib-0020","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1161\/01.CIR.96.7.2221","article-title":"Lung function and exercise gas exchange in chronic heart failure","volume":"96","author":"Wasserman","year":"1997","journal-title":"Circulation"},{"key":"2026012114165199800_ehf213781-bib-0021","first-page":"919","article-title":"The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure","volume":"132","author":"Guyatt","year":"1985","journal-title":"Can Med Assoc J"},{"key":"2026012114165199800_ehf213781-bib-0022","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2165\/00007256-198401020-00002","article-title":"Tests of maximum oxygen intake. A critical review","volume":"1","author":"Shephard","year":"1984","journal-title":"Sports Med"},{"key":"2026012114165199800_ehf213781-bib-0023","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1164\/arrd.1984.129.2P2.S25","article-title":"Exercise instruments, schemes, and protocols for evaluating the dyspneic patient","volume":"129","author":"Hansen","year":"1984","journal-title":"Am Rev Respir Dis"},{"key":"2026012114165199800_ehf213781-bib-0024","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1136\/heart.88.3.239","article-title":"Ventilatory variables are strong prognostic markers in elderly patients with heart failure","volume":"88","author":"Mejhert","year":"2002","journal-title":"Heart"},{"key":"2026012114165199800_ehf213781-bib-0025","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1161\/CIRCULATIONAHA.112.110460","article-title":"The safety of cardiopulmonary exercise testing in a population with high-risk cardiovascular diseases","volume":"126","author":"Skalski","year":"2012","journal-title":"Circulation"},{"key":"2026012114165199800_ehf213781-bib-0026","doi-asserted-by":"crossref","first-page":"2666","DOI":"10.1161\/01.CIR.0000097115.61309.59","article-title":"Exercise-induced pulmonary edema in heart failure","volume":"108","author":"Agostoni","year":"2003","journal-title":"Circulation"},{"key":"2026012114165199800_ehf213781-bib-0027","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2165\/00007256-199316010-00003","article-title":"Exercise-induced hypoxaemia in elite endurance athletes. Incidence, causes and impact on V\u0307O2max","volume":"16","author":"Powers","year":"1993","journal-title":"Sports Med"},{"key":"2026012114165199800_ehf213781-bib-0028","doi-asserted-by":"crossref","first-page":"2538","DOI":"10.1093\/eurheartj\/ehl302","article-title":"Gas diffusion and alveolar\u2013capillary unit in chronic heart failure","volume":"27","author":"Agostoni","year":"2006","journal-title":"Eur Heart J"},{"key":"2026012114165199800_ehf213781-bib-0029","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1136\/hrt.71.6.528","article-title":"Usefulness of arterial blood gas estimations during exercise in patients with chronic heart failure","volume":"71","author":"Clark","year":"1994","journal-title":"Br Heart J"},{"key":"2026012114165199800_ehf213781-bib-0030","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1136\/heart.88.5.453","article-title":"Does lung diffusion impairment affect exercise capacity in patients with heart failure?","volume":"88","author":"Agostoni","year":"2002","journal-title":"Heart"},{"key":"2026012114165199800_ehf213781-bib-0031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.resp.2016.06.004","article-title":"The alveolar to arterial oxygen partial pressure difference is associated with pulmonary diffusing capacity in heart failure patients","volume":"233","author":"Morosin","year":"2016","journal-title":"Respir Physiol Neurobiol"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ehf2.13781","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ehf2.13781","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/9\/2\/812\/65375651\/eschf_9_2_812.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/9\/2\/812\/65375651\/eschf_9_2_812.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T19:20:18Z","timestamp":1769023218000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/9\/2\/812\/8326209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,30]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,12,30]]},"published-print":{"date-parts":[[2022,4,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.13781","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,4]]},"published":{"date-parts":[[2021,12,30]]},"assertion":[{"value":"2021-09-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}