{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:35:46Z","timestamp":1784097346495,"version":"3.55.0"},"reference-count":55,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:00:00Z","timestamp":1674604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>A tele-assessed 6MWT (TL 6MWT) could be an alternative method of evaluating functional capacity in patients with diabetes mellitus type 2 (DM2). This study aimed to assess the validity and reliability of a TL 6MWT. The functional capacity of 28 patients with DM2 (75% men) aged 61 \u00b1 13 years was evaluated twice via an indoor, center-based 6MWT (CB 6MWT) and twice outside each patient\u2019s home via a web-based platform TL 6MWT. The study showed a high statistically significant correlation between the CB and TL 6MWT (Pearson\u2019s r = 0.76, p &lt; 0.001). Reliability testing showed no statistically significant differences in the distance covered (CB1: 492 \u00b1 84 m and CB2: 506 \u00b1 86 m versus TL1: 534 \u00b1 87 m and TL2: 542 \u00b1 93 m, respectively) and in the best distance of the TL 6MWT (545 \u00b1 93 m) compared to the best CB distance (521 \u00b1 83 m). Strong internal reliability for both the CB (intraclass correlation coefficient (ICC) = 0.93) and the TL 6MWT (ICC = 0.98) was found. The results indicate that a TL 6MWT performed outdoors can be a highly valid and reliable tool to assess functional capacity in patients with DM2. No learning effect between the TL and CB assessment was found, minimizing the need for repetition.<\/jats:p>","DOI":"10.3390\/s23031354","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T01:30:30Z","timestamp":1674696630000},"page":"1354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Tele-Assessment of Functional Capacity through the Six-Minute Walk Test in Patients with Diabetes Mellitus Type 2: Validity and Reliability of Repeated Measurements"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8012-0325","authenticated-orcid":false,"given":"Garyfallia","family":"Pepera","sequence":"first","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evmorfia","family":"Karanasiou","sequence":"additional","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Blioumpa","sequence":"additional","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varsamo","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kalatzis","sequence":"additional","affiliation":[{"name":"Independent Researcher, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonidas","family":"Lanaras","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, General Hospital of Lamia, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-1541","authenticated-orcid":false,"given":"Ladislav","family":"Batalik","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic"},{"name":"Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20190306","DOI":"10.1590\/0034-7167-2019-0306","article-title":"Cognitive capacity and functional development assessment in elderly people with Type 2 Diabetes Mellitus","volume":"74","author":"Albernaz","year":"2021","journal-title":"Rev. Bras. Enferm."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.dsx.2016.06.004","article-title":"Relationship between functional capacity and health-related quality of life of patients with type-2 diabetes","volume":"11","author":"Awotidebe","year":"2017","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1080\/09593985.2018.1517198","article-title":"The effects of type 2 diabetes mellitus and its complications on physical and pulmonary functions: A case-control study","volume":"36","author":"Okur","year":"2020","journal-title":"Physiother. Theory Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.numecd.2017.12.008","article-title":"Effects of aerobic or resistance exercise training on cardiovascular autonomic function of subjects with type 2 diabetes: A pilot study","volume":"28","author":"Bellavere","year":"2018","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"52C","DOI":"10.1016\/0002-9149(86)91027-1","article-title":"Exercise capacity in the elderly","volume":"57","author":"Posner","year":"1986","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0954-6111(06)80164-2","article-title":"Measuring functional status in chronic lung disease: Conclusions from a randomized control trial","volume":"85","author":"Guyatt","year":"1991","journal-title":"Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1378\/chest.119.1.256","article-title":"A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain","volume":"119","author":"Solway","year":"2001","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1002\/rnj.111","article-title":"Test-retest reliability and minimal detectable change scores for fitness assessment in older adults with type 2 diabetes","volume":"39","author":"Rogers","year":"2014","journal-title":"Rehabil. Nurs."},{"key":"ref_10","first-page":"2","article-title":"Correlation between the six-minute walk test and maximal exercise test in patients with type ii diabetes mellitus","volume":"53","year":"2019","journal-title":"Rehabilitacion"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Kuziemski, K., S\u0142omi\u0144ski, W., and Jassem, E. (2019). Impact of diabetes mellitus on functional exercise capacity and pulmonary functions in patients with diabetes and healthy persons. BMC Endocr. Disord., 19.","DOI":"10.1186\/s12902-018-0328-1"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S0003-9993(03)00011-X","article-title":"Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease","volume":"84","author":"Brooks","year":"2003","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","first-page":"20","article-title":"A pilot study to investigate the safety of exercise training and exercise testing in CR patients","volume":"20","author":"Pepera","year":"2013","journal-title":"Br. J. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1164\/ajrccm.167.9.950","article-title":"ATS statement on six-minute walk test","volume":"167","author":"Brooks","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"454","DOI":"10.12968\/bjca.2015.10.9.454","article-title":"Predictors of the 6-minute walk test in patients with chronic heart failure","volume":"10","author":"Pepera","year":"2015","journal-title":"Br. J. Card. Nurs."},{"key":"ref_16","first-page":"15","article-title":"Does turning affect shuttle walking test performance in cardiovascular disease patients? a narrative review","volume":"33","author":"Pepera","year":"2021","journal-title":"Crit. Rev. Phys. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Saiphoklang, N., Pugongchai, A., and Leelasittikul, K. (2022). Comparison between 20 and 30 meters in walkway length affecting the 6-minute walk test in patients with chronic obstructive pulmonary disease: A randomized crossover study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0262238"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1177\/1741826710389403","article-title":"Repeat six-minute walk tests in patients with chronic heart failure: Are they clinically necessary?","volume":"18","author":"Adsett","year":"2011","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/PHM.0b013e3181583e66","article-title":"Six-minute walk test as an outcome measure: Are two six-minute walk tests necessary immediately after pulmonary rehabilitation and at three-month follow-up?","volume":"87","author":"Spencer","year":"2008","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1089\/dia.2006.0057","article-title":"The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: A randomized trial","volume":"9","author":"Bond","year":"2007","journal-title":"Diabetes Technol. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Molavynejad, S., Miladinia, M., and Jahangiri, M. (2022). A randomized trial of comparing video telecare education vs. in-person education on dietary regimen compliance in patients with type 2 diabetes mellitus: A support for clinical telehealth Providers. BMC Endocr. Disord., 22.","DOI":"10.1186\/s12902-022-01032-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"203","DOI":"10.25122\/jml-2019-0006","article-title":"Telemonitoring in diabetes: Evolution of concepts and technologies, with a focus on results of the more recent studies","volume":"12","author":"Meyer","year":"2019","journal-title":"J. Med. Life"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e24687","DOI":"10.2196\/24687","article-title":"Improving Management of Type 2 Diabetes Using Home-Based Telemonitoring: Cohort Study","volume":"6","author":"Milani","year":"2021","journal-title":"JMIR Diabetes"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Batalik, L., Filakova, K., Sladeckova, M., Dosbaba, F., Su, J., and Pepera, G. (2023). The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: A systematic review. Eur. J. Phys. Rehabil. Med., 59.","DOI":"10.23736\/S1973-9087.23.07773-0"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"28","DOI":"10.31083\/j.rcm2301028","article-title":"Epidemiology, risk factors and prognosis of cardiovascular disease in the Coronavirus Disease 2019 (COVID-19) pandemic era: A systematic review","volume":"23","author":"Pepera","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"(2021). American Diabetes Association. Standards of Medical Care in Diabetes-2021 Abridged for Primary Care Providers. Clin. Diabetes, 39, 14\u201343.","DOI":"10.2337\/cd21-as01"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1053\/rmed.2002.1462","article-title":"Reliability, repeatability and sensitivity to change of externally and self-paced walking tests in COPD patients","volume":"97","author":"Eiser","year":"2003","journal-title":"Respir. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2021). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care, 44, S15\u2013S33.","DOI":"10.2337\/dc21-S002"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.4067\/S0034-98872016000900009","article-title":"Validation of the Borg scale in participants with type 2 diabetes mellitus","volume":"144","author":"Rosales","year":"2016","journal-title":"Rev. Med. Chil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1097\/MBP.0000000000000302","article-title":"Validation of the Microlife BP A3 PC upper arm blood pressure monitor in patients with diabetes mellitus according to the ANSI\/AAMI\/ISO 81060-2: 2013 protocol","volume":"23","author":"Beime","year":"2018","journal-title":"Blood Press. Monit."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.physio.2011.08.005","article-title":"Influence of step length on 6-minute walk test performance in patients with chronic heart failure","volume":"98","author":"Pepera","year":"2012","journal-title":"Physiotherapy"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S1836-9553(13)70181-4","article-title":"Course length of 30 metres versus 10 metres has a significant influence on six-minute walk distance in patients with COPD: An experimental crossover study","volume":"59","author":"Beekman","year":"2013","journal-title":"J. Physiother."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1183\/09031936.00150314","article-title":"An official European Respiratory Society\/American Thoracic Society technical standard: Field walking tests in chronic respiratory disease","volume":"44","author":"Holland","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"1","author":"Bland","year":"1986","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"286","DOI":"10.4187\/respcare.01922","article-title":"Assessing exercise capacity using telehealth: A feasibility study in adults with cystic fibrosis","volume":"58","author":"Cox","year":"2013","journal-title":"Respir. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1177\/1357633X16634258","article-title":"Assessing functional exercise capacity using telehealth: Is it valid and reliable in patients with chronic heart failure?","volume":"23","author":"Hwang","year":"2017","journal-title":"J. Telemed. Telecare"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"105","DOI":"10.4314\/ahs.v21i1.15","article-title":"Comparison of heart rate response and heart rate recovery after step test among smoker and non-smoker athletes","volume":"21","author":"Pepera","year":"2021","journal-title":"Afr. Health Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.3109\/09638288.2014.956815","article-title":"The 6-minute walk distance cannot be accurately assessed at home in people with COPD","volume":"37","author":"Holland","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S0168-8227(03)00064-0","article-title":"Evaluation of physical fitness in patients with Type 2 diabetes mellitus","volume":"60","author":"Ozcan","year":"2003","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1111\/dme.13032","article-title":"Can a simple test of functional capacity add to the clinical assessment of diabetes?","volume":"33","author":"Stewart","year":"2016","journal-title":"Diabet. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1111\/j.1464-5491.2005.01627.x","article-title":"A systematic review of telemedicine interventions to support blood glucose self-monitoring in diabetes","volume":"22","author":"Farmer","year":"2005","journal-title":"Diabet. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1748-5908-2-14","article-title":"The use of telehealth for diabetes management: A qualitative study of telehealth provider perceptions","volume":"2","author":"Hopp","year":"2007","journal-title":"Implement. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Antoniou, V., Davos, C., Kapreli, E., Batalik, L., Panagiotakos, D., and Pepera, G. (2022). Effectiveness of home-based cardiac rehabilitation, using wearable sensors, as a multicomponent, cutting-edge intervention: A systematic review and meta-analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133772"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ijcard.2022.08.055","article-title":"Cardiac telerehabilitation improves lipid profile in the long term: Insights and implications","volume":"367","author":"Batalik","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e059945","DOI":"10.1136\/bmjopen-2021-059945","article-title":"Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: The TELEWEAR-CR study protocol","volume":"12","author":"Antoniou","year":"2023","journal-title":"BMJ Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.pcd.2019.03.007","article-title":"Effect of tele-rehabilitation on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes: A double blind randomized controlled trial","volume":"13","author":"Duruturk","year":"2019","journal-title":"Prim. Care Diabetes"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2471\/BLT.19.250068","article-title":"Telemedicine to deliver diabetes care in low- and middle-income countries: A systematic review and meta-analysis","volume":"99","author":"Correia","year":"2021","journal-title":"Bull. World Health Organ."},{"key":"ref_48","first-page":"783","article-title":"The six-minute walk test","volume":"48","author":"Enright","year":"2003","journal-title":"Respir. Care"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.gaitpost.2008.09.002","article-title":"Does walking strategy in older people change as a function of walking distance?","volume":"29","author":"Najafi","year":"2009","journal-title":"Gait. Posture"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Annegarn, J., Spruit, M.A., Savelberg, H.H.C.M., Willems, P.J.B., Van De Bool, C., Schols, A.M.W.J., Wouters, E.F.M., and Meijer, K. (2012). Differences in walking pattern during 6-min walk test between patients with COPD and healthy subjects. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0037329"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/02701367.2008.10599489","article-title":"Walkway length determination for steady state walking in young and older adults","volume":"79","author":"Macfarlane","year":"2008","journal-title":"Res. Q. Exerc. Sport."},{"key":"ref_52","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":"ref_53","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/00008483-200103000-00005","article-title":"Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years","volume":"21","author":"Gibbons","year":"2001","journal-title":"J. Cardiopulm. Rehabil."},{"key":"ref_54","first-page":"1124","article-title":"Knowledge of Cardiopulmonary Resuscitation among Greek physiotherapists","volume":"89","author":"Pepera","year":"2020","journal-title":"Monaldi. Arch. Chest Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.hrtlng.2022.04.016","article-title":"Safety of home-based cardiac rehabilitation: A systematic review","volume":"55","author":"Stefanakis","year":"2022","journal-title":"Heart Lung"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/3\/1354\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:15:40Z","timestamp":1760120140000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/3\/1354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,25]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["s23031354"],"URL":"https:\/\/doi.org\/10.3390\/s23031354","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,25]]}}}