title: Six-minute walk test in systemic sclerosis: A systematic review and meta-analysis.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) are the leading causes of death in systemic sclerosis (SSc). Although the six-minute walk test (6MWT) is generally used for evaluating PAH and ILD, utility in SSc is undetermined. This study evaluates the role of 6MWT in SSc by systematic review and meta-analysis.
  
  
  METHODS
  A systematic literature search on PubMed, Web of Science and Cochrane Library Online was performed using the medical subject heading search terms for "systemic sclerosis", "CREST" and "six minute walk test", "six minute walk distance (6MWD)", "(cardiopulmonary) exercise test", "treadmill test" or "step test".
  
  
  RESULTS
  Meta-analysis of 43 included studies (3185 SSc-all patients) revealed that the mean 6MWD was comparable between the SSc-PAH and SSc-ILD-PH subgroups (288m [95% CI: 259-317m] vs 286m [95% CI: 259-314m], p=0.93). The pooled mean of 725 SSc-PAH patients was significantly lower than the pooled mean of 413 SSc-noPAH patients (430m [95% CI: 402-458m], p<0.001). 95 SSc-ILD-PH patients walked significantly less than 328 SSc-ILD patients (388m [95% CI: 362-415m], p<0.001) and significantly less than 86 SSc-noILD patients (420m [95% CI: 325-515m], p=0.008). 81-98% of the SSc-PAH/ILD/ILD-PH patients performed a 6MWT.
  
  
  CONCLUSIONS
  During a 6MWT, SSc-PAH patients walk less than SSc-noPAH patients and SSc-ILD-PH patients walk less than SSc-ILD and SSc-noILD patients.
authors.affiliation: Department of Cardiology, Ghent University Hospital, Ghent, Belgium. Electronic address: els.vandecasteele@ugent.be.
authors.forename: Els
authors.initials: E
authors.lastname: Vandecasteele
authors.affiliation: Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: De Pauw
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: De Keyser
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.
authors.forename: Saskia
authors.initials: S
authors.lastname: Decuman
authors.affiliation: Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Ellen
authors.initials: E
authors.lastname: Deschepper
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Yves
authors.initials: Y
authors.lastname: Piette
authors.affiliation: Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Brusselle
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications / Q000503:physiopathology*; D000070857:Walk Test / Q000379:methods*
keywords: Exercise testing; Interstitial lung disease; Pulmonary arterial hypertension; Six-minute walk test; Systemic sclerosis