A Practical Cardiovascular Health Assessment for Manual Wheelchair Users During the 6-Minute Push Test

Abstract

Traditional VO_2max testing methods are often impractical for manual wheelchair users, as they rely on lower-body exercise protocols, require specialized equipment, and trained personnel. The 6-Minute Push Test (6MPT) is a widely used cardiovascular assessment that may provide a feasible alternative for estimating aerobic capacity in this population. This study aimed to develop a predictive model for VO_2max using physiological variables recorded during the 6MPT. Twenty-eight participants (14 novice and 14 expert manual wheelchair users) completed the test while wearing a VO₂ mask and heart rate monitor. Spearman correlation analysis showed that distance covered during the 6MPT significantly correlated with VO_2max (r = 0.685, p < 0.001). A stepwise linear regression identified two predictive models: one using distance alone (R² = 0.416, p < 0.001) and another incorporating both distance and maximum heart rate (R² = 0.561, p < 0.001). These models offer practical estimations of VO_2max, eliminating separate protocols. Our findings suggest that the 6MPT can serve as a simple, cost-effective alternative to laboratory-based VO₂ testing, facilitating routine cardiovascular fitness assessments for manual wheelchair users in clinical and community settings. Future research should focus on validating these models in a larger, more diverse cohort to enhance their generalizability.

Keywords: 6-Minute Push Test; VO2max; cardiovascular assessment; cardiovascular health; heart rate; manual wheelchair users; oxygen consumption; physical exertion.

Figure 1

(a) Laboratory wheelchair used by a participant wearing a VO₂ mask and heart rate monitor; (b) screenshot of the VO₂ Master Manager phone application used to collect data from both sensors.

Figure 2

6-Minute Push Test Setup: 30 m long hallway marked with 2 cones. Participants began on one end and pushed themselves around the cones as many times as possible in 6 min.

Figure 3

VO₂ and heart rate data for two participants, both with a reported rate of perceived exertion (RPE) of 8: (a) expert, on the left; (b) novice, on the right, showing much lower VO₂ values and slower increases in both heart rate and VO₂, possibly due to a lower propulsion skill level.