Six-Minute Walk Test in Children and Adolescents

doi:10.1016/j.jpeds.2006.12.052

The Journal of Pediatrics

Volume 150, Issue 4, April 2007, Pages 395-399.e2

https://doi.org/10.1016/j.jpeds.2006.12.052 Get rights and content

Objective

To evaluate the 6-minute walking distance (6MWD) for healthy Caucasian children and adolescents of a population-based sample from the age of 3 to 18 years.

Study design

Two hundred and eighty boys and 248 girls completed a modified test, using a measuring wheel as incentive device.

Results

Median 6MWD increased from the age of 3 to 11 years in boys and girls alike and increased further with increasing age in boys (from 667.3 m to 727.6 m), whereas it essentially plateaued in girls (655.8 m to 660.9 m). After adjusting for age, height (P = .001 in boys and P < .001 in girls) remained independently correlated with the 6MWD. In the best fitting and most efficient linear and quadratic regression models, the variables age and height explained about 49% of the variability of the 6MWD in boys and 50% in girls.

Conclusion

This modified 6-minute walk test (6MWT) proved to be safe, easy to perform, and highly acceptable to children. It provides a simple and inexpensive means to measure functional exercise capacity in children, even of young age, and might be of value when conducting comparable studies.

Section snippets

Method

Subjects of this study were children of Caucasian ethnicity. The study was approved by the local university ethics committee and the institutional boards of the participating local schools and kindergartens. Informed consent was obtained from parents and subjects. The measuring wheels were commercially available (Nedo GmbH + Co. KG, Dornstetten, Germany). The handling bar of the measuring wheel was customized to three interchangeable different lengths (240 mm, 370 mm, 560 mm) to fit optimally

Results

Of the 640 intended participants, 280 boys and 248 girls completed the test (82.5%). The response rate varied from 39% in the group 3 to 5 years of age to 93% in 6 to 8 years, 99% in 9 to 11 years, 94% in 12 to 15 years, and 83% in ≥16 years of age. On the day of the test, three children had to be excluded after the physical examination because of acute infection. In no case was it necessary to stop the test prematurely, and there were no unexpected events during the tests. Anthropometric

Discussion

Weight correlates to the 6MWD in adults¹ but not in the children investigated. This might relate to the fact that the percentage of overweight children, according to age and sex-based BMI in our study sample was considerably lower (3.6%-5%) than the expected prevalence of 7% to 12%.11, 12, 13 As this test was voluntary, obese children might thus have refused to participate. Because of this potential bias this study group might not represent a “true” population sample. We also have incomplete

References (15)

P.A. Nixon et al.
A six-minute walk test for assessing exercise tolerance in severely ill children
J Pediatr
(1996)
P.L. Enright et al.
The 6-min walk test: a quick measure of functional status in elderly adults
Chest
(2003)
P.L. Enright
The six-minute walk test
Respir Care
(2003)
ATS Statement: Guidelines for the six-minute walk test
Am J Respir Crit Care Med
(2002)
V.A. Gulmans et al.
The six-minute walking distance in children with cystic fibrosis: reliability and validity
Pediatr Pulmonol
(1996)
M.T. Cunha et al.
Six-minute walk test in children and adolescents with cystic fibrosis
Pediatr Pulmonol
(2006)
E. Paap et al.
Physiologic response of the six-minute walk test in children with juvenile idiopathic arthritis
Arthritis Rheum
(2005)

There are more references available in the full text version of this article.

Cited by (457)

Characterizing ambulatory function in children with PPP2R5D-related neurodevelopmental disorder
2024, Gait and Posture
Individuals with PPP2R5D-related neurodevelopmental disorder have an atypical gait pattern characterized by ataxia and incoordination. Structured, quantitative assessments are needed to further understand the impact of these impairments on function.
How do gait parameters and ambulatory function of individuals with PPP2R5D-related neurodevelopmental disorder compare to age and sex matched healthy norms?
Twenty-six individuals with PPP2R5D pathogenic genetic variants participated in this observational, single visit study. Participants completed at least one of the following gait assessments: quantitative gait analysis at three different speeds (preferred pace walking (PPW), fast paced walking (FPW) and running, six-minute walk test (6MWT), 10-meter walk run (10MWR), and timed up and go (TUG). Descriptive statistics were used to summarize gait variables. Percent of predicted values were calculated using published norms. Paired t-tests and regression analyses were used to compare gait variables.
The median age of the participants was 8 years (range 4–27) and eighteen (69.2 %) were female. Individuals with PPP2R5D-related neurodevelopmental disorder walked slower and with a wider base of support than predicted for their age and sex. Stride velocity ranged from 48.9 % to 70.1 % and stride distance from 58.5 % to 81.9 % of predicted during PPW. Percent of predicted distance walked on the 6MWT ranged from 30.6 % to 71.1 % representing varied walking impairment. Increases in stride distance, not cadence, were associated with changes in stride velocity in FPW (R² = 0.675, p =< 0.001) and running conditions (R² = 0.918, p =< 0.001).
We quantitatively assessed the abnormal gait in individuals with PPP2R5D-related neurodevelopmental disorder. These impairments may affect ability to adapt to environmental changes and participation in daily life.
Rehabilitative interventions targeting gait speed and balance may improve function and safety for individuals with PPP2R5D-related neurodevelopmental disorder.
Long-term outcomes of pulmonary embolism in children and adolescents
2024, Blood
Knowledge regarding the long-term consequences of pulmonary embolism (PE) in children is limited. This cohort study describes the long-term outcomes of PE in children who were followed-up at a single-center institution using a local protocol that included clinical evaluation, chest imaging, echocardiography, pulmonary function tests, and cardiopulmonary exercise tests at follow-up, starting 3 to 6 months after acute PE. Children objectively diagnosed with PE at age 0 to 18 years, who had ≥6 months of follow-up were included. Study outcomes consisted of PE resolution, PE recurrence, death, and functional outcomes (dyspnea, impaired pulmonary or cardiac function, impaired aerobic capacity, and post-PE syndrome). The frequency of outcomes was compared between patients with/without underlying conditions. In total, 150 patients were included; median age at PE was 16 years (25th-75th percentile, 14-17 years); 61% had underlying conditions. PE did not resolve in 29%, recurrence happened in 9%, and death in 5%. One-third of patients had at least 1 documented abnormal functional finding at follow-up (ventilatory impairments, 31%; impaired aerobic capacity, 31%; dyspnea, 26%; and abnormal diffusing capacity of the lungs to carbon monoxide, 22%). Most abnormalities were transient. When alternative explanations for the impairments were considered, the frequency of post-PE syndrome was lower, ranging between 0.7% and 8.5%. Patients with underlying conditions had significantly higher recurrence, more pulmonary function and ventilatory impairments, and poorer exercise capacity. Exercise intolerance was, in turn, most frequently because of deconditioning than to respiratory or cardiac limitation, highlighting the importance of physical activity promotion in children with PE.
Considerations in Children and Adolescents Related to Coronavirus Disease 2019 (COVID-19)
2023, Physical Medicine and Rehabilitation Clinics of North America
Ferric Carboxymaltose Versus Ferrous Fumarate in Anemic Children with Inflammatory Bowel Disease: The POPEYE Randomized Controlled Clinical Trial
2023, Journal of Pediatrics
To determine whether intravenous (IV) or oral iron suppletion is superior in improving physical fitness in anemic children with inflammatory bowel disease (IBD).
We conducted a clinical trial at 11 centers. Children aged 8-18 with IBD and anemia (defined as hemoglobin [Hb] z-score < −2) were randomly assigned to a single IV dose of ferric carboxymaltose or 12 weeks of oral ferrous fumarate. Primary end point was the change in 6-minute walking distance (6MWD) from baseline, expressed as z-score. Secondary outcome was a change in Hb z-score from baseline.
We randomized 64 patients (33 IV iron and 31 oral iron) and followed them for 6 months. One month after the start of iron therapy, the 6MWD z-score of patients in the IV group had increased by 0.71 compared with −0.11 in the oral group (P = .01). At 3- and 6-month follow-ups, no significant differences in 6MWD z-scores were observed. Hb z-scores gradually increased in both groups and the rate of increase was not different between groups at 1, 3, and 6 months after initiation of iron therapy (overall P = .97).
In this trial involving anemic children with IBD, a single dose of IV ferric carboxymaltose was superior to oral ferrous fumarate with respect to quick improvement of physical fitness. At 3 and 6 months after initiation of therapy, no differences were discovered between oral and IV therapies. The increase of Hb over time was comparable in both treatment groups.
NTR4487 [Netherlands Trial Registry].
Clinical phenotypic spectrum of CTNNB1 neurodevelopmental disorder
2024, Clinical Genetics
Pediatric neurorehabilitation of functional gait disorders
2024, Monatsschrift fur Kinderheilkunde

View all citing articles on Scopus

: Supported in part by an unrestricted grant from Actelion Pharmaceuticals, Austria.

View full text

Original articleSix-Minute Walk Test in Children and Adolescents

Objective

Study design

Results

Conclusion

Section snippets

Method

Results

Discussion

J Pediatr

Chest

The six-minute walk test

Respir Care

ATS Statement: Guidelines for the six-minute walk test

Am J Respir Crit Care Med

The six-minute walking distance in children with cystic fibrosis: reliability and validity

Pediatr Pulmonol

Six-minute walk test in children and adolescents with cystic fibrosis

Pediatr Pulmonol

Physiologic response of the six-minute walk test in children with juvenile idiopathic arthritis

Arthritis Rheum

Original article
Six-Minute Walk Test in Children and Adolescents