Reference equation for the six-minute walk test in healthy Chilean children: a secondary analysis
DOI:
https://doi.org/10.47197/retos.v70.114154Keywords:
Adolescent, child, physical fitness, reference values, walk testAbstract
Introduction: Various studies conducted in Chile have published reference equations for distance walked (6MWD) during the six-minute walk test (6MWT) in healthy Chilean children; however, their accuracy remains low.
Objective: To develop new reference equations to determine if a constant stimulation protocol allows a more accurate prediction of 6MWD in the 6MWT in the Chilean pediatric population. Secondly, to construct normality curves of the physiological response to 6MWT.
Methodology: We performed a post-hoc analysis of an observational study that included 294 children aged 6 to 14 from the Metropolitan Region, Chile, subjected to a constant stimulation protocol. Children with abnormal BMI and missing data were excluded. A multiple linear regression analysis was performed to develop reference equations, and normality curves were constructed for the percentage of the heart rate reserve (%HRR) used.
Results: 200 (68%) children were included, and 117 (59%) were female. The 6MWD can be predicted with the following equation: 626.42 x height (meters) + 10.75 x age (years) - 6.03 x weight (kg) - 54.97 (R2 43.75%). In addition, normality curves were presented for the %HRR used by determining the 5th, 10th, 25th, 50th, 50th, 75th, 90th, and 95th percentiles.
Conclusions: The equation proposed by this study predicts 6MWD in 6MWT in healthy Chilean children between six and 14 years of age with better accuracy compared to equations published so far. Future studies should incorporate a validation cohort to improve the validity of the results.
References
Agarwala, P., & Salzman, S. H. (2020). Six-Minute Walk Test. Chest, 157(3), 603–611. https://doi.org/10.1016/j.chest.2019.10.014
Ajnakina, O., Agbedjro, D., McCammon, R., Faul, J., Murray, R. M., Stahl, D., & Steptoe, A. (2021). Devel-opment and validation of prediction model to estimate 10-year risk of all-cause mortality using modern statistical learning methods: a large population-based cohort study and external vali-dation. BMC Medical Research Methodology, 21(1), 8. https://doi.org/10.1186/s12874-020-01204-7
Alarcón Vásquez, D., Llantén Poblete, R., & Herrera Romero, M. (2006). Valores normales de los indi-cadores del test de marcha 6 minutos, según el protocolo de la ATS, en niños normopeso de en-tre 6 y 14 años, de la provincia de Talagante. Universidad de Chile. https://repositorio.uchile.cl/handle/2250/110642
ATS Statement. (2002). American Journal of Respiratory and Critical Care Medicine, 166(1), 111–117. https://doi.org/10.1164/ajrccm.166.1.at1102
Bekendam, M. T., Mommersteeg, P. M. C., Kop, W. J., Widdershoven, J. W., & Vermeltfoort, I. A. C. (2021). Anxiety and hemodynamic reactivity during cardiac stress testing: The role of gender and age in myocardial ischemia. Journal of Nuclear Cardiology, 28(6), 2581–2592. https://doi.org/10.1007/s12350-020-02079-3
de Assis Pereira Cacau, L., Carvalho, V. O., dos Santos Pin, A., Araujo Daniel, C. R., Ykeda, D. S., de Car-valho, E. M., Francica, J. V., Faria, L. M., Gomes-Neto, M., Fernandes, M., Velloso, M., Karsten, M., de Sá Barros, P., & de Santana-Filho, V. J. (2018). Reference Values for the 6-min Walk Distance in Healthy Children Age 7 to 12 Years in Brazil: Main Results of the TC6minBrasil Multi-Center Study. Respiratory Care, 63(3), 339–346. https://doi.org/10.4187/respcare.05686
Elpern, E. H., Stevens, D., & Kesten, S. (2000). Variability in Performance of Timed Walk Tests in Pul-monary Rehabilitation Programs. Chest, 118(1), 98–105. https://doi.org/10.1378/chest.118.1.98
Enright, P. L. (2003). The six-minute walk test. Respiratory care, 48(8), 783–785. https://www.liebertpub.com/doi/10.4187/respcare.03480783
Escobar-Cabello, M., López, A., Véliz, C., Crisóstomo, S., & Pinochet, R. (2001). Test de Marcha en 6 Minutos en Niños Chilenos Sanos. Kinesiología, 62, 16–20. https://www.researchgate.net/publication/285323325_Test_de_marcha_en_6_minutos_en_ninos_chilenos_sanos
Gatica, D., Puppo, H., Villarroel, G., San Martín, I., Lagos, R., Montecino, J. J., Lara, C., & Zenteno, D. (2012a). Valores de referencia del test de marcha de seis minutos en niños sanos. Revista mé-dica de Chile, 140(8), 1014–1021. https://doi.org/10.4067/S0034-98872012000800007
Gehringer, C. K., Martin, G. P., Van Calster, B., Hyrich, K. L., Verstappen, S. M. M., & Sergeant, J. C. (2024). How to develop, validate, and update clinical prediction models using multinomial lo-gistic regression. Journal of Clinical Epidemiology, 174, 111481. https://doi.org/10.1016/j.jclinepi.2024.111481
Goemans, N., Klingels, K., van den Hauwe, M., Boons, S., Verstraete, L., Peeters, C., Feys, H., & Buyse, G. (2013). Six-Minute Walk Test: Reference Values and Prediction Equation in Healthy Boys Aged 5 to12 Years. PLoS ONE, 8(12), e84120. https://doi.org/10.1371/journal.pone.0084120
Hamilton, D. M., & Haennel, R. G. (2000). Validity and Reliability of the 6-Minute Walk Test in a Cardiac Rehabilitation Population. Journal of Cardiopulmonary Rehabilitation, 20(3), 156–164. https://doi.org/10.1097/00008483-200005000-00003
Kervio, G., Carre, F., & Ville, N. (2003). Reliability and Intensity of the Six-Minute Walk Test in Healthy Elderly Subjects. Medicine & Science in Sports & Exercise, 35(1), 169–174. https://doi.org/10.1097/00005768-200301000-00025
Li, A. M., Yin, J., Au, J. T., So, H. K., Tsang, T., Wong, E., Fok, T. F., & Ng, P. C. (2007). Standard Reference for the Six-Minute-Walk Test in Healthy Children Aged 7 to 16 Years. American Journal of Res-piratory and Critical Care Medicine, 176(2), 174–180. https://doi.org/10.1164/rccm.200607-883OC
Li, A. M., Yin, J., Yu, C. C. W., Tsang, T., So, H. K., Wong, E., Chan, D., Hon, E. K. L., & Sung, R. (2005). The six-minute walk test in healthy children: reliability and validity. European Respiratory Journal, 25(6), 1057–1060. https://doi.org/10.1183/09031936.05.00134904
Matos Casano, H. A., & Anjum, F. (2024). Six-Minute Walk Test. In: StatPearls [Internet]. Treasure Is-land (FL): StatPearls Publishing; 2025 Jan. 2023 Aug 14.
Meys, R., Janssen, S. M. J., Franssen, F. M. E., Vaes, A. W., Stoffels, A. A. F., van Hees, H. W. H., van den Borst, B., Klijn, P. H., Burtin, C., van ’t Hul, A. J., & Spruit, M. A. (2023). Test-retest reliability, construct validity and determinants of 6-minute walk test performance in adult patients with asthma. Pulmonology, 29(6), 486–494. https://doi.org/10.1016/j.pulmoe.2022.10.011
Morales Mestre, N., Audag, N., Caty, G., & Reychler, G. (2018). Learning and Encouragement Effects on Six-Minute Walking Test in Children. The Journal of Pediatrics, 198, 98–103. https://doi.org/10.1016/j.jpeds.2018.02.073
O’Connor, P. J., Petruzzello, S. J., Kubitz, K. A., & Robinson, T. L. (1995). Anxiety responses to maximal exercise testing. British Journal of Sports Medicine, 29(2), 97–102. https://doi.org/10.1136/bjsm.29.2.97
Portela-Pino, I., López-Castedo, A., Martínez-Patiño, M. J., Valverde-Esteve, T., & Domínguez-Alonso, J. (2019). Gender Differences in Motivation and Barriers for The Practice of Physical Exercise in Adolescence. International Journal of Environmental Research and Public Health, 17(1), 168. https://doi.org/10.3390/ijerph17010168
Priesnitz, C. V., Rodrigues, G. H., da Silva Stumpf, C., Viapiana, G., Cabral, C. P., Stein, R. T., Marostica, P. J. C., & Donadio, M. V. F. (2009). Reference values for the 6‐min walk test in healthy children aged 6–12 years. Pediatric Pulmonology, 44(12), 1174–1179. https://doi.org/10.1002/ppul.21062
Ramspek, C. L., Jager, K. J., Dekker, F. W., Zoccali, C., & van Diepen, M. (2021). External validation of prognostic models: what, why, how, when and where? Clinical Kidney Journal, 14(1), 49–58. https://doi.org/10.1093/ckj/sfaa188
Rasekaba, T., Lee, A. L., Naughton, M. T., Williams, T. J., & Holland, A. E. (2009). The six‐minute walk test: a useful metric for the cardiopulmonary patient. Internal Medicine Journal, 39(8), 495–501. https://doi.org/10.1111/j.1445-5994.2008.01880.x
Rodríguez-Núñez, I., Mondaca, F., Casas, B., Ferreira, C., & Zenteno, D. (2018). Valores normales del test de marcha de 6 minutos en niños y adolescentes sanos: Una revisión sistemática y me-taanálisis. Revista chilena de pediatría, 89(1), 128–136. https://doi.org/10.4067/S0370-41062018000100128
Salazar, G., Vasquez, F., & Vasquez, S. (2024). Reference for the six minutes’ walk test for children 4 to 10 years old. Retos, 58, 176–181. https://doi.org/10.47197/retos.v58.105127
Ulrich, S., Hildenbrand, F. F., Treder, U., Fischler, M., Keusch, S., Speich, R., & Fasnacht, M. (2013). Ref-erence values for the 6-minute walk test in healthy children and adolescents in Switzerland. BMC Pulmonary Medicine, 13(1), 49. https://doi.org/10.1186/1471-2466-13-49
Uszko-Lencer, N. H. M. K., Mesquita, R., Janssen, E., Werter, C., Brunner-La Rocca, H.-P., Pitta, F., Wouters, E. F. M., & Spruit, M. A. (2017). Reliability, construct validity and determinants of 6-minute walk test performance in patients with chronic heart failure. International Journal of Cardiology, 240, 285–290. https://doi.org/10.1016/j.ijcard.2017.02.109
Vásquez-Gómez, J., Rojas Araya, L., & Castillo Retamal, M. (2018). La prueba de caminata de seis minu-tos relacionada con variables del estado nutricional, antropométricas y de actividad física en adolescentes chilenos. Revista Española de Nutrición Comunitaria, 24(4), 135–140. https://www.renc.es/imagenes/auxiliar/files/RENC_2018_4_02.pdf
Villamañán Montero, A., Martín de Vicente, C., García Íñiguez, J. P., & Ramos Fuentes, F. (2024). Refer-ence charts for the six-minute walk test in healthy school-aged children from the city of Zara-goza, Spain. Anales de Pediatría (English Edition), 101(4), 230–237. https://doi.org/10.1016/j.anpede.2024.09.002
WHO. (s. f.). Nutrition Landscape Information System (NLiS). https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=420. Recuperado 14 de diciembre de 2024, de https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=420
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Ruvistay Gutierrez-Arias, Celya Carrasco Fuentes, Jorge Farías Pavez, Máximo Escobar-Cabello
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
