Evaluation of Validity and Reliability of Diagnostic 6 Minute Walk Test (6MWT) in the Measurment of Cardio-Respiratory Efficiency with Gass Exchage Analysis in Boys

Document Type : Original Article


1 PhD Student of Physical Education and Sport Sciences.Department of Sport Physiology, Section of Health Science, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamedan, Iran.

2 Professor of Sport Physiology Physical activity. Department of Sport Physiology, Section of Health Science, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamedan, Iran.


Background  and  Objective: Application of standard field tests for measurement of the physiological abilities of elite athletes, clinical conditions and/or diseases rehabilitations, can be as an outstanding tool for cardiorespiratory fitness evaluation. The aim of this study was to evaluate validity and reproducibility of the 6 minute walk test (6MWT) in healthy children and adolescent boys.
Subjects  and  Methods: Actual peak oxygen uptake (VO2peak) was measured in modified Buruce protocol with gass exchange analysis in 349 healthy boys (8-17 yrs). Six- minute walk distance (6MWD) and anthropometric variables were measured with standard methods. Pearson correlation and intraclass correlation coefficient (ICC) were used to assess concurrent validity and reproducibility of the 6MWT respectively.
Results: Concurrent validity of the 6MWT was confirmed by good correlation between 6MWD and VO2peak (r=0.638, p<0.001). Using partial correlation controlling for age, this correlation increased (r=0.733, p<0.001). Reproducibility of the 6MWT was demonstrated by ICC of 98% in first and second 6MWT (687±77 and 700±78 and mean diff : 14 m respectively).
Conclusion: This is the first study about validity and reproducibility of the 6MWT in Iranian boys. With application of the 6MWT, physicians, physical therapists exercise coaches will receive a simple, inexpensive and safe assessment tool to evaluate functional exercise capacity in healthy and sick children and adolescents.


1-Bartels B, de Groot JF, Terwee CB. The six-minute walk test in chronic pediatric conditions: a systematic review of measurement properties. Physical therapy. 2013 Apr;93(4):529-41. PubMed PMID: 23162042. Epub 2012/11/20. Eng.
2-Oliveira MF, Zanussi G, Sprovieri B, Lobo DM, Mastrocolla LE, Umeda, II, et al. Alternatives to Aerobic Exercise Prescription in Patients with Chronic Heart Failure. Arquivos brasileiros de cardiologia. 2016 Feb;106(2):97-104. PubMed PMID: 26815313. Pubmed Central PMCID: PMC4765007. Epub 2016/01/28. Eng Por.
3-Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest. 2001 Jan;119(1):256-70. PubMed PMID: 11157613. Epub 2001/02/07. Eng.
4-Papathanasiou JV, Ilieva E, Marinov B. Six-minute walk test: an effective and necessary tool in modern cardiac rehabilitation. Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese. 2013 Mar-Apr;54(2):126-30. PubMed PMID: 23557612. Epub 2013/04/06. Eng.
5-Nixon PA, Joswiak ML, Fricker FJ. A six-minute walk test for assessing exercise tolerance in severely ill children. The Journal of pediatrics. 1996 Sep;129(3):362-6. PubMed PMID: 8804324. Epub 1996/09/01. Eng.
6-ATS statement: guidelines for the six-minute walk test. American journal of respiratory and critical care medicine. 2002 Jul 1;166(1):111-7. PubMed PMID: 12091180. Epub 2002/07/02. Eng.
7-Takken T, Engelbert R, van Bergen M, Groothoff J, Nauta J, van Hoeck K, et al. Six-minute walking test in children with ESRD: discrimination validity and construct validity. Pediatric nephrology (Berlin, Germany). 2009 Nov;24(11):2217-23. PubMed PMID: 19633871. Pubmed Central PMCID: PMC2753769. Epub 2009/07/28. Eng.
8-Chuang ML, Lin IF, Wasserman K. The body weight-walking distance product as related to lung function, anaerobic threshold and peak VO2 in COPD patients. Respiratory medicine. 2001 Jul;95(7):618-26. PubMed PMID: 11453321. Epub 2001/07/17. Eng.
9-Boucault R, Fernandes M, Oliveira Carvalho V. Six-minute walking test in children. Disability and rehabilitation. 2013 Aug;35(18):1586-7. PubMed PMID: 23294465. Epub 2013/01/09. Eng.
10-Cruz-Anleu ID, Banos-Mejia BO, Galicia-Amor S. [Six-minute walk test in children with neuromuscular disease.]. Revista medica del Instituto Mexicano del Seguro Social. 2013 November-December;51(6):674-9. PubMed PMID: 24290021. Epub 2013/12/03. Prueba de marcha de seis minutos en ninos con enfermedad neuromuscular. Spa.
11-Du H, Newton PJ, Salamonson Y, Carrieri-Kohlman VL, Davidson PM. A review of the six-minute walk test: its implication as a self-administered assessment tool. European journal of cardiovascular nursing. 2009;8(1):2-8.
12-Salzman SH. The 6-min walk test: clinical and research role, technique, coding, and reimbursement. Chest. 2009 May;135(5):1345-52. PubMed PMID: 19420202. Epub 2009/05/08. Eng.
13-Enright PL. The six-minute walk test. Respiratory care. 2003 Aug;48(8):783-5. PubMed PMID: 12890299. Epub 2003/2/8 Eng.
14-Hinkle DE, Wiersma W, Jurs SG. Applied statistics for the behavioral sciences. 2003.
15-Gulmans VA, van Veldhoven NH, de Meer K, Helders PJ. The six-minute walking test in children with cystic fibrosis: reliability and validity. Pediatric pulmonology. 1996 Aug;22(2):85-9. PubMed PMID: 8875580. Epub 1996/08/01. Eng.
16-Morinder G, Mattsson E, Sollander C, Marcus C, Larsson UE. Six-minute walk test in obese children and adolescents: reproducibility and validity. Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2009 Jun;14(2):91-104. PubMed PMID: 19003813. Epub 2008/11/13. Eng.
17-Li AM, Yin J, Yu CC, Tsang T, So HK, Wong E, et al. The six-minute walk test in healthy children: reliability and validity. The European respiratory journal. 2005 Jun;25(6):1057-60. PubMed PMID: 15929962. Epub 2005/06/03. Eng.
18-Moalla W, Gauthier R, Maingourd Y, Ahmaidi S. Six-minute walking test to assess exercise tolerance and cardiorespiratory responses during training program in children with congenital heart disease. International journal of sports medicine. 2005;26(09):756-62.
19-Vanhelst J, Fardy PS, Salleron J, Béghin L. The six-minute walk test in obese youth: reproducibility, validity, and prediction equation to assess aerobic power. Disability and rehabilitation. 2013;35(6):479-82.
20-Tabachnick BG, Fidell LS, Osterlind SJ. Using multivariate statistics. 2001.
21-Medicine ACoS. ACSM's health-related physical fitness assessment manual: Lippincott Williams & Wilkins; 2013.
22-Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology. 2001 Jan;37(1):153-6. PubMed PMID: 11153730. Epub 2001/01/12. Eng.
23-Winter EM, Jones AM, Davison RR, Bromley PD, Mercer TH. Sport and Exercise Physiology Testing Guidelines: Volume I–Sport Testing: The British Association of Sport and Exercise Sciences Guide: Routledge; 2006.
24-Rostagno C, Gensini GF. Six minute walk test: a simple and useful test to evaluate functional capacity in patients with heart failure. Internal and emergency medicine. 2008 Sep;3(3):205-12. PubMed PMID: 18299800. Epub 2008/02/27. Eng.
25-Geiger R, Strasak A, Treml B, Gasser K, Kleinsasser A, Fischer V, et al. Six-minute walk test in children and adolescents. The Journal of pediatrics. 2007 Apr;150(4):395-9, 9.e1-2. PubMed PMID: 17382117. Epub 2007/03/27. Eng.
26-Li AM, Yin J, Au JT, So HK, Tsang T, Wong E, et al. Standard reference for the six-minute-walk test in healthy children aged 7 to 16 years. American journal of respiratory and critical care medicine. 2007 Jul 15;176(2):174-80. PubMed PMID: 17463419. Epub 2007/04/28. Eng.
27-Saad HB, Prefaut C, Missaoui R, Mohamed IH, Tabka Z, Hayot M. Reference equation for 6‐min walk distance in healthy North African children 6–16 years old. Pediatric pulmonology. 2009;44(4):316-24.
28-Ulrich S, Hildenbrand FF, Treder U, Fischler M, Keusch S, Speich R, et al. Reference values for the 6-minute walk test in healthy children and adolescents in Switzerland. BMC pulmonary medicine. 2013;13(1):1.
29-Lammers AE, Hislop AA, Flynn Y, Haworth SG. The 6-minute walk test: normal values for children of 4–11 years of age. Archives of disease in childhood. 2008;93(6):464-8.
30-Dourado VZ. [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.]. Arquivos brasileiros de cardiologia. 2011 Feb 25. PubMed PMID: 21359481. Epub 2011/03/02. Equacoes de Referencia para o Teste de Caminhada de Seis Minutos em Individuos Saudaveis. Por.
31-Loftin M, Sothern M, Abe T, Bonis M. Expression of VO2peak in Children and Youth, with Special Reference to Allometric Scaling. Sports Medicine. 2016;46(10):1451-60.
32-Goemans N, Klingels K, van den Hauwe M, Van Orshoven A, Vanpraet S, Feys H, et al. Test-retest reliability and developmental evolution of the 6-min walk test in Caucasian boys aged 5-12 years. Neuromuscular disorders : NMD. 2013 Jan;23(1):19-24. PubMed PMID: 23137525. Epub 2012/11/10. Eng.