BACKGROUND: The 6-min walk test (6MWT) has become an established measure for assessing exercise capacity in children with chronic diseases. However, little evidence has been provided regarding population-based normal data in healthy children. The main purpose of the study was to provide normative data in a large sample of children. METHODS: In this cross-sectional study, 4352 children between 11 and 14 years were recruited (66% girls). The main outcome measure was the distance walked for six minutes. Sex- and age-specific percentile values (5th, 15th, 25th, 50th, 75th, 85th and 95th) for the 6MWT were created and the differences and correlations were examined by the analysis of variance and Pearson's coefficient of correlation. RESULTS: The mean distance walked in 6 min was 576 ± 93 m in boys and 545 ± 92 m in girls, respectively. The mean walking speed for boys and girls was 98 ± 5 m/min and 91 ± 6 m/min. Older boys and girls performed better, compared to their younger counterparts (p for age < 0.001). The 6MWT was significantly correlated with age (r = 0.24, p < 0.001), height (r = 0.09, p < 0.001), weight (r = - 0.13, p < 0.001) and body-mass index (r = - 0.26, p < 0.001). CONCLUSIONS: This is the first population-based study aiming to provide normative data for the 6MWT in healthy children between 11 to 14 years. Children in lower percentiles are 'target groups' for special intervention aiming to enhance the performance.

Department of Educational Studies Faculty of Teacher Education University of Rijeka Rijeka Croatia

Department of General and Applied Kinesiology Faculty of Kinesiology University of Zagreb Horvaćanski zavoj 15 Zagreb Croatia

Department of Sport Motorics and Methodology in Kinanthropology Faculty of Sports Studies Masaryk University Brno Czech Republic

Recruitment and Examination Faculty of Science Masaryk University Brno Czech Republic

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Casanova C, Celli BR, Barria P, Casas A, Cote C, de Torres JP, et al. The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J. 2011;37(1):150–156. doi: 10.1183/09031936.00194909. PubMed DOI

Lammers AE, Hislop AA, Flynn Y, Haworth SG. The 6-minute walk test: normal values for children of 4–11 years of age. Arch Dis Child. 2008;93(6):464–468. doi: 10.1136/adc.2007.123653. PubMed DOI

Chetta A, Zanini A, Pisi G, Aiello M, Tzani P, Neri M, et al. Reference values for the 6-min walk test in healthy subjects 20–50 years old. Respir Med. 2006;100(9):1573–1578. doi: 10.1016/j.rmed.2006.01.001. PubMed DOI

Chen CA, Chang CH, Lin MT, Hua YC, Fang WQ, Wu MH, et al. Six-minute walking test: normal reference values for Taiwanese children and adolescents. Acta Cardiol Sin. 2015;31(3):193–201. PubMed PMC

Kanburoglu MK, Ozdemir FM, Ozkan S, Tunaoglu FS. Reference values of the 6-minute walk test in healthy Turkish children and adolescents between 11 and 18 years of age. Respir Care. 2014;59(9):1369–1375. doi: 10.4187/respcare.02891. PubMed DOI

Papathanasiou JV, Ilieva E, Marinov B. Six-minute walk test: an effective and necessary tool in modern cardiac rehabilitation. Hellenic J Cardiol. 2013;54(2):126–130. PubMed

Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, et al. The 6-min walk test: a quick measure of functional status in elderly adults. Chest. 2003;123(2):387–398. doi: 10.1378/chest.123.2.387. PubMed DOI

Casanova C, Cote C, de Torres JP, Aguirre-Jaime A, Marin JM, Pinto-Plata V, et al. Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(6):591–597. doi: 10.1164/rccm.200407-867OC. PubMed DOI

Pinto-Plata VM, Cote C, Cabral H, Taylor J, Celli BR. The 6-min walk distance: change over time and value as a predictor of survival in severe COPD. Eur Respir J. 2004;23(1):28–33. doi: 10.1183/09031936.03.00034603. PubMed DOI

Gulmans VA, van Veldhoven NH, de Meer K, Helders PJ. The six-minute walking test in children with cystic fibrosis: reliability and validity. Pediatr Pulmonol. 1996;22:85–89. doi: 10.1002/(SICI)1099-0496(199608)22:2<85::AID-PPUL1>3.0.CO;2-I. PubMed DOI

Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2000;161:487–492. doi: 10.1164/ajrccm.161.2.9906015. PubMed DOI

Nixon PA, Joswiak ML, Fricker FJ. A six-minute walk test for assessing exercise tolerance in severely ill children. J Pediatr. 1996;129:362–366. doi: 10.1016/S0022-3476(96)70067-7. PubMed DOI

Andrade LB, Silva DA, Salgado TL, Figueroa JN, Lucena-Silva N, Britto MC. Comparison of six-minute walk test in children with moderate/severe asthma with reference values for healthy children. J Pediatr. 2014;90(3):250–257. doi: 10.1016/j.jped.2013.08.006. PubMed DOI

Bartels B, de Groot JF, Terwee CB. The six-minute walk test in chronic pediatric conditions: a systematic review of measurement properties. Phys Ther. 2013;93(4):529–541. doi: 10.2522/ptj.20120210. PubMed DOI

Rhodes J, Tikkanen AU, Jenkins KJ. Exercise testing and training in children with congenital heart disease. Circulation. 2010;122(19):1957–1967. doi: 10.1161/CIRCULATIONAHA.110.958025. PubMed DOI

ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–7. PubMed

Cacau LA, de Santana-Filho VJ, Maynard LG, Gomes MN, Fernandes M, Carvalho VO. Reference values for the six-minute walk test in healthy children and adolescents: a systematic review. Braz J Cardiovasc Surg. 2016;31(5):381–388. PubMed PMC

Keppler SE, Muir N. Reference values on the 6-minute walk test for children living in the United States. Wolters Kluwer Health, Lippincott Williams & Wilkins and Section on Pediatrics of the American Physical Therapy Association. 2011:34–40. PubMed

Rahman SAA, Alnegimshi AA. Normative values of six-minute walk distance for healthy Saudi girls. World Appl Sci J. 2014;32(8):1721–1730.

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. Pediatr Pulmonol. 2009;44(4):316–324. doi: 10.1002/ppul.20942. PubMed DOI

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 Pulm Med. 2013;13:49. doi: 10.1186/1471-2466-13-49. PubMed DOI PMC

Priesnitz CV, Rodrigues GH, Stumpf Cda S, Viapiana G, Cabral CP, Stein RT, et al. Reference values for the 6-min walk test in healthy children aged 6–12 years. Pediatr Pulmonol. 2009;44(12):1174–1179. doi: 10.1002/ppul.21062. PubMed DOI

D’Silva C, Vaishali K, Venkatesan P. Six-minute walk test-normal values of school children aged 7–12 y in India: a cross-sectional study. Indian J Pediatr. 2012;79(5):597–601. doi: 10.1007/s12098-011-0559-x. PubMed DOI

Croatian Bureau of Statistics. First release of the basic schools; end of 2018/2019 school year and beginning of 2019/2020 school year. https://www.dzs.hr/Hrv_Eng/publication/2020/08-01-02_01_2020.htm. Assessed on March 12, 2021.

Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr. 1990;44(1):45–60. PubMed

Vandoni M, Correale L, Puci MV, Galvani C, Codella R, Togni F, et al. Six minute walk distance and reference values in healthy Italian children: A cross-sectional study. PLOS ONE. 2018;13(10):e0205792. doi: 10.1371/journal.pone.0205792. PubMed DOI PMC

Shoemaker MJ, Curtis AB, Vangsnes E, Dickinson MG. Clinically meaningful change estimates for the six-minute walk test and daily activity in individuals with chronic heart failure. Cardiopulm Phys Ther J. 2013;24(3):21–29. doi: 10.1097/01823246-201324030-00004. PubMed DOI PMC

Polkey MI, Spruit MA, Edwards LD, Watkins ML, Pinto-Plata V, Vestbo J, et al. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med. 2013;187(4):382–386. doi: 10.1164/rccm.201209-1596OC. PubMed DOI