Is the Six-minute Walk Test Still Reliable Compared to Cardiopulmonary Exercise Test for Exercise Capacity in Children with Congenital Heart Disease?

Objectives: We aimed to assess the validity of the six-minute walk test (6MWT) to reflect the functional capacity of children with congenital heart disease (CHD), evaluate a possible correlation between the 6MWT distance with cardiopulmonary exercise test (CPET) variables, as well as to find a cutoff value to stratification the physical fitness in this population.

Methods: We enrolled 459 children with CHD, 6-18 years old, who performed a complete CPET and 6MWT on the same day in a cross-sectional observational study. Correlations between variables of CPET and six-minute walking distance (6MWD) were analyzed and cutoff values of 6MWD were identified for the classification of the physical fitness in the population.

Results: The mean distance ambulated during the 6MWT was 578 ± 65 m, 590 ± 65 m for boys, and 562 ± 62 m for girls ( < 0.001). Both VO and %predicted VO showed a correlation with the 6MWT distance ( = 0.35,  < 0.001 and  = 0.51,  < 0.001, respectively), and an inverse correlation was found between VE/VCO2 slope and the 6MWT distance ( = -0.31;  < 0.001). There appeared to be a linear association between 6MWD and VO up to a 6MWD of approximately 600 m. We divided the population into 4 subgroups (boys <130 cm; boys ≥130 cm; girls <130 cm; girls ≥130 cm), and get the cutoff values (554 m, 617 m, 549 m, 587 m) respectively equivalent to 80% of predicted VO. The 6MWT distances of another 102 patients were applied for external verification of the cutoff values.

Conclusions: Our study provided evidence on when a 6MWT should be considered as a convincing complementary test in the pediatric population with CHD and explored the classification of exercise tolerance using a 6MWD value. The cut-off values for 6MWD may be qualified as an intervention target for exercise rehabilitation.