Predictive Equation for Six-minute Walk Test in Indian Children, Adolescents, and Adults

Overview

Journal Lung India

Specialty Pulmonary Medicine

Date 2023 Apr 3

PMID 37006098

Authors

Bela Agarwal

Monal Shah

Bhoomika Sawant

Hiranmayee Bagwe

Payal Murkudkar

Rajani Mullerpatan

Affiliations

Soon will be listed here.

Abstract

Background: Post-COVID residual dysfunction has been observed in a majority of people, with reduction in cardiopulmonary endurance emerging as a primary symptom. The Six-Minute Walk Test is a simple, reliable, and valid test that is used routinely on people with chronic respiratory dysfunction. In the current COVID-19 pandemic situation, reference values and a predictive equation developed from a large sample across a large age group, from 6 to 75 years, will enable one to establish goals of treatment for post-COVID rehabilitation.

Methods: Following institutional ethical clearance, we recruited 1369 participants for the study (685 females and 684 males). Participants were classified according to biological age into group 1 (6-12 years), group 2 (13-17 years), group 3 (18-40 years), group 4 (41-65 years), and group 5 (>65 years). Informed consent was sought and participants were screened using a health history questionnaire. Demographic features, namely, age, height, weight, and body mass index (BMI) were noted. The Six-Minute Walk Test was administered as per ATS guidelines. Clinical parameters, namely, pulse rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and rate of perceived exertion were recorded.

Results: The Six-Minute Walk Test (6MWT) was significantly influenced by age and gender (r = 0.257, P = 0.00 and r = 0.501, P = 0.00, respectively). Walking distance was longest in 13-17-year-old males, whereas females demonstrated a linear decline after 12 years. In each age group, males walked a greater distance than females. Stepwise linear regression analysis was used to derive the following predictive equation: 6MWT = 491.93 - (2.148 × age) + (107.07 × gender) (females = 0, males = 1).

Conclusion: The study confirmed variability of the Six-Minute Walk Test, with age and gender being predominant predictors. Reference values, equations, and percentile charts generated from the study can be utilised to guide clinical decision-making while exercise prescription for patients with post COVID dysfunction.

Citing Articles

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Developing normative values and predictive models for the 6-minute walk test across diverse adolescent developmental stages.

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References

Guazzi M, Dickstein K, Vicenzi M, Arena R . Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: a comparative analysis on clinical and prognostic insights. Circ Heart Fail. 2009; 2(6):549-55. DOI: 10.1161/CIRCHEARTFAILURE.109.881326. View

Pappachan M . Increasing prevalence of lifestyle diseases: high time for action. Indian J Med Res. 2011; 134:143-5. PMC: 3181012. View

Jenkins S, Cecins N, Camarri B, Williams C, Thompson P, Eastwood P . Regression equations to predict 6-minute walk distance in middle-aged and elderly adults. Physiother Theory Pract. 2009; 25(7):516-22. DOI: 10.3109/09593980802664711. View

Fernandes L, Mesquita A, Vadala R, Dias A . Reference Equation for Six Minute Walk Test in Healthy Western India Population. J Clin Diagn Res. 2016; 10(5):CC01-4. PMC: 4948381. DOI: 10.7860/JCDR/2016/17643.7714. View

Pandit R, Vaity C, Mulakavalupil B, Matthew A, Sabnis K, Joshi S . Unmasking Hypoxia in COVID 19 - Six Minute Walk Test. J Assoc Physicians India. 2020; 68(9):50-51. View

Rejbi I, Trabelsi Y, Chouchene A, Ben Turkia W, Ben Saad H, Zbidi A . Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects. Int J Chron Obstruct Pulmon Dis. 2010; 5:209-15. PMC: 2921688. DOI: 10.2147/copd.s7955. View

Singh S, Puhan M, Andrianopoulos V, Hernandes N, Mitchell K, Hill C . An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014; 44(6):1447-78. DOI: 10.1183/09031936.00150414. View

Mandic S, Walker R, Stevens E, Nye E, Body D, Barclay L . Estimating exercise capacity from walking tests in elderly individuals with stable coronary artery disease. Disabil Rehabil. 2013; 35(22):1853-8. DOI: 10.3109/09638288.2012.759629. View

Vaish H, Ahmed F, Singla R, Shukla D . Reference equation for the 6-minute walk test in healthy North Indian adult males. Int J Tuberc Lung Dis. 2013; 17(5):698-703. DOI: 10.5588/ijtld.12.0474. View

10.

Zou H, Zhu X, Zhang J, Wang Y, Wu X, Liu F . Reference equations for the six-minute walk distance in the healthy Chinese population aged 18-59 years. PLoS One. 2017; 12(9):e0184669. PMC: 5598997. DOI: 10.1371/journal.pone.0184669. View

11.

Vittori A, Lerman J, Cascella M, Gomez-Morad A, Marchetti G, Marinangeli F . COVID-19 Pandemic Acute Respiratory Distress Syndrome Survivors: Pain After the Storm?. Anesth Analg. 2020; 131(1):117-119. PMC: 7199772. DOI: 10.1213/ANE.0000000000004914. View

12.

Chetta A, Zanini A, Pisi G, Aiello M, Tzani P, Neri M . Reference values for the 6-min walk test in healthy subjects 20-50 years old. Respir Med. 2006; 100(9):1573-8. DOI: 10.1016/j.rmed.2006.01.001. View

13.

Casanova C, Celli B, Barria P, Casas A, Cote C, de Torres J . The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J. 2010; 37(1):150-6. DOI: 10.1183/09031936.00194909. View

14.

Hill K, Wickerson L, Woon L, Heidar Abady A, Overend T, Goldstein R . The 6-min walk test: responses in healthy Canadians aged 45 to 85 years. Appl Physiol Nutr Metab. 2011; 36(5):643-9. DOI: 10.1139/h11-075. View

15.

Holland A, Spruit M, Troosters T, Puhan M, Pepin V, Saey D . An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014; 44(6):1428-46. DOI: 10.1183/09031936.00150314. View

16.

Grundtvig M, Eriksen-Volnes T, Orn S, Slind E, Gullestad L . 6 min walk test is a strong independent predictor of death in outpatients with heart failure. ESC Heart Fail. 2020; 7(5):2904-2911. PMC: 7524091. DOI: 10.1002/ehf2.12900. View

17.

Dourado V . [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.]. Arq Bras Cardiol. 2011; . View

18.

Osses A R, Yanez V J, Barria P P, Palacios M S, Dreyse D J, Diaz P O . [Reference values for the 6-minutes walking test in healthy subjects 20-80 years old]. Rev Med Chil. 2011; 138(9):1124-30. DOI: /S0034-98872010000900006. View

19.

Alameri H, Al-Majed S, Al-Howaikan A . Six-min walk test in a healthy adult Arab population. Respir Med. 2009; 103(7):1041-6. DOI: 10.1016/j.rmed.2009.01.012. View

20.

. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-7. DOI: 10.1164/ajrccm.166.1.at1102. View