Six-minute walk test in children and adolescents with renal diseases: tolerance, reproducibility and comparison with healthy subjects

Abstract

OBJECTIVES:To evaluate exercise tolerance and the reproducibility of the six-minute walk test in Brazilian children and adolescents with chronic kidney disease and to compare their functional exercise capacities with reference values for healthy children.METHODS:This cross-sectional study assessed the use of the six-minute walk test in children and adolescents aged 6-16 with stage V chronic kidney disease. For statistical analysis of exercise tolerance, including examinations of correlations and comparisons with reference values, the longest walked distances were considered. The reproducibility of the six-minute walk test was assessed using intraclass correlation coefficients.RESULTS:A total of 38 patients (14 females and 24 males) were evaluated, including 5 on peritoneal dialysis, 12 on hemodialysis and 21 who had undergone renal transplantation, with a median age of 11.2 years (6.5-16). The median walked distance was 538.5 meters (413-685) and the six-minute walk test was found to be reproducible. The walked distance was significantly correlated with age (r=0.66), weight (r=0.76), height (r=0.82), the height Z score (r=0.41), hemoglobin (r=0.46), hematocrit (r=0.47) and post-test systolic blood pressure (r=0.39). The chronic kidney disease patients predicted walked distance was 84.1% of the reference value according to age, 90.6% according to age-corrected height and 87.4% according to a predictive equation.CONCLUSIONS:The stage V chronic kidney disease patients had a significantly decreased functional exercise capacity, as measured by the six-minute walk test, compared with the healthy pediatric reference values. In addition, the six-minute walk test was shown to be well tolerated, reliable and applicable as a low-cost tool to monitor functional exercise capacity in patients with renal disease.

Reference values for the six-minute walk test in Nigerian adolescents aged 10 to 18 years

“…It evaluates the global and integrated responses of the pulmonary, cardiovascular and muscular components and reflects the functional exercise level for daily physical activities (8). Several studies have demonstrated its usefulness in children and it has become part of the standard of care for the management of children with pulmonary arterial hypertension, chronic heart failure, renal disease, asthma and Duchenne muscular dystrophy, amongst others (2,(9)(10)(11)(12)(13).…”

“…The alternate method for interpretation relies on comparisons of values obtained in cross sectional studies with population level standards (8). This method is most useful in establishing disease severity, prognosis and need to treat (8)(9)(10)(11)13).…”

“…Some described limitations of conducting the test in children include motivation and willingness to cooperate and follow instructions and have made some question its reliability (8,12). However, with a better understanding of the test and stricter conditions for performing the test reproducibility is no longer a major issue and the test has severally been validated as a reliable method of testing exercise capacity in healthy children and children with cardiopulmonary disease (9,10,17). Variations in children are related to age, sex, caps or hats.…”

Valores de referencia del test de marcha en 6 minutos para niños y adolescentes sanos colombianos de 7 a 17 años de edad

“…Existe evidencia científica que permite recomendar esta prueba tanto en niños sanos como en niños con diferentes patologías, incluyendo las enfermedades de tipo neuromuscular y articular al cumplir criterios de confiabilidad y validez 5 . Se han publicado diferentes estudios: en adultos sanos, para establecer valores de referencia normales, como los realizados por Enright P. en 1998 6 ; en niños sanos, diferentes estudios entre los cuales se tienen los realizados en China 7 , Brasil 8 , Chile 5 , Suiza 9 y Austria, 10 relacionando índice de masa corporal y test de marcha en 6 minutos( 11 ; en pacientes con peso normal y sobrepeso 12 ; en niños y adolescentes con fibrosis quística 13 ; también se han realizado estudios implementando esta prueba en pacientes con bronquiolitis obliterante 14 , en patología congénita cardiaca 15 , en asma 16 , diabetes mellitus 17 , obesidad 18 y enfermedad renal crónica 19 , en enfermedades neuromusculares como la enfermedad de Pompe( 20 ) y distrofia muscular de Duchenne. 21 A pesar de los múltiples estudios existentes a nivel mundial, esta prueba clínica continúa siendo de poca aplicación en población pediátrica, posiblemente debido a la falta de información y difusión respecto a los beneficios y facilidad de aplicación tanto en niños sanos como con algún tipo de enfermedad; con el objeto de valorar la tolerancia al ejercicio fí-sico y de manera indirecta poder valorar el consumo de oxígeno, es decir, la capacidad aeróbica, así mismo se ha presentado dificultad para obtener valores de referencia en esta población.…”

Application of the Test of 6-Minute Walking for Estimation of the Physical Endurance of Children and Adolescents Treated for Oncological Diseases

“…Непременным атрибутом теста является проведение кардиореспираторной пробы, однако к анализу принимается только пройденное расстояние, что снижает его информативность [4]. Интерпретация результатов теста детально разработана для здоровых людей и пациентов с кардиологической и пульмонологической патологией; для пациентов онкологического профиля не определены коридоры нормы, не изучены особенности реакции кардиореспираторных показателей [3,5,6]. В ряде зарубежных исследований предложена более тонкая оценка результатов теста с помощью расчета долженствующих расстояний, учитывающая антропометрические данные человека и его физическое состояние [4].…”