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

Abstract

The six-minute walking test (6MWT) is commonly used to measure functional capacity in field settings, primarily through the distance covered. This study aims to establish reference curves for the six-minute walking distance (6MWD) and peak heart rate (PHR) and develop a predictive equation for cardiovascular capacity in Tunisian children and adolescents. A total of 1501 participants (706 boys and 795 girls), aged 10–18 years, were recruited from schools in Tunisia. The Lambda (L), Mu (M), and Sigma (S) methods (LMS method) were employed to develop smoothed percentile curves for 6MWD and PHR. Multivariate linear regression was utilized to formulate a prediction equation for 6MWD. Smoothed percentiles (3rd, 10th, 25th, 50th, 75th, 90th, and 97th) for 6MWD and PHR were presented with age. All variables showed a strong positive correlation (p < 0.001) with a six-minute walking distance (r ranged from 0.227 to 0.558 for girls and from 0.309 to 0.610 for boys), except resting heart rate, which showed a strong negative correlation (girls: r = −0.136; boys: r = −0.201; p < 0.001). Additionally, PHR showed a weak correlation (p > 0.05). The prediction equations, based on age as the primary variable, were established for both genders. For boys: 6MWD = 66.181 + 38.142 × Age (years) (R² = 0.372; Standard Error of Estimate (SEE) = 122.13), and for girls: 6MWD = 105.535 + 28.390 × Age (years) (R² = 0.312; SEE = 103.66). The study provides normative values and predictive equations for 6MWD and PHR in Tunisian children and adolescents. These findings offer essential tools for identifying, monitoring, and interpreting cardiovascular functional deficits in clinical and research settings.