Classification of cardiorespiratory fitness using the six-minute walk test in adults: Comparison with cardiopulmonary exercise testing

Abstract

Background: The six-minute walk test (6MWT) distance could facilitate the assessment of cardiorespiratory fitness (CRF) in clinical practice as recommended. We aimed to develop a CRF classification using the 6MWT distance in asymptomatic adults considering the treadmill maximum oxygen uptake (V˙O_2max) as the gold standard method.

Methods: We evaluated V˙O_2max and 6MWT distance in 1295 asymptomatic participants aged 18-80 years (60% women). Age- and sex-related CRF was classified based on the percentiles as very low (<5th percentile), low (5th-25th percentile), regular (26th-50th percentile), good (51st-75th percentile), excellent (76th-95th percentile), and superior (>95th percentile) for both V˙O_2max and 6MWT distance. We investigated the 6MWT distance cut-off (%pred.) with the highest sensitivity and specificity for identifying each V˙O_2max classification.

Results: V˙O_2max declined by 8.7% per decade in both men and women. The 6MWT distance declined by 9.3% per decade in women and 9.5% in men. We formulated age- and sex-related classification tables for CRF using the 6MWT distance. Moreover, the 6MWT distance (%pred.) showed excellent ability to identify very low CRF (6MWT distance ≤ 96%; AUC=0.819) and good ability to differentiate CRF as low (6MWT distance=97%-103%; AUC=0.735), excellent (6MWT distance=107%-109%; AUC=0.715), or superior (6MWT distance>109%; AUC=0.790). It was not possible to differentiate between participants with regular and good CRF.

Conclusion: The CRF classification by the 6MWT distance is valid in comparison with V˙O_2max, especially for identifying adults with low CRF. It could be useful in clinical practice for screening and monitoring the cardiorespiratory risk in adults.

Keywords: 6MWT; Cardiovascular risk; O(2max); Reference values; Walking.