Six-minute walk distance reference values using a 15-metre course: A pragmatic study for resource-constrained settings

Background The six-minute walk test (6MWT) is a simple, widely used measure of functional exercise capacity in children. Standard protocols recommend a 30-meter walking course; however, this is often impractical in routine clinical settings, particularly in resource-limited environments. Normative data for Indian children, especially younger age groups and under pragmatic testing conditions, remain limited.Objectives To establish age- and sex-specific reference values for six-minute walk distance (6MWD) in apparently healthy Indian children aged 4–14 years using a pragmatic 15-meter walking course and evaluate associations with anthropometric variables.Methods In this community-based cross-sectional study, 400 healthy school-going children underwent the 6MWT using a standardized 15-meter indoor course. Anthropometric and baseline physiological parameters were recorded. Percentile reference values were generated, and multivariable linear regression was performed to identify determinants of 6MWD and derive a predictive equation.Results Mean (SD) 6MWD was 365.3 (50.8) meters. Distance increased significantly with age, height, weight, and body mass index (all p<0.001). After adjustment, no independent sex-based differences were observed. The predictive equation was: 6MWD = 279.5 + 8.6 × age (years) + 2.7 × weight (kg) – 5.0 × BMI (kg/m2) (R2 = 0.62). No significant differences were observed by residence or school type.Conclusions This study provides 15-meter course-specific reference values for 6MWD in healthy Indian children aged 4–14 years. The derived predictive equation may assist interpretation of 6MWD obtained using this protocol; however, external validation and direct comparison with the standard 30-meter course are required before broader application, where longer courses are not feasible.