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Six-Minute Walk Test Results Predict Risk of Hospitalization for Youths with Cystic Fibrosis: A 5-Year Follow-Up
Márcio V F Donadio1, João P Heinzmann-Filho2, Fernanda M Vendrusculo2
1Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Pediatrics and Child Health, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil.
Insights
The 6-minute walk test (6MWT) is linked to fewer hospitalizations for pulmonary exacerbations in pediatric cystic fibrosis (CF) patients. Greater 6-minute walk distance (6MWD) in children with CF reduces hospitalization risk.
Area of Science:
- Pediatric Pulmonology
- Clinical Medicine
- Respiratory Medicine
Background:
- Cystic Fibrosis (CF) is a genetic disorder affecting multiple organs, primarily the lungs.
- Pulmonary exacerbations are a major cause of morbidity and hospitalization in pediatric CF patients.
- Identifying early markers for exacerbation risk is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between the 6-minute walk test (6MWT) and other clinical variables with hospitalization risk in pediatric CF patients.
- To determine if functional capacity measures predict pulmonary exacerbation hospitalizations.
Main Methods:
- A 5-year prospective cohort study including 26 pediatric patients (6-18 years) with CF.
- Participants underwent spirometry, manovacuometry, and 6MWT.
- Data on anthropometry, chronic Pseudomonas aeruginosa colonization, and hospitalization events were collected.
Main Results:
- A significant decline in forced expiratory volume in 1 second (FEV1) was observed over 5 years.
- Respiratory muscle strength (inspiratory pressure) increased, while expiratory pressure and 6-minute walk distance (6MWD) remained stable.
- Inverse associations were found between 6MWD and total hospitalization days (r=-0.813, P<.001).
- A greater 6MWD was associated with a reduced risk of first hospitalization (Cox HR 0.32, P=.037).
Conclusions:
- The 6-minute walk test (6MWT) is associated with the risk of hospitalization for pulmonary exacerbations in children and adolescents with CF.
- Functional capacity, assessed by 6MWT, may not decline as expected with pulmonary function, and may serve as a predictor of exacerbation risk.
- Inspiratory muscle strength appears to increase with disease progression in this cohort.
Objective:
To evaluate the association of 6-minute walk test (6MWT) and other variables (anthropometry, chronic Pseudomonas aeroginosa colonization, pulmonary function, and respiratory muscle strength) with the risk of hospitalization for pulmonary exacerbation in children and adolescents with cystic fibrosis (CF).
Study Design:
Cohort study that included patients with CF aged 6-18 years. All participants underwent spirometry, manovacuometry, and 6MWT during the 5-year follow-up. Anthropometric and clinical data were collected and the time to first hospitalization, total days of hospitalization, and antibiotic use during follow-up was recorded.
Results:
A total of 26 patients with CF, mean age 10.2 ± 2.8 years, were included. The group had mild impairment of lung function with a significant decline in forced expiratory volume in 1 second (P = .019) over the 5 years. Respiratory muscle strength and 6MWT proved to be preserved, although maximum inspiratory pressure increased (P < .001) and maximum expiratory pressure and 6-minute walk distance (6MWD) remained stable. There were inverse associations of 6MWD in meters (r = -0.813, P < .001) and z score (r = -0.417, P = .015) with total days of hospitalization. Moreover, there was a reduction in the risk of a first hospitalization (Cox HR 0.32; P = .037) in patients with a greater 6MWD.
Conclusions:
We found an association between the 6MWT and the risk of hospitalization in children and adolescents with CF. Furthermore, functional capacity apparently does not follow the expected decline in pulmonary function over time, whereas inspiratory muscle strength increases with disease progression.
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