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Vol. 61. Issue 8.
Pages 459-466 (August 2025)
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Vol. 61. Issue 8.
Pages 459-466 (August 2025)
Original Article
Development and Comparison of Reference Equations for the Six-Minute Walk Test in Spanish Healthy Adults Aged 45–85 Years
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Elena Gimeno-Santosa,b,c,d,
, Jordi Vilaróe, Ane Arbilllaga-Etxarrif, Beatriz Herrero-Cortinag,h, Maria Antonia Ramonc,i,j, Ana Balañá Corberók, Juan Carlos Fernández-Domínguezl,m, Carlos Zárate-Tejeroj, Anael Barberan-Garciad, Tamara Del Corraln, Begoña Jiménez-Reguerao, Asenet Lópezp, Daniel López-Fernándezq,r, Patricia Madrid Trevess, Roberto Martinez-Alejost,u, Gerard Muñozv,w, Antonio Ríos-Cortésx,y, Ketty Ruiz-Lópezz, Marta San Miguel-Pagolah, Natalia Sánchez-Cayadoaa,ab..., Beatriz Valeiroac, Marie Carmen Valenzaad, Gerald Valenzaad, Ana Beatriz Varasae, Silvia Córdobaaf, Angeles Vegaaa, Maria Linareso, Eva María Madridx,y, Sonia Soutop, Montserrat Vendrellv, Judith Garcia-Aymericha,b,cVer más
a Barcelona of Global Health Institute (ISGlobal), Barcelona, Spain
b Universitat Pompeu Fabra (UPF), Barcelona, Spain
c CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
d Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
e Facultat Ciències de la Salut Blanquerna, Global Research on Wellbeing (GRoW), Universitat Ramon Llull, Barcelona, Spain
f Deusto Physical TherapIker, Physical Therapy Department, Faculty of Health Science, Faculty of Health Science Deusto, Donostia-San Sebastián, Spain
g Precision Medicine in Respiratory Diseases Group, Instituto de Investigacion Sanitaria de Aragon, Spain
h Universidad San Jorge, Zaragoza, Spain
i Pneumology Department, Vall d’Hebron University Hospital, Barcelona, Spain
j Physical Therapy Department, Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
k Servicio de Neumología Hospital del Mar – PSMAR, Barcelona, Spain
l Nursing and Physiotherapy Department, University of the Balearic Islands, Palma, Spain
m Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
n Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), IdISSC, Madrid, Spain
o Departamento de Fisioterapia, Facultad de Medicina, Universidad CEU San Pablo, CEU Universities, Madrid, Spain
p Facultad de Fisioterapia, Universidad de A Coruña, Spain
q Faculty of Health Science, University of Las Palmas de Gran Canaria (ULPGC), Gran Canaria, Spain
r Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, Spain
s Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain
t Montpellier University Training School of Physiotherapy, Montpellier, France
u Kernel Biomedical, Rouen, France
v Department of Pneumology, Dr Josep Trueta University Hospital, Bronchiectasis Group, Girona Biomedical Research Institute, Girona, Spain
w Department of Physical Therapy, EUSES & ENTI, University of Girona and University of Barcelona, Girona, Spain
x Santa Lucia's University Hospital, Cartagena, Spain
y Department of Physiotherapy, University of Murcia, Spain
z Hospital Universitario Son Espases, Palma, Spain
aa Hospital Universitario Central de Asturias, Oviedo, Spain
ab Departamento de Cirugía y Especialidades Médico Quirúrgicas, Área de Fisioterapia, Universidad de Oviedo, Oviedo, Spain
ac Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
ad Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
ae Escuela Universitaria de Fisioterapia de la ONCE, Universidad Autónoma de Madrid, Madrid, Spain
af Centro de recuperación de personas con discapacidad física (CRMF), Instituto de Mayores y Servicios Sociales (IMSERSO), Cádiz, Spain
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Figures (2)
Tables (6)
Table 1. Characteristics of the Sample Used for the Development of the 6-Min Walking Distance Reference Equations Stratified by Sex.
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Table 2. Characteristics of the 6-Min Walk Tests Stratified by Sex.
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Table 3. Predictive Model for 6-Min Walking Distance in the Healthy Spanish Subjects for (a) Males (b) and Females.
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Table 4. Reference Equations Developed for 6MWD for Males and Females in the Spanish Population.
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Table 5. Characteristics of Spanish COPD Patients From the Urban Training and PAC-COPD Studies.
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Table 6. Comparison of Percentage of 6MWD Predicted Values by Using 9 Published Prediction Equations Versus the One Developed in This Study (Gimeno-Santos) Over a Data Set of Spanish Patients With COPD From the Urban Training and PAC-COPD Studies (a) n=633 Males and (b) n=82 Females.
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Additional material (1)
Abstract
Objectives

(i) To develop sex-specific reference equations to predict distance walked (6MWD) in the 6-minute walk test (6MWT), in healthy subjects aged 45–85 years, from different geographic areas of Spain; and (ii) to compare developed equations with previously published in a large sample of COPD patients.

Methods

First, a cross-sectional multicentre sample of randomly selected healthy subjects from 17 Spanish hospitals and universities performed two 6MWT. Linear regression and fractional polynomial modelling were used to develop the equations. Second, the developed equations were applied to 715 COPD patients from Spanish primary care centres and hospitals, and the % predicted 6MWD obtained was compared with previously published equations using Dunnett's multiple comparisons test.

Results

568 healthy subjects were included (51% females, mean (SD) age 62 (11) years), walked a 6MWD of 615 (113) and 557 (93)m in males and females, respectively. The developed equations included age, weight and height, and explained 43% and 51% of the 6MWD variance for males and females, respectively. In the COPD sample (n=715, 14% females, 68 (9) years, FEV1 61 (18) % predicted, 6MWD 464 (97)m), only 1 out of 9 previously published equations for males, and 6 out of 9 for females predicted 6MWD values similar to those of the newly developed Spanish reference equations.

Conclusions

The newly developed reference equations provide a more valid prediction of 6MWD in Spanish adults with COPD compared to previously published equations. We suggest their use in future research and clinical practice for the Spanish adult population.

Keywords:
Epidemiology
Field test
6-Minute walk test
Exercise capacity
Reference equation
Healthy adults
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