Query: 6mwt children

title: Reference Values for the Six Minute Walk Test in Children with Juvenile Idiopathic Arthritis.
abstract: To (1) describe six minute walk test (6MWT) reference values for children with Juvenile Idiopathic Arthritis (JIA) and (2) explore predictors of 6MWT distance. A secondary objective was to determine how 6MWT distances of children with JIA compare to those of children without JIA reported in the literature.  Demographic, clinical, height, weight and 6MWT data were extracted from clinical records of 120 children with JIA (70.8% female, mean age=12.4 3.2 years) who attended a follow up rheumatology clinic. A total of 272 6MWTs were included in the analyses. Linear mixed effects modeling was used to determine the relationship between predictive variables and 6MWT distance. 6MWT distances were compared to predicted values using published equations for estimating 6MWT distances in children without JIA.  Height, weight, and age were predictive of 6MWT distance (R2 0.62) Mean 6MWT distances for children with JIA were lower than those reported for children without JIA (p 0.001) Mean 6MWT distance was 84% and 78% of predicted values for children without JIA.  The reference values and associated predictive model have application for assessing exercise capacity in children with JIA.

title: L carnitine supplementation for muscle weakness and fatigue in children with neurofibromatosis type 1: A Phase 2a clinical trial
abstract: Reduced muscle tone, muscle weakness, and physical fatigue can impact considerably on quality of life for children with neurofibromatosis type 1 (NF1) Human muscle biopsies and mouse models of NF1 deficiency in muscle show intramyocellular lipid accumulation, and preclinical data have indicated that L carnitine supplementation can ameliorate this phenotype. The aim of this study is to examine whether daily L carnitine supplementation is safe and feasible, and will improve muscle strength and reduce fatigue in children with NF1. A 12 week Phase 2a trial was conducted using 1000 mg daily oral levocarnitine tartrate supplementation. Recruited children were between 8 and 12 years old with a clinical diagnosis of NF1, history of muscle weakness and fatigue, and naive to L carnitine. Primary outcomes were safety (self reporting, biochemical testing) and compliance. Secondary outcomes included plasma acylcarnitine profiles, functional measures (muscle strength, long jump, handwriting speed, 6 minute walk test [6MWT] and parent reported questionnaires (PedsQL(tm) CBCL/6 18) Six children completed the trial with no self reported adverse events. Biochemical tests for kidney and liver function were normal, and the average compliance was 95% Plasma acylcarnitine levels were low, but within a range not clinically linked to carnitine deficiency. For strength measures, there was a mean 53% increase in dorsiflexion strength (95% confidence interval [CI] 8.89 60.75; p 0.02) and mean 66% increase in plantarflexion strength (95% CI 12.99 134.1; p 0.03) In terms of muscle performance, there was a mean 10% increase in long jump distance (95% CI 2.97 16.03; p 0.01) and 6MWT distance (95% CI 5.88 75.45; p 0.03) Comparison with the 1000 Norms Project data showed a significant improvement in Z score for all of these measures. Parent reports showed no negative impact on quality of life, and the perceived benefits led to the majority of individuals remaining on L carnitine after the study. Twelve weeks of L carnitine supplementation is safe and feasible in children with NF1, and a Phase 3 trial should confirm the efficacy of treatment.

title: The 3 Minute Step Test is a validated field test to evaluate the functional exercise capacity in children aged 6 to 12.
abstract: Field tests are useful to assess the functional exercise capacity. The 6minute walking test (6MWT) is the most common field test even if alternatives are needed. The main aim of the study was to verify if the 3minute step test (3MST) is a valid tool to measure the functional exercise capacity and can surrogate the 6MWT in healthy children from 6 to 12 years old.  This randomized cross over trial recruited 30 healthy children from 6 to 12 years. One 6MWT and two 3MST (3MST1 and 3MST2) were performed randomly on 3 consecutive days. The variables were the distance (6MWT) the number of steps (3MST) and the cardiorespiratory parameters.  The distance walked during 6MWT was very strongly correlated to the number of steps during the 3MST (3MST1: rho=0.833; P<0.001 and 3MST2: rho=0.868; P<0.001) Heart rate (HR) was lower than the theoretical maximal HR at the end of both tests. The change in HR and perceived fatigue were significantly higher after the 3MST. A learning effect was observed in the 3MST +8 steps; P<0.001)  The 3MST is validated and can be a surrogate for the 6MWT in healthy children population between 6 and 12 years old. A training test is required in these children.

title: Add on Home Centred Activity Based Therapy vs Conventional Physiotherapy in Improving Walking Ability at 6 Months in Children with Diplegic Cerebral Palsy: A Randomized Controlled Trial.
abstract: Institutional physiotherapy as a standard of care for management of cerebral palsy (CP) has certain shortcomings, especially in resource constrained settings. This is a proof of concept trial to evaluate the efficacy of individualized home centered activity based therapy in children with spastic diplegic CP.  Randomized controlled trial (open label) SETTINGS Tertiary care hospital with pediatric neurology services (July 2014 to July 2016) PARTICIPANTS Consecutive sample of 59 children (5 12yrs) with spastic diplegic CP (Gross Motor Function Classification System scores II III) without fixed lower limb contractures, illnesses impeding physiotherapy or history of recent botulinum toxin injection/surgery were recruited. PROCEDURE Children were randomized to Intervention or Control arms. Their 6 minute walk Test (6MWT) scoring and clinical examination were performed at baseline, 3 and 6 months. Children in Intervention Arm (n=30) were prescribed parent supervised home centered activity based therapy (walking, standing, squatting, climbing up/downstairs, kicking a ball, dancing, riding a tricycle/bicycle) in addition to their institutional physiotherapy. Children in Control Arm (n=29) were prescribed ongoing institutional physiotherapy alone. Logbooks, home videos and telephonic follow ups were used to ensure compliance.  Comparison of the mean change in 6MWT scores at 6 months (from baseline) between the two groups.  Median (IQR) change in 6MWT scores at 6 months (from baseline) in the Intervention and Control arms were 3.5 5.3, 9) m and 3 7.8, 6.3) m.  Adjunct home centered activity based therapy was safe and feasible, but did not result in appreciable gains over 6 months.

title: Wearable Technologies for Children with Chronic Illnesses: An Exploratory Approach.
abstract: To determine the utility of wearable technologies in physical activity assessment in three paediatric diseases, namely, Niemann Pick C (NP C) Juvenile Idiopathic Arthritis (JIA) and Duchenne Muscular Dystrophy (DMD) DESIGN Exploratory study SETTING  Thirty children were recruited across three UK hospitals (Royal Manchester's Children Hospital, Great Ormond Street Children's Hospital, and the Great North Children's Hospital) Ten were diagnosed with NP C, eight with DMD and twelve with JIA.  All participants completed the 6 min walk test (6MWT) at enrolment. Patients were provided with disease specific smartphone apps paired with a wearable device via Bluetooth. Ambulation was recorded in 30 min epochs measuring average daily maximum (ADM) average daily steps (ADS) and average daily steps per 30 min epoch (ASE) RESULTS Median 6MWT results were 450 m, 325 m and 434.5 m for the NP C, DMD and JIA cohorts, respectively. Wearable data capture was feasible in all three disease cohorts, although complete data capture was not sustained. A statistically significant between cohort difference was identified for ADM, ADS and ASE. Statistically significant differences were found between DMD/JIA for ADM; NP C/DMD for ADS and DMD/JIA for ASE.  Wearable sensor technologies have the potential to provide additional information for our understanding of ambulation in chronic paediatric disease. The wearable devices were easy to use and popular with patients although key features need to be addressed to appropriately meet study objectives. As the technology continues to evolve at a rapid pace, opportunities to implement child friendly solutions are already available.

title: Effects of Inspiratory Muscle and Balance Training in Children with Hemiplegic Cerebral Palsy: A Randomized Controlled Trial.
abstract: The aim of the study was to investigate the effects of inspiratory muscle and balance training on pulmonary function, respiratory muscle strength (RMS) functional capacity, and balance in children with hemiplegic cerebral palsy (CP) Thirty children with hemiplegic CP (Gross Motor Function Classification System I II) included in this study. The control group (n 15) underwent conventional physiotherapy rehabilitation program (CPRP) that included balance exercises, and the training group's (n 15) program included inspiratory muscle training (IMT) in addition to CPRP for 8 weeks. The outcome measures were pulmonary function test, RMS measurement, the six minute walk test (6MWT) and balance tests. There were no significant differences in the score changes of pulmonary function, balance, and 6MWT distance between groups (p .05) whereas maximum inspiratory and expiratory pressure further increased in the training group (p .05) RMS assessment and the identification of children who need it, and adding IMT to CPRP will contribute greatly to the rehabilitative approach of children with CP.

title: Prognostic value of oxygen saturation and heart rate during six minute walk test in pediatric pulmonary hypertension.
abstract: To evaluate the pre and post treatment heart rate and oxygen (O2) saturation values measured before, during and after 6MWT in children who received PAH specific treatment and to determine the effect of these variables on prognosis.  This retrospective study included 29 patients who were diagnosed as PAH and treated. The transcutaneous O2 saturation and heart rate levels were recorded before the test: baseline (Sat0, HR0) at the end of the test: exercise (Sat1, HR1) and 5 minutes after the test: recovery (Sat2, HR2) The increase in heart rate was defined as HR1 HR0 and the decrease in saturation as Sat0 Sat1. The results obtained before and after the PAH specific treatment were analyzed and their effect on survival was assessed.  Fifteen of 29 patients were female (51.7% The mean age was 127.2+ 44.8 months and the median follow up time was 60 (12 156) months. Only pre treatment HR1 was found associated with survival. The mean HR1 value of survivors was 122.8+ 18.4 and that of deceased 94.3+ 19.1 (p=0.03) Post treatment 6MWT was associated with survival. It was 453.3+ 96.5 m for survivors and 250+ 135.2 m for deceased (p=0.02)  Post treatment 6MWT, FC and proBNP had prognostic value in pediatric patients with PAH. The decrease in saturation and increase in heart rate were not found to have a prognostic value. Pre treatment HR1 was associated with survival. Identification of these prognostic factors at the beginning and throughout the treatment may be a guide for detecting the severity of the disease and follow up.

title: The correlation between 6 min walk test and respiratory parameters in children with cystic fibrosis
abstract: The 6 min walk test (6MWT) is a sub maximal exercise test and has been widely used for evaluating of exercise capacity of patients with cystic fibrosis (CF) in recent years. Few studies have examined the relationship between 6MWT and parameters used to assess the severity of the disease in children with CF. In this study, we have examined this relationship to find out if 6MWT can be a marker of the severity of cystic fibrosis. A cross sectional study was done to analyze the correlations among spirometry parameters, body mass index (BMI) chest tomography (CT) and 6MWT. CF patients, aged 7 14 years, were involved. Seventy six patients, 32F/44M, mean age 10.49 3.18 years, were studied. The mean distance in 6MWT was 447 84.1. The following correlations versus distance were found: FEV1 (r 0.255, p 0.026) FVC(r 0.285, p 0.013) FEF25 75% (r 0.546, p 0.001) BMI (r 0.163, p 0.160) and CT (r 0.075, p 0.520).The following correlations versus O2 saturation (SpO2) decline were found: FEV1 (r 0.393, p 0.001) FVC (r 0.431, p 0.001) FEF25 75% (r 0.296, p 0.010) BMI (r 0.042, p 0.721) and CT (r 0.196, p 0.090) There was a significant correlation between 6MWT (distance and SpO2 decline) and pulmonary function test. There was no significant correlation between BMI, chest CT, and 6MWT. 6MWT can be applied beside spirometry and chest CT for CF patients follow up.

title: The effect of GMFCS level, age, sex, and dystonia on multi dimensional outcomes after selective dorsal rhizotomy: prospective observational study
abstract: Investigate the effect of age category (1 9 years vs 10 18 years) sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR) Prospective, single center study of all children aged 3 18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes. From 2012 to 2019, 42 children had follow up available at 24 months. Mean GMFM 66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05 7.13, p 0.001) Statistically significant improvements were observed in CPQoL, PEDI Self care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively) SDR may improve gross and fine motor function, mobility and self care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi center, prospective registries investigating the effect of SDR are required.

title: Six Minute Walking Test Performance Relates to Neurocognitive Abilities in Preschoolers
abstract: This study investigated the relationship between six minute walking test (6MWT) distance walked and preschool aged children's academic abilities, and behavioral and event related potentials (ERP) indices of cognitive control. There were 59 children (25 females; age: 5.0 0.6 years) who completed a 6MWT (mean distance: 449.6 82.0 m) to estimate cardiorespiratory fitness. The Woodcock Johnson Early Cognitive and Academic Development Test evaluated academic abilities. A modified Eriksen flanker, hearts and flowers task, and auditory oddball task eliciting ERPs (N2, P3) assessed cognitive control. After adjusting for adiposity, diet, and demographics, linear regressions resulted in positive relationships between 6MWT distance and General Intellectual Ability (b 0.25, Adj R2 0.04, p 0.04) and Expressive Language (b 0.30, Adj R2 0.13, p 0.02) 6MWT distance was positively correlated with congruent accuracy (b 0.29, Adj R2 0.18, p 0.01) and negatively with incongruent reaction time (b 0.26, Adj R2 0.05, p 0.04) during the flanker task, and positively with homogeneous (b 0.23, Adj R2 0.21, p 0.04) and heterogeneous (b 0.26, Adj R2 0.40, p 0.02) accuracy on the hearts and flowers task. Higher fit children showed faster N2 latencies and greater P3 amplitudes to target stimuli; however, these were at the trend level following the adjustment of covariates. These findings indicate that the positive influence of cardiorespiratory fitness on cognitive function is evident in 4 6 year olds.