The six-minute walk test (6MWT) is an objective evaluation of functional exercise capacity in adults with cardiovascular diseases, obesity, or respiratory disorders. The 6MWT is increasingly used in paediatrics, and especially for children with cerebral palsy (CP) to define their capacities and to evaluate therapeutic interventions. The aim of this study is to report the validity of the 6MWT in children with CP and to propose an adapted-6MWT.

A systematic review was performed following the EQUATOR network guideline. The primary search strategy screened online databases [PubMed (MEDLINE), CINAHL, Embase, Pascal, Cochrane Library, Google Scholar] and grey literature in October 2017. The key terms were ‘Six-minutes walk test’, ‘cerebral palsy’, AND ‘reliability’, ‘validity’, ‘responsiveness’, ‘reference value’.

After adjusting for duplicates and applying the search filter, 26 articles over 146 articles were included in this review. Walking speed must be self-selected. Reference value for healthy and CP children are classified by age. This allows comparisons. The distance travelled during the 6MWT is significantly lower for children with CP. There is a significant difference in the 6MWT results between children with GMFCS I/II and GMFCS III. The reliability test-retest is excellent (ICC 0.87–0.98). The 6MWT is not correlated with the VO₂ peak recorded on a cyclo ergometer. The 6MWT is correlated with ABILOCO-kids test, which evaluates the locomotor capacities of children with CP (r=0.70). We introduce an adapted-6MWT for children with cerebral palsy (Fig. 1) adapted on the basis of the comments and suggestions identified in the studies.

The 6MWT is a simple test of the locomotor capacities, easy to access, inexpensive, and quickly achievable. The 6MWT is not a measurement of physical condition or aerobic fitness, in children with PC. We propose a standardized use of this version, adapted for children with CP.