{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:09:07Z","timestamp":1789963747360,"version":"4.0.1"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T00:00:00Z","timestamp":1594857600000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013918","name":"Foundation Innovation Alliance","doi-asserted-by":"crossref","award":["2011\u201312-35P"],"award-info":[{"award-number":["2011\u201312-35P"]}],"id":[{"id":"10.13039\/501100013918","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,28]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Despite the common occurrence of lower levels of physical activity and physical fitness in youth with spina bifida (SB) who use a wheelchair, there are very few tests available to measure and assess these levels. The purpose of this study was to determine reliability and the physiologic response of the 6-minute push test (6MPT) in youth with SB who self-propel a wheelchair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this reliability and observational study, a sample of 53 youth with SB (5\u201319\u00a0years old; mean age\u00a0=\u00a013\u00a0years 7\u00a0months; 32 boys and 21 girls) who used a wheelchair performed 2 exercise tests: the 6MPT and shuttle ride test. Heart rate, minute ventilation, respiratory exchange ratio, and oxygen consumption were measured using a calibrated mobile gas analysis system and a heart rate monitor. For reliability, intraclass correlation coefficients (ICCs), SE of measurement, smallest detectable change for total covered distance, minute work, and heart rate were calculated. Physiologic response during the 6MPT was expressed as percentage of maximal values achieved during the shuttle ride test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The ICCs for total distance and minute work were excellent (0.95 and 0.97, respectively), and the ICC for heart rate was good (0.81). The physiologic response during the 6MPT was 85% to 89% of maximal values, except for minute ventilation (70.6%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For most youth with SB who use a wheelchair for mobility or sports participation, the 6MPT is a reliable, functional performance test on a vigorous level of exercise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Impact<\/jats:title><jats:p>This is the first study to investigate physiologic response during the 6MPT in youth (with SB) who are wheelchair using. Clinicians can use the 6MPT to evaluate functional performance and help design effective exercise programs for youth with SB who are wheelchair using.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ptj\/pzaa121","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T19:10:09Z","timestamp":1594321809000},"page":"1852-1861","source":"Crossref","is-referenced-by-count":20,"title":["6-Minute Push Test in Youth Who Have Spina Bifida and Who Self-Propel a Wheelchair: Reliability and Physiologic Response"],"prefix":"10.1093","volume":"100","author":[{"given":"Karlijn M S","family":"Damen","sequence":"first","affiliation":[{"name":"Research Group Lifestyle and Health , HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, 3501 AA Utrecht, the Netherlands; and Master Program Physiotherapy, Specialisation Paediatric Physiotherapy, HU University of Applied Sciences Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Takken","sequence":"additional","affiliation":[{"name":"Child Development & Exercise Center , Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janke F","family":"de Groot","sequence":"additional","affiliation":[{"name":"Research Group Lifestyle and Health , HU University of Applied Sciences Utrecht and Child Development & Exercise Center, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J G","family":"Backx","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation , Physiotherapy Science and Sports, University Medical Center Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bob","family":"Radder","sequence":"additional","affiliation":[{"name":"Research Group Lifestyle and Health , HU University of Applied Sciences Utrecht; and Child Development & Exercise Center, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene C P M","family":"Roos","sequence":"additional","affiliation":[{"name":"Research Group Lifestyle and Health , HU University of Applied Sciences Utrecht and Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon A T","family":"Bloemen","sequence":"additional","affiliation":[{"name":"Research Group Lifestyle and Health , HU University of Applied Sciences Utrecht; Master Program Physiotherapy, Specialisation Paediatric Physiotherapy, HU University of Applied Sciences Utrecht; and Child Development & Exercise Center, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"2023011805122403600_ref1","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.2105\/AJPH.2015.302902","article-title":"Global birth prevalence of spina bifida by folic acid fortification status: a systematic review and meta-analysis","volume":"106","author":"Attas","year":"2016","journal-title":"Am J Public Health."},{"key":"2023011805122403600_ref2","doi-asserted-by":"crossref","first-page":"h5949","DOI":"10.1136\/bmj.h5949","article-title":"Long term trends in prevalence of neural tube defects in Europe: population based study","volume":"351","author":"Khoshnood","year":"2015","journal-title":"BMJ."},{"key":"2023011805122403600_ref3","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1159\/000056005","article-title":"Spina bifida outcome: a 25-year prospective","volume":"34","author":"Bowman","year":"2001","journal-title":"Pediatr Neurosurg."},{"key":"2023011805122403600_ref4","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1016\/S0140-6736(04)17445-X","article-title":"Spina bifida","volume":"364","author":"Mitchell","year":"2004","journal-title":"Lancet."},{"key":"2023011805122403600_ref5","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1023\/A:1021452220291","article-title":"Families of children with spina bifida: a review","volume":"15","author":"Singh","year":"2003","journal-title":"J Dev Phys Disabil."},{"key":"2023011805122403600_ref6","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1111\/j.1469-8749.2009.03322.x","article-title":"Adult outcomes and lifespan issues for people with childhood-onset physical disability","volume":"51","author":"Roebroeck","year":"2009","journal-title":"Dev Med Child Neurol."},{"key":"2023011805122403600_ref7","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1093\/ptj\/71.12.935","article-title":"Myelodysplasia\u2014the musculoskeletal problem: habilitation from infancy to adulthood","volume":"71","author":"Ryan","year":"1991","journal-title":"Phys Ther."},{"key":"2023011805122403600_ref8","volume-title":"Pediatric Exercise Medicine From Physiologic Principles to Healthcare Application","author":"Bar-Or","year":"2004"},{"key":"2023011805122403600_ref9","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1080\/16501970310012400","article-title":"Body fat, fitness and level of everyday physical activity in adolescents and young adults with meningomyelocele","volume":"35","author":"van den Berg-Emons","year":"2003","journal-title":"J Rehabil Med."},{"key":"2023011805122403600_ref10","volume-title":"Physical Fitness and Physical Behavior in (Wheelchair-Using) Youth With Spina Bifida","author":"Bloemen","year":"2017"},{"key":"2023011805122403600_ref11","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1080\/17476348.2016.1258305","article-title":"Reference value for the 6-minute walk test in children and adolescents: a systematic review","volume":"10","author":"Mylius","year":"2016","journal-title":"Expert Rev Respir Med."},{"key":"2023011805122403600_ref12","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/S1836-9553(11)70026-1","article-title":"The six-minute walk test in paediatric populations","volume":"57","author":"de Groot","year":"2011","journal-title":"J Physiother."},{"key":"2023011805122403600_ref13","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1097\/00008483-200005000-00003","article-title":"Validity and reliability of the 6-minute walk test in a cardiac rehabilitation population","volume":"20","author":"Hamilton","year":"2000","journal-title":"J Cardiopulm Rehabil."},{"key":"2023011805122403600_ref14","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1164\/ajrccm.166.1.at1102","article-title":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. 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