Cardiovascular

The Association of Race and Ethnicity with Six-Minute Walk Distance: The Multi-Ethnic Study of Atherosclerosis.

TL;DR

Among older adults, differences in 6-minute walk distance between racial/ethnic groups were smaller than what is considered clinically meaningful or not significantly different after consideration of socioeconomic status, health behaviors, comorbid conditions, cardiovascular parameters, and pulmonary function.

Key Findings

Mean 6-minute walk distance was 33 to 56 meters lower for non-White than for White participants before covariate adjustment.

  • Study included 1,829 participants with mean age 73 years (age range 59-96 years)
  • Sample was 53% female, 24% African American, 14% Chinese, 21% Hispanic, and 41% White
  • Participants were drawn from the Multi-Ethnic Study of Atherosclerosis (MESA) sixth exam conducted 2016-2018
  • All participants were free of clinically evident cardiovascular disease at enrollment (2000-2002)
  • 6MWD was measured by participants walking at their own pace along a flat 20-meter course under staff supervision

After full covariate adjustment, a statistically significant difference in 6-minute walk distance remained only for African American participants compared with White participants.

  • Adjusted difference for African American vs. White participants was -13 m (95% CI: -22, -3)
  • Differences for Chinese and Hispanic participants were not significantly different from White participants after adjustment
  • Adjustments included age, sex, height, BMI, site, education, income, private health insurance, health behaviors, health status, KCCQ score, CVD risk factors, and heart and lung function parameters
  • The 13-meter residual difference for African Americans is smaller than what is generally considered a clinically meaningful difference in 6MWD

Socioeconomic status, health behaviors, comorbid conditions, cardiovascular parameters, and pulmonary function collectively explained a substantial portion of racial and ethnic differences in 6-minute walk distance.

  • Unadjusted differences ranged from 33 to 56 meters across non-White groups compared to White participants
  • After full adjustment, the remaining difference for African Americans was reduced to 13 meters
  • Covariates included education, income, private health insurance, health behaviors, KCCQ score, CVD risk factors, and heart and lung function parameters
  • The study used a cross-sectional analysis design

The study population consisted of older adults ages 45-84 years at enrollment who were free of clinically evident cardiovascular disease, assessed at the sixth MESA exam approximately 16 years later.

  • Participants self-reported race/ethnicity as African American, Chinese, Hispanic, or White
  • Original enrollment was between 2000 and 2002; sixth exam was conducted 2016-2018
  • Mean age at sixth exam was 73 years with a range of 59-96 years
  • Total analytic sample was 1,829 participants
  • Linear regression models were used for all adjusted analyses

What This Means

This research examined whether older adults of different racial and ethnic backgrounds walk different distances in a standardized 6-minute walk test, and whether any differences could be explained by factors like income, education, health behaviors, and medical conditions. The study used data from nearly 1,900 older adults (average age 73) who participated in a long-running heart health study and included African American, Chinese, Hispanic, and White participants. Before accounting for any other factors, non-White participants walked 33 to 56 fewer meters than White participants on average during the 6-minute test. After the researchers accounted for socioeconomic factors (like income and education), health insurance status, health behaviors, existing medical conditions, and measures of heart and lung function, the differences largely disappeared or shrank considerably. For Chinese and Hispanic participants, the differences were no longer statistically significant. For African American participants, a small difference of about 13 meters remained compared to White participants, but this is below what is typically considered a clinically meaningful difference in walking ability. This research suggests that racial and ethnic differences in physical functional capacity among older adults are largely—though not entirely—explained by differences in social and economic conditions, health behaviors, and underlying health status rather than race or ethnicity itself. The findings point to the importance of addressing socioeconomic inequalities and access to healthcare as potential pathways to reducing disparities in physical functioning among older Americans.

Have a question about this study?

Citation

Bertoni A, Bancks M, Crago L, Chen H, Barr R, Smith B, et al.. (2026). The Association of Race and Ethnicity with Six-Minute Walk Distance: The Multi-Ethnic Study of Atherosclerosis.. Ethnicity & disease. https://doi.org/10.18865/EthnDis-2024-36