Six-Minute Walk Test (6MWT)

Purpose of the measure

The Six-Minute Walk Test (6MWT) (Butland, Pang, Gross, Woodcock, & Geddes, 1982) is a functional walking test in which the distance that a client can walk within six minutes is evaluated. This test has been used to assess individuals with stroke (Kosak & Smith, 2005), head injury (Rossier & Wade, 2001), and Parkinson’s disease (Garber & Friedman, 2003), as well as pulmonary and cardiac diseases.

Available versions

There are 5 versions of walking tests available in the stroke population, the 12-, 6-, 5-, 3-, and 2-Minute Walk Tests. The differences between the 12-, 6-, and 2-Minute Walk Tests are summarized in the table below.

Version of walking test in Stroke Purpose Strength Limitation
12MWT (Kosak & Smith, 2005)
  • To evaluate the level of physical fitness of healthy individuals.
  • Adapted to assess disability in patients with chronic bronchitis.
  • Compared to the 2 and 6MWTs, the 12MWT was the most responsive to change during post-stroke rehabilitation (Kosak & Smith, 2005).
  • Exhausting for patients.
6MWT (Kosak & Smith, 2005)
  • To evaluate exercise tolerance among individuals with respiratory diseases. Derived from the 12 MWT.
  • Easy to administer
  • Better tolerated than 12MWT
  • More reflective of performance in ADLs than the other walking tests (Solway, Brooks, Lacasse & Thomas, 2001)
  • Good measure of endurance
  • Does not assess balance, quality of movement, use of assistive devices and amount of physical assistance needed (Barak & Duncan, 2006)
  • Described as a test of functional capacity, endurance, fatigability and cardiovascular fitness
  • Stroke-specific impairments (ie muscle weakness, spasticity, balance, hemiparesis) may influence distance walked (Barak & Duncan, 2006).
2MWT (Kosak & Smith, 2005)
  • To assess exercise tolerance in chronic air flow limitation.
  • Highly correlated with the 6 and 12 MWTs.
  • A valid measure of self-selected walking speed.
  • The most time efficient.
  • Compared to the 6 and 12 MWTs, the 2MWT was the least responsive to change for stroke over the course of inpatient rehabilitation (Kosak & Smith, 2005).

There are two more adaptations of the 6MWT that have been used in patients with stroke: 3MWT (Sakai, Tanaka, & Holland, 2002), and 5MWT (Teixeira da Cunha-Filho et al., 2003)

Features of the measure

Items:
There are no actual items to the 6MWT.

The 6MWT is a simple test that requires a 100-ft, quiet, indoor, flat, straight rectangular hallway. The walking course must be 30m in length. The length of the 30m corridor must be marked by colored tape at every 3m. The turnaround must be marked with a cone. Some studies have used 20 and 50m corridors.

(American Thoracic Society “ATS (http://ajrccm.atsjournals.org/cgi/reprint/166/1/111?ijkey=58e74d53a3942c7bf82e79d2495f8b944bf3f0c2) statement: guidelines for the six-minute walk test,” 2002).

To prepare for the 6MWT, the client should be encouraged to:

  • Wear comfortable clothing
  • Wear appropriate walking shoes
  • Use their usual walking aides during the test (cane, walker, etc.)
  • Take their usual medications
  • Avoid engaging in vigorous exercise 2 hours prior to testing

To prepare for the 6MWT, clinicians may wish to:

  • Have the client stand and rate their baseline dyspnea and overall fatigue using the Borg scale. The Borg scale is a 15 or 12 grade rating scale of perceived exertion – the client’s perception of physical effort or strain.
  • Pulse oximetery is optional. If it is conducted, baseline heart rate, and oxygen saturation should be measured and recorded.

(“ATS statement: guidelines for the six-minute walk test,” 2002)

According to the American Thoracic Society (ATS) protocol, patients should be instructed in the following way:
“The object of this test is to walk as far as possible for 6 minutes. You will walk back and forth in this hallway. Six minutes are a long time to walk, so you will be exerting yourself. You will probably get out of breath or become exhausted. You are permitted to slow down, to stop, and to rest as necessary. You may lean against the wall while resting, but resume walking as soon as you are able. You will be walking back and forth around the cones. You should pivot briskly around the cones and continue back the other way without hesitation. Now I’m going to show you. Please watch the way I turn without hesitation.”

Demonstrate by walking one lap yourself. Walk and pivot around a cone briskly. Then say:
“Are you ready to do that? I will write down each time you turn around at this starting line. Remember that the object is to walk as far as possible for 6 minutes, but don’t run or jog. Start now or whenever you are ready.”

The patient should be positioned at the starting line. The clinician should stand near the starting line during the test. As soon as the patient starts to walk, the timer should be started.

No conversations should take place during the walk. An even tone of voice should be used when providing the standard phrases of encouragement (see below). The patient should be supervised. The clinician should remain focused and not lose count of the laps.

After the first minute, the patient should be told the following (in an even tone):
“You are doing well. You have 5 minutes to go.”

When the timer shows 4 minutes remaining, the patient should be told the following:
“Keep up the good work. You have 4 minutes to go.”

When the timer shows 3 minutes remaining, the patient should be told the following:
“You are doing well. You are halfway done.”

When the timer shows 2 minutes remaining, the patient should be told the following:
“Keep up the good work. You have only 2 minutes left.”

When the timer shows only 1 minute remaining, the patient should be told the following:
“You are doing well. You have only 1 minute to go.”

Other words of encouragement or body language (eg. to speed up) should not be used.

Please note:

  • Do not provide a “warm-up” period.For at least 10 minutes before the beginning of the test, the client should sit in a chair located near the starting position. During this time, the clinician should review the contraindications (see Client Suitability section of module), the appropriateness of the client’s clothing and shoes, and complete the first part of the worksheet (see below).

    (“ATS statement: guidelines for the six-minute walk test,” 2002)
    The following elements should be present on the 6MWT worksheet and report:
    Lap counter: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
    Patient name: ____________________ Patient ID# ___________
    Walk # ______ Tech ID: _________ Date: __________
    Gender: M F Age: ____ Race: ____ Height: ___ft ____in, ____ meters
    Weight: ______ lbs, _____kg Blood pressure: _____ / _____
    Medications taken before the test (dose and time): __________________
    Supplemental oxygen during the test: No Yes, flow ______ L/min, type _____
    Baseline End of Test
    Time ___:___ ___:___
    Heart Rate _____ _____
    Dyspnea ____ ____ (Borg scale)
    Fatigue ____ ____ (Borg scale)
    SpO2 ____ % ____%
    Stopped or paused before 6 minutes? No, Yes, reason: _______________
    Other symptoms at end of exercise: angina, dizziness hip, leg, or calf pain
    Number of laps: ____ (_60 meters) _ final partial lap: _____ meters _
    Total distance walked in 6 minutes: ______ meters
    Predicted distance: _____ meters Percent predicted: _____%
    Tech comments:
    Interpretation (including comparison with a pre-intervention 6MWT).

  • A lap counter (or pen and paper) should be used to note the number of laps that the client is able to walk during the 6 minutes.

Upon completion of the test:

  • Clients should be asked to rate their post walk dyspnea and overall fatigue levels using the Borg scale.
  • The following should be asked: “What, if anything, kept you from walking farther?”
  • If using a pulse oximeter, measure SpO2 and pulse rate from the oximeter and then remove the sensor.
  • The number of laps should be recorded on the worksheet.
  • The total distance walked, rounded to the nearest meter, should be calculated and recorded on the worksheet.
  • The client should be congratulated for good effort and should be offered a drink of water (if not on a liquid restricted diet due to dysphagia).

Scoring:

  • The lap counter or pen and paper should be used to note the number of laps that the patient is able to walk during the 6MWT.
  • Distance walked, and the number and duration of rests during the 6 minutes should be measured.
  • Scores range from 0 meters or feet for patients who are non-ambulatory to the maximum biological limits for normal healthy individuals (approximately 900 meters or 2953 feet).

Time: Six minutes.

Subscales: None.

Equipment: (“ATS statement: guidelines for the six-minute walk test,” 2002)

  1. Stopwatch (countdown timer).
  2. Pulse oximeter when indicated (optional).
  3. A chair at the end of track in case patients are tired and wish to rest midway through the test.
  4. Two small cones to mark the turnaround points.
  5. Other safety equipment (source of oxygen, telephone, automated electronic defibrillator).

Training:
There is no need for training of clinicians as long as they comply with the 6MWT protocol.

Alternative forms of the Six-Minute Walk Test
  • 12MWT and 2MWT are also valid and reliable measures in clients with stroke (Kosak & Smith, 2005). The other versions of MWTs that have also been used in a stroke population include the 3MWT and 5MWT.
Client suitability

Can be used with: Patients with stroke (acute, sub-acute, and chronic)

Other groups tested with this measure:

  • Chronic Obstructive Pulmonary Disease (Steele et al., 2000),
  • Heart failure (Guyatt, Sullivan et al., 1985)
  • Peripheral arterial disease (Montgomery & Gardner, 1998),
  • Fibromyalgia (King et al., 1999; Pankoff, Overend, Lucy, & White, 2000; Pankoff, Overend, Lucy, & White, 2000),
  • Cystic fibrosis (Gulmans, van Veldhoven, de Meer, & Helders, 1996),
  • Renal failure (Fitts & Guthrie, 1995),
  • Elderly individuals ( King, Judge, Whipple, & Wolfson, 2000),
  • Healthy adults (Harada, Chiu, & Stewart, 1999),
  • Individuals with pacemakers (Langenfeld et al., 1990),
  • Transplant candidates with end stage lung disease (Cahalin, Pappagianopoulos, Prevost, Wain, & Ginns, 1995).

Should not be used in: (“ATS statement: guidelines for the six-minute walk test,” 2002; Enright, 2003)

  • Absolute contraindications for the 6MWT include: unstable angina and myocardial infarction (MI) in the previous month.
  • Relative contraindications: resting heart rate> 120, systolic blood pressure (BP) > 180mm Hg, and diastolic BP > 100 mm Hg.
  • Testing should be performed in a location where a rapid appropriate response to emergency is possible.
  • Supplies that must be available in rehabilitation and hospital settings include oxygen, sublingual nitroglycerine, aspirin, and albuterol. A telephone should be in place to enable an emergency call.
  • The clinician should be certified in cardiopulmonary resuscitation with a minimum of basic life support.
  • If a client is on chronic oxygen therapy, oxygen should be given at the standard rate or as directed by a physician or a protocol.
  • Reasons for immediately stopping a 6MWT include the following: (1) chest pain, (2) intolerable dyspnea, (3) leg cramps, (4) staggering, (5) diaphoresis, and (6) pale or ashen appearance. If the test is stopped for any of the above reasons, the patients should sit or lie supine as necessary depending on the severity of events. Based on judgment of clinician, blood pressure, pulse rate, oxygen saturation, and physician evaluation should be obtained.

NOTE: Care should be taken to evaluate safety in ambulation prior to testing to ensure that the patient is safe to walk alone without supervision before the test is chosen as an assessment.

In what languages is the measure available?

No information available.