Six-Minute Walk Test (6MWT)


We conducted a literature search to identify all relevant publications on the psychometric properties of the 6MWT in individuals with stroke.

Floor/Ceiling Effects

The 6MWT is a continuous variable without ceiling effects (Kosak & Smith, 2005).


Eng, Dawson, and Chu (2004) examined the test-retest reliability of the 6MWT in 12 community-dwelling individuals with chronic stroke. The test-rest reliability of the 6MWT was found to be excellent for distance covered in meters (ICC = 0.99) and for the submaximal exercise variable Vo2 (ml/kg.min) (ICC = 0.96).

Flansbjer, Holmback, Downham, Patten, and Lexell (2005) studied the reliability of gait performance tests in 50 men and women with hemiparesis after stroke (chronic stroke). They reported the 6MWT had excellent test-retest reliability (ICC = 0.99) with smallest real differences of 13% (SRD) when compared to the Timed Up & Go, gait speed tests, and stair climbing ascend and descend tests.

Fulk, Echternach, Nof, and O’Sullivan (2008) examined the test-retest reliability of the 6MWT in 37 clients undergoing inpatient rehabilitation post-stroke. Clients were on average 33.7 days post-stroke and a mean age of 66.3 years. Clients were administered the 6MWT twice, with 1-3 days between trials. The 6MWT was found to have excellent test-retest reliability (ICC = 0.97).

Liu, Drutz, Kumar, McVicar, Weinberger, Brooks et al. (2008) investigated whether a practice effect as verified by various criteria including test-retest reliability occurred across 2 trials of the 6-minute walking test on 91 people with stroke. Participants were administered the 6MWT twice with 30-minutes between trials. Test-retest reliability calculated using Intraclass Correlation Coefficients (ICC) was excellent (ICC = 0.98).

Intra-rater & Inter-rater
Kosak and Smith (2005) examined the inter- and intra-rater reliability of the 6MWT in 18 clients enrolled in an inpatient stroke rehabilitation program (28 ± 34 days post-stroke). The intra-rater reliability was found to be adequate (ICC = 0.74). The inter-rater reliability was also found to be excellent (ICC = 0.78).



The 6MWT had an excellent correlation with Vo2 max in patients with stroke (r = 0.66) (Vo2 max is the maximum volume of the oxygen that the body can consume during intense whole body exercise, while breathing air at sea level) (Eng et al., 2004; Pang, Eng, & Dawson, 2005).

Tang, Sibley, Bayley, McIlroy, and Brooks (2006) administered the 6MWT to 36 individuals with stroke (sub-acute) and reported excellent correlations between the 6MWT and the Five Meter Walk Velocity for preferred (r = 0.79), and fast speed (r = 0.82). This suggests that the speed selected by the patient during the 6MWT was strongly related to velocities chosen during the Five Meter Walk Distance (Kelly, Kilbreath, Davis, Zeman, & Raymond, 2003; Tang et al., 2006).

Tang et al. (2006) found an adequate correlation between the 6MWT and both a record of patients’ average oxygen uptake during cardiopulmonary exercise test (Vo2peak) (r = 0.56) and exercise test duration (r = 0.60) in 36 clients with stroke. This suggests that even though the 6MWT may challenge the cardiorespiratory system, it appears to be more strongly influenced by walking speed rather than cardiorespiratory capacity (Tang, Sibley, Bayley, McIlroy, & Brooks, 2006).

Fulk et al. (2008) examined the concurrent validity of the 6MWT using Pearson product moment correlations and Spearman Rank correlation coefficients in 37 clients undergoing inpatient rehabilitation post-stroke. Clients were on average 33.7 days post-stroke and a mean age of 66.3 years. The 6MWT was compared to subscales of the Functional Independence Measure (FIM) (Keith, Granger, Hamilton & Sherwin, 1987). The 6MWT had an excellent correlation with discharge locomotion (walk) FIM scores (Spearman r = 0.69), and with discharge locomotion (walk) + stairs FIM scores (Spearman r = 0.69). The 6MWT had adequate correlations with discharge motor FIM scores (Pearson r = 0.52), and discharge total FIM scores (Pearson r = 0.45).

Fulk, Reynolds, Mondal & Deutsch (2010) examined the predictive validity of the 6MWT and other widely used clinical measures (FMA LE, self-selected gait-speed, SIS and BBS) in 19 patients with stroke. The 6MWT was found to be an excellent predictor of mean steps per day (r = 0.68; P = 0.001). Although gait speed and balance were related to walking activity, only the 6MWT was found to be a predictor of community ambulation in patients with stroke.


Kosak and Smith (2005) compared the 2MWT to the 6MWT in 18 clients with stroke. An excellent correlation was found between these two measures (r = 0.997).

Kosak and Smith (2005) compared the 12MWT to the 6MWT in 18 clients with stroke. An excellent correlation was found between these two measures (r = 0.99).

Patterson et al. (2007) administered both the Berg Balance Scale (BBS) (Patterson, Forrester, Rodgers, Ryan, Ivey, Sorkin, et al., 2007) and the 6MWT to 74 clients (43 men, 31 women) with chronic hemiparetic stroke. An excellent relationship was reported between the BBS and the 6MWT (r = 0.69).

Patterson et al. (2007) compared quadriceps eccentric paretic strength to the 6MWT in 74 individuals (43 men, 31 women) with chronic hemiparetic stroke. An adequate relationship was reported between the 6MWTand quadriceps strength (r = 0.57).

Pang, Eng, and Miller (2007) administered the Reintegration to Normal Living Index (RNL) and the 6MWT to 63 clients with chronic stroke. An adequate correlation was reported between these two measures (r = 0.35).

Fulk et al. (2008) examined the convergent validity of the 6MWT by comparing it to the 5MWT in 37 clients undergoing inpatient rehabilitation post-stroke. Clients were on average 33.7 days post-stroke and a mean age of 66.3 years. Using Pearson product moment correlation, the 5MWT and the 6MWT were found to have an excellent correlation (r = 0.89).

Known groups and Discriminant:
Not available.


The table below summarizes studies that have examined the responsiveness of the 6MWT among individuals with stroke.

Authors Name Type of study Result of Study
(Kosak & Smith, 2005) Cross-sectional N=18 clients with stroke An inpatient stroke rehabilitation program (standard protocol as set out by the American Association of Cardiovascular and Pulmonary Rehabilitation) lasting 3.9 + 2 weeks of observation indicated that the responsiveness to change for the 6MWT as measured by standardized response mean (SRM) score was 1.52. This translates into a 2.4 fold increase in the distance walked by clients enrolled in this rehabilitation program.
(Duncan et al., 1998) RCT, pilot study N=20 clients with stroke The results of an 8-week home-based exercise program indicated a change of 59.4 meters on the 6MWT (mean changes = 195 ft) compared with 34.7 meters (mean changes = 114 ft) following usual care.
(Dean, Richards, & Malouin, 2000) RCT, pilot study N=12 clients with stroke A 4-week exercise class was offered to improve locomotor tasks (Dean et al., 2000). Participants achieved a change of 42.1 meters (SD = 119.0) in the 6MWT compared with only a 4.7 meter change following equal intensity of in upper-extremity (UE) intervention.
(Visintin, Barbeau, Korner-Bitensky, & Mayo, 1998) RCT, N=100 clients with stroke After 6 weeks of treadmill training with body weight support, the mean change in the distance walked in 6 minutes following the intervention was 102.8 meters (SD = 67.4) compared with 58.8 meters (SD = 72.2) in the control group.
(Salbach et al., 2004) RCT, N=91 stroke patients The efficacy of a task-oriented intervention in comparison to usual care in enhancing competence in walking with stroke was evaluated. Clients with a mild, moderate or severe walking deficit at baseline improved an average of 36 (SD = 96), 55 (SD = 56) and 18 m (SD = 23), respectively, in 6MWT performance at post-intervention.
(Duncan et al., 2003) RCT, N=100  stroke patients (Subacute phase) The efficacy of therapeutic exercise for individuals with subacute stroke was compared to usual care. The intervention group improved in 6MWT performance by an average of 28.2 meters (12.52%) more than the usual care group.
(Tanne, Tsabari, Chechik, Toledano, Orion, Schwammenthal, et al., 2008) RCT, N=52 post-minor ischemic stroke Three-month outpatient exercise program. Improvement in exercise capacity in the intervention group in comparison to the control group was demonstrated using the 6MWT (from 444 ± 90 at baseline to 557 ± 99 meters post-intervention in the exercise group; from 438 ± 101 at baseline to 418 ± 126 in the control group).
  • ATS statement: guidelines for the six-minute walk test. (2002). Am J Respir Crit Care Med, 166(1), 111-117.
  • Barak, S., & Duncan, P. W. (2006). Issues in selecting outcome measures to assess functional recovery after stroke. NeuroRx, 3(4), 505-524.
  • Butland, R. J., Pang, J., Gross, E. R., Woodcock, A. A., & Geddes, D. M. (1982). Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed), 284(6329), 1607-1608.
  • Cahalin, L., Pappagianopoulos, P., Prevost, S., Wain, J., & Ginns, L. (1995). The relationship of the 6-min walk test to maximal oxygen consumption in transplant candidates with end-stage lung disease. Chest, 108(2), 452-459.
  • Dean, C. M., Richards, C. L., & Malouin, F. (2000). Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil, 81(4), 409-417.
  • Duncan, P., Richards, L., Wallace, D., Stoker-Yates, J., Pohl, P., Luchies, C., et al. (1998). A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Stroke, 29(10), 2055-2060.
  • Duncan, P., Studenski, S., Richards, L., Gollub, S., Lai, S. M., Reker, D., et al. (2003). Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke, 34(9), 2173-2180.
  • Eng, J. J., Dawson, A. S., & Chu, K. S. (2004). Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Arch Phys Med Rehabil, 85(1), 113-118.
  • Enright, P. L. (2003). The six-minute walk test. Respir Care, 48(8), 783-785.
  • Fitts, S. S., & Guthrie, M. R. (1995). Six-minute walk by people with chronic renal failure. Assessment of effort by perceived exertion. Am J Phys Med Rehabil, 74(1), 54-58.
  • Flansbjer, U. B., Holmback, A. M., Downham, D., Patten, C., & Lexell, J. (2005). Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med, 37(2), 75-82.
  • Fulk, G. D., Echternach, J. L., Nof, L., & O’Sullivan, S. (2008). Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke. Physiotherapy Theory and Practice, 24(3), 195-204.
  • Fulk, G. D., Reynolds, C., Mondal, S., & Deutsch, J. E. (2010). Predicting home and community walking activity in people with stroke. Arch Phys Med Rehabil, 91, 1582-1586.
  • Garber, C. E., & Friedman, J. H. (2003). Effects of fatigue on physical activity and function in patients with Parkinson’s disease. Neurology, 60(7), 1119-1124.
  • Gulmans, V. A., van Veldhoven, N. H., de Meer, K., & Helders, P. J. (1996). The six-minute walking test in children with cystic fibrosis: reliability and validity. Pediatr Pulmonol, 22(2), 85-89.
  • Guyatt, G. H., Sullivan, M. J., Thompson, P. J., Fallen, E. L., Pugsley, S. O., Taylor, D. W., et al. (1985). The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J, 132(8), 919-923.
  • Guyatt, G. H., Thompson, P. J., Berman, L. B., Sullivan, M. J., Townsend, M., Jones, N. L., et al. (1985). How should we measure function in patients with chronic heart and lung disease? J Chronic Dis, 38(6), 517-524.
  • Harada, N. D., Chiu, V., & Stewart, A. L. (1999). Mobility-related function in older adults: assessment with a 6-minute walk test. Arch Phys Med Rehabil, 80(7), 837-841.
  • Keith, R. A, Granger, C. V., Hamilton, B. B., & Sherwin, F. S. (1987). The Functional Independence Measure: a new tool for rehabilitation. In: Eisenberg, M.G. & Grzesiak, R.C. (Ed.), Advances in clinical rehabilitation (pp. 6-18). New York: Springer Publishing Company.
  • Kelly, J. O., Kilbreath, S. L., Davis, G. M., Zeman, B., & Raymond, J. (2003). Cardiorespiratory fitness and walking ability in subacute stroke patients. Arch Phys Med Rehabil, 84(12), 1780-1785.
  • King, M. B., Judge, J. O., Whipple, R., & Wolfson, L. (2000). Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention. Phys Ther, 80(1), 8-16.
  • King, S., Wessel, J., Bhambhani, Y., Maikala, R., Sholter, D., & Maksymowych, W. (1999). Validity and reliability of the 6 minute walk in persons with fibromyalgia. J Rheumatol, 26(10), 2233-2237.
  • Kosak, M., & Smith, T. (2005). Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. J Rehabil Res Dev, 42(1), 103-107.
  • Langenfeld, H., Schneider, B., Grimm, W., Beer, M., Knoche, M., Riegger, G., et al. (1990). The six-minute walk–an adequate exercise test for pacemaker patients? Pacing Clin Electrophysiol, 13(12 Pt 2), 1761-1765.
  • Liu, J., Drutz, C., Kumar, R., McVicar, L., Weinberger, R., Brooks, D., Salbach, N.M. (2008). Use of the six-minute walk test poststroke: Is there a practice effect? Arch Phys Med Rehabil., 89(9), 1686-1692.
  • McGavin, C. R., Gupta, S. P., & McHardy, G. J. (1976). Twelve-minute walking test for assessing disability in chronic bronchitis. Br Med J, 1(6013), 822-823.
  • Montgomery, P. S., & Gardner, A. W. (1998). The clinical utility of a six-minute walk test in peripheral arterial occlusive disease patients. J Am Geriatr Soc, 46(6), 706-711.
  • Pang, M. Y., Eng, J. J., & Dawson, A. S. (2005). Relationship between ambulatory capacity and cardiorespiratory fitness in chronic stroke: influence of stroke-specific impairments. Chest, 127(2), 495-501.
  • Pankoff, B., Overend, T., Lucy, D., & White, K. (2000). Validity and responsiveness of the 6 minute walk test for people with fibromyalgia. J Rheumatol, 27(11), 2666-2670.
  • Pankoff, B. A., Overend, T. J., Lucy, S. D., & White, K. P. (2000). Reliability of the six-minute walk test in people with fibromyalgia. Arthritis Care Re, 13(5), 291-295.
  • Patterson, S. L., Forrester, L. W., Rodgers, M. M., Ryan, A. S., Ivey, F. M., Sorkin, J. D., et al. (2007). Determinants of walking function after stroke: differences by deficit severity. Arch Phys Med Rehabil, 88(1), 115-119.
  • Pearson, O. R., Busse, M. E., van Deursen, R. W., & Wiles, C. M. (2004). Quantification of walking mobility in neurological disorders. QJM, 97(8), 463-475.
  • Rossier, P., & Wade, D. T. (2001). Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil, 82(1), 9-13.
  • Sakai, T., Tanaka, K., & Holland, G. J. (2002). Functional and locomotive characteristics of stroke survivors in Japanese community-based rehabilitation. Am J Phys Med Rehabil, 81(9), 675-683.
  • Salbach, N. M., Mayo, N. E., Wood-Dauphinee, S., Hanley, J. A., Richards, C. L., & Cote, R. (2004). A task-orientated intervention enhances walking distance and speed in the first year post stroke: a randomized controlled trial. Clin Rehabil, 18(5), 509-519.
  • Solway, S., Brooks, D., Lacasse, Y., Thomas, S. (2001). A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest,119, 256-270.
  • Steele, B. G., Holt, L., Belza, B., Ferris, S., Lakshminaryan, S., & Buchner, D. M. (2000). Quantitating physical activity in COPD using a triaxial accelerometer. Chest, 117(5), 1359-1367.
  • Tang, A., Sibley, K. M., Bayley, M. T., McIlroy, W. E., & Brooks, D. (2006). Do functional walk tests reflect cardiorespiratory fitness in sub-acute stroke? J Neuroeng Rehabil, 3, 23.
  • Teixeira da Cunha-Filho, I., Henson, H., Qureshy, H., Williams, A. L., Holmes, S. A., & Protas, E. J. (2003). Differential responses to measures of gait performance among healthy and neurologically impaired individuals. Arch Phys Med Rehabil, 84(12), 1774-1779.
  • Tanne, D., Tsabari, R., Chechik, O., Toledano, A., Orion, D., Schwammenthal, Y., et al. (2008) Improved exercise capacity in patients after minor ischemic stroke undergoing a supervised exercise training program. IMAJ, 10, 113-116.
  • Visintin, M., Barbeau, H., Korner-Bitensky, N., & Mayo, N. E. (1998). A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke, 29(6), 1122-1128.