6-Minute Walk Test Authors: R.J.A. Butland, J. Pang, E.R. Gross, A.A. Woodcock, D.M.

Geddes Purpose of tool: To evaluate functional aerobic exercise capacity and endurance. Target population: Research shows that efficacy of this test for ages 4 and older. As this test evaluates exercise capacity, it is applied to a large range of patients including individuals with chronic obstructive pulmonary disease, heart failure, cystic fibrosis, fibromyalgia, stroke, and old age. Areas Tested: Distance walked, number and duration of rests in 6 minutes, perceived exertion, dyspnea, oxygen saturation, heart rate, overall aerobic exercise capacity and endurance. Reliability of test: Internal consistency: Unavailable. Interrater: Unavailable. Test-Retest: Chronic Heart and Lung Disease: ICC=. 91, significant increase in distance walked between first 3 trials Heart Failure: ICC=. 82-.91 Chronic Renal Failure: ICC=. 91 Fibromyalgia: ICC=. 73 Validity of test: Content: Subjects with heart failure and pacemakers consider the 6-minute walk test similar to daily physical activity. Concurrent: COPD: VO2 peak r =.64; Congestive Heart Failure: Correlated with age r =-.34 Fibromyalgia: VO2 peak r =.657 Chronic Renal Failure: Heart rate r =.78 Heart Failure: Vo2 peak r =.64 (<300m) Heart Disease: VO2 peak r =.64 Convergent: Fibromyalgia Impact Questionnaire r =-.494 Treadmill Performance r =.78 Chronic Heart Failure Questionnaire r =-.79 2 minute Walk Test r =.89-.95 12-minute Walk Test r =.96 Shuffle Walk Test r =.68 Cycle Ergometery r =.42-.58 Measure of Balance and Function: r =.52-.73 Divergent: Not available

Administration: Little training is necessary to administer this test. Patients should rest near starting position for at least 10 minutes. Directions should be given to patient with phrases such as Walk as far as possible, and stop if you need to, but start again as soon as possible. In studies, the walking course, encouragement, surroundings, instructions, and many other factors varied. When performing this test, it is important to find a stable setting and standard instructions to increase validity. Distance walked, number and duration of rests in 6 minutes, perceived exertion, dyspnea, oxygen saturation, heart rate, and overall aerobic exercise capacity and endurance may be tested during the walk with proper equipment. It is important that subjects do not hold the equipment. Prior to the test, administering 2 practice walks increases reliability. Time required: 6 minutes of test time; 20-60 minutes to set-up, administer, and evaluate. Advantages: This test is objective and has limited costs. Depending on your patient and the area of aerobic capacity and endurance the clinician is evaluating, little equipment is needed (stopwatch, sphygmomanometer, pulse oximeter, etc.). It can be used for a wide range of patients and shows strong correlation with the 12-minute walking test, allowing a shorter testing time with similar results for those with less endurance and more limitations. Limitations: Reliability and validity varies from population to population. Clinicians and researches perform it differently with respects to walking course, encouragement, surroundings, instructions, and many other factors. Must be used with caution for patients with poor balance and frail health. Ordering/Acquisition information: This test is easy to access and free online and through scientific journals by searching for 6-Minute Walk Test instructions. References: 1. Firch E, Brooks D, Stratford P, Mayo N. Physical Rehabilitation Outcome Measures. Second ed. Hamilton, ON: BC Decker Inc; 2002:186-187. 2. Jenkins SC. 6-minute walk test in patients with COPD: Clinical applications in pulmonary rehabilitation. Physiotherapy. 2007;93:175-182. 3. Kosak M, Smith T. Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. Journal of Rehabilitation Research and Development. 2005;42:103-108. 4. Lammers AE, Hislop AA, Flynn Y, Haworth SG. The 6-minute walk test: Normal values for children of 4-11 years of age. Archives of Disease in Childhood. 2008;93:464468. 5. Laskin JJ, Bundy S, Marron H, et al. Using a treadmill for the 6-minute walk test: Reliability and validity. Journal of Cardiopulmonary Rehabilitation and Prevention. 2007;27:407-410.

6. Sadaria KS, Bohannon RW. The 6-minute walk test: A brief review of literature. Clinical Exercise Physiology. 2001;3:127-132.

Appraised by: D. Shalom Fielding

Date appraised: July 31, 2008