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6 Minute Walk Test
Availability
Freely available at this website: 6 Minute Walk Test

 
The protocol is freely available here: 6 Minute Walk Test Protocol

Classification
Supplemental - Highly Recommended: Congenital Muscular Dystrophy (CMD), Facioscapulohumeral Muscular Dystrophy (FSHD) and Spinal Cord Injury (SCI)
 
Supplemental: Amyotrophic Lateral Sclerosis (ALS), Cerebral Palsy (CP), Duchenne Muscular Dystrophy (DMD), Mitochondrial Disease (Mito), Myotonic Dystrophy (DM), Multiple Sclerosis (MS), Neuromuscular Disease (NMD), SCI-Pediatric (age 4 and over), Spinal Muscular Atrophy (SMA) and Stroke
 
*Recommendations on Use: Indicated for studies targeted at walking function where the intended population is less severely impaired (i.e., AIS D) and may be able to walk 6 minutes. Consider a shorter test (i.e., 2 Minute Walk Test) for patients with more severe injuries or less endurance.
Short Description of Instrument
Background: This test was originally developed for use in patients with cardiopulmonary disease, but has since been used in a variety of neurological conditions including MS. The 6-minute walk test (6MWT) measures the distance a patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 6MWD). This evaluates the global and integrated responses of all the systems involved during exercise, including pulmonary and cardiovascular systems, systemic circulation, peripheral circulation, blood, neuromuscular units, and muscle metabolism. The 6MWT does not provide specific information on the function of each of the different organs and systems involved in exercise, or the mechanism of exercise limitation as is possible with maximal cardiopulmonary exercise testing. The self-paced 6MWT assesses the submaximal level of functional capacity. Most patients do not achieve maximal exercise capacity during the 6MWT; instead, they choose their own intensity of exercise and can stop and rest during the test. However, because most activities of daily living are performed at submaximal levels of exertion, the 6MWD may better reflect the functional exercise level for daily physical activities.
 
Construct measured: Walking speed
 
Generic vs. disease specific: Generic
 
Means of administration: Administered in-person by a trained examiner.
 
Intended respondent: Patient
Comments/Special Instructions
MS-Specific: Goldman et al (2008) has modified the American Thoracic Society 6MWT script (ATS 2002) for use in MS, to maximize effort and better assess motor fatigue.
 
Administration: Administration time will vary depending on the patient's ability. Total administration time should be approximately 6 minutes.
 
SCI-Specific:This test would mainly be applicable to individuals with a very incomplete injury (AIS D).
 
SCI-Pediatric-Specific: Assistive devices can be used but should be kept consistent and documented.
 
Rationale/Justification
Strengths/Weaknesses: Sources of variability include the following: Factors reducing the 6MWD - Shorter height, Older age, Higher body weight, Female sex, Impaired cognition, A shorter corridor (more turns), Pulmonary disease (COPD, asthma, cystic fibrosis, interstitial lung disease), Cardiovascular disease (angina, MI, CHF, stroke, TIA, PVD, AAI), Musculoskeletal disorders (arthritis, ankle, knee, or hip injuries, muscle wasting, fatigue, etc.); Factors increasing the 6MWD - Taller height (longer legs), Male sex, High motivation, A patient who has previously performed the test, Medication for a disabling disease taken just before the test, Oxygen supplementation in patients with exercise-induced hypoxemia.
 
CMD-Specific: Highly recommended only for ambulatory CMD patients.
Scoring and Psychometric Properties
Scoring: Record the number of laps from the counter (or tick marks on the worksheet). Record the additional distance covered (the number of meters in the final partial lap) using the markers on the wall as distance guides. Calculate the total distance walked, rounding to the nearest meter, and record it on the worksheet. Most 6MWTs will be done before and after intervention, and the primary question to be answered after both tests have been completed is whether the patient has experienced a clinically significant improvement. Assistive devices can be used but should be recorded at each test.
 
Psychometric Properties: The 6-min walk has good test-retest reliability in older populations (.88 <R < .94). particularly when a practice trial preceded the test trial. Convergent validity of the 6-min walk was demonstrated by its moderate correlation (.71 < r < .82) with treadmill performance. Construct validity was assessed by determining the ability of the test to detect differences between different age and activity level groups. As expected, walking scores decreased significantly across decades and were significantly lower for low-active subjects compared to high-active subjects. There was a moderate relationship between 6-min walk scores and self-reported functional ability. It was concluded that the 6-min walk can be used to obtain reasonably reliable and valid measures of physical endurance in older adults and that it moderately reflects overall physical functional performance. In healthy children, the 6-min walk test is a reliable and valid functional test for assessing exercise tolerance and endurance.
References
Balke B. A simple field test for the assessment of physicial fitness. Rep Civ Aeromed Res Inst US. 1963;53:1-8.
 
Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed). 1982;284(6329):1607-1608.
 
Gandhi P, Chan K, Verrier MC, Pakosh M, Musselman KE. Training to Improve Walking after Pediatric Spinal Cord Injury: A Systematic Review of Parameters and Walking Outcomes. J Neurotrauma. 2017;34(9):1713-1725.
 
Kierkegaard M, Tollback A. Reliability and feasibility of the six minute walk test in subjects with myotonic dystrophy. Neuromuscul Disord. 2007;17(11-12):943-949.
 
Li AM, Yin J, Yu CCW, Tsang T, So HK, Wong E, Chan D, Hon EKL, Sung R. The six-minute walk test in healthy children: reliability and validity. European Respiratory Journal. 2005; 25: 1057-1060.
 
Rikli RE, Jones CJ. The Reliability and Validity of a 6-Minute Walk Test as a Measure of Physical Endurance in Older Adults. J Aging Phys. 1998; 6(4): 363-375.
 
Sanjak M, Bravver E, Bockenek WL, Norton HJ, Brooks BR. Supported treadmill ambulation for amyotrophic lateral sclerosis: a pilot study. Arch Phys Med Rehabil. 2010;91(12):1920-1929.
 
Society AT. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-117.
 
MS Specific References:
Bethoux F, Bennett S. Evaluating walking in patients with multiple sclerosis: which assessment tools are useful in clinical practice? Int J MS Care. 2011;13(1):4-14.
 
Goldman MD, Marrie RA, Cohen JA. Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls. Mult Scler. 2008;14(3):383-390.
 
SMA and DMD Specific References:
Balke B. A simple field test for the assessment of physicial fitness. Rep Civ Aeromed Res Inst US. 1963;53:1-8.
 
Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed). 1982;284(6329):1607-1608.
 
McDonald CM, Henricson EK, Han JJ, Abresch RT, Nicorici A, Atkinson L, Elfring GL, Reha A, Miller LL. The 6-minute walk test in Duchenne/Becker muscular dystrophy: longitudinal observations. Muscle & Nerve. 2010;42(6):966-974.
 
Montes J, Dunaway S, Montgomery MJ, Sproule D, Kaufmann P, De Vivo DC, Rao AK. Fatigue leads to gait changes in spinal muscular atrophy. Muscle & Nerve. 2011;43(4):485-488.
 
Montes J, McDermott MP, Martens WB, Dunaway S, Glanzman AM, Riley S, Quigley J, Montgomery MJ, Sproule D, Tawil R, Chung WK, Darras BT, De Vivo DC, Kaufmann P, Finkel RS. Six-Minute Walk Test demonstrates motor fatigue in spinal muscular atrophy. Neurol. 2010;74(10):833-838.
 
Stroke Specific References:
Bushnell C, Bettger J, Cockroft K, Cramer S, Edelen M, Hanley D, Katzan I, Mattke S, Nilsen D, Piquado T, Skidmore E, Wing K, Yenokyan G. Chronic Stroke Outcome Measures for Motor Function Intervention Trials: Expert Panel Recommendations. Circ Cardiovasc Qual Outcomes. 2015 October; 8(6 Suppl 3): S163-S169. doi: 10.1161/CIRCOUTCOMES. 115.002098.
 
Kwakkel G, Lannin NA, Borschmann K, English C, Ali M, Churilov L, Saposnik G, Winstein C, van Wegen EE, Wolf SL, Krakauer JW, Bernhardt J. Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable.Int J Stroke. 2017 Jul;12(5):451-461. doi: 10.1177/1747493017711813.