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Availability
Please visit this website for more information about the instrument: 6 Minute Walk Test

 
The protocol is freely available here: 6 Minute Walk Test Protocol
Classification
NeuroRehab Supplemental - Highly Recommended:
Recommendations for Use: Indicated for studies requiring a measure of walking endurance.
 
Supplemental - Highly Recommended: Congenital Muscular Dystrophy (CMD), Facioscapulohumeral Muscular Dystrophy (FSHD) and Spinal Cord Injury (SCI)
Recommendations for 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 (2MWT)) for patients with more severe injuries or less endurance.
 
Supplemental: Amyotrophic Lateral Sclerosis (ALS), Cerebral Palsy (CP), Duchenne Muscular Dystrophy (DMD), Mitochondrial Disease (Mito), Multiple Sclerosis (MS), Myotonic Dystrophy (DM), Neuromuscular Disease (NMD), SCI-Pediatric (age 4 and over), Spinal Muscular Atrophy (SMA), and Stroke
Short Description of Instrument
Background:
This test was originally developed for use in people 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 participant can quickly walk on a flat, hard surface in a period of six minutes (the 6-minute walk duration, 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 participants 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: Participant
Comments/Special Instructions
Administration: Administration time will vary depending on the participant's ability. Total administration time should be approximately 6 minutes.
 
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.
 
CP-Specific: If orthotics are used to perform the 6MWT, the External Devices - CP CRF should be completed as well.
 
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.
 
NeuroRehab-Specific: Measurement of walking endurance is a critical aspect of understanding a person's overall walking capacity. A performance-based measure is most suited to understanding capacity.
 
Both the 2MWT and the 6MWT are used as measures of functional capacity, but the briefer duration of the 2MWT may be less burdensome in busy settings when many people may need to be tested or many tests performed, or when attention span limits participation in prolonged activities (e.g., very young children or those with cognitive challenges), or for those with greater walking limitations (e.g., advanced multiple sclerosis). In contrast, when trying to discriminate subtle differences in walking ability amongst those with greater walking capacity, the 2MWT may be limited by a floor effect compared to the 6MWT.
 
Not needed for conditions with only upper limb impairment.
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 participant has experienced a clinically significant improvement. Assistive devices can be used but should be recorded at each test.
 
Psychometric Properties: The 6MWT has good test-retest reliability in older populations (.88 <R < .94), particularly when a practice trial preceded the test trial. Convergent validity of the 6MWT 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 participants compared to high-active participants. There was a moderate relationship between 6MWT scores and self-reported functional ability. It was concluded that the 6MWT 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 6MWT is a reliable and valid functional test for assessing exercise tolerance and endurance.
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.
 
NeuroRehab Specific:
Widely accepted, gold standard measure of walking endurance.
 
Mitochondrial Disease-Specific:
Strengths: Does reflect both strength and endurance impairments.
 
Weaknesses: May be difficult to perform if the patient has ataxia or hemiparesis. May be impaired due to secondary neuropathy (i.e., secondary to diabetes) and consequently, may not reflect the cardio-metabolic or muscle defect.
References
Key Reference:
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7.
 
Additional References:
Bohannon RW, Bubela D, Magasi S, McCreath H, Wang YC, Reuben D, Rymer WZ, Gershon R. Comparison of walking performance over the first 2 minutes and the full 6 minutes of the Six-Minute Walk Test. BMC Res Notes. 2014 Apr 25;7:269.
 
Kierkegaard M, Tollbaeck A. Reliability and feasibility of the six-minute walk test in subjects with myotonic dystrophy. Neuromuscul Disord. 2007 Dec;17(11-12):943-9.
 
Li AM, Yin J, Yu CC, Tsang T, So HK, Wong E, Chan D, Hon EK, Sung R. The six-minute walk test in healthy children: reliability and validity. Eur Respir J. 2005 Jun;25(6):1057-60.
 
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 Dec;91(12):1920-9.
 
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 Spring;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 Apr;14(3):383-90.
 
NeuroRehab-Specific References:
Moore JL, Potter K, Blankshain K, Kaplan SL, O'Dwyer LC, Sullivan JE. A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE. J Neurol Phys Ther. 2018 Jul;42(3):174-220.
 
Scalzitti DA, Harwood KJ, Maring JR, Leach SJ, Ruckert EA, Costello E. Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and Other Functional Measures in Persons with Multiple Sclerosis. Int J MS Care. 2018 Jul-Aug;20(4):158-163.
 
SMA and DMD-Specific References:
Balke B. A simple field test for the assessment of physical 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 May 29;284(6329):1607-8.
 
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 Dec;42(6):966-74.
 
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 Apr;43(4):485-8.
 
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; Muscle Study Group and the Pediatric Neuromuscular Clinical Research Network. Six-Minute Walk Test demonstrates motor fatigue in spinal muscular atrophy. Neurology. 2010 Mar 9;74(10):833-8.
 
Stroke-Specific References:
Bushnell C, Bettger JP, Cockroft KM, Cramer SC, Edelen MO, Hanley D, Katzan IL, Mattke S, Nilsen DM, Piquado T, Skidmore ER, Wing K, Yenokyan G. Chronic Stroke Outcome Measures for Motor Function Intervention Trials: Expert Panel Recommendations. Circ Cardiovasc Qual Outcomes. 2015 Oct;8(6 Suppl 3):S163-9.
 
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):451-61.
 
Document last updated March 2024