The Six-Minute Walk Test
The 6 Minute Walk Test is a sub-maximal exercise test used to assess
aerobic capacity and endurance. The distance covered over a time of 6
minutes is used as the outcome by which to compare changes in
performance capacity.
The equipment
1. the examiner needs a 100-foot hallway marked by two cones or a
straight path with 50-foot intervals,
2. a clipboard,
3. lap counter,
4. timer,
5. chair,
6. vital signs monitor,
7. Borg scale,
8. oxygen source,
9. and access to emergency assistance as needed.
Close monitoring of SpO2 (oxygen saturation measured by pulse
oximetry) is vital among patients with pulmonary and cardiac dysfunction
to maintain safety during the test period. The use of a treadmill or circular
track for this test is not recommended. The course should include a 100-
foot track that can be marked at the end with two cones on which the
patient walks down and back in a straight-line pattern.
Patient preparation includes the following
: The patient should wear comfortable clothing and shoes (Fig. 22-3).
The patient should use their normal and everyday assistive device, for
example, walker, rolling walker, or cane, during the test, and the patient’s
normal medical regimen should be continued. Patients should not have
exercised vigorously within 2 hours of the exam. The instructions provided
to the patient are very explicitly outlined by the American Thoracic
Society and are found in Box 22-5.
To prepare for the 6MWT,
the patient should be placed in a seated position at the start line and vital
sign/Borg scale/ contraindication information collected.
Once instructions and demonstration of a lap have been provided to the
patient, the test begins when the patient starts walking. The examiner
should not say “ready, set go!” In addition, it is important that the
examiner use limited and neutral encouragement once a minute (giving
the patient an update on the time that has passed), in addition to not
walking with the patient during the exam.
These two errors can affect the validity of the exam.
During the exam, if any rest breaks are taken, vital sign and Borg scale
information should be recorded, as long as it does not disrupt possible
continuation of the exam. Following the exam or upon termination by the
patient, the Borg scale and vital signs should again be recorded and the
patient should be questioned as to what, if anything, might have limited
them from going further. The total distance should be recorded. Gait
speed can also be calculated by taking the distance walked and dividing
by time.
The average distance walked can vary based on the patient population,
but distances of less than 400 meters are predictive of mortality across
various patient populations. The MCID for this test was also found to be
approximately 86 meters for an individual patient.120 In addition to being
predictive of mortality, the test is a good indicator of outcomes from a
pulmonary or cardiac rehabilitation program and should be considered
across all settings in which therapists see patients with cardiopulmonary
dysfunction.
Interpretation
An increase in the distance walked indicates improvement in basic
mobility. Resnik et al (2011)[3] suggested in Amputee rehabilitation, Post
training a difference of at least 45m should be observed for the 6 minutes
walk test to be sure that a “real” change in the patient’s condition.
In some neuromuscular conditions such as Duchenne/Becker muscular
dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth disease, and
Myasthenia Gravis the 6MWT has been implemented in the assessment of
those patients and it has been regularly used to capture any changes,
which provides valuable information regarding the natural history of these
disorders.
Some studies used the six minute walking test to identify patients with
neuromuscular junction dysfunction[4]. By splitting the test into six
different components where each minute is a different data point, the
researches discovered that the 6MWT can identify any malfunctions in the
neuromuscular junctions. Also by comparing the distance covered in the
first and the last minute suggested how much the fatigue has influenced
the individual.
Key points about 6MWT interpretation for genders:
Male reference equation: 6MWD = (7.57 x height cm) - (5.02 x
age) - (1.76 x weight kg) - 309 m
Female reference equation: 6MWD = (2.11 x height cm) - (2.29 x
weight kg) - (5.78 x age) + 667 m