![]() In most populations, at least two practice walks should be administered (with adequate time for rest and recovery) prior to recording measurements22. Therefore, one to two practice trials may be useful4. Variation on the tests performed is less than 10% between the first two trials and may reflect true variation in functional capacity 17, 21. Number of Trials Performed: Number of trials has been known to increase 6 minute walk distance 17-19, with largest improvements seen over the first 3 trials 4,20. ![]() ![]() Encouragement increases the distance walked6 and if used, the exact protocol should be reported. Use of Encouragement: Encouragement is often given and is typically standardized, although it varies in frequency across studies from providing encouragement every 30 seconds to every 2 minutes. Although treadmills have been used to conduct the 6MWT, treadmills may underestimated total distance compared to the standard method done in a hallway or exercise room 45,46. A recent study 44 in stroke patients suggest the 30 meter length (versus 10 or 20 meter) resulted in the longest distance covered. In the literature, the corridor distance across studies varies which is likely due to the need to use what is readily available. Walkway length and number of turns in the course: The ATS recommends an indoor, 30 meter corridor or walkway with cones placed at the beginning and end of the 30 meter boundary to indicate turns. Participants are instructed prior to the test to wear comfortable clothing and shoes and to use their typical walking aid during the test. While many studies do not report the exact instructions, most describe the instruction as having participants walk at their usual pace or a comfortable pace and to walk as far as possible. In contrast, some articles instruct people to walk as quickly as possible 14. For patients with moderate to severe heart or lung disease, there are detailed instructions provided by the American Thoracic Society (ATS) 15 which highlight how patients may become out of breath or exhausted and instruct them on taking rest breaks. Test instructions: Due to the differing functional statuses of participants, the 6 minute walk test may cause some people to perform at higher exertion levels than others. Each of these variations will be outlined briefly. These variations include the instructions provided to the participant, the number of turns in the course, the frequency and type of encouragement given, and the number of trials performed. However, it is important to note that there are variations among studies in how the test is conducted which affects performance. This is ideally conducted in an enclosed, quiet hallway by a single administrator. World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Components: changing and maintaining body position (d410-d429) and walking (d450). ![]() The 6MWT has been used with a variety of other conditions such as heart failure 9, 10, chronic obstructive pulmonary disease (COPD) 11 and stroke 12, 13 It has also been used to predict hospitalization and mortality 6,14. The 6MWT has also been used to detect changes following interventions to improve exercise tolerance for healthy older adults 5, 6 as well as people with rheumatic conditions such as knee or hip osteoarthritis 7 and fibromyalgia 8. However, the test has been used in a variety of chronic disease adult and pediatric populations as well as in healthy adults. The 6MWT was developed in frail elderly patients 60-90 years of age referred to a geriatric hospital, and it targets community dwelling frail elders 1. Number of items in scale: Not applicable. Later studies showed that timed walks under 4 minutes were found to be not as sensitive to evaluate the differences in walked distances 3, 4. Different variations of the timed walk have been tested, and the six minute timed walk was recommended given its reproducibility and ease of administration compared to longer timed tests 2. The 6MWT was developed in 1963 by Balke to evaluate functional capacity 1. The individual is allowed to self-pace and rest as needed as they traverse back and forth along a marked walkway. The goal is for the individual to walk as far as possible in six minutes. The six-minute walk test (6MWT) measures the distance an individual is able to walk over a total of six minutes on a hard, flat surface. The test has since been used as a performance-based measure of functional exercise capacity in other populations including healthy older adults, people undergoing knee or hip arthroplasty, fibromyalgia, and scleroderma. The original purpose of the six minute walk was to test exercise tolerance in chronic respiratory disease and heart failure.
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