Skip to 0 minutes and 6 seconds This video demonstrates how to conduct the six-minute walk test. The protocol followed for this test is one outlined by the American Thoracic Society. We advise those interested in conducting this test to first consult the American Thoracic Society’s publication, which you can find in the Downloads section at the bottom of the page, and to read the pretest considerations in the text below. Unlike many other exercise tests, a warmup period before the test should not be performed. The patient should instead sit at rest in a chair located near the starting position before the test starts. Before starting the test, you should check for contraindications, measure pulse and blood pressure, and make sure that clothing and shoes are appropriate.
Skip to 0 minutes and 54 seconds It is useful to ask the patient to rate their baseline dyspnea and overall fatigue using the Borg scale at the start of the test when they stand up. When you and your patient are ready to begin, instruct the patient as follows. The object of this test is to walk as far as possible for six minutes. You will walk back and forth in this hallway. Six minutes is a long time to walk, so you will be exerting yourself. You will probably get out of breath or become exhausted. You are permitted to slow down, to stop, and to rest as necessary. You may lean against the wall while resting, but resume walking as soon as you’re able.
Skip to 1 minute and 36 seconds You will be walking back and forth around the cones. You should pivot briskly around the cones and continue back the other way without hesitation. Now I’m going to show you. Please watch the way I turn without hesitation. Demonstrate by walking one lap yourself. Walk and pivot around a cone briskly. Are you ready to do that? I’m going to keep track of the number of laps you complete. I will click it each time you turn around at the starting line. Remember that the object is to walk as far as possible for six minutes, but don’t run or jog. Start now or whenever you are ready. Do not walk with the patient.
Skip to 2 minutes and 17 seconds As soon as the patient starts to walk, start the timer. Do not talk to anyone during the walk. Use an even tone of voice when using the standard phrases of encouragement. Watch the patient. Each time the participant returns to the starting line, click the lap counter once or mark the lap on the worksheet. Let the participant see you do it. After each minute has passed, there are standard encouraging phrases, which you can tell your patient in even tones. These are detailed in the American Thoracic Society document. If the patient stops walking during the test and needs a rest, say this. You can lean against the wall if you would like. Then continue walking whenever you feel able.
Skip to 3 minutes and 3 seconds Do not stop the timer. If the patient stops before the six minutes are up and refuses to continue, or you decide that they should not continue, wheel the chair over for the patient to sit on, discontinue the walk, and note on the worksheet the distance, the time stopped, and the reason for stopping prematurely. When the timer is 15 seconds from completion, say this. In a moment, I’m going to tell you to stop. When I do, just stop right where you are, and I will come to you. When the timer rings or buzzes, say this. Stop. Walk over to the patient. Consider taking the chair if they look exhausted.
Skip to 3 minutes and 47 seconds In this video, we have placed cones with distance markers on them at regular intervals to make it easy to measure the exact distance walked by the patient when they stop if they have not completed a full lap when six minutes have elapsed. After the test, record the post-walk Borg dyspnea and fatigue levels, and ask this. What, if anything, kept you from walking farther? Record the number of laps from the counter or tick marks on the worksheet. Calculate the total distance walked, rounding to the nearest metre, and record it on the worksheet. Congratulate the patient on a good effort, and offer a drink of water.
Skip to 4 minutes and 27 seconds To interpret the results of the test, you can compare the distance achieved by your patient to normative data that has been published in the literature available in the Downloads section below. Reassessing your patient and comparing results over time can be very useful to track progress.
The six minute walk test
The 6 minute walk test (6MWT) is a practical simple test that measures the distance a patient can quickly walk on a flat, hard surface in a period of 6 minutes. It is used to gather information on a patient’s functional capacity and is an excellent tool for ongoing monitoring of patients. Most patients do not achieve maximal exercise capacity during the 6MWT; instead, they choose their own intensity of exercise and are allowed to stop and rest during the test if they need to.
- Testing should be performed in a location where a rapid, appropriate response to an emergency is possible.
- The health care professional supervising the test should be certified in cardiopulmonary resuscitation with a minimum of Basic Life Support.
- Physicians are not required to be present during all tests.
If a patient is on chronic oxygen therapy, oxygen should be given at their standard rate or as directed by a physician or a protocol.
- To ensure comfort your patient should be wearing comfortable clothing, appropriate shoes and should use any walking aids as they normally would.
- Use of walking aids are permitted during the 6MWT.
- Any medication should be continued as per usual and it is permitted for your patient to have had a light meal before the 6MWT, especially if the test is conducted in the early morning or early afternoon.
- Vigorous intensity exercise should be discouraged within 2 hours of beginning the test.
Absolute contraindications include:
- Unstable angina during the previous month
- Myocardial infarction during the previous month
Relative contraindications include:
- Resting heart rate of more than 120
- Systolic blood pressure of more than 180 mm Hg
- Diastolic blood pressure of more than 100 mm Hg
The test requires a long hallway but no exercise equipment or advanced training for technicians. The following pieces of equipment are recommended to conduct the test:
- A countdown timer (or stopwatch)
- A mechanical lap counter or alternative means of keeping track of distance walked
- A minimum of two small cones to mark the turnaround points
- A chair that can be easily moved along the walking course
- Worksheets on a clipboard to keep notes (for example on whether the patient requires a break during the test)
- A source of oxygen
- A sphygmomanometer
- A telephone
- An automated electronic defibrillator
Interpreting the results
To interpret the results of the test you can compare the distance achieved by your patient to normative data that has been published in the literature (see Table 1 in Rasekaba et al, 2009). Re-assessing your patient and comparing results over time can be very useful to track progress.
The six minute walk test can be very useful to to gather information on a patient’s functional capacity, but it also has limitations.
- Can you think of any limitations of the 6 minute walk test?
- Would there be any situations that the test would not be suitable?
- Could the test give results that does not reflect a patients’ status?
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