Six-Minute Walk Test

(Taken from the American Thoracic Society Statement, March 2002)

Absolute Contraindications: Unstable angina during the previous month, myocardial infarction during the previous month.

Relative Contraindications: Resting heart rate > 120 bpm, Systolic BP >180 mm Hg or Diastolic BP > 100mm Hg.

**In cases of stable exertional angina, have the subject perform the test after using their antiangina medication, rescue nitrate medication should be readily available.

Reasons for stopping a 6MWT immediately include:

(1)Chest pain

(2)Intolerable dyspnea

(3)Leg cramps

(4)Staggering

(5)Diaphoresis

(6)Pale or ashen appearance

**If a test is stopped for any of these reasons, the subject should sit or lie supine as appropriate depending on the severity of the event and the risk of syncope. Obtain vital signs and contact a physician if needed.

Equipment:

  1. A level, straight walkway, preferably 100 feet in length, with markers every 10 feet. The turnaround points should be marked with a cone such as an orange traffic cone. Mark the starting line (marking the beginning and end of each 200 foot lap) on the floor using brightly colored tape.
  2. Caution: A recent multicenter trial found no significant effect of length of straight courses ranging form 50 to 164 feet in length, but patients walked an average of 92 feet farther when using a continuous track rather than a straight hallway – Weiss RA et al. 2000
  3. Treadmill tests are not interchangeable with corridor tests
  4. Stopwatch
  5. Mechanical lap counter or paper system
  6. A chair that can be easily moved along the walking course
  7. Sphygmomanometer and stethoscope
  8. Data collection sheets

Patient Preparation

  1. Comfortable clothing should be worn, including appropriate shoes for walking.
  2. Subject should use their usual walking aids (cane, walker, etc).
  3. A light meal is acceptable before the test.
  4. Subjects should not have exercised vigorously within 2 hours of beginning the test.
  5. Repeat testing should be performed at about the same time of day to minimize intraday variability.
  6. A “warm-up” should NOT be performed. The subject should rest in a chair, located near the starting position, for at least 10 minutes before the tests starts. During this time, vitals can be taken, including heart rate and blood pressure.
  7. Have the subject stand and rate baseline Rate of Perceived Exertion using the Borg scale.

TABLE 2: THE BORG SCALE
0 / Nothing at all
0.5 / Very, very slight (just noticeable)
1 / Very slight
2 / Slight (light)
3 / Moderate
4 / Somewhat severe
5 / Severe (heavy)
6
7 / Very severe
8
9
10 / Very, very severe (maximal)
  1. Position the subject at the starting line. Set the lap counter to zero and the timer to 6 minutes. Stand near the patient, but do not walk with the, unless necessary because of balance/ fall concerns. In that case, stay slightly behind the patient to avoid setting the pace.
  2. Give the following initial instructions:

“The object of this test is to walk as far as possible for 6 minutes. You will walk back and forth in this hallway (along this walkway). Six minutes is a long time, so you will be exerting yourself. You will probably get out of breath. 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 are able. 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.”

Are you ready to do that? I am going to use this counter (or paper) to keep track of the number of laps you complete. I will make a mark each time you turn around this starting line. Remember that the object is to walk AS FAR AS POSSIBLE for 6 minutes, but don’t run or jog.”

Start now, or whenever you are ready.”

  1. As soon as the subject starts to walk, start the timer. The tester should not talk to anyone during the walk. Use an even tone of voice when using phrases of encouragement. Each time the participant return to the starting line, click thecounter once (or mark the lap on your worksheet), making sure that the subject sees you do it.
  2. Provide the following cues: Do NOT use other words of encouragement (or body language) to speed the subject up.

After the first minute: tell the subject the following (in even tones): “You have 5minutes to go”

When the timer shows 4 minutes remaining, tell the subject the following: “Keepup the good work. You have 4 minutes to go.”

When the timer shows 3 minutes remaining, tell the patient the following: “Youare doing well. You are halfway done.”

When the timer shows 2 minutes remaining, tell the patient the following: “Keepup the good work. You only have 2 minutes left.”

When the timer shows only 1 minute remaining, tell the patient the following:“You are doing well. You have only 1 minute to go.”

If the subject 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.” Do not stop the timer. If the subject stops before the 6 minutes are up and refuses to continue (or you decide that they should not continue), wheel the chair over for the subject to sit on, discontinue the walk, and note the distance, time stopped, and reason for stopping prematurely.

When the timer is 15 seconds from completion, say this: “In a moments, I am 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, say: “Stop!” Walk over to the patient. Take a chair if they appear exhausted. Mark the spot where they stopped by placing a marker or piece of tape on the floor.

Post-Test:

  1. Measure the postwalk vitals – pulse rate and blood pressure.
  2. Record the postwalk Borg Rate of Perceived Exertion level and ask: “What, if anything, kept you from walking farther?” Record answer on data collection sheet.
  3. Record the number of laps form the counter (or the marks on the worksheet)
  4. Record the additional distance covered (the number of feet in the final partial lap) using the markers on the wall as distance guides or using a measuring wheel. Calculate the total distance walked, rounded to the nearest meter, and record is on the worksheet.
  5. Congratulate the patient on good effort and offer a drink if water.