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6 Minute Walk Test
Availability
Freely available at this website: 6 Minute Walk Test
Classification
Supplemental – Highly Recommended: Congenital Muscular Dystrophy (CMD), Facioscapulohumeral Muscular Dystrophy (FSHD) and Spinal Cord Injury (SCI)
Supplemental: Amyotrophic Lateral Sclerosis (ALS), Cerebral Palsy (CP), Duchenne Muscular Dystrophy (DMD), Mitochondrial Disease (Mito), Myotonic Dystrophy (DM), Multiple Sclerosis (MS), Neuromuscular Disease (NMD), SCI-Pediatric (age 4 and over) and Spinal Muscular Atrophy (SMA)
Short Description of Instrument
Background: This test was originally developed for use in patients 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 patient can quickly walk on a flat, hard surface in a period of 6 minutes (the 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 patients 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: Patient
Comments/Special Instructions
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 patient has experienced a clinically significant improvement. Assistive devices can be used but should be recorded at each test.
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.
Administration: Administration time will vary depending on the patient’s ability. Total administration time should be approximately 6 minutes.
SCI-Specific: This test would not be applicable to many individuals. Even in the small minority of ASIA D cases that one might think of applying it to, it would still be more reasonable to use a shorter (say 2 Minute) Walk Test.
SCI-Pediatric-Specific: Assistive devices can be used but should be kept consistent and documented.
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, 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.
References
Balke B. A simple field test for the assessment of physicial 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;284(6329):1607–1608.
 
Kierkegaard M, Tollback A. Reliability and feasibility of the six minute walk test in subjects with myotonic dystrophy. Neuromuscul Disord. 2007;17(11-12):943–949.
 
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;91(12):1920–1929.
 
Society AT. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–117.
 
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;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;14(3):383–390.
 
SMA and DMD Specific References:
Balke B. A simple field test for the assessment of physicial 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;284(6329):1607–1608.
 
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;42(6):966–974.
 
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;43(4):485–488.
 
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. Six-Minute Walk Test demonstrates motor fatigue in spinal muscular atrophy. Neurol. 2010;74(10):833–838.
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