Two-Minute Walk Test (2MWT)

The Two Minute Walk Test (2MWT) is a simple and effective measurement tool for assessing endurance and functional mobility by measuring the distance an individual can walk in two minutes. The test is particularly useful for patients with limited capacity who cannot perform longer tests such as the Six-Minute Walk Test (6MWT) or the Twelve-Minute Walk Test (12MWT). Its simplicity and short duration make it well-suited for clinical use across a wide range of populations and conditions.

Target population

The 2MWT is applicable to a broad range of patients and has been used in multiple clinical settings, including:

• Neurological disorders

  • Multiple sclerosis (MS), where strong correlations have been demonstrated between the 2MWT and the Expanded Disability Status Scale (EDSS)【1】

  • Stroke, both acute and chronic cases【2】

  • Spinal cord injury, with excellent test–retest reliability【3】

• Respiratory and cardiovascular conditions

  • COPD, where the 2MWT is responsive to improvements following rehabilitation【4】

  • Post-cardiac surgery patients【5】

• Older adults

  • Suitable for assessing physical capacity in both community-dwelling and institutionalized elderly【6】

• Amputations and mobility impairments

  • Individuals with lower-limb amputations, where the 2MWT strongly correlates with functional measures such as the Locomotor Capabilities Index【7】

    

Administration and equipment

Required equipment:

• Stopwatch

• A course of at least 15 meters, with marked start and endpoints

• Measuring wheel or tape for accurate distance measurement

• Walking aids (e.g., cane, walker, crutches) may be used but must be documented and kept consistent

Instructions and procedure:

• Standardized instructions are provided before starting:“Walk as far as you can in two minutes at your fastest safe pace. If you need to rest, you may do so, but try to resume walking as quickly as possible.”

• Timing begins as the participant starts walking, and the total distance covered in two minutes is recorded.

• Standardized encouragement is provided at one minute:“You’re doing well, one minute left.”

• Document total distance, use of walking aids, and any pauses or obstacles during the test.

Normative values and influencing factors

Research has established normative values for the 2MWT across age, sex, and clinical populations:

Adults and elderly

• Men (20–29 yrs): 217.9 m【8】

• Women (70–79 yrs): 150.3 m【9】

Children and adolescents

• Boys (16 yrs): 209 m

• Girls (16 yrs): 194.1 m【10】

Multiple sclerosis

• Mild MS: Mean 173 m (SD 31)

• Moderate MS: Mean 104 m (SD 41)【11】

Psychometric properties

Reliability

• Test–retest reliability: Excellent (ICC = 0.97) across multiple populations, including neurological patients【12】

• Interrater and intrarater reliability: Strong consistency across different raters and sessions【13】

Validity

• Construct validity: Strong correlation with the 6MWT and other functional tests such as the Timed Up and Go (TUG)【14】

• Criterion validity: Reliable predictor of functional outcomes, particularly in older adults and patients with amputations【15】

Responsiveness

The 2MWT is responsive to clinically meaningful change, especially in rehabilitation contexts involving neurological and respiratory conditions.

• Example: In COPD, an improvement of ≥5.5 meters is considered clinically significant【16】.

Clinical significance and recommendations

The 2MWT provides valuable information on functional mobility and is useful for:

• Monitoring rehabilitation progress

• Identifying functional limitations

• Setting realistic and measurable therapy goals

Its short duration makes it especially well-suited for patients with low endurance, such as frail elderly or individuals with severe health challenges.

Sources:

1.        Light, K. E., Bebrman, A. L., et al. (1997). "The 2-minute walk test: a tool for evaluating walking endurance in clients with Parkinson's disease." Journal of Neurologic Physical Therapy 21(4): 136.

2.        Kosak, M. and Smith, T. (2005). "Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke." J Rehabil Res Dev 42(1): 103-107.

3.        Lemay, J. F. and Nadeau, S. (2010). "Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale." Spinal Cord 48(3): 245-250.

4.        Johnston, K. N., Potter, A. J., Phillips, A. C. (2017). "Minimal important difference and responsiveness of 2-minute walk test performance in people with COPD undergoing pulmonary rehabilitation." Int J Chron Obstruct Pulmon Dis 12: 2849–2857.

5.        Brooks, D., Parsons, J., et al. (2004). "The two-minute walk test as a measure of functional capacity in cardiac surgery patients." Archives of Physical Medicine and Rehabilitation 85(9): 1525-1530.

6.        Connelly, D. M., Thomas, B. K., et al. (2009). "Clinical utility of the 2-minute walk test for older adults living in long-term care." Physiotherapy Canada 61(2): 78-87.

7.        Salavati, M., Mazaheri, M., et al. (2011). "The Persian version of locomotor capabilities index: translation, reliability and validity in individuals with lower limb amputation." Quality of Life Research 20(1): 1-7.

8.        Bohannon, R. W. (2015). "Normative reference values for the two-minute walk test derived by meta-analysis." J Phys Ther Sci 29(12): 2224–2227.

9.        Bohannon, R. W., Wang, Y., Gershon, R. C. (2015). "Two-Minute Walk Test performance by adults 18 to 85 years: normative values, reliability, and responsiveness." Arch Phys Med Rehabil 96: 472-7.

10.   Bohannon, R. W., Wang, Y., Gershon, R. C. (2017). "Normative Two-Minute Walk Test Distances for Boys and Girls 3 to 17 Years of Age." Physical and Occupational Therapy in Pediatrics 38(11): 1-7.

11.   Gijbels, D., Dalgas, U., et al. (2012). "Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set." Mult Scler 18(3): 364-371.

12.   Rossier, P. and Wade, D. T. (2001). "Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment." Arch Phys Med Rehabil 82(1): 9-13.

13.   Brooks, D., Hunter, J. P., et al. (2002). "Reliability of the two-minute walk test in individuals with transtibial amputation." Archives of Physical Medicine and Rehabilitation 83(11): 1562-1565.

14.   Leung, A. S., Chan, K. K., et al. (2006). "Reliability, validity, and responsiveness of a 2-min walk test to assess exercise capacity of COPD patients." Chest 130(1): 119-125.

15.   Reid, L., Thomson, P., et al. (2015). "Going places: Does the two-minute walk test predict the six-minute walk test in lower extremity amputees?" Journal of Rehabilitation Medicine 47(3): 256-261.

16.   Johnston, K. N., Potter, A. J., Phillips, A. C. (2017). "Minimal important difference and responsiveness of 2-minute walk test performance in people with COPD undergoing pulmonary rehabilitation." Int J Chron Obstruct Pulmon Dis 12: 2849–2857.

17.   Neurology Section of the American Physical Therapy Association’s Taskforces. (2013). "Outcome Measures Recommendations." Available at: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations