6 Minute Walk Test (6MWT)

The 6 Minute Walk Test (6MWT) is a submaximal test developed by the American Thoracic Society and standardized in 2002【1】. The test measures the total distance a person can walk in six minutes, providing a reliable indication of functional capacity, aerobic endurance, and the body’s ability to handle physical activity. It is widely used in both diagnostics and patient follow-up across different clinical settings.

Target population and application

The 6MWT can be applied across a broad spectrum of populations, from children to older adults, and includes both acute and chronic conditions. It evaluates the combined response of the pulmonary, cardiovascular, and muscular systems during physical activity【2】【3】.

Typical patient groups:

• COPD and asthma

• Heart failure and other cardiac conditions

• Neuromuscular disorders such as muscular dystrophy

• Stroke patients

• Parkinson’s disease and multiple sclerosis

• Older adults with reduced mobility

Test procedure

Required equipment:

• Stopwatch

• Measuring wheel or tape (30 m walkway)

• Two cones for turning points

• Pulse oximeter (optional)

• Borg rating of perceived exertion scale (optional)

Preparations:

• Place cones at each end of a 30 m corridor.

• Provide chairs along the walkway if rest is needed.

• Give standardized instructions, e.g.:“The purpose of the test is to walk as far as possible in six minutes. You may walk at your own pace, rest as needed, but resume walking as soon as possible.”

Standardized encouragements:

• After 1 minute: “You are doing well, you have 5 minutes left.”

• At 1 minute remaining: “You are almost done, just one minute left.”

• At 6 minutes: “Stop where you are.”

Measurements:

• Primary outcome: total distance walked.

• Secondary outcomes: heart rate, oxygen saturation, perceived exertion【4】.

Interpretation and clinical utility

The result provides a clear picture of the patient’s functional capacity:

• Increased distance → improved endurance/mobility

• Reduced distance → potential deterioration of health condition

Example: An improvement of ≥45 meters is considered clinically significant in patients undergoing amputation rehabilitation【6】. In neurological conditions such as Duchenne muscular dystrophy, minute-by-minute analysis provides valuable insight into fatigue profiles【7】.

Advantages and limitations

Advantages:

• Simple and cost-effective

• Reflects daily function (walking longer distances)

• Applicable across many patient groups【8】

Limitations:

• Dependent on patient motivation and effort

• Influenced by understanding of instructions

• May lack sensitivity to detect small changes【9】

Evidence for reliability and validity

Reliability

The 6MWT consistently demonstrates excellent test–retest reliability:

• Alzheimer’s disease: ICC = 0.98【5】

• Older adults: r = 0.95–0.95【6】【7】

• Osteoarthritis: ICC = 0.94【8】

• Stroke: ICC = 0.97–0.99【9】【10】【11】【12】

• TBI: ICC = 0.94–0.96【13】【14】

• Parkinson’s disease: ICC = 0.95–0.96【15】

• Spinal cord injury (SCI): ICC = 0.99【17】【18】

Inter-rater and intra-rater reliability:

• Alzheimer’s disease: ICC = 0.76–0.99【16】

• Stroke: ICC = 0.74–0.78【18】

• SCI: ICC = 0.99【17】【18】

Validity

Criterion validity:

• COPD: high specificity (84%) and sensitivity (82%) for postoperative outcomes【19】

• Older adults: moderate correlation with chair rise test (r = 0.67) and gait speed (r = –0.73)【20】

• SCI: strong correlation with 10MWT (r = –0.95) and TUG (r = –0.88)【21】

• Stroke: strong correlation with TUG (r = –0.89) and stair climbing (r = –0.82)【22】

Construct validity:

• Geriatrics: r = 0.55 for physical function, r = 0.39 for general health【6】

• SCI: R² = 0.87 for gait speed post-injury【18】

Responsiveness:

• COPD: highly sensitive to exacerbations【23】

• Older adults: 20 m = minimal clinically important change; 50 m = large improvement【24】

• SCI: detects early gains but less sensitive after 6–12 months【18】

• Stroke: SRM = 1.52 (very strong change during rehab)【18】

Conclusion

The 6MWT is a standardized, valid, and reliable test for assessing functional capacity and endurance. It is simple to administer, widely applicable across patient groups, and strongly supported by research. While results can be influenced by patient motivation and effort, its ease of use and broad applicability make the 6MWT an essential tool in clinical practice and rehabilitation.

Referanser

1. Laboratories, A. T. S. C. o. P. S. f. C. P. F. (2002). "ATS statement: guidelines for the six-minute walk test." American Journal of Respiratory and Critical Care Medicine, 166(1), 111–117.

2. YSUMediaAcademicComp. Six Minute Walk Test 2012. Available from: http://www.youtube.com/watch?v=JHzsgeudQ1I [last accessed 10/10/14].

3. Resnik, L., & Borgia, M. (2011). Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error. Physical Therapy, 91(4), 555–565.

4. Pera, M. C., et al. (2017). "6MWT can identify type 3 SMA patients with neuromuscular junction dysfunction." Neuromuscular Disorders, 27(10), 879–882.

5. Ries, J. D., Echternach, J. L., et al. "Test-retest reliability and minimal detectable change scores for the timed 'up & go' test, the six-minute walk test, and gait speed in people with Alzheimer disease." Physical Therapy, 89(6), 569–579.

6. Harada, N., Chiu, V., et al. "Mobility-related function in older adults: assessment with a 6-minute walk test." Archives of Physical Medicine and Rehabilitation, 80(7), 837–841.

7. Steffen, T. M., Hacker, T. A., et al. "Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds." Physical Therapy, 82(2), 128–137.

8. Kennedy, D. M., Stratford, P. W., et al. "Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty." BMC Musculoskeletal Disorders, 6, 3.

9. Eng, J. J., Dawson, A. S., et al. "Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption." Archives of Physical Medicine and Rehabilitation, 85(1), 113–118.

10. Flansbjer, U. B., Holmback, A. M., et al. "Reliability of gait performance tests in men and women with hemiparesis after stroke." Journal of Rehabilitation Medicine, 37(2), 75–82.

11. Fulk, G. D., & Echternach, J. L. "Test-retest reliability and minimal detectable change of gait speed in individuals undergoing rehabilitation after stroke." Journal of Neurologic Physical Therapy, 32(1), 8–13.

12. Wevers, L. E., Kwakkel, G., et al. "Is outdoor use of the six-minute walk test with a global positioning system in stroke patients' own neighbourhoods reproducible and valid?" Journal of Rehabilitation Medicine, 43(11), 1027–1031.

13. Mossberg, K. A. "Reliability of a timed walk test in persons with acquired brain injury." American Journal of Physical Medicine and Rehabilitation, 82(5), 385–390; quiz 391–382.

14. Van Loo, M. A., Moseley, A. M., et al. "Test-re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study." Brain Injury, 18(10), 1041–1048.

15. Steffen, T., & Seney, M. "Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism." Physical Therapy, 88(6), 733–746.

16. Tappen, R. M., Roach, K. E., et al. "Reliability of physical performance measures in nursing home residents with Alzheimer's disease." Journal of Gerontology: Biological Sciences and Medical Sciences, 52(1), M52–M55.

17. Scivoletto, G., Tamburella, F., et al. "Validity and reliability of the 10-m walk test and the 6-min walk test in spinal cord injury patients." Spinal Cord, 49(6), 736–740.

18. Van Hedel, H. J., Wirz, M., et al. "Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests." Archives of Physical Medicine and Rehabilitation, 86(2), 190–196.

19. Szekely, L., Oelberg, D., et al. "Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery." Chest, 111(3), 550.

20. Lam, T., Noonan, V., et al. "A systematic review of functional ambulation outcome measures in spinal cord injury." Spinal Cord, 46(4), 246–254.

21. Casanova, C., Cote, C. G., et al. "The 6-min walking distance: long-term follow up in patients with COPD." European Respiratory Journal, 29(3), 535–540.

22. Perera, S., Mody, S., et al. "Meaningful change and responsiveness in common physical performance measures in older adults." Journal of the American Geriatrics Society, 54(5), 743–749.