WALK THE WALK, DON'T TALK THE TALK...
The Six Minute Walk Test (6MWT) is structured to be a field test, that includes as much continuous walking as possible for the duration of six minutes. The purpose of this exercise test is to examine a person's ability to accumulate the greatest distance possible within the six minutes allocated for the test. The six minute walking test has prognostic properties, yet not diagnostic properties. Thus, it is not used to diagnose a disease, rather than draw possible and research supported meanings to the outcomes of this exercise test.
The six minute walking test is a bit tricky to define as either a sub-maximal or maximal exercise test, since the person being tested is allowed to choose at which pace they advance, and they are allowed to stop and sit down. While the expectation is for them to walk in a way that will result in the biggest distance traveled per the six minutes, that is not always the case. It is used as a test for their aerobic fitness, to observe any heart and lung problems, and can be used to test their motivation.
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The test is meant for people that cannot run, can walk safely, and are not yet accustomed to a treadmill, ergometer cycle, elliptical, or any other possible equipment. It is simple to administer, and requires a minimum extent of equipment and effort on the administrator's behalf. It is important to use a flat surface, that you know its distance from one end to the other. It is further suggested that it allow at least 50 meters in every direction (about 164-165 feet) and no more than double that (100 metes; 330 feet).
It is highly recommended that there be a chair at each end, and in the middle (three in total) so the person tested does not have to walk to far before being able to safely sit down and rest in case of shortness of breath, angina, claudication, or any other problematic symptom.
Before the test begins, it is custom to measure the person's blood pressure, heart rate, and oxygen saturation (via a pulse oximeter). It is further suggest to test the person for proper blood glucose levels (see another post of fasting blood glucose).
It is crucial throughout all parts of the six minute walk test, that you do not do or say anything that will increase nor decrease the distance traveled by the person's being tested. In other words, it is crucial that you do not do or say anything that will increase nor decrease the walking pace of the person tested. For example, we do not encourage them verbally; we may walk behind them to catch them if needed; we inform them of how much time is left out of the total sic minute allocated; and we inform them that they can sit down, slow down, or stop (only if they ask!).
We do not speak to them otherwise; we do not allow listening to music nor talk to them about anything since talking slows people down naturally; we do not walk beside them; we definitely do not walk in front of them; we never tell them if to walk faster or slower, yet can indicate that the their goal is to pass the greatest distance within six minutes.We only engage in talk with them if absolutely crucial, especially related to being symptomatic and safety of any kind.
After six minutes, regardless of the distance traveled, the test ends, and we go into recovery mode. We take post-exercise test measurements (the same as before the test) and any other measure as required or wished if the benefits out-weigh the risks. If the six minute mark occurs before the person has reached one of the ends of the area used, we either measure the exact distance traveled with a measuring wheel, or estimate it.
The distance traveled is used for the following possible prognoses and comparisons (in addition to the possible occurrences of symptoms during the test itself):
The distance in suspected-healthy adults has been reported to range from 400m to 700m (1,312 – 2,296 feet).
An improvement of 54m ( 177 feet) has been shown to be a clinically important difference in a study of people with chronic lung disease.
An improvement of 50m (165 feet) has been shown to be a clinically important difference in a study of people that have experienced a stroke.
An improvement of 43m (141 feet) has been shown to be a clinically important difference in a study of people with heart failure (HF; people with an EF of less than 39%).
A distance of >350m (1,148 feet) is highly correlated with early mortality and increased hospitalizations in cardiac patients. 3.5 times more compared to a distance of 450m (1,476 feet).
Failure to meet the minimal clinical improvement in distance, is correlated with a two-fold increase in the risk associated with the total distance. The minimal clinical improvement in distance is the improvement in distance expected between two different test, while the person has been exercising for at least two months in between.
A distance of >250m (820 feet) is associated with a high probability of death within three years of the day of the test.
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Additional suggested equipment: and instructions:
Stopwatch
Information/result recording form
RPE Scale
Dyspnea Scale
Angina Scale
Claudication Scale
Supplemental Oxygen – for patients with Pulmonary/Respiratory clinical conditions
Comfortable clothing should be used
Appropriate shoes for walking should be used
The person being tested should use their usual walking aids during the test (cane, walker, etc.) to simulate their daily function
The person being tested usual medical regimen should be continued
A light meal is acceptable before early morning or early afternoon tests
The person being tested should not have exercised vigorously within 2 hours before the beginning the test
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