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  2. 2 Minute Walk Test

2 Minute Walk Test

Last Updated

Purpose

The 2MWT is a measurement of endurance that assesses walking distance over two minutes.

Link to Instrument

Instrument Details

Acronym 2MWT

Area of Assessment

Aerobic Capacity
Functional Mobility
Gait

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Brain Injury Recovery
  • Limb Loss & Impairment
  • Multiple Sclerosis
  • Pulmonary Disorders
  • Spinal Cord Injury
  • Stroke Recovery

Populations

Stroke
Spinal Injuries
Pulmonary Diseases
Older Adults and Geriatric Care
Non-Specific Patient Population
Multiple Sclerosis
Limb Loss and Amputation
Brain Injury

Key Descriptions

  • Walk or cover as far a distance as possible over 2 minutes.
  • Assistive devices can be used but should be kept consistent from test to test.
  • Individual should be able to ambulate without physical assistance.
  • NIH toolbox adapted the instructions from the American Thoracic Society's 6 minute walk test.
  • Normative data establish with n = 4800 ages 5 - 85. NIH study utilized a 50 ft. course. One trial was performed.
  • Parkinson's disease: The 2MWT requires up to 2 practice sessions to reduce a practice effect (Light et al., 1997), with Light noting that the walking distance increased significantly over 3 trials in a population of individuals with Parkinson's disease.

Equipment Required

  • Stopwatch

Time to Administer

2 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Rachel Tappan, PT, NCS in 2010; Updated with references from the geriatric population by Ernesto Garcia, SPT and Matthew Walthers, SPT in 2011; Updated with references from the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated with references from the geriatric population by Ernesto Garcia, SPT and Matthew Walthers, SPT in 2012; Updated with references for the PD population in 2013.

ICF Domain

Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

  I II III IV V
PD EDGE R R R R NR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

UR

UR

UR

UR

UR

TBI EDGE

LS

LS

LS

LS

LS

Recommendations for use based on ambulatory status after brain injury:

  Completely Independent Mildly dependant Moderately Dependant Severely Dependant
TBI EDGE LS LS NR NR

Recommendations based on EDSS Classification:

  EDSS 0.0 – 3.5 EDSS 4.0 – 5.5 EDSS 6.0 – 7.5 EDSS 8.0 – 9.5
MS EDGE UR UR UR NR

Recommendations for entry-level physical therapy education and use in research:

  Students should learn to administer this tool? (Y/N) Students should be exposed to tool? (Y/N) Appropriate for use in intervention research studies? (Y/N) Is additional research warranted for this tool (Y/N)
MS EDGE Yes Yes No Yes
PD EDGE Yes Yes Yes Not reported
TBI EDGE No Yes Yes Not reported

Considerations

Should only be used on individuals who are able to ambulate without physical assistance.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Limb Loss and Amputation

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Standard Error of Measurement (SEM)

Lower Extremity Amputation:

(Resnik & Borgia, 2011, n = 44 [unilateral LE amputations, > 2 years post, current prosthesis users], mean age = 66 (13) years, assessed twice in a week, US sample, LE Amputation)

  • SEM = 14.9 meters or 48.5 feet (95% confidence)

Minimal Detectable Change (MDC)

Lower Extremity Amputation:

(Resnik & Borgia, 2011, LE Amputation)

  • MDC (calculated) = 34.3 meters or 112.5 feet (90% confidence)

Test/Retest Reliability

Lower Extremity Amputation:

(Resnik & Borgia, 2011, LE Amputation)

  • Excellent test-retest reliability (ICC = 0.83)

Interrater/Intrarater Reliability

Transtibial Amputation:

(Brooks et al, 2002, Transtibial Amputation)

  • Excellent interrater reliability (ICC = 0.98-0.99)
  • Excellent intrarater reliability (ICC = 0.90-0.96)

Criterion Validity (Predictive/Concurrent)

Lower Extremity Amputees:

(Reid et al, 2015, n = 86, mean age = 60.0 (15.3) years, lower extremity amputees)

  • Excellent correlation with the 6MWT (R^2= 0.91) 
    "A 2MWT distance of > 113m is required for patients to be likely to walk > 300m in the 6MWT and demonstrate community ambulation potential."

Construct Validity

Lower Extremity Amputation:

(Salavati et al, 2010, n = 106, mean age = 44.9 (6.6) years, [lower limb amputees], Persian sample, LE Amputation)

  • Excellent correlation with the Locomotors Capabilities Index (LCI-5) (r = 0.71, P < 0.01)

Responsiveness

Lower Extremity Amputation:

(Brooks et al, 2001, LE Amputation)

  • Responsive to change with rehabilitation for lower extremity amputation

Multiple Sclerosis

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Standard Error of Measurement (SEM)

Multiple Sclerosis:

(Gijbels et al, 2010; n = 50 (29 mild, 21 moderate MS); mean age = 49 (10) years; assessed twice at a 7 day interval, Belgium sample, Multiple Sclerosis)

  • SEM = 6.93 meters (95% confidence)

(Gijbels et al, 2011, n = 40, ambulatory pwMS, mean age=48, Belgium sample, Multiple Sclerosis)

  • SEM (calculated) = 7.59 meters (95% confidence)

Minimal Detectable Change (MDC)

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • MDC = 19.21 meters (95% confidence)

Normative Data

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • Mean (SD) 2MWT (m) score = 144 (49), range = 92-630)
    • Mean (SD) 2MWT (m) score for mild MS = 173 (31), range = 108-220
    • Mean (SD) 2MWT (m) score for moderate MS = 104 (41), range = 40-172)

(Gijbels et al, 2012, n = 189, mean age = 47 (11) years, European and US sample, cross-sectional multicentre design, Multiple Sclerosis)

  • Mean (SD) gait velocities (m/s) – static start, fastest speed; 1.14 (0.42), range = 0.31 to 2.00
    • Mild MS (EDSS < 4.0, n = 99) Mean (SD) gait velocities (m/s); 1.39 (0.31), range = 0.58 to 2.00
    • Moderate MS (EDSS 4.5-6.5, n = 79) Mean (SD) gait velocities (m/s); 0.81 (0.30), range=0.31 to 1.67

Interrater/Intrarater Reliability

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • Poor intrarater reliability
  • Poor interrater reliability

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Gijbels et al, 2010, Multiple Sclerosis)

  • Adequate concurrent validity between the mild and moderate MS 2-minute walk tests (r = 0.64)

(Gijbels et al, 2011, Multiple Sclerosis)

  • Adequate concurrent validity between the 2MWT and EDSS (r = -0.61)
  • Good concurrent validity between the 2MWT and MSWS-12 (r = -0.72)

Construct Validity

Multiple Sclerosis:

(Gijbels et al, 2011, Multiple Sclerosis)

  • Walking distances across 1 minute intervals of 2MWT and 2’_6MWT did not differ significantly (p = 0.82)

(Gijbels et al, 2012, Multiple Sclerosis)

  • Excellent correlation with 6MWT (r = 0.97, p < 0.01)
    • Excellent correlation with 6MWT in patients with mild MS (r = 0.94, p < 0.01)
    • Excellent correlation with 6MWT in patients with moderate MS (r = 0.96, p < 0.01)

Responsiveness

Multiple Sclerosis:

(Gijbels et al, 2012, Multiple Sclerosis)

  • 2MWT is justified as practical replacement for 6MWT in pwMS as demonstrated by high univariate regression coefficient = 0.97 and low mean relative estimation error = 5%. P < 0.01

Older Adults and Geriatric Care

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Standard Error of Measurement (SEM)

Older Adults:

(Connelly & Thomas, 2009, n = 16, residents of long term care [LTC], mean age 87, Canadian sample, Older Adults)

  • SEM = 6.3 meters or 20.7 feet (95% confidence)

Minimal Detectable Change (MDC)

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • MDC (calculated) = 12.2 meters or 40 feet (90% confidence) 

Normative Data

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Mean (SD) 2MWT for long term care group (LTC); 77.5 (25.6) meters
  • Mean (SD) 2MWT for retirement dwelling older adults; 150.4 (23.1) meters

Test/Retest Reliability

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Excellent test-retest reliability (ICC = 0.95)

Criterion Validity (Predictive/Concurrent)

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Excelllent concurrent validity between 2MWT and Berg Balance Scale (r = 0.88)

(Brooks et al, 2004, n = 122, mean age = 63 (9) years, [patients undergoing coronary artery bypass grafting], Canadian sample, Older Adults)

  • Adequate concurrent validity between the 2MWT and the SF-36 (r = 0.44, 0.48; pre-operatively and at follow-up respectively)

Construct Validity

Geriatrics:

(Brooks et al, 2006, Inpatient Geriatrics)

  • Adequate correlation between 2MWT and admission FIM score (r = 0.59)

(Brooks et al, 2006, n = 52; mean age = 79.9 (7.7); length of stay in rehab = 1.4 (0.6), Geriatrics)

  • Adequate correlation (r = 0.47-0.59) between 2MWT and FIM score
  • Excellent correlation (r = 0.81-(-)0.68) between 2MWT and TUG
  • Adequate correlation (r = 0.35-0.42) between 2MWT and Modified Barthel Index
  • Adequate correlation (r = 0.41-0.51) between 2MWT and FRT

Older Adults:

(Connelly & Thomas, 2009, Older Adults)

  • Excellent correlation with the 6MWT (r = 0.93)
  • Excellent correlation with the Timed Up and Go test (r = -0.87)

Responsiveness

Geriatrics:

(Brooks et al, 2006, Inpatient Geriatrics)

  • Standardized response mean score 0.7

Older Adults:

(Brooks et al, 2007, n = 52, mean age = 80(8) years, Canadian sample, Older Adults)

  • The 2MWT was more tolerable than the 6MWT in inpatient geriatric rehab population. All patients were able to complete the 2MWT whereas 1 patient completed the 6MWT out of the 8 patients who tried.

Spinal Injuries

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Normative Data

SCI:

(Lemay & Nadeau, 2010; n = 32; mean age = 47.9 (12.8); mean time post lesion 77.2 (44.3) days, SCI)

  • Mean (SD) 2MWT (m) score; 109.3 (48.6), range = 11 to 214
    • Mean (SD) 2MWT for Paraplegia; 101.3 (50.0), range = 11 to 212
    • Mean (SD) 2MWT for Tetraplegia; 115.9 (48.0), range = 43 to 214

Construct Validity

SCI:

(Lemay & Nadeau, 2010, SCI)

Convergent Validity Evidence:

 

 

 

Measure

2MWT

10MWT

TUG

BBS

0.781**

0.792**

-0.815**

2MWT

 

0.932 a**

-0.623 a**

10MWT

 

 

-0.646 a**

a = Pearson’s product moment correlation; other coefficients are Spearman’s r

 

 

 

**Significant at p < 0.01

 

 

 

Pulmonary Diseases

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Test/Retest Reliability

COPD:

(Leung et al, 2006, n = 45, mean age = 71.8 (8.3) years, Chinese sample, COPD)

  • Excellent test-retest reliability (r = 0.9994)

Construct Validity

COPD:

(Leung et al, 2006, COPD)

  • Excellent correlation with the 6MWT (r = 0.937)
  • Adequate correlations were found with the VO2max (r = 0.454) and the VO2max/kg (r = 0.555)

Brain Injury

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Standard Error of Measurement (SEM)

Neurologic:

(Rossier & Wade, 2001, n = 46 (21 chronic stroke, 25 other), mean age = 47 (13) years, assessed twice at a 7 day interval, UK sample, Neurologic)

  • SEM = 12 meters or 40 feet (95% confidence)

Minimal Detectable Change (MDC)

Neurologic:

(Rossier & Wade, 2001, Neurologic)

  • MDC (calculated) = 16.4 meters or 53.8 feet (95% confidence)

Test/Retest Reliability

Neurologic Impairment:

(Rossier & Wade, 2001, Neurologic Impairment)

  • Excellent test-retest reliability (ICC = 0.97)

Content Validity

Neurologic Impairment:

(Rossier & Wade, 2001)

  • Subjects using an assistive device (p < 0.0005) or with LE sensory impairments (p = 0.02) scored lower on the 2MWT

Non-Specific Patient Population

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Construct Validity

Cardiac Surgery (CABG):

(Brooks et al, 2004, n = 122 (but 20 lost during follow-up); mean age=63.4 (8.6); 49% NYHA class I or II, 28% NYHA class III or IV, CABG)

  • Adequate correlation (r = 0.44-0.48) between 2MWT and SF36 physical functioning subscale
  • Poor correlation (r = 0.12 (-0.03) between 2MWT and SR36 social functioning subscale Inpatient

Responsiveness

Cardiac Surgery (CABG):

(Brooks et al, 2004, CABG)

  • No significant difference in 2MWT between individuals who developed cardiac or pulmonary complications postoperatively and those who did not (p ≥ 0.02)

Bibliography

Brooks, D., Davis, A. M., et al. (2006). "Validity of 3 physical performance measures in inpatient geriatric rehabilitation." Arch Phys Med Rehabil 87(1): 105-110. Find it on PubMed

Brooks, D., Davis, A. M., et al. (2007). "The feasibility of six-minute and two-minute walk tests in in-patient geriatric rehabilitation." Can J Aging 26(2): 159-162. Find it on PubMed

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. Find it on PubMed

Brooks, D., Parsons, J., et al. (2001). "The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation." Archives of Physical Medicine and Rehabilitation 82(10): 1478-1483. Find it on PubMed

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. Find it on PubMed

Canning, C. G., Ada, L., et al. (2006). "Walking capacity in mild to moderate Parkinson's disease." Archives of Physical Medicine and Rehabilitation 87(3): 371-375. Find it on PubMed

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. Find it on PubMed

Ellis, T., Katz, D. I., et al. (2008). "Effectiveness of an inpatient multidisciplinary rehabilitation program for people with Parkinson disease." Phys Ther 88(7): 812-819. Find it on PubMed

Gijbels, D., Alders, G., et al. (2010). "Predicting habitual walking performance in multiple sclerosis: relevance of capacity and self-report measures." Mult Scler 16(5): 618-626. Find it on PubMed

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. Find it on PubMed

Gijbels, D., Eijnde, B. O., et al. (2011). "Comparison of the 2- and 6-minute walk test in multiple sclerosis." Mult Scler 17(10): 1269-1272. Find it on PubMed

Hiengkaew, V., Jitaree, K., et al. (2012). "Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone." Arch Phys Med Rehabil 93(7): 1201-1208. Find it on PubMed

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. Find it on PubMed

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. Find it on PubMed

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. Find it on PubMed

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.

Miller, P. A., Moreland, J., et al. (2002). "Measurement properties of a standardized version of the two-minute walk test for individuals with neurological dysfunction." Physiotherapy Canada 54(4): 241-248.

Reid, L., Thomson, P., Besemann, M., & Dudek, N. (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.

Resnik, L. and 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. Find it on PubMed

Reuben, D. B., Magasi, S., et al. (2013). "Motor assessment using the NIH Toolbox." Neurology 80(11 Supplement 3): S65-S75.

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. Find it on PubMed

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. Find it on PubMed

Schenkman, M., Ellis, T., et al. (2011). "Profile of functional limitations and task performance among people with early- and middle-stage Parkinson disease." Phys Ther 91(9): 1339-1354. Find it on PubMed

Stewart, D. A., Burns, J. M. A., et al. (1990). "The two-minute walking test: a sensitive index of mobility in the rehabilitation of elderly patients." Clinical Rehabilitation 4(4): 273-276.

White, D. K., Wagenaar, R. C., et al. (2009). "Changes in walking activity and endurance following rehabilitation for people with Parkinson disease." Arch Phys Med Rehabil 90(1): 43-50. Find it on PubMed

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