The 6 minute walk test (6MWT) assesses distance walked over 6 minutes as a sub-maximal test of aerobic capacity/endurance.
Less than 10 minutes
Preschool Child
2 - 5
yearsChild
6 - 12
yearsAdult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by Jason Raad, MS and Rachel Tappan PT, NCS in 2010; Updated with references for the SCI and PD populations by Lars Petersen, SPT and Shawn White, SPT in 2011; Updated by candy Tefertiller PT, DPT, ATP, NCS and Jennifer Kahn PT, DPT, NCS and the SCI EDGE task force of the Neurology section of the APTA in 2012; Updated with references for the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA; Updated with references for Osteoarthritis, Stroke, and Alzheimer's Disease by Kevin Pelczarski, SPT, Melissa Potts, SPT, and Brittany Brown, SPT in 10/2012; Updated with references for the PD population by Jeffrey Hoder, PT, DPT, NCS and the PD EDGE task force of the Neurology Section of the APTA in 2013.
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 for use based on acuity level of the patient:
|
|
Acute (CVA < 2 months post) (SCI < 1 month post) (Vestibular < 6 weeks post) |
Subacute (CVA 2 to 6 months) (SCI 3 to 6 months) |
Chronic (> 6 months) (Vestibular < 6 months weeks post) |
|
SCI EDGE |
HR |
HR |
HR |
|
StrokEDGE |
HR |
HR |
HR |
Recommendations Based on Parkinson Disease Hoehn and Yahr stage:
| I | II | III | IV | V | |
| PD EDGE | HR | HR | HR | HR | 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 |
R |
HR |
R |
HR |
NR |
|
StrokEDGE |
HR |
HR |
HR |
HR |
HR |
|
TBI EDGE |
LS |
R |
LS |
R |
NR |
Recommendations based on SCI AIS Classification:
| AIS A/B | AIS C/D | |
| SCI EDGE | LS | HR |
Recommendations for use based on ambulatory status after brain injury:
|
|
Completely Independent |
Mildly dependant |
Moderately Dependant |
Severely Dependant |
|
TBI EDGE |
HR |
R |
LS |
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 |
HR |
HR |
R |
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 |
Yes |
No |
|
PD EDGE |
Yes |
Yes |
Yes |
Not reported |
|
SCI EDGE |
Yes |
Yes |
Yes |
Not reported |
|
StrokEDGE |
Yes |
Yes |
Yes |
Not reported |
|
TBI EDGE |
Yes |
Yes |
Yes |
Not reported |
Reference Equations:
6MWD: (Enright et al., 1998; n = 290 healthy adults 40-80yo)
Considerations:
The 6MWT demonstrated significant differences depending on the length of track used. Asking participants to walk on a 10 meter track where participants were asked to walk back and forth resulted in shorter distances than when asked to walk on a 10 by 50 meter indoor track (Scivoletto et al., 2011). Therefore, it is important to standardize the track for both clinical and research purposes.
The American Thoracic Society guidelines for the Six-Minute Walk Test recommend use of a 30 meter or 100 foot walkway with the length of the corridor marked every 3 meters. Turnaround points are to be marked by a cone (ATS, 2002).
Less affected limb more important than affected limb in explaining variance in walking capacity using 6MWD in chronic incomplete spinal cord injury (Kim et al., 2004)
Contraindications are unstable angina and MI in the last month since testing (Rasekaba et al., 2004).
Outdoor testing of the 6MWT in participants with stoke can be performed with consideration of the SEM scores. Using a GPS provides similar results as a measuring wheel and may be more convenient while freeing up the hands of the therapist to assist the participant. Testing outdoors over level ground free of street crossings allows for testing in the participants’ own neighborhood after discharge from an impatient facility.
Alzheimer’s Disease: (Tappen et al., 1997) Individuals with moderate to severe Alzheimer’s disease may have impaired balance and require physical assistance to ambulate. Some individuals may also require the use of an assistive device to walk. Examiners may need to use physical and verbal cues during the testing period because patients with Alzheimer’s disease may become distracted or have difficulty understanding directions.
Translated 6MWT:
Spanish:
https://www.medigraphic.com/pdfs/neumo/nt-2015/nt152h.pdf
French:
http://www.apa-sante.fr/wiki/tdm6
Italian:
http://www.geird.org/protocolli_misura/6-mwt_worksheet_it_vr.pdf
Chinese (simplified):
http://www.clinicmed.net/journal/fulltext/volume/1/issue/4/article/410
Japanese:
http://sugp.wakasato.jp/Material/Medicine/cai/text/subject02/no8/html/section17.html
These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database (RMD). Shirely Ryan AbilityLab (formerly RIC) is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at RehabMeasures@sralab.org.
Do you see an error or have a suggestion for this instrument summary? Please email us!
Alzheimer’s Disease:
(Ries et al, 2009; n = 20; mean age = 81.05 (9.48) years; mild to moderate AD; n = 31; mean age = 80.48 (8.43); moderately severe to severe AD, Alzheimer’s Disease)
Alzheimer’s Disease:
(Ries et al, 2009, Alzheimer’s Disease)
Alzheimer's Disease:
(Tappen et al, 1997; n = 33; mean age = 84.7 (3.94) years, Alzheimer’s Disease)
Alzheimer’s Disease:
(Ries et al, 2009, Alzheimer’s disease)
Alzheimer’s Disease:
(Tappen et al. 1997; n = 33; mean age = 84.7 (3.94) years, Alzheimer’s Disease)
Geriatrics and Stroke:
(Perera et al, 2006; Strength training trial: n = 100 older adults with mobility disabilities; mean age = 77.6 (7.6) years; Intervention trial: n =100 geriatrics w/ mild to moderate mobility limitations and stroke; mean time since stroke onset 76 (28) days; mean age = 69.8 (10.3) years, Geriatrics and Stroke)
Geriatrics:
(Perera et al, 2006, Geriatrics)
Geriatrics and Stroke:
(Perera et al, 2006, Geriatrics and Stroke)
Community-dwelling Elderly:
(Steffen et al, 2002; n = 96; community dwelling elderly people with independent function who were nonsmokers with no history of dizziness; > 60 yo and did not use assistive devices, Community-dwelling Elderly)
|
Mean Distance in Meters by Age & Gender |
|
|
|
Age |
Male |
Female |
|
60-69 yrs |
572 m |
538 m |
|
70-79 yrs |
527 m |
471 m |
|
80-89 yrs |
417 m |
392 m |
Geriatrics:
(Harada et al, 1999; n = 86; mean age = 75 (6) years, Geriatrics)
(Steffen et al, 2002, Geriatrics)
Elderly:
(Harada et al, 1999; n = 86 older adults without significant disease; 35 were recruited from retirement homes and 57 from community centers; mean age = 75 (6) years, Elderly)
*Distance walked was greater in active older healthy adults than in inactive older healthy adults (p < 0.0001)
Geriatrics:
(Harada et al, 1999, Geriatrics)
Geriatrics:
(Perera et al, 2006, Geriatrics)
Osteoarthritis:
(Kennedy et al, 2005; n = 150; mean age = 63.7 (10.7) years; diagnosis of OA, Osteoarthritis)
Osteoarthritis:
(Kennedy et al, 2005; n = 150; mean age = 63.7 (10.7) years; diagnosis of OA, Osteoarthritis)
Osteoarthritis:
(Kennedy et al, 2005, Osteoarthritis)
Parkinsonism:
(Steffen and Seney, 2008; n = 37 community-dwelling older adults with Parkinsonism, mean age = 71 (12) years; mean Hoehn & Yahr Stage of 2, Parkinsonism)
Parkinson's Disease:
(Steffen et al, 2008)
Excellent test retest reliability (ICC = 0.95 - 0.96)
SCI:
(van Hedel et al, 2005; n = 22 SCI patients assessed within the first month injury and reassessed at 3, 6, and 12 months; mean age = 45.5 (16.7) years; WISCI II score > 0; quoted from Lam et al; 2008, Acure SCI)
(Lam et al, 2008; SCI measures meta analysis; Incomplete SCI; C2-L1; < 12 months post injury, SCI)
SCI:
(Lam et al, 2008; SCI measures meta analysis; Incomplete SCI; C2-L1; < 12 months post injury, SCI)
Spinal Cord Injury:
(Forrrest et al, 2014; n = 249 patients enrolled in standardized Locomotor Training therapy programs that were admitted between February 2008 and April 2011; patients were evaulated at 7 out-patient clinical sites; mean age = 42 (16) years; AIS C = 20, D = 179, Not Evaluated = 50; mean time since SCI = 0.7 years)
Overall MCID = 0.10 m/s
Slow MCID = 0.11 m/s
Fast MCID = N/A: among fast walkers, the 6MWT did not significantly correspond with clinically relevant change and reliable MCID could not be calculated
SCI:
(Barbeau et al, 2007; n = 107, AIS-C and D; n = 38; with lesions between C-5 and L-3, tested at 3, 6 and 12 months post-injury, Acute SCI)
|
Comparison of Walking Speed Within Subjects With Upper Motor Neuron Lesions During the SCILT: |
|
|
|
|
|
Months after entry to trial |
n |
Walking Speed (m/s) over 6 minutes |
Walking Speed (m/s) over 15.2m |
p value |
|
3 |
66 |
0.64 (0.06) |
0.72 (0.05) |
0.14 |
|
6 |
69 |
0.79 (0.05) |
0.92 (0.06) |
0.29 |
|
12 |
70 |
0.88 (0.06) |
1.08 (0.06) |
0.001 |
*Gait speed was very similar at 3 and 6 month testing between 15.2 m and 6 minute walking tests; however, gait speed was significantly faster during the shorter distance test at 12 month follow up.
|
Comparison of Walking Speed by the slowest, middle and fastest patients in each data collection at end of therapy: 3 months |
|
|
|
|
|
Variable |
n |
Quartile |
Walking Speed (m/s) over 15.2 m |
p value |
|
15.2 m 6 minute |
14 |
Lower |
0.02 (0.06) 0.16 (0.06) |
0.15 |
|
15.2 m 6 minute |
33 |
Middle |
0.74 (0.05) 0.62 (0.29) |
0.07 |
|
15.2 m 6 minute |
19 |
Upper |
1.55 (0.06) 1.33 (0.41) |
0.01 |
**No statistical difference noted in gait speed between the two measures for the lower and middle quartile subject when stratified by walking speed; However, a statistical difference was found for individuals who achieved community walking speeds (> 0.8 m/s - 1.0 m/s) in the 15.2 m walking test upon completion of the 3 month treatment intervention as well as 12 month follow up.
(Olmos et al, 2008; n = 18; all participants were AIS D; tested three times each with a 60 minute interval between test run, in a Physical Therapy gym versus in a community environment, Chronic SCI)
|
Six-Minute Walking Test (m) |
|
|
|
|
6MWT Gym |
6MWT Community |
|
Mean |
382.39 |
401.44 |
|
Median |
371.75 |
367.80 |
|
SD |
120.988 |
130.276 |
|
Min |
151 |
151 |
|
Max |
560 |
584 |
SCI:
(Scivoletto et al, 2011; n = 37; median age = 58.5 (range 19–77) years; median time from onset = 24 (range 6–109) months; AIS D = 35, C = 2; Median; WISCI = 16, Chronic SCI)
(van Hedel et al, 2005; n = 22; AIS-A = 1, B = 0, C = 3, D = 18; mean age = 52 (20) years)
Tested on 3 occasions within 7 days:
Determined by comparing the 2 measurements performed by a single therapist
SCI:
(Lam et al, 2008, SCI)
(van Hedel et al, 2005; n = 75, mean age = 54 (20) years; AIS classifications C and D included, SCI)
SCI:
(van Hedel et al, 2007; longitudinal study looking at 6min and 10 MWT at 1, 3, and 6 mo post injury, incomplete SCI who were able to ambulate 10m within 3 months post SCI n = 51, 22 tetraplegic, 29 paraplegic. Cross sectional study n = 18 incomplete SCI, acute and chronic range 2wks to 8 years AIS-C or D, utilized middle 10m of 14m walk, Acute/Subacute SCI)
(Musselman and Brunton, 2011; n = 32 individuals with incomplete SCI; sex = 24 males, 8 females; mean age = 47.6 (14.2) years, SCI)
(Hedel et al 2006, n = 22, incomplete SCI who could ambulate within the 1st month post SCI, measured at 1 mo, 3 mo, 6 mo, and 12 mo post, middle 10 m of 14 m walk used, Acute to chronic incomplete SCI)
|
|
LEMS |
WISCI II |
10MWT |
|
Within 1 Month |
|
|
|
|
6MWT |
Adequate r = 0.54** |
Excellent r = -0.78* |
Excellent r = -0.91* |
|
After 3 Months |
|
|
|
|
6MWT |
Adequate r = -0.34 |
Poor r = -0.28 |
Excellent r = -0.90* |
|
After 6 Months |
|
|
|
|
6MWT |
Adequate r = -0.49*** |
Adequate r = -0.36 |
Excellent r = -0.87* |
|
After 12 Months |
|
|
|
|
6MWT |
Adequate r = -0.55* |
Adequate r = -0.36 |
Excellent r = -0.86* |
|
*p < 0.001 ** p ≤ 0.01 ***** p = 0.02 Spearman’s Correlations |
|
|
|
SCI:
(Jackson et al, 2008; n = 54 expert raters asked to assess each measure in three categories: valid or useful, useful but requires validation or changes/improvements, not useful or valid for research in SCI, SCI)
|
Expert Evaluations: |
|
|
|
|
|
|
Measure |
Valid or Useful |
Useful but requires validation |
Not useful or valid for RESEARCH |
Total Votes |
Measure |
|
10 Meter Walk Test |
32 (60%) |
20 (38%) |
1 (2%) |
53 |
10 Meter Walk Test |
|
6 Minute Walk Test |
19 (37%) |
30 (58%) |
3 (6%) |
52 |
6 Minute Walk Test |
|
FIM-L |
3 (6%) |
18 (36%) |
29 (58%) |
50 |
FIM-L |
|
Votes (%) |
|
|
|
|
|
(Scivolleto et al, 2011; n = 37 with mean time of onset 24 months; 32 AIS-D and 2 AIS-C; Assessed 6MWT using a short or long track, SCI)
SCI:
(van Hedel et al, 2006, SCI)
Further study with a larger sample size needs evaluate responsiveness for chronic (> 12 months ) injuries
Stroke:
(Eng et al, 2004; n = 12; mean age = 62.5 (8.6) years; mean time since stroke onset = 3.5 (2.0) years, moderate motor deficits, Chronic Stroke)
SEM=12.4 meters (40.68 feet)
(Flansbjer et al, 2005; n = 50; mean age = 58 (6.4) years; mean time since stroke onset 16 (5) months for males; 18 (5) months for females, Chronic Stroke)
(Wevers et al, 2011; n = 27 patients discharged home from an inpatient rehabilitation center after stroke, in the Functional Ambulation category; tested outdoors with both GPS and a measuring wheel; mean age = 60.7 (10.9) years; mean time since stroke onset = 266 (38) days, Chronic Stroke)
Geriatrics and Stroke:
(Perera et al, 2006; Strength training trial: n = 100 older adults with mobility disabilities; mean age = 77.6 (7.6) years; Intervention trial: n = 100 geriatrics w/ mild to moderate mobility limitations and stroke; mean time since stroke onset 76 (28) days; mean age = 69.8 (10.3) years, Geriatrics and Stroke)
Stroke:
(Eng et al, 2004, Chronic Stroke)
(Flansbjer et al, 2005, Chronic Stroke)
(Perera et al, 2006, Subacute Stroke)
Stroke
(Tang, Eng, & Rand, 2012)
(n= 22; Men= 13/22; Mean Age (SD)= 67 (10.3); Time Post Stroke (SD)= 1.8 (0.9)).
Suggested MCID= 34.4 meters
Geriatrics and Stroke:
(Perera et al, 2006, Geriatrics and Stroke)
Stroke:
(Wevers et al, 2011, Chronic Stroke)
|
6MWT Outcome (n=27) |
|
|
|
Variable |
Mean (SD) |
Range |
|
GPS 1st Measurement, m |
408 (132) |
133-700 |
|
GPS 2nd Measurement, m |
417 (139) |
127-695 |
|
MW 1st Measurement, m |
413 (127) |
129-664 |
|
MW 2nd Measurement, m |
422 (132) |
125-668 |
|
6MWT: six-minute walk test; GPS: global positioning system; MW: measuring wheel; SD: standard deviation |
|
|
Stroke:
(Eng et al, 2004; n = 12 community-dwelling individuals who had a stroke with moderate motor deficits; mean time since stroke onset = 3.5 (2.0) years; mean age = 62.5 (8.6) years, Chronic Stroke)
(Flansbjer et al, 2005, Chronic Stroke)
(Fulk et al, 2008; n = 35 patients who are enrolled in inpatient rehabilitation after stroke; mean age = 67.4 (13.8) years; mean time since stroke onset = 34.5 (17.7) days, Acute Stroke)
(Wevers et al, 2011, Chronic Stroke)
Stroke:
(Kosak & Smith, 2005; n = 18; mean age = 77 (11) years; mean time since stroke onset = 28 (34) day; enrolled in inpatient rehabilitation; mean FIM score at time of admission to inpatient rehabilitation = 68 (17), Acute Stroke)
Stroke:
(Flansbjer et al, 2005, Chronic Stroke)
(Kosak & Smith, 2005, Acute Stroke)
(Patterson et al, 2007, n = 74, mean age = 64 (10) years; time since stroke onset 48 (59) months; dichotomized based on median speed, Chronic Stroke)
Results indicate that faster walkers had significantly higher (p < 0.02) values on:
(Wevers et al, 2011, Chronic Stroke)
Stroke:
(Kosak & Smith, 2005, Stroke)
COPD:
(Redelmeier et al, 1997; n = 112 patients with COPD; mean age = 67 years; mean FEV1 = 975 ml, COPD)
COPD:
(Rasekaba et al, 2009; review article, COPD)
COPD:
(Casanova et al, 2007; Szekely et al, 1997, COPD)
(Szekely et al, 1997, COPD)
COPD:
(Szekely et al, 1997; n = 47, average age 60.5 (7.5) years, individuals undergoing volume reduction surgery, COPD)
COPD:
(Casanova et al, 2007, COPD)
TBI:
(Mossberg, 2003, n = 23; mean age 35.5 (12.5) years male, 30.5 (12.8) years female; approximately 12 months since injury, TBI)
(VanLoo et al, 2004, n = 13; mean age = 32.5 (11.3) years; average time post injury 11.9 (15.7) months; mean initial GCS 5.8 (2.9); mean PTA 43.8 (39.1) days, TBI)
TBI:
(Moseley et al, 2004, n = 10, mean age 31.9 (14.2) years, mean days post injury = 56.4 (25.5); mean duration of PTA = 26.6 (8.7) days, TBI)
Chronic Heart Failure:
(Rasekaba et al, 2009, Chronic Heart Failure)
Average distance of 238-388 meters for subjects with COPD
Healthy Adults:
(Enright el al, 1998, Healthy Adults)
Healthy Adults:
(Enright el al, 1998, Healthy Adults)
Modified 6MWT:
(Geiger et al, 2007; n = 528 children between 3 and 18 years old, Modified 6MWT)
|
Modified 6MWT Distance in Children |
|
|
|
Age |
Male |
Female |
|
3-5 yrs |
536.5 (95.6) |
501.9 (90.2) |
|
6-8 yrs |
577.8 (56.1) |
573.2 (69.2) |
|
9-11 yrs |
672.8 (61.6) |
661.9 (56.7) |
|
12-15 yrs |
697.8 (74.7) |
663.0 (50.8) |
|
16-18 yrs |
725.8 (61.2) |
664.3 (49.5) |
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The Rehabilitation Measures Database (RMD) is a service provided by the Shirley Ryan AbilityLab, the nation’s #1 rehabilitation hospital and leader in translational medicine. Learn more about the conditions we treat, the continuing education courses and credits provided and about career opportunities.
We have reviewed nearly 300 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.