Procedure
The 6MWT should be performed indoors, along a long, flat, straight, enclosed corridor with a hard surface that is seldom travelled. If weather permits, the test may be completed outdoors. The walking track must be 30 metres in length and marked every 3 metres, with the turn-around points marked with a cone. Mark the start and finish lines with brightly coloured tape.
Instructions:
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Repeat testing should be completed at the same time of day to minimise intradayvariability.
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A ‘warm-up’ period before the test should not be performed.
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The client should sit and rest in a chair for at least 10 minutes before the test. During this time, check for contraindications, measure pulse and blood pressure and ensure clothing and footwear are appropriate.
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Pulse oximetry is optional. If performed, measure and record baseline heart rate and oxygen saturation. Make sure the readings are stable before recording. Note pulse regularity.
Note: If pulse oximeter is to be worn throughout the test, clinician is not to walk with the client. The pulse oximeter must be lightweight (less than 1 kg or 2 pounds), battery operated, and held in place so that the client does not have to hold or stabilise the pulse oximeter and therefore stride is not affected.
5. Have the client stand and rate their baseline dyspnoea and overall fatigue using the Borg Scale.
6.Set the timer to 6 minutes, assemble all necessary equipment and move to the starting point.
7.Instruct the client as follows:-
The object of this test is to walk as far as possible for 6 minutes. You will walk back and forth in this hallway. Six minutes is a long time to walk, so you will be exerting yourself.
You will probably get out of breath or become exhausted. You are permitted to slow down, to stop and to rest as necessary. You may lean against the wall while resting but resume walking as soon as you are able.
You will be walking back and forth around the cones. You should pivot briskly around the cones and continue back the other way without hesitation. Now I’m going to show you.
Please watch the way I turn without hesitation.
Demonstrate by walking one lap yourself. Walk and pivot around the cones briskly without hesitation.
Are you ready to do that? I am going to use this counter to keep track of the number of laps you complete. I will click it each time you turn around at this starting line. Remember that the object is to walk AS FAR AS POSSIBLE for 6 minutes, but don’t run or jog. “Start now, or whenever you are ready”.
8. Do not talk to anyone during the test.
9.Use a standard tone of voice during encouragement:
A!er the first minute:
You are doing well. You have 5 minutes to go.
A!er 2 minutes:
Keep up the good work. You have 4 minutes to go.
A!er 3 minutes:
You are doing well. You are halfway done.
A!er 4 minutes:
Keep up the good work. You have only 2 minutes le”.
A!er 5 minutes:
You are doing well. You have only 1 minute to go.
Note: Do not use other words of encouragement (or body language) to encourage the client to walk faster.
If the client stops walking or needs a rest during the test, say: You can lean against the wall if you would like; then continue walking whenever you feel able. Do not stop the timer.
If the client stops before the 6 minutes are up and refuses to continue (or the clinician decides that they should not continue), allow the client to sit down and note the distance, the time stopped and the reason for stopping prematurely.
When the timer is 15 seconds from completion, say: In a moment I’m going to tell you to stop. When I do, just stop right where you are and I will come to you.
At the completion, say Stop!
10. Post-test: Record the post-walk Borg and fatigue levels and ask: What, if anything, kept you from walking further?
11. If using a pulse oximeter, measure oxygen saturation (SpO2) and pulse rate on the oximeter and then remove the sensor.
12. Record the number of laps and any additional distance covered by using the markers on the wall. Calculate the total distance walked, rounding to the nearest metre.
Note: A practice test is not required in most clinical settings; however, it should be considered. If a practice test is completed, wait for at least 1 hour before the second test and report the highest 6MWD as the client’s baseline (ATS, 2002).
Note: Record the flow rate and the source of oxygen used by client. Note how the oxygen source was carried by the client (e.g. carried oxygen bottle, pushed or pulled cylinder) (ATS, 2002).
Note: The type of medication, dose and number of hours taken before test should be recorded.
Converting 6MWT results into exercise intensity
6-minute walk distance (6MWD)/6 = Distance in 1 minute
Distance in 30 minutes = 1-minute distance x 30
Note: The client would not be expected to keep up the same walking pace throughout thewalking training session that they achieved in the 6MWT. Therefore, prescribe approximately80% of the calculated distance.
For example:
If the client walked 220 m in 6 minutes:
1-minute distance = 220/6 = 36.7 m
30-minute distance = 36.7 x 30 = 1100 m
80% of 1100 = 880 m target distance in 30 minutes
(Australian Lung Foundation & Australian Physiotherapy Association, 2009).
Normative data:
• The median 6MWD was approximately 580 metres for 117 healthy men and 500 metres for 173 healthy women (Miyamoto et al., 2000).
• A mean 6MWD of 630 metres was reported by another study of 51 healthy adults (Stevens et al., 1999).
References:
American Thoracic Society (ATS). (2002). ATS statement. Guidelines for the Six-Minute WalkTest. Respiratory and Critical Care Medicine, 166(1), 111-117.
Australian Lung Foundation & Australian Physiotherapy Association, 2009