Six Minute Walk Test


Besides standard echocardiograms and exercise stress tests the Six-minute walk test (6MWT) is a commonly used technique, often carried out by nurses to assess a patient's exercise tolerance for daily physical activities The 6MWT has been shown to be a reliable, inexpensive, safe and easy to administer test that correlates with health outcomes (Rostagno, C. Gensini, 2008).

Indications: Baseline screening, pre-intervention and post-intervention functional capacity for daily physical activity.

Contraindications: Acute or potential cardiovascular compromise, potential for pulmonary compromise, thrombosis, significant musculo-skeletal impairment, exercise intolerance, etc.

Online resources:

Casanova et al (2011) studied 444 healthy subjects from seven countries to determine standard performance on the 6MWT. The 6MWT measures meters (m) walked as quickly as possible by the individual in six minutes.
The mean meters walked by all subjects was 571+ or – 90 m with male subjects walking 30m more than females. This is consistent with other similar studies. Older subjects walked shorter distances than younger subjects.

• 40–49 yrs of age, 611±85 m
• 50–59 yrs of age, 588±91 m
• 60–69 yrs of age, 559±80 m
• 70–80 yrs of age, 514±71 m

Rasekaba, Lee, Naughton, Williams & Holland (2009) determined a distance less than 350 m on the 6MWT to be associated with an increased mortality in chronic HF patients. A lowering of the walking distance of 50 m or more is considered clinically significant. Ferreira, et al. (2019) concluded in their research the 6-minute walk test distance at baseline and a decline in walking distance were both associated with worse prognosis.

Bittner et al (1993) studied 898 patients with left ventricular dysfunction with either radiological evidence of HF and/or an ejection fraction of 0.45 or lower. During the 242 days of follow up 114 patients either died or were hospitalized for CHF. The lowest performance group on the 6MWT had a statistically greater chance of dying or being hospitalized than the higher performing group.

In an updated study by Wegrzynowska-Teodorczyk (2013), the researchers also found the distance covered during the 6MWT predicted the risk of death or hospitalization. Distance covered during a six-minute walk test predicts long-term cardiovascular mortality and hospitalization rates in men with systolic heart failure: an observational study. They studied 243 men with stable systolic heart failure. 69% of the participants died or required hospitalization during the following 3 years. The statistical analysis showed the shorter the distance walked in the 6MWT, the greater the 1-year and 3-year mortality risk.


References

American Heart Association. Professional Heart Daily. Accessed 8/2/16
http://professional.heart.org/professional/General/UCM_423811_Classification-of-Functional-Capacity-and-Objective-Assessment.jsp

Bittner et al. (1993). Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. JAMA, 270(14), 1702-7.

Casanova, C. et al. (2011). The 6-min walk distance in healthy subjects: reference standards from seven countries. European Respiratory Journal, 37, 150-156.

Ferreira, J.P., Metra, M., Anker, S.D., Dickstein, K., Lang, C.C.. & Ng, L. (2019). Clinical correlates and outcome associated with changes in 6-minute walking distance in patients with heart failure: findings from the BIOSTAT-CHF study. Eur J Heart Fail. 21(2), 218-226.

Rasekaba, T., Lee, A. L., Naughton, M. T. ,Williams, T. J. & Holland, A. E. (2009). The six-minute walk test: a useful metric for the cardiopulmonary patient. Intern Med J., 39(8),495-501.

Rostagno C., Gensini G.F. (2008). Six minute walk test: a simple and useful test to evaluate functional capacity in patients with heart failure. Intern Emerg Med. 3(3):205-12.

The Criteria Committee of the New York Heart Association. (1994). Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. (9th ed.). Boston: Little, Brown & Co. pp. 253–256.

Wegrzynowska-Teodorczyk, K., Rudzinska, E., Lazorczyk, M., Nowakowska, K., Banasiak, W. Ponikowski, P et al. (2013). Distance covered during a six-minute walk test predicts long-term cardiovascular mortality and hospitalization rates in men with systolic heart failure: an observational study. J Physiother. 59(3), 177-87.


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