3 and 6 Minute Walk Test
Title:
6 Minute Walk Test (6 MWT)
3 Minute Walk Test (3 MWT)
Edition:
6 MWT: 1.01
3 MWT: None reported.
Dates of Publication:
6 MWT: The original guidelines for this test were published in 2002 by the American Thoracic Society in the American Journal of Respiratory Critical Care Medicine.1-3
3 MWT: Currently, there are standardized guidelines published for the administration of this test.
Date of Revision:
6 MWT: In 2007, Geiger et al published guidelines in The Journal of Pediatrics for administration of a modified 6 minute walk test for children ages 3 – 18.2,3
3 MWT: Currently, there are no standardized guidelines published for the administration of this test and no reported revisions for the pediatric population.
Author (s):
6 MWT: Original Guidelines: American Thoracic Society. Pediatric Guidelines: Ralf Geiger, MD, Alexander Strasak MD, Benedikt Tremi, MD, Axel Kleinsasser, PhD, Victoria Fischer, MD, Harald Geiger, MD, Alexander Loeckinger, PhD, Joerg I Stein, PhD. 2
3 MWT: Currently, there are no revisions or standardized guidelines for the 3-minute walk test published.
Publisher/Distributor:
6 MWT: American Thoracic Society
3 MWT: No current publication or distributor of this test.
Costs:
6 MWT: The test is free of cost to obtain and administer
3 MWT: This test is free of cost administer.
Purpose:
6 MWT: To perform an assessment of the patient’s ability to ambulate at a self-selected speed, covering as much distance as possible in six minutes, as an estimate of physical fitness and endurance.2,3
3 MWT: To perform an assessment of a patient’s ability to ambulate at a self-selected speed, covering as much distance as possible in three minutes, while monitoring heart rate and shortness of breath. Pan et al (2009) reported utilization of this test in the emergency department with adults reporting acute dyspnea and significant cardiovascular history to predict poor outcomes after discharge.6
Type of Test:
6 MWT: Evaluative, observation
3 MWT: Evaluative, observation
Target Population and Ages:
6 MWT: Children and adolescents, ages 3-18, with severe cardiopulmonary disease, cystic fibrosis, juvenile idiopathic arthritis and cerebral palsy whom cannot otherwise engage in a full cardiopulmonary exercise test.2,3
3 MWT: Some studies have reported use of a 3-minute walk test in children of variable age.
Time Requirements:
6 MWT: This test requires approximately 13 minutes to administer; 3 minutes to measure your 15-20 meter distance and set up the cones, 3 minutes for proper explanation of instructions and evaluation of their vital signs, 6 minutes for the actual performance of the walk test, and 1 minute at the conclusion for re-evaluation of the patient’s vital signs.
3 MWT: No standardized guidelines outline administration of this test or the time requirements. It does take 3 minutes for the participant to complete the evaluative portion of this test.
Administration:
6 MWT: The standardized guidelines published by the American Thoracic Society should be followed throughout the administration of the test, with the exception of placing two cones 15-20 meters for the pediatric population versus 30 meters apart for adults.2,3 The patient is instructed to cover as much distance as possible in 6 minutes without running by walking back and forth between the cones. Heart rate should be taken prior to beginning the test, while the patient is at rest and documented. The therapist instructs the patient to “begin walking” starting the stopwatch and keeping track of the number of laps the patient performs between the two sets of cones. Standardized encouragements are provided at minute 1, “you are doing well. You have 5 minutes to go”, minute 2, “Keep up the good work. You have 4 minutes to go”, mInute 3, “You are doing well. You are halfway done”, Minute 4, “Keep up the good work. You have 2 minutes left” and minute 5, “You are doing well. You only have 1 minute to go”. No other instructions or words of encouragement should be provided during the test.1 The therapist should remain in a static position and not following the patient to avoid setting a “pace”; the exception lies with those whom are a high fall risk such as boys with Duchenne Muscular Dystrophy.3 The patient’s heart rate is taken at the conclusion of the test and documented.1
3 MWT: Currently there are no standardized guidelines published for the administration of this test for both the adult and/or pediatric population. Studies which have utilized this test have not indicated specifications under which it was performed but often mention following the guidelines described by the American Thoracic Society for the 6 MWT as a reference.
Scoring:
6 MWT: The score is the total distance covered (feet or meters) throughout the 6 minute duration of the test.1-5
3 MWT: The score is the total distance covered (feet or meters) throughout the 3 minute duration of the test.
Type of information, resulting from testing
6 MWT: Standard measurement of distance (feet or meters) which can be utilized as both a baseline measurement and to demonstrate progression/digression of the patient.1-5
3 MWT: Standardized measurement of distance (feet or meters).
Environment for Testing:
6 MWT: The test should be performed indoors, in a quiet hallway or exercise facility.
3 MWT: No specific guidelines have been reported for the implementation of this test, however, it has been suggested to perform the test indoors in a quiet area similar to that of the 6 MWT.
Equipment and Materials Needed:
6 MWT: 2 cones spread 15-20 meters apart, a tape measure or measuring wheel to determine distance, a stopwatch to keep time, heart rate monitor to assess vitals before, during and after the test.1-3
3 MWT: 2 cones, a tape measure or measuring wheel to determine distance, a stopwatch, a heart rate monitor to assess vitals before, during and after the test.
Examiner Qualifications:
6 MWT: There are no certifications or specific qualifications required to administer this test. The administrator should be extremely familiar with the general guidelines and proper protocol for administering the test as indicated by the American Thoracic Society and the pediatric modification of 15-20 meter distance.
3 MWT: There are no certifications or specific qualifications required to administer this test.
Standardization/normative data
6 MWT: Geiger et al (2007) established normative values for healthy children taking into account their age and gender for standardized comparison.2
| Age | Male | Female |
| 3-5 yrs | 536.5 m (95.6) | 501.9 m (90.2) |
| 6-8 yrs | 577.8 m (56.1) | 573.2 m (69.2) |
| 9-11 yrs | 672.8 m (61.6) | 661.9 m (56.7) |
| 12-15 yrs | 697.8 m (74.7) | 663.0 m (50.8) |
| 16-18 yrs | 725.8 m (61.2) | 664.3 m (49.5) |
3 MWT: There are no current publications of normative data for the 3 MWT in the adult or pediatric populations.
Evidence of Reliability:
6 MWT: Reproducible tests have demonstrated good reliability (ICC 0.96 – 0.98) in both healthy children and those diagnosed with chronic disease. Minimal detectible differences vary throughout the literature in the pediatric population. The smallest minimal detectable difference has been noted to be 36 meters in children with spina bifida and as large as 139 meters in children with cystic fibrosis.4,5
3 MWT: Currently, there are no publications to establish the reliability of this test with the pediatric population.
Evidence of Validity:
6 MWT: Publications have noted good correlation between ambulation distances and VO2max in healthy children deeming the test valid. Low correlations have been noted between walking distance and VO2 max in children with juvenile idiopathic arthritis, hemophilia, spina bifida and end-stage renal disease indicating that this test should not be utilized as a replacement for maximal exercise testing.4,5
3 MWT: Currently, there are no publications to establish the validity of this test with the pediatric population.
Discriminative
6 MWT: This test may have the ability to discriminate between those with significant physical or cardiovascular impairments and healthy children without impairments.2,4,5
3 MWT: None at this time.
Predictive
6 MWT: Physical fitness in children in healthy school aged children, cardiopulmonary disease and juvenile idiopathic arthritis. It can be used to predict a child’s walking distance with age and gender.2,3
3 MWT: None at this time.
Strengths
6 MWT: low cost, easy to set up, reliable, easy to administer, minimal space required, normative values established for children 3-18 based on age & gender
3 MWT: low cost, easy to set up and administer, minimal space required
Weaknesses
6 MWT: No established validity in the pediatric population
3 MWT: No evidence to support use of measure as reliable and valid, no normative values lacks specific published guidelines for administration of the test
Clinical Applications
6 MWT: The six-minute walk test can be utilized to estimate physical fitness of pediatric patients with cardiovascular, pulmonary or neurological impairments. This measure is an easy-to-implement in the clinic to establish a baseline level of impairment, monitor disease progression and evaluate the effectiveness of current therapeutic interventions in children with significant illness.
3 MWT: This test has little to no evidence to support it’s use in the clinic, however, the shorter time frame may be more conducive for children whom are severely limited in their ability to perform exercise for a longer periods of time or children with significant physical impairments whom are unable to ambulate farther distances.
References:
- American Thoracic Society. ATS Statement: Guidelines for the Six-minute Walk Test. Am J Respir Crit Care Med. 2002; 166: 111-117
- Geiger, R, Strasak, A, Tremi, B, Gasser, K, Kleinsasser, A, Fischer, V, Geiger, H, Loeckinger, A, Stein, J. Six-Minute Walk Test in Children and Adolescents. Jour Pediatr. 2007: 395-399e2
- Groot, JF, Takken, T. The Six-Minute Walk Test in Paediatric Populations. Jour Physiother. 2011; 57: 128
- Li AM, Lin J, Au JT, et al. Standard references for the six minute walk in healthy children aged 7 – 16 years. Am J Respir Crit Care Med. 2007; 176; 174 – 180
- Li, AM, Yin, J, Yu, CC, Tsang, T, So, HK, Wong, E, Chan, D, Hon, EKL, Sung, R. The Six-minute walk test in healthy children: reliability and validity. Eur Respir J. 2005; 25: 1057-1060
- Pan, AM, Stiell, IG, Clement, CM, Acheson, J, Aaron SD. Feasibility of a structured 3-minute walk test as a clinical decision tool for patients presenting to the emergency department with acute dyspnea. Emerg Med J. 2009; 26(4): 278-282
Kalirathinam, D, Arumugam, J. Gait training on Spastic Diplegic children-A physiotherapy Approach. Jour Nurse Health Sci. 2012; 1(1): 1-5
The purpose of this randomized controlled study is to evaluate if the implementation of quadriceps strengthening exercises can improve gait in children diagnosed with spastic diplegia. Thirty children ages 4-12 met the inclusion criteria of ambulating for 3 minutes on level surface with or without an assistive device, the ability to follow multi-step commands and a grade of 3 or more voluntary muscle control were included in the study. Children with recent botox injection, dorsal rhizotomy, use of a baclofen pump or severe cardiopulmonary disease were excluded. Fifteen children were randomly assigned to group A who engaged in stretching, quadriceps strengthening with free ankle weights, half squats, sit-to-stand and step up exercises. Fifteen children were randomly assigned to Group B engaging in only conventional exercises. Both groups participated in their respective interventions for 90 minutes, 5 days per week for 2 weeks. All children were evaluated using a 10 meter-walk test to assess cadence and a 3 minute walk test prior to and after their respective interventions. Results of this study indicate the use of a quadriceps strengthening program for two weeks has the ability to potentially improve gait in children with spastic diplegia. A paired t-test to compare “pre” and “post” values between Group A and Group B. Results yielded a significant change in cadence (p=0.00) and distance ambulated during the 3 minute walk test (p=0.00) from pre to post testing favoring Group A or the quadriceps strengthening intervention. The authors speculate that the increase in distance during the 3 minute walk test may potentially correlate with increased gait speed and step length. Participants in the quadriceps strengthening group verbalized increased ease walking ascending and descending steps at school. Authors identified no limitations in this study. The authors conclude that although 2-weeks of strength training improved walking distance and cadence, the management of a complex disease such as cerebral palsy may require the involvement of multiple disciplines and a combination of strengthening and anti-spasticity interventions for optimal outcomes.
Corral, T, Percegona, J, Seborga, M, Rabinovich, R, Vilaro, J. Physiological response during activity programs using Wii-based video games in patients with cystic fibrosis (CF). Jour Cystic Fib. 2014; 13(6): 706-711
The purpose of this observational study was to assess the physiological response of three different Nintendo Wii video game activities (VGA) in children and adolescents with cystic fibrosis to establish the most suitable modality of training. Twenty-four patients (M=16, F=8) ages 7-18 diagnosed with CF met the inclusion criteria of being clinically stable with the absence of exacerbations of their disease in the 6 weeks prior to beginning the study. All patients were receiving routine management of their disease including inhaled antibiotics, chest physiotherapy and nutritional supplementation. Participants were excluded from the study if they had any evidence of abnormal cardiovascular, neuromuscular or osteo-articular diseases. All participants performed three different VGA (Wii-Acti, Wii-Train, Wii-Fit) and two 6-minute walk tests (6 MWT) in a random order, over two days utilizing a minimum of 30 minutes of rest between each exercise modality. All VGA were 5 minutes in duration consisting of the Wii-Fit game emphasizing aerobic exercise using bilateral arms and legs, the Family Trainer Extreme Challenge game (Wii-Train) which utilizes whole body movements including jumping, cutting, and running. Lastly, the Wii-Acti aerobic exercise using the EA Sports Active game designed for muscle strength, body endurance and flexibility. Measures of height, weight, SpO2, HR and spirometry were taken at baseline while VO2, minute ventilation (Ve), HR and RR were monitored during each exercise modality. Results yielded a high VO2 levels during the last 3 minutes of the Wii-Acti (p<0.001) and Wii-Train (p<0.001) VGA’s when compared to the 6 MWT. The Wii-Fit demonstrated lower VO2 max when compared to the 6 MWT. Minute ventilation and heart rate reached a plateau approximately 3 minutes into the 6 MWT and all VGA. The average distance ambulated during the 6 MWT was 637 m + 46.9 m which was an average of 97% + 7.3% the predicted distance based on established normative values for age and gender. The authors identified that one of the limitations of this study was a lack of investigation into the effectiveness of the VGA to achieve improvement in aerobic capacity; this could have been evaluated by using the 6 MWT not only for comparison but evaluation. Another limitation identified in this study was that the VGA were only programmable for 2 or 5 minute intervals, deeming it impossible to evaluate the 6th minute in comparison to the 6 MWT. This study demonstrates that children and adolescents diagnosed with cystic fibrosis and preserved lung function are capable of exercising at 75% max heart rate with VGA, similar to what is produced during the 6 MWT. The authors conclude that the incorporation of VGA into pulmonary rehabilitation programs for patients with CF should be further evaluated.
3 responses to “3 and 6 Minute Walk Test”
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It’s interesting to see how we can apply the six minute and three minute walk test to the pediatric population. However, I could foresee an issue with encouraging a younger child to stay on task for 6 minutes or pace themselves, so it would be great to see more research on, validity, reliability and norms of a 3 minute walk test.
I agree with Heather on the potential difficulty of keeping a child on task for long enough to make the 6 minute walk test reliable or valid in any pediatric population. It makes me wonder if there would be any way to make either of these tests more appealing for the pediatric population without skewing the test. It was interesting to see researchers look at the use of the video games, as I think it could be a good solution to getting children to buy into staying on task. It’ll be very interesting to me to see where things are heading with its application to both evaluation and PT interventions in the pediatric population.
Just to echo what was stated above, I can imagine 3-6 mins feeling like an eternity to a young child, because many times it feels like an eternity to me. I like the simplicity and time to administer this test however would find it difficult utilizing this test with this population. With the six minute test being the only one with published norms for age, I would likely lean towards that instead of the three minute, but that adds the constraint of keeping a child focused on one task for six minutes.