Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Repeat six-minute walk tests in patients with chronic heart failure: are they clinically necessary? Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Lack of Specificity of the 6-Minute Walk Test as an Outcome Measure for Patients with Systemic Sclerosis Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: a comparison with cardiopulmonary exercise testing. Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.] Six-Minute Walk Test as an Outcome Measure: Are Two Six-Minute Walk Tests Necessary Immediately After Pulmonary Rehabilitation and at Three-Month Follow-up? Usefulness of the 6-minute walk test and the 200-metre fast walk test to individualize high intensity interval and continuous exercise training in coronary artery disease patients after acute coronary syndrome: a pilot controlled clinical study Course length of 30 metres versus 10 metres has a significant influence on six-minute walk distance in patients with COPD: an experimental crossover study. Comparison between an indoor and an outdoor 6-minute walk test among individuals with chronic obstructive pulmonary disease. The endurance shuttle walk test: An alternative to the six-minute walk test for the assessment of ambulatory oxygen Reproducibility of the 6-Minute Walk Test for Ambulatory Oxygen Prescription The minimal important difference in the 6-minute walk test for patients with pulmonary arterial hypertension. Comparison of hallway and treadmill six-minute walk tests. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Shuttle Walking Test and 6-Minute Walking Test Induce a Similar Cardiorespiratory Performance in Patients Recovering from an Acute Exacerbation of Chronic Obstructive Pulmonary Disease
OBJECTIVE To estimate the minimal clinical ly important difference ( MCID ) for the 6-minute walk test ( 6MWT ) and the 200-m fast-walk test ( FWT ) in patients with coronary artery disease ( CAD ) during a cardiac rehabilitation program . DESIGN Prospect i ve study using distribution- and anchor-based methods . SETTING Out patients from a cardiac rehabilitation unit . PARTICIPANTS Stable patients with CAD ( N=81 ; 77 men ; mean±SD age , 58.1±8.7y ) enrolled 31±12.1 days after an acute coronary syndrome ( ACS ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  6MWT and 200-m FWT results before and after an 8-week cardiac rehabilitation program and at the 6th and 12th sessions . Patients and physiotherapists who supervised the training were asked to provide a global rating of perceived change in walking ability while blinded to changes in walk test performances . RESULTS Mean change in 6MWT distance ( 6MWD ) in patients who reported no change was -6.5 m versus 23.3 m in those who believed their performance had improved ( P<.001 ) . This result was consistent with the MCID determined by using the distribution method ( 23 m ) . Considering a 25-m cutoff , positive and negative predictive values were 0.9 and .63 , respectively . Conversely , there was no difference in 200-m FWT performance between these 2 groups ( 0.1 vs -1.4s , respectively ) . There was poor agreement with the physiotherapist 's perceived change . CONCLUSIONS The MCID for 6MWD in patients with CAD after ACS was 25 m . This result will help physicians interpret 6MWD change and help research ers estimate sample sizes in further studies using 6MWD as an endpoint Background : Owing to a reported learning effect in patients with chronic cardiopulmonary disease , performance of at least two six-minute walk tests ( 6MWT ) are recommended as st and ard practice . Patients with chronic heart failure ( CHF ) are typically elderly and frail and it is unknown whether current guidelines are practical in a clinical setting . Aims : The aim of this study was to determine whether repeat performance of 6MWTs in patients with CHF is related to between-test interval or baseline performance . Methods : This was a multisite observational study enrolling participants entering into heart failure rehabilitation programmes . Participants performed two 6MWTs with r and omly allocated inter-test intervals between 15 and 90 minutes . Distance walked in the second test was compared with the first test using a paired t test . Results : Eighty-eight participants ( 45 females , age 65 ± 14 years ) with stable CHF were enrolled . Mean distance walked increased from 301 metres in test 1 to 313 metres in test 2 ( p < 0.001 ) . No significant change was recorded between test 1 and test 2 for those whose baseline distance was < 300 metres . The interval between tests had no significant effect on the distance walked . Conclusion : The change in 6MWT distance was significantly associated with better baseline performance but not with the interval between tests RATIONALE The 6-minute-walk test ( 6MWT ) is a practical and clinical ly meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases . Performance characteristics in patients with idiopathic pulmonary fibrosis ( IPF ) have not been systematic ally evaluated . OBJECTIVES To assess the reliability , validity , and responsiveness of the 6MWT and estimate the minimal clinical ly important difference ( MCID ) in patients with IPF . METHODS The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b ( n = 822 ) .  Six-minute walk distance ( 6MWD )  and other parameters were measured at baseline and at 24-week intervals using a st and ardized protocol . Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function , dyspnea , and health-related quality of life . Both distribution-based and anchor-based methods were used to estimate the MCID . MEASUREMENTS AND MAIN RESULTS Comparison of two proximal measures of 6MWD ( mean interval , 24 d ) demonstrated good reliability ( coefficient = 0.83 ; P < 0.001 ) . 6MWD was weakly correlated with measures of physiologic function and health-related quality of life ; however , values were consistently and significantly lower for patients with the poorest functional status , suggesting good construct validity . Importantly , change in 6MWD was highly predictive of mortality ; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year ( hazard ratio , 4.27 ; 95 % confidence interval , 2.57- 7.10 ; P < 0.001 ) . The estimated MCID was 24 - 45 m. CONCLUSIONS The 6MWT is a reliable , valid , and responsive measure of disease status and a valid endpoint for clinical trials in IPF Objective . The 6-minute walk test ( 6MWT ) is an important prognostic tool in various cardiovascular diseases and has been considered as a surrogate endpoint . However , conflicting results have been reported in systemic sclerosis ( SSc ) . Our objective was to evaluate the relationships of the 6-min walking distance  ( 6MWD ) and organ damage in SSc . Methods . Eighty-seven consecutive patients with SSc were included and prospect ively investigated ; they underwent 6MWT in addition to conventional assessment of possible lung , heart , kidney , skin , and muscle involvement , and disease activity scoring , severity , and quality of life determination . Results . Twenty-six patients ( 30 % ) had an abnormal 6MWT and the mean 6MWD was 461.8 ± 103.0 m. When considering 6MWT as a binary variable — normal or abnormal — C-reactive protein ( CRP ) was the only independent variable associated with abnormal 6MWT . Considered as a continuous variable , the 6MWD was associated with measures of lung involvement and inflammation , with the activity and severity of disease , and also with quality of life ; nevertheless , calcinosis was the only independent factor associated in multivariate analyses with a trend for an association for CRP . Conclusion . The 6MWD relates to broad factors in SSc and these results raise doubts about the specificity of the 6MWD in this systemic disease , and its relevance to monitoring therapy AIMS Heart rate recovery ( HRR ) appears to be a robust prognostic marker in heart failure ( HF ) . When using the 6 min walk test ( 6MWT ) in HF , distance ambulated is generally the reference prognostic variable . We hypothesized that HRR after the 6MWT would be a better prognostic measure than distance ambulated . METHODS AND RESULTS A 6MWT and cardiopulmonary exercise testing ( CPX ) were r and omly performed in 258 HF patients [ 216 HF with reduced EF ( HFrEF ) and 42 HF preserved EF ( HFpEF ) ] , after which HRR was measured . HRR was defined as the difference between heart rate at peak exercise and 1 min following test termination . Patients were assessed for major cardiac events during a mean follow-up period of 22.8 ± 22.1 months . There were 50 major cardiac events during the tracking period . Univariate Cox regression analysis results identified HRR after both the 6MWT and CPX as a significant ( P < 0.001 ) predictor of adverse events . Multivariate Cox regression analysis revealed that dichotomized HRR after the 6MWT and CPX was the strongest predictor of survival ( χ(2 ) 61.1 and 53.8 , respectively ; P < 0.001 ) , with LVEF ( residual χ(2 ) 6.1 , P < 0.05 ) adding significant prognostic value to the 6MWT model and ventilatory efficiency ( the VE/VCO2 slope ) ( residual χ(2 ) 6.6 , P < 0 .05 ) adding significant prognostic value to the CPX model . CONCLUSIONS HRR after the 6MWT is a powerful prognosticator that performs similarly to HRR after maximal exercise . If confirmed in subsequent studies , 6MWT HRR should replace 6MWT distance as the reference criterion 6MWT measure to consider when grading cardiovascular risk in HF patients Objective : To examine the utility of the six-minute walk test ( 6′WT ) , in assessing the effectiveness of a six-week cardiac rehabilitation programme , of which exercise training was an integral part . Setting : Royal Liverpool and Broad Green Hospitals Rehabilitation Unit . Design : Two hundred and thirty-nine consecutive patients referred for cardiac rehabilitation were allocated to one of two groups . In group A 209 entered and 159 completed the usual rehabilitation programme whilst group B patients ( n = 30 ) acted as a control by deferring entry to the programme for six weeks , continuing only activities of daily living . Outcome measures : Both groups were assessed using the 6′WT , peak expiratory flow rate ( PEFR ) and isometric grip strength at enrolment and six weeks . Results : At baseline , groups A and B were demographically identical without significant differences in terms of 6′WT , PEFR or grip strength . Following the study period , group A showed a significant increase in 6′WT from 314.7 ± 76.2 to 377.3 ± 78.6 m , in PEFR from 406.9 ± 115.9 to 437.8 ± 118.6 litres per minute and in grip strength from 28.8 ± 9.31 to 30.3 ± 8.93 kg , all p < 0.001 . There were no significant changes in group B. Conclusions : The 6′WT proved to be a simple and effective measurement of functional capacity in patients performing cardiac rehabilitation . The clinical programme investigated successfully increased patients ' functional capacity as assessed by the 6′WT . Significant improvement in PEFR and grip strength was also demonstrated , compared with a control population The six-minute walk test ( 6MWT ) has been broadly used in clinical setting s. Several reference equations for prediction of the total distance walked during the test ( 6MWD ) are available in literature . The present review aim ed to critically discuss studies , published in Portuguese and English ( LILACS , SCIELO , MEDLINE , PUBMED ) , which evaluated normal values and created reference equations for predicting 6MWD in healthy subjects , comparing them with the results that were recently obtained in Brazilian individuals . Age , sex , weight , height and body mass index were the main demographic and anthropometric features more often correlated with 6MWD . The equations derived from these characteristics were able to explain between 25 and 66 % of the total variability in the 6MWD . Unfortunately , the foreign equations were not applicable to the Brazilian population . Even when the 6MWT was performed following strict st and ardization , the difference in 6MWT performance between foreign and Brazilian individuals remains , indicating the necessity of providing specific reference equations for each population and /or ethnic group . Accordingly , these equations developed in Brazil are probably the most appropriate for interpreting 6MWT performance in Brazilian patients with chronic diseases affecting the exercise capacity . Future studies are necessary with larger sample sizes ( e.g. multicentric ones ) and r and omized design for the reference values of the 6MWD to be considered reliable Spencer LM , Alison JA , McKeough ZJ :  Six-minute walk test as an outcome measure : are two six-minute walk tests necessary immediately after pulmonary rehabilitation and at three-month follow-up ? Am J Phys Med Rehabil 2008;87:224–228.A 3-mo prospect i ve , longitudinal , repeated- measures study was undertaken in subjects with chronic obstructive pulmonary disease ( COPD ) . The study aim ed to determine whether there was a difference in 6-min walk distance ( 6MWD ) when two 6-min walk tests were performed after pulmonary rehabilitation ( n = 44 ) and at 3-mo follow-up ( n = 40 ) , and whether the results reflected the program outcomes . There was a significant increase in 6MWD between two 6-min walk tests before rehabilitation ( P < 0.001 ) , and at 3-mo follow-up ( P < 0.001 ) , but not immediately after rehabilitation ( P = 0.1 ) . In terms of program outcomes , there was an increase in 6MWD from before to after pulmonary rehabilitation ( P < 0.001 ) ; however , the increase was greater if the better of two tests was reported .  Six-minute walk tests  performed twice before and after pulmonary rehabilitation programs and at 3-mo follow-up assessment s ensure accuracy of measurement of the 6MWD and program outcomes Objective : To study the effects of three individualized exercise training prescriptions using either a percentage of maximal heart rate ( HR ) , maximal 6-minute walk test ( 6MWT ) HR , or maximal 200-metre fast walk test ( 200-mFWT ) HR , on walking performance and exercise capacity in coronary artery disease ( CAD ) patients . Design : Controlled clinical study . Participants : Twenty-seven out patients enrolled in a rehabilitation programme after an acute coronary syndrome . Setting : Cardiac rehabilitation unit . Interventions : Three groups : ( A ) : moderate intensity continuous exercise ( MICE ) at 70 % of the maximal HR of the grade d maximal exercise test ( n = 10 ) ; ( B ) : MICE at the maximal 6MWT HR ( n = 8) ; ( C ) : high intensity interval training ( HIIT ) based on the 6MWT and the 200-mFWT maximal HR ( n = 9 ) . Group B and C performed walk tests every 2 weeks , to readjust training HR ( THR ) if needed . Measures : 6MWT and 200-mFWT performances , peak VO2 and peak power ( Pmax ) . Results : 6MWT and 200-mFWT performances improved significantly and similarly in all groups ( P < 0.05 ) . Peak VO2 improved significantly in all groups ( P < 0.05 ) , this improvement being higher in group C ( HIIT ) versus A ( P < 0.05 ) . Group B was closer to the recommended THR during exercise sessions compared to group A. Conclusion : This pilot study showed that using the 6MWT and 200-mFWT HR to individualize MICE or HIIT prescription is feasible in CAD patients , and could lead them closer to THR objective , to similar improvements in walking performance , and greater peak VO2 increase for HIIT . Future r and omised studies should investigate long-term effects of programmes prescribed from walk tests HR , especially for HIIT modality QUESTIONS Do patients with chronic obstructive pulmonary disease ( COPD ) achieve a different distance on the six minute walk test ( 6MWT ) conducted on a 10 m course versus on a 30 m course ? When assessing the distance on a 6MWT conducted on a 10 m course , is it valid to use existing reference equations that were generated on longer courses ? DESIGN A r and omised double-crossover experimental study . PARTICIPANTS Forty-five patients with COPD in primary physiotherapy care . INTERVENTION All patients performed a 6MWT twice over a 10 m course and twice over a 30 m course . The 6MWTs were performed in accordance with the American Thoracic Society guidelines . OUTCOME MEASURES 6MWD was assessed and predicted distance was calculated based on a range of reference equations . RESULTS The 6MWD on the 10 m course was 49.5 m shorter than on the 30 m course , which was statistically significant ( 95 % CI 39.4 to 59.6 ) . By using existing reference equations for a 6MWT conducted on the 10 m course , the predicted distance is highly overestimated ( with a range of 30 % to 33 % ) and the average distance as a percentage of the predicted value is 8%pred lower compared to a 6MWT conducted on the 30 m course , result ing in a worse representation of a COPD patient 's functional exercise capacity . CONCLUSION This study shows that the impact of course length on the 6MWD and on the use of reference equations in patients with COPD is substantial and clinical ly relevant ( based on the most conservative published minimum clinical ly important difference ) . Therefore , existing reference equations established for a 6MWT conducted over a 30 m ( or longer ) course can not be applied to predict the distance achieved on the 6MWT on a 10 m course , which is frequently used in primary care physiotherapy practice s for patients with COPD OBJECTIVES To investigate the feasibility of an outdoor 6-minute walk test ( 6MWT ) as a measure of functional status among individuals with chronic obstructive pulmonary disease ( COPD ) , and to examine the relationship between performance on an indoor and an outdoor 6MWT . DESIGN An experimental , repeated- measures crossover design . Subjects were studied on 2 separate days in the same week . Two 6MWTs-one indoors and the other outdoors-were performed on each study day , with a rest in between . The test order was r and omly selected on the first day and reversed on the second day . Outdoor tests were performed on days of moderate weather conditions ( mean temperature + /- st and ard deviation , 21 degrees + /-3 degrees C ; mean wind speed , 15+/-7 km/h ; no precipitation ) and on a flat surface ( sidewalk ) . SETTING  Outpatient rehabilitation program in Ontario . PARTICIPANTS Eighteen subjects with COPD ( 10 men , 8 women ; age , 70+/-8y ) , 5 using supplemental oxygen at rest ( forced expiratory volume in 1s , 1.0+/-0.3L ; 42%+/-8 % of predicted ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Distance walked in 6 minutes ( in meters ) , duration of rest ( in seconds ) , and change in rate of perceived dyspnea . RESULTS There was no significant effect of setting ( indoors vs outdoors ) on distance walked ( 394+/-86 m vs 398+/-84 m , P=0.4 ) , duration of rest ( 13+/-28s vs 9+/-20s , P=0.4 ) , or change in rate of perceived dyspnea ( 2.3+/-1.7 vs 2.3+/-2.0 , P=0.8 ) . Testing day had no significant effect on walk test performance ( all P>0.1 ) . CONCLUSIONS The results indicate that the 6MWT performed outdoors within reasonable climatic parameters may be reflective of 6MWT performance indoors UK guidelines for domiciliary oxygen have suggested the six-minute walk test or shuttle walk tests as suitable functional measures for the clinical assessment of ambulatory oxygen ( AO ) . To date , there is limited evidence that would support the use of shuttle walk tests as assessment tools for AO . The endurance shuttle walk test ( ESWT ) is used increasingly as an assessment tool within pulmonary rehabilitation ( PR ) but its potential as an investigative test for AO has not been explored . Using the same test for both PR and AO assessment is appealing since it would improve efficiency and act to st and ardise outcome measures in this patient population . The aim of this study was to examine the responsiveness and repeatability of the ESWT to AO and to compare the response with that of the six-minute walk test ( 6MWT ) .  Twenty-three patients with chronic obstructive pulmonary disease ( COPD ) performed , in r and om order , the ESWT and the 6MWT on air and whilst breathing AO . Oxygen saturation and Borg ratings of breathlessness and perceived exertion were recorded . On a third day , eleven patients repeated the ESWT with AO in order to measure repeatability . There was a significantly greater change in the ESWT with oxygen than the change recorded from the 6MWT ( 66 [ 91 ] vs 6 [ 28 ] m respectively ; P < .05 ) . When repeated on a separate day , the mean difference ( 95 % CI ) between distances walked on the ESWT with AO was 0.91 ( -47 , 49 ) m. The ESWT was more responsive than the 6MWT for detecting improvements in walking endurance whilst breathing AO Background : Ambulatory oxygen is frequently prescribed for patients with chronic obstructive pulmonary disease ( COPD ) who have oxygen desaturation ≤88 % during exercise . The 6-min walk test ( 6MWT ) with continuous pulse oximetry monitoring is a common method to document this oxygen desaturation , but the reproducibility of this test in determining the need for ambulatory oxygen in patients with COPD is not well documented . Objective : The aim of this study was to establish the reproducibility of the 6MWT in determining the need for ambulatory oxygen prescription in stable COPD patients using the Centers for Medicare and Medicaid ( CMS ) criteria for ambulatory oxygen prescription . Methods : The study was design ed as a prospect i ve observational study in an academic health center and associated pulmonary rehabilitation program . Eighty-eight COPD patients referred to pulmonary rehabilitation underwent continuous pulse oximetry while performing st and ard 6MWT on 3 separate days . Results : Fifty-one ( 58 % ) of these patients desaturated by continuous pulse oximetry to an SpO2 ≤88 % on a least one of the 6MWTs . Only 26 patients ( 30 % ) demonstrated consistency in meeting the criteria for ambulatory oxygen set forth by the CMS on all three 6MWT with a κ statistic of 0.62 . The percent agreement between 6MWTs for ambulatory oxygen prescription was 72 % and the paired observation was 51 % . Conclusions : The 6MWT distance is simple and widely used as a consistent measure of functional capacity in patients with COPD ; however , the 6MWT oxygen saturation has only modest reproducibility in determining the need for ambulatory oxygen in stable COPD patients undergoing pulmonary rehabilitation RATIONALE Although commonly used as the primary outcome measure of clinical trials in pulmonary arterial hypertension ( PAH ) , the minimal important difference ( MID ) of the 6-minute walk test ( 6MWT ) has not been well defined for this population of patients . OBJECTIVES To estimate the MID in the 6MWT in patients with PAH . METHODS Study subjects from the clinical trial of tadalafil in PAH , a 16-week , parallel-group , r and omized clinical trial of patients who were treatment naive or on background therapy with an endothelin receptor antagonist , were eligible . 6MWT was performed using a st and ardized protocol . Distributional and anchor-based methods were used to estimate the MID ; the latter method used the Physical Component Summary Score ( PCS ) of the Medical Outcomes Study 36-item short form ( SF-36 ) . MEASUREMENTS AND MAIN RESULTS Four hundred five subjects were analyzed .  Domains of the SF-36 were weakly to modestly associated with 6MWT . Change in the PCS of the SF-36 was most strongly associated with change in 6MWT ( r = 0.40 , P < 0.001 ) and thus was selected as the anchor for subsequent anchor-based analyses . Distributional analyses yielded estimates of the MID ranging from 25.1 to 38.5 m , whereas anchor-based analyses yielded an estimate of 38.6 m. CONCLUSIONS Using both distributional and anchor-based methods , the estimated consensus MID in the 6MWT for PAH is approximately 33 m. These results have important implication s for ( 1 ) assessing treatment responses from clinical trials and metaanalyses of specific PAH therapy , and ( 2 ) sample size calculations for future study design The 6-min walk test ( SMWT ) performed in the hallway ( HW ) is used as a clinical indicator of functional capacity in patients with lung disease . A 6-min walk test utilizing a treadmill ( TM ) is easier to perform and allows easier patient monitoring . Therefore , we formulated a st and ardized TM SMWT protocol and compared the results with those of a HW SMWT .  All patients were enrolled in a pulmonary rehabilitation program . Patients with current infection , recent change in inhaled medications or oral steroid use , and significant cardiovascular disease were excluded . Each subject performed three HW SMWTs and three TM SMWTs assigned r and omly on subsequent days . There was a 30-min rest between each walk and at least a 48-h rest between each test day . All patients completed both HW and TM SMWT within 7 d. Supplemental oxygen was utilized or increased if the saturation fell below 88 % . The best of the three tests was used for data analysis . Twenty-one subjects completed the protocol . The mean age was 65 + /- 10.9 yr ( range , 35 to 79 yr ) . Ten subjects were receiving supplemental oxygen . The mean FEV(1 ) was 1.07 + /- 0.53 L. The mean HW SMWT distance was 1,228 + /- 255 ft ( range , 612 to 1,679 ft ) and the mean TM SMWT distance was 1,060 + /- 389 ft ( range , 475 to 1,819 ft ) , which were statistically different ( p = 0.01 ) . The mean difference was 168 + /- 280 ft ( range , -326 to 743 ft ) . Oxygen saturation and supplemental oxygen requirements did not differ significantly . The intra-test variability of the three HW SMWTs was similar to the three TM SMWTs and no significant difference in the coefficient of variation was found . A st and ardized TM SMWT is feasible and allows easier patient monitoring , but there is a statistically significant difference between the HW and TM SMWT distance and therefore they are not interchangeable . However , the intratest reproducibility of the TM and HW SMWTs are similar when three walks are performed in a single test session . The role of the TM SMWT in pulmonary rehabilitation requires further exploration OBJECTIVE To establish the minimal important difference ( MID ) for the six-minute walk distance ( 6MWD ) in persons with chronic obstructive pulmonary disease ( COPD ) . DESIGN Analysis of data from an observational study using distribution- and anchor-based methods to determine the MID in 6MWD . SETTING Outpatient pulmonary rehabilitation program at 2 teaching hospitals . PARTICIPANTS Seventy-five patients with COPD ( 44 men ) in a stable clinical state with mean age 70 years ( SD 9 y ) , forced expiratory volume in one second 52 % ( SD 21 % ) predicted and baseline walking distance 359 meters ( SD 104 m ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Participants completed the  six-minute walk test  before and after a 7-week pulmonary rehabilitation program . Participants and clinicians completed a global rating of change score while blinded to the change in 6MWD . RESULTS The mean change in 6MWD in participants who reported themselves to be unchanged was 17.7 meters , compared with 60.2 meters in those who reported small change and 78.4 meters in those who reported substantial change ( P=.004 ) . Anchor-based methods identified an MID of 25 meters ( 95 % confidence interval 20 - 61 m ) . There was excellent agreement with distribution-based methods ( 25.5 - 26.5 m , kappa=.95 ) . A change in 6MWD of 14 % compared with baseline also represented a clinical ly important effect ; this threshold was less sensitive than for absolute change ( sensitivity .70 vs .85 ) . CONCLUSIONS The MID for 6MWD in COPD is 25 meters . Absolute change in 6MWD is a more sensitive indicator than percentage change from baseline . These data support the use of 6MWD as a patient-important outcome in research and clinical practice Background : The incremental shuttle walking test ( SWT ) has recently been proposed as a more valid and reproducible alternative to the conventional 6-min walking test ( 6MWT ) in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease ( COPD ) . Objective : To compare the cardiorespiratory performance obtained during two sessions of SWT with that obtained during two sessions of 6MWT . Methods : We examined 18 patients ( forced expiratory volume in 1 s : 48 ± 14 % ) recovering from an acute exacerbation of COPD that had required hospitalization . In the same afternoon , each patient performed two SWT and two 6MWT , with an interval of at least 30 min between each test ; the sequence of the tests was r and omized . Results : Mean walking distance was greater in the second SWT test than in the first SWT . The changes from baseline in systolic blood pressure , heart rate , respiratory rate , oxygen saturation and dyspnea Borg index at the end of the test were similar between the two 6MWT and the two SWT . There was a highly significant correlation between walking distances measured during SWT and during 6MWT ( ρ : 0.85 , p < 0.0005 ) . Neither SWT nor 6MWT correlated with functional data of COPD . Conclusions : SWT , though being considered to be closer to a submaximal exercise test than 6MWT , does not induce a greater cardiorespiratory performance  than 6MWT in patients recovering from acute exacerbation of COPD
Qualitative analysis indicated moderate evidence for repeatability of the 6MWT in patients undergoing cardiac rehabilitation , for a 2 % to 8 % learning effect between repeated 6MWTs , for a relationship between peak heart rate during the 6MWT and during cycle exercise at the ventilatory threshold , and for moderate-to-high correlation between the 6-minute walk distance and maximum metabolic equivalents achieved on symptom-limited exercise tests .
Strong evidence suggests that the 6MWT is responsive to clinical change following cardiac rehabilitation .
BACKGROUND The  6-minute walk test ( 6MWT ) is a common outcome measurement in cardiac rehabilitation .
However , a search of the literature found no established guidelines for use of the 6MWT in cardiac rehabilitation .
OBJECTIVES Systematic review of the validity , reliability and responsiveness of the 6MWT in cardiac rehabilitation .