6-Minute Walk Test (6MWT) Assessment Form & Report
Form Filling, Test Administration, Scoring, and Clinical Interpretation Guide
Purpose of the 6MWT
The 6-Minute Walk Test (6MWT) is a sub-maximal functional exercise test that measures the distance an individual can walk on a flat surface in six minutes. It reflects functional exercise capacity, integrating cardiovascular, pulmonary, neuromuscular, and metabolic systems.
The test is widely used in:
- Cardiac and pulmonary rehabilitation
- Post-COVID and post-ICU rehabilitation
- Oncology rehabilitation
- Neurological and geriatric rehabilitation
- Baseline assessment and outcome tracking
The test measures functional capacity, not maximal aerobic power.
Patient Information Section
How to Fill
Record:
- Patient name and UHID
- Referring doctor
- Date of assessment
- Lap counter name (if applicable)
- Gender, age, height, and weight
Clinical Guidance
Height, weight, age, and sex are required for predicted distance calculation. Always measure height and weight rather than relying on estimates for accuracy.
Pre-Test Information
Medications
How to fill
Document medications taken on the day of testing, including dose and timing (e.g., beta-blockers, bronchodilators, antihypertensives).
Clinical significance
Medications influence heart rate response, blood pressure, and perceived exertion. This is essential for interpretation and comparison across sessions.
Supplemental Oxygen
How to fill
Tick whether oxygen was used. If yes, document:
- Flow rate (L/min)
- Delivery type (nasal cannula, mask)
Clinical significance
Distance achieved on oxygen must always be compared with previous tests under the same oxygen conditions.
Baseline Measures
How to Assess and Fill
Record values after the patient rests for at least 5 minutes:
- Heart rate (bpm)
- Blood pressure (mmHg)
- SpO₂ (%)
- Dyspnea using Borg scale
- Presence of baseline symptoms (angina, dizziness, leg pain)
Clinical Interpretation
- Resting SpO₂ < 88%, unstable BP, or angina are relative contraindications and require medical clearance.
- Baseline Borg score provides reference for exertional symptom progression.
Test Observation Recording (Minute-by-Minute)
How to Conduct
- Instruct the patient to walk as far as possible for six minutes at a self-selected pace.
- Standardized encouragement should be used.
- The patient may slow down or stop if needed but should resume walking as soon as possible.
How to Fill
At each minute (1–6), record:
- Heart rate
- SpO₂
- Dyspnea (Borg)
- Exertion (RPE)
Also record 3-minute post-test values to assess recovery.
Clinical Interpretation
- Progressive desaturation (>4% drop) suggests pulmonary limitation.
- Disproportionate dyspnea with modest HR rise suggests ventilatory or deconditioning limitation.
- Slow recovery indicates reduced cardiopulmonary reserve.
Lap Counter
How to Fill
- Record number of complete laps walked.
- Measure and record any final partial lap distance in meters.
Test Data & Calculations
Total Distance Walked
How to calculateTotal Distance=(Number of full laps×track length)+partial lap distance
Record the final distance in meters.
Predicted Distance
How to Fill
- Use the appropriate Enright & Sherrill equation based on sex.
- Clearly indicate the equation used.
Clinical significance
Predicted distance allows comparison with normative values, but change over time is more clinically meaningful than absolute percent predicted.
Percent Predicted
How to calculatePercent Predicted=Predicted DistanceActual Distance×100
Test Interruption
How to Fill
Indicate whether the patient stopped or paused before 6 minutes and document the reason (e.g., dyspnea, leg pain, dizziness).
Clinical interpretation
Frequent pauses indicate poor functional tolerance and guide intensity of rehabilitation.
Symptoms at End of Test
How to Fill
Tick symptoms present at test completion.
Clinical interpretation
End-test angina, dizziness, or excessive dyspnea warrant medical review.
Borg RPE Scale Reference
How to Use Clinically
- Borg 12–13: light to moderate (common rehab target)
- Borg 14–15: moderate to somewhat hard
- Borg ≥17: high exertion; caution required
RPE is particularly important when heart rate response is blunted (e.g., beta-blockers).
Heart Rate Calculations
How to Fill
- Calculate maximum heart rate (220 − age)
- Record percentages (90%, 80%, 70%, 60%, 50%)
Clinical Interpretation
These values help:
- Interpret test intensity
- Prescribe aerobic training zones
- Compare exertional response between sessions
Interpretation / Comments Section
How to Complete
Provide a concise clinical interpretation, including:
- Overall functional capacity (low / moderate / good)
- Primary limiting factor (dyspnea, fatigue, desaturation, pain, fear)
- Test tolerance
- Rehabilitation implications
Example:
“Patient completed 420 m with moderate dyspnea (Borg 4), minimal desaturation (−2%). Findings suggest moderate deconditioning. Suitable for moderate-intensity aerobic rehabilitation.”
Evaluator Authentication
How to Fill
Record:
- Evaluator name
- Signature
Clinical Significance
Ensures professional accountability and medico-legal validity.
Clinical Interpretation Summary
- The 6MWT reflects functional exercise capacity, not maximal fitness.
- Absolute distance is less important than:
- Change over time
- Symptom response
- Oxygen desaturation
- Recovery pattern
- Always interpret alongside:
- Borg scales
- Vital signs
- Clinical context
Clinical Summary
The 6-Minute Walk Test Assessment Form & Report provides a standardized, reproducible framework for evaluating functional exercise tolerance across multiple rehabilitation populations. Accurate preparation, consistent administration, meticulous documentation, and thoughtful interpretation are essential to ensure safe testing, meaningful outcome tracking, and effective rehabilitation planning