2 Minute Walk Test

Original Editor - Ammar Suhail Top Contributors - Lauren Lopez, Kim Jackson, Rucha Gadgil, George Prudden and Ammar Suhail  

Objective

The Two/2 Minute Walk Test (2MWT) is a measure of self-paced walking ability and functional capacity[1], particularly for those who cannot manage the longer Six Minute Walk Test (6MWT) or 12 Minute Walk Test.

Intended Population

The 2MWT has been used in a variety of health conditions including COPD[1][2], lower limb amputation[3], neuromuscular disease[4] in adults as well as pediatric population[5], cardiac disease[6], functionally restrictive conditions like cystic fibrosis[7] and the elderly[8], including those in long term care[9].

Method of Use

PROCEDURE:

The 2MWT is a simple measure of the distance a person can walk in two minutes. Rest breaks are allowed if needed. The person is encouraged to walk as fast as they can, safely, for two minutes.

Walking aids can be used as needed e.g. for elderly people with a record made of walking aid used.

If Assistive devices used , they should be kept consistent and documented from test to test.

EQUIPMENT: A clear course such as a hallway with cones or similar to mark an approximately 15m "out and back" course[10], stopwatch, pen and paper or a device to record distance walked and any other observations e.g BORG scale.

INSTRUCTIONS:

Commands given are based on those of the 6MWT: before the participant starts walking the observer advises them to "Cover as much ground as possible without running" or "Walk as fast as possible"[10] and to take a rest break if needed. The observer then gives encouragement after the first minute with standardised responses: "You're doing well" and "One minute left"[8].

The 2MWT requires two practice walks before it is measured due to a training effect[1][8][11].

Evidence

Reliability

Studies have shown that the 2MWT is consistently reproducible[1][8][11].

Validity

The 2MWT shows good construct validity with similar walking measures. The 2MWT correlates highly with the six and 12 minute walk tests indicating they are similar measures of gait and exercise tolerance in population-based samples[11] and those with respiratory disease[1] or Multiple Sclerosis[4].

A study conducted in Pediatric population with neuromuscular disorders showed that the 2 MWT had strong correlations with Motor Function Measure-32 and Timed Functional test and can be used interchangebly with 6MWT[5].

Responsiveness

Research shows the 2MWT does not discriminate as well as the longer six and 12 minute walk tests in subjects with respiratory disease[1].

One study reported a minimum detectable change for the distance walked (DW) in the 2MWT was 42.5m[11].

In subjects with COPD undergoing pulmonary rehabilitation, a clinically meaningful change of 5.5m in DW has been reported[2].

A study of subjects post cardiac surgery (for coronary artery bypass grafts) demonstrated that the 2MWT was sensitive to change but could not discriminate between those who developed cardiac or respiratory complications and those who did not[6].

Normative Data

Age and gender explain 51% of variance in the distance walked in the 2MWT[8], i.e. older age and female gender are associated with shorter distances walker. Other studies have found some correlation between DW and height, weight, age and gender[11].

One study[8] has shown that subjects reached 70% of their maximum heart rate which was comparable with similar testing of the 6MWT. Authors hypothesised that this could suggest that a steady state of exertion is reached after only a short period of walking, as both the two and six minute walk tests are self-paced. So the 2MWT is a useful measure instead of the 6MWT if it is not practical to perform.

A 2017 meta-analysis[10] pooled data from four studies to produce the following normative values however the authors recommended further research is needed in multiple nations and populations to add more value to the 2MWT.

Data from Bohannon (2017)[10]
Gender Age

(years)

Mean Distance with Standard Error

(metres)

Male 20-29 217.9 (5.4)
30-39 202.1 (3.0)
40-49 192.1 (2.7)
50-59 189.8 (2.6)
60-69 183.0 (7.0)
70-79 163.1 (5.3)
Female 20-29 194.1 (8.4)
30-39 181.4 (1.7)
40-49 180.7 (10.4)
50-59 169.1 (10.0)
60-69 163.7 (6.9)
70-79 150.3 (1.3)

- One study[8] has described, with evidence, an equation to predict the DW, regardless of health condition. It takes into account age and gender. The equation is 2MWTpredicted􏰆 = 252.583 􏰄- (1.165 􏰅x age) +􏰈 (19.987 x􏰅 gender*), where * is male=􏰆 1 and female= 0[8].

- Another study[11] used the following equations for men and women, respectively, with normative values available here.

Men: 2MWTpredicted = 279.096 - (0.998 x age) - (1.426 x BMI)

Women: 2MWTpredicted = 257.177 - (0.723 x age) - (1.688 x BMI)

*where BMI is Body Mass Index where weight (in kilogram) divided by height (in metres) squared

- A third study[12] has reported on normative values for healthy Chinese adults aged 18-85 years old (see here) using the following equations:

Male: 2MWD(m)=123.252−[age(yr)×0.699]+[height(cm)×0.711]

Female:2MWD(m)=108.278−[age(yr)×0.691]+[height(cm)×0.698]

- A fourth study[13] reported an average WD of 182.69 + 32.40 metres in healthy Indian adults (20-80 years, n= 300). The authors found that there was no significant difference between different age strata. The authors did not report separate means for men and women but did note that men walked further than women, in general.

-Researchers have also more recently reported on equations for children and adolescents aged 3 - 17 years[14]:

For boys; 39.69 + 16.11(age) - 0.58(age squared) + 53.56(height) - 0.54(body mass)

For girls; 56.56 + 18.04(age) - 0.67(age squared) - 0.64(body mass) + 36.08(height)

Clinical Significance of 2 MWT:

IN PEDIATRIC POPULATION :

  1. The 2MWT is of shorter duration, objective, easily administered, and provides a standardized evaluation of functional capacity in populations with reduced ambulatory capability in adults with neuromuscular disease[15]. This format of the test helps in neurologically affected children with behavioral problems, limited ambulatory capacity, lower muscular strength and increased fatigue levels lower cognition levels to test their functional capacity[5]
  2. It is an easy-to-implement measure to establish a baseline level of impairment, monitor disease progression and evaluate the effectiveness of current therapeutic interventions in children with significant illness.

IN ADULT POPULATION:

  1. It can used in the aged population, individuals with lower extremity amputations, cystic fibrosis, traumatic brain injury, and neurological disorders as a measure of endurance.
  2. It is used as a measure of gait speed, aerobic capacity in patients who are unable to complete 6MWT.

Resources

2 Minute Walk Test Shirley Ryan Ability Lab.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed). 1982. 29; 284(6329): 1607–1608. Accessed 19 February 2019.
  2. 2.0 2.1 Johnston KN, Potter AJ, Phillips AC. Minimal important difference and responsiveness of 2-minute walk test performance in people with COPD undergoing pulmonary rehabilitation. Int J Chron Obstruct Pulmon Dis. 2017:12 2849–2857. Accessed 19 February 2019.
  3. Brooks D, Parsons J, Hunter JP, Devlin M, Walker J. The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation. Arch Phys Med Rehab. 2001: 82(10):1478-83
  4. 4.0 4.1 Scalzitti DA, Harwood KJ, Maring JR, Leach SJ, Ruckert EA, Costello E. Validation of the 2-Minute Walk Test with the 6-Minute Walk Test and other functional measures in persons with Multiple Sclerosis. Int J MS Care. 2018; 20(4): 158–163. Accessed 19 February 2019.
  5. 5.0 5.1 5.2 J.W. Witherspoon, R. Vasavada, R.H. Logaraj et al. Two-minute versus 6-minute walk distances during 6-minute walk test in neuromuscular disease: Is the 2-minute walk test an effective alternative to a 6-minute walk test? European journal of Paediatric Neurology; 2019; 165-170
  6. 6.0 6.1 Brooks D, Parsons J, Tran D, Jeng B, Gorczyca B, Newton J, Lo V, Dear C, Silaj E, Hawn T. The two-minute walk test as a measure of functional capacity in cardiac surgery patients. Arch Phys Med Rehabil. 2004;85: 1525-30. Accessed 23 February 2019.
  7. Upton CJ, Tyrrell JC, Hiller EJ. Two minute walking distance in cystic fibrosis. Arch Dis Child 1988;63:1444e8.
  8. 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 Selman, JPR, de Camargi AA, Santos J, Lanza FC, Dal Corso S. Reference Equation for the 2-Minute Walk Test in Adults and the Elderly. Respir Care. 2014; 59 (4): 525-530. Accessed 19 February 2019.
  9. Connelly DM, Thomas BK, Cliffe SJ, Perry WM, Smith RE. Clinical utility of the 2-Minute Walk Test for older adults living in long-term care. Physiother Can. 2009; 61(2):78-87.
  10. 10.0 10.1 10.2 10.3 Bohannon RW. Normative reference values for the two-minute walk test derived by meta-analysis. J Phys Ther Sci. 2017 Dec; 29(12): 2224–2227. Accessed 25 February 2019.
  11. 11.0 11.1 11.2 11.3 11.4 11.5 Bohannon RW, Wang Y, Gershon RC. Two-Minute Walk Test performance by adults 18 to 85 years: normative values, reliability, and responsiveness. Arch Phys Med Rehab. 2015; 96:472-7. Accessed 19 February 2019.
  12. Zhang J, Chen X, Huang S, Wang Y, Lin W, Zhou R, Zou H. Two-minute walk test: Reference equations for healthy adults in China. PLoS One. 2018; 13(8): e0201988. Published online 2018 Aug 9. doi: 10.1371/journal.pone.0201988. Accessed 23 February 2019.
  13. Priya TK, Verma S. A study to determine the reference values for Two Minute Walk Distance in healthy Indian adults. Int J Physiother Res 2015, Vol 3(5):1208-14. Accessed 25 February 2019.
  14. Bohannon RW, Wang Y, Bubela D, Gershon RC. Normative Two-Minute Walk Test distances for boys and girls 3 to 17 years of age. Phys Occup Ther Pediatr. 2018; 38:1, 39-45. Accessed 23 February 2019.
  15. Rossier P, Wade DT. Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil 2001;82:9e13.