Six minute walk and push test

The results of the test can be used to set goals for exercise, design customised exercise plans and interventions and identify when the person’s mobility has improved.

The Six Minute Walk and Push Tests can be used for any person of any age with cerebral palsy who is capable of walking or propelling themselves forward in a wheelchair.

In the Six Minute Walk and Push Tests, the assessor will measure the distance the person can walk or self-propel in a manual wheelchair. The surface they are tested on should be hard and flat. The corridor length to undertake the assessment can vary, but 30 metres is recommended by the American Thoracic Society¹. The aim is for the participant to cover as much distance as possible in the six minutes. They should self-pace throughout the assessment and can take breaks if needed.

This assessment takes six minutes. Additional time is needed for the assessor to set up and record the assessment, discuss the results with their client and develop an appropriate exercise program.

Fees will apply for an exercise physiologist, physiotherapist or occupational therapist to conduct the assessment. The cost will vary depending on the service provider. You should also check with your provider to confirm if there will be additional costs to develop a home program, travel to the sessions or prepare reports.

You can ask your health care provider if you are eligible for funding to assist with the assessment fees. People with disability living in Australia may also be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Training

The assessment should be conducted by a qualified health professional with experience carrying out the Six Minute Walk and Push Tests and knowledge of standard testing protocol.

Assessors should be familiar with the guidelines and instructions for administering the Six Minute Walk Test that are provided by the American Thoracic Society. They include safety considerations, precautions and contraindications such as cardiovascular disease. There are no norms available for people with cerebral palsy and limited information regarding clinically important change.

Cost to administer

The only cost involved in conducting the Six Minute Walk and Push tests is the purchase of equipment such as cones, measuring wheel, tape and stopwatch or timer.

Psychometric properties reviewed

Construct validity

The available research indicates the Six Minute Push Test has significant and strong construct validity when measured against the one stroke push test (r=0.73). When assessed against heart rate, however, this test shows significant, but low, correlation (r=0.29)². There was no research available assessing construct validity of the Six Minute Walk Test.

Criterion validity

One study assessed the criterion validity of the Six Minute Walk Test to measure aerobic fitness and found it had poor criterion validity. It was recommended that the test be used to measure walking, not aerobic fitness. This is likely a result of the interplay between gait inefficiencies and cardiovascular fitness in adults with cerebral palsy³. There was no research available assessing criterion validity of the Six Minute Push Test.

Reliability

Several studies have assessed the test-retest reliability of the Six Minute Walk Test for people with cerebral palsy. Results indicate excellent test-retest reliability with intra-class correlation coefficients (ICC) ranging from 0.97-0.99^{4, 5, 6}. There is less research available assessing the reliability of the Six Minute Push Test, however the available literature shows excellent test re-test reliability and reproducibility (ICC = 0.97)².

Consistency of the test results will vary, depending on the amount of encouragement provided to the participant, the test set-up including walkway length, and the number of trials⁷.