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== Objective ==
== Objective ==
The Two/2 Minute Walk Test (2MWT) is a measure of self-paced walking ability and functional capacity<ref name=":0">Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1498516/pdf/bmjcred00608-0027.pdf 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.</ref>, particularly for those who cannot manage the longer [[Six Minute Walk Test / 6 Minute Walk Test|Six Minute Walk Test]] (6MWT) or 12 Minute Walk Test.<br>
The Two/2 Minute Walk Test (2MWT) is a measure of self-paced walking ability and functional capacity, particularly for those who cannot manage the longer [[Six Minute Walk Test / 6 Minute Walk Test|Six Minute Walk Test]] (6MWT) or [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1639415/pdf/brmedj00510-0042.pdf 12 Minute Walk Test].<ref name=":0">Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1498516/pdf/bmjcred00608-0027.pdf 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.</ref><br>


== Intended Population  ==
== Intended Population  ==
The 2MWT has been used in a variety of health conditions including [[COPD (Chronic Obstructive Pulmonary Disease)|COPD]]<ref name=":0" /><ref name=":4" />, [[Amputations|lower limb amputation]]<ref>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
The 2MWT has been used as an outcome measure for patients with a variety of conditions and in multiple populations including:  
</ref>, [[Neuromuscular Disorders|neuromuscular disease]]<ref name=":2" />, [[Cardiovascular Disease|cardiac disease]]<ref name=":5" /> and the elderly<ref name=":1">Selman, JPR, de Camargi AA, Santos J, Lanza FC, Dal Corso S. [http://rc.rcjournal.com/content/respcare/59/4/525.full.pdf Reference Equation for the 2-Minute Walk Test in Adults and the Elderly]. Respir Care. 2014; 59 (4): 525-530. Accessed 19 February 2019.
</ref> including those in long term care<ref>Connelly DM, Thomas BK, Cliffe SJ, Perry WM, Smith RE. [https://www.researchgate.net/publication/41623570_Clinical_Utility_of_the_2-Minute_Walk_Test_for_Older_Adults_Living_in_Long-Term_Care Clinical utility of the 2-Minute Walk Test for older adults living in long-term care.] Physiother Can. 2009; 61(2):78-87.</ref>.


== Method of Use  ==
* Functionally restrictive conditions such as [[Cystic Fibrosis|cystic fibrosis]] <ref>Upton CJ, Tyrrell JC, Hiller EJ. Two minute walking distance in cystic fibrosis. Arch Dis Child 1988;63:1444e8.</ref>
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.
* [[Amputations|Lower limb amputation]]<ref>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
</ref>
* Paediatric [[Neuromuscular Disorders|neuromuscular disorders]]<ref>Pin TW, Choi HL. Reliability, validity, and norms of the 2-min walk test in children with and without neuromuscular disorders aged 6–12.  Disabil Rehabil. 2018: 40(11), 1266-1272.</ref>
* Adult [[Neuromuscular Disorders|neuromuscular disease]] such as Multiple Sclerosis<ref name=":2">Scalzitti DA, Harwood KJ, Maring JR, Leach SJ, Ruckert EA, Costello E. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107337/ 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.
</ref>
* [[Cardiovascular Disease|Cardiac diseases]]<ref name=":5" />
* Pulmonary diseases such as [[COPD (Chronic Obstructive Pulmonary Disease)|COPD]]<ref name=":4" /><ref name=":10" />
*[[Older People - An Introduction|Elderl]]<nowiki/>[[Older People - An Introduction|y]], including those in long term care<ref name=":1">Selman, JPR, de Camargi AA, Santos J, Lanza FC, Dal Corso S. [http://rc.rcjournal.com/content/respcare/59/4/525.full.pdf Reference Equation for the 2-Minute Walk Test in Adults and the Elderly]. Respir Care. 2014; 59 (4): 525-530. Accessed 19 February 2019.
</ref><ref>Connelly DM, Thomas BK, Cliffe SJ, Perry WM, Smith RE. [https://www.researchgate.net/publication/41623570_Clinical_Utility_of_the_2-Minute_Walk_Test_for_Older_Adults_Living_in_Long-Term_Care Clinical utility of the 2-Minute Walk Test for older adults living in long-term care.] Physiother Can. 2009; 61(2):78-87.</ref>
* Genera<nowiki/>l [[:Category:Paediatrics|paediatrics]]<ref name=":9" /> <nowiki/>


Equipment: A clear course such as a hallway with cones or similar to mark an approximately 15m "out and back" course<ref name=":3" />, stopwatch, pen and paper or a device to record distance walked and any other observations e.g BORG scale.
== General Information ==


Instructions are based on those of the 6MWT: before the participant starts walking advise them to "Cover as much ground as possible without running" and to take a rest break if needed. Give encouragement after the first minute with standardised responses: "You're doing well" and "One minute left"<ref name=":1" />.
The person is encouraged to walk as fast as they can, safely, without assistance for two minutes and the distance is measured<ref name=":8">sralab 2 Minute Walking test Available: https://www.sralab.org/sites/default/files/2017-07/2%20Minute%20Walk%20Test%20Instructions.pdf (accessed 7.10.20210</ref>.


The 2MWT requires two practice walks before it is measured due to a training effect<ref name=":0" /><ref name=":1" /><ref name=":3" />.
* Start timing when the individual is instructed to “Go”.
* Stop timing at 2 minutes.
* Assistive devices can be used but should be kept consistent and documented from test to test.


== Evidence  ==
* If physical assistance is required to walk, the test should not be performed.
* Measuring wheel is helpful to determine distance walked.
* Person should walk at the fastest speed possible.
* Rest breaks are allowed if needed. 
== Equipment ==
A clear "out and back"course such as a hallway with cones or similar to mark an approximately 15m, stopwatch, pen and paper or a device to record distance walked. Other observations tools e.g. [[Borg Rating Of Perceived Exertion|BORG]] scale may be used for additional assessment.<ref name=":6">Bohannon RW. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890237/ 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.</ref>


=== Reliability  ===
== Instructions and Guidelines ==
Studies have shown that the 2MWT is consistently reproducible<ref name=":0" /><ref name=":1" /><ref name=":3" />.
Before starting the test, observer gives initial instructions :


=== Validity  ===
“Cover as much ground as possible over 2 minutes. Walk continuously if possible, but do not be concerned if you need to slow down or stop to rest. The goal is to feel at the end of the test that more ground could not have been covered in the 2 minutes” <ref name=":8" />.
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 Physiology|exercise tolerance]] in population-based samples<ref name=":3" /> and those with respiratory disease<ref name=":0" /> or [[MS Multiple Sclerosis|Multiple Sclerosis]]<ref name=":2">Scalzitti DA, Harwood KJ, Maring JR, Leach SJ, Ruckert EA, Costello E. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107337/ 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.
</ref>.


=== Responsiveness  ===
The observer provides encouragement after the first minute of the person walking with standardized responses: "You're doing well" and "One minute left"<ref name=":1" />.
Research shows the 2MWT does not discriminate as well as the longer six and 12 minute walk tests in subjects with respiratory disease<ref name=":0" />.


One study reported a minimum detectable change for the distance walked (DW) in the 2MWT was 42.5m<ref name=":3">Bohannon RW, Wang Y, Gershon RC. [https://www.researchgate.net/publication/269177497_Two-Minute_Walk_Test_2MWT_Performance_by_Adults_18-85_Years_Normative_Values_Reliability_and_Responsiveness 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.</ref>.
The 2MWT requires two practice walks before it is measured due to a training effect<ref name=":0" /><ref name=":1" /><ref name=":3" />.


In subjects with COPD undergoing pulmonary rehabilitation, a clinically meaningful change of 5.5m in DW has been reported<ref name=":4">Johnston KN, Potter AJ, Phillips AC. [https://www.dovepress.com/minimal-important-difference-and-responsiveness-of-2-minute-walk-test--peer-reviewed-fulltext-article-COPD 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.
{{#ev:youtube|hhgQw7hd_RY|300}}<ref>Mac ICU Rehab. 2 Minute Walk Test Tutorial. Available from: http://www.youtube.com/watch?v=hhgQw7hd_RY</ref>
</ref>.


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<ref name=":5">Brooks D, Parsons J, Tran D, Jeng B, Gorczyca B, Newton J, Lo V, Dear C, Silaj E, Hawn T. [https://www.archives-pmr.org/article/S0003-9993(04)00280-1/pdf 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.</ref>.
== Psychometric Properties ==


=== Miscellaneous<span style="font-size: 20px; font-weight: normal;" class="Apple-style-span"></span>   ===
* Reliability:
Age and gender explain 51% of variance in the distance walked in the 2MWT<ref name=":1" />, 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<ref name=":3" />.
** Studies have shown that the 2MWT is consistently reproducible.<ref name=":0" /><ref name=":1" /><ref name=":3" /><ref name=":10">Leung A, Chan KK, Sykes K, Chan KS. Reliability, Validity, and Responsiveness of a 2-Min Walk Test To Assess Exercise Capacity of COPD Patients. CHEST Journal. 2006; 130(1): 119-125.</ref>
 
* Validity:
One study<ref name=":1" /> 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.
** Construct validity:
 
*** The 2MWT has been shown to be strongly correlated with the six minute walk test across multiple populations ([[Multiple Sclerosis (MS)|Multiple Sclerosis]], pulmonary disease, and [[Older People Introduction|older adults]]).<ref>Karle V, hartung V, Ivanovska K, Maurer M, Flachenecker P, Pfeifer K, Tallner A. The Two-Minute Walk Test in Persons with Multiple Sclerosis: Correlations of Cadence with Free-Living Walking Do Not Support Ecological Validity. International Journal of Environmental Research and Public Health. 2020; 17(23).</ref><ref name=":10" /><ref name=":11">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. Physiotherapy Canada. 2009; 61(2); 78-87.</ref>
==== Normative Data ====
*** A study conducted in paediatric population with neuromuscular disorders showed that the 2 MWT had strong correlations with [https://link.springer.com/article/10.1007/s40120-020-00206-3 Motor Function Measure-32] and timed function tests and can be used interchangeably with 6MWT.<ref name=":7">[https://www.ejpn-journal.com/article/S1090-3798(18)30105-3/pdf 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]</ref>
One study<ref name=":1" /> 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<ref name=":1" />.  
** Concurrent validity:
 
*** The 2MWT has been shown to produce results consistent with those of the Berg Balance Scale, Timed Up and Go, and six minute walk test when tested in the same patients at the same time.<ref name=":11" />
Another study<ref name=":3" /> used the following equations for men and women, respectively, with normative values available [https://www.researchgate.net/publication/269177497_Two-Minute_Walk_Test_2MWT_Performance_by_Adults_18-85_Years_Normative_Values_Reliability_and_Responsiveness here].  
* Responsiveness:
 
** One study reported a minimum detectable change for the distance walked in the 2MWT was 42.5m<ref name=":3">Bohannon RW, Wang Y, Gershon RC. [https://www.researchgate.net/publication/269177497_Two-Minute_Walk_Test_2MWT_Performance_by_Adults_18-85_Years_Normative_Values_Reliability_and_Responsiveness 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.</ref>.
Men: 2MWTpredicted = 279.096 - (0.998 x age) - (1.426 x BMI)
** In subjects with COPD undergoing [[Pulmonary Rehabilitation|pulmonary rehabilitation]], a clinically meaningful change of 5.5m in distance walked has been reported<ref name=":4">Johnston KN, Potter AJ, Phillips AC. [https://www.dovepress.com/minimal-important-difference-and-responsiveness-of-2-minute-walk-test--peer-reviewed-fulltext-article-COPD 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.
</ref>.
** A study of subjects post  [[Coronary Artery Bypass Graft|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<ref name=":5">Brooks D, Parsons J, Tran D, Jeng B, Gorczyca B, Newton J, Lo V, Dear C, Silaj E, Hawn T. [https://www.archives-pmr.org/article/S0003-9993(04)00280-1/pdf 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.</ref>.


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


<nowiki>*</nowiki>where BMI is Body Mass Index where weight (in kilogram) divided by height (in metres) squared
* Many factors can influence the distance that a participant is able to walk for the 2MWT.
* A strong inverse relationship has been found between a participants age and the distance they are able to walk.  This is represented in that, generally, as a participant gets older the distance they are able to walk decreases.<ref name=":1" /><ref name=":6" /><ref name=":3" />
* It has also been established that, across all age groups, males tend to walk farther than females.<ref name=":1" /><ref name=":6" /><ref name=":3" />


A third study<ref>Zhang J, Chen X, Huang S, Wang Y, Lin W, Zhou R, Zou H. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085060/ 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.
* One study found that participants height, weight, age, and gender were all predictive of distance walked.<ref name=":3" />
</ref> has reported on normative values for healthy Chinese adults aged 18-85 years old (see [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085060/ here]) using the following equations:
** It was further determined that BMI was a better predictor of distance walked than height or weight alone.
** As such, they derived equations for predicting the distance a participant (age 18-85) should be able to walk.
*** Women: 257.177 - (0.723 x age) - (1.688 x BMI)
*** Men: 279.096 - (0.998 x age) - (1.426 x BMI)
* One study looked specifically at the [[:Category:Paediatrics|paediatric]]/adolescent populations.
** The authors were not only able to compile normative data for these populations, but also derive equations predicting the distance a participant (age 3-17) should be able to walk.<ref name=":9">Bohannon, Wang, Gershan. Normative Two-Minute Walk Test Distances for Boys and Girls 3 to 17 Years of Age. Physical and Occupational Therapy in Pediatrics. 2017. (38)11:1-7.</ref>
*** Boys: 39.69 + 16.11(age) - 0.58(age squared) + 53.56(height) - 0.54(body mass)
*** Girls: 56.56 + 18.04(age) - 0.67(age squared) - 0.64(body mass) + 36.08(height)
 
{| class="wikitable"
|+Data from Bohannon, Wang, and Gershon, 2015<ref name=":3" />
!Gender
!Age in years (# in study)
!Mean distance in meters
|-
|Male
|18-54 (260)
|200.9
|-
|
|55-59 (23)
|191.0
|-
|
|60-64 (29)
|179.1
|-
|
|65-69 (22)
|184.2
|-
|
|70-74 (32)
|172.2
|-
|
|75-79 (19)
|157.6
|-
|
|80-85 (32)
|144.1
|-
|Female
|18-54 (539)
|183.0
|-
|
|55-59 (30)
|176.4
|-
|
|60-64 (48)
|166.4
|-
|
|65-69 (22)
|155.2
|-
|
|70-74 (33)
|145.9
|-
|
|75-79 (14)
|140.9
|-
|
|80-85 (34)
|134.3
|}
{| class="wikitable"
|+Data from Bohannon (2017) based on meta analysis including four studies<ref name=":6" />
!Gender
!Age in years (total # in studies)
!Weight Mean Distance, in meters (SD)


Male: 2MWD(m)=123.252−[age(yr)×0.699]+[height(cm)×0.711]
|-
|Male
|20-29 (108)
|217.9 (5.4)
|-
|
|30-39 (98)
|202.1 (3.0)
|-
|
|40-49 (116)
|192.1 (2.7)
|-
|
|50-59 (98)
|189.8 (2.6)
|-
|
|60-69 (94)
|183.0 (7.0)
|-
|
|70-79 (1209)
|163.1 (5.3)
|-
|Female
|20-29 (203)
|194.1 (8.4)
|-
|
|30-39 (248)
|181.4 (1.7)
|-
|
|40-49 (189)
|180.7 (10.4)
|-
|
|50-59 (130)
|169.1 (10.0)
|-
|
|60-69 (99)
|163.7 (6.9)
|-
|
|70-79 (1188)
|150.3 (1.3)
|}
{| class="wikitable"
|+Data from Bohannon, Wang, and Gershon, 2017 <ref name=":9" />
!Gender
!Age in years (# in study)
!Mean distance in meters (SD)
|-
|Male
|3 (63)
|122.9 (26.6)
|-
|
|4 (70)
|137.3 (23.6)
|-
|
|5 (72)
|155.1 (25.2)  
|-
|
|6 (68)
|171.4 (20.6)
|-
|
|7 (99)
|184.0 (29.8)
|-
|
|8(81)
|193.3 (25.5)
|-
|
|9 (80)
|196.9 (27.4)
|-
|
|10 (91)
|195.4 (26.3)
|-
|
|11 (92)
|200.9 (26.7)
|-
|
|12 (86)
|202.6 (29.4)
|-
|
|13 (104)
|201.1 (28.9)
|-
|
|14 (101)
|201.8 (29.9)
|-
|
|15 (87)
|202.9 (26.6)
|-
|
|16 (97)
|209.0 (29.4)
|-
|
|17 (99)
|204.2 (29.2)
|-
|Female
|3 (54)
|125.9 (24.9)
|-
|
|4 (88)
|143.3 (23.4)
|-
|
|5 (80)
|155.4 (22.9)
|-
|
|6 (84)
|174.1 (22.7)
|-
|
|7 (89)
|182.2 (24.3)
|-
|
|8 (81)
|187.1 (26.6)
|-
|
|9 (75)
|199.8 (23.0)
|-
|
|10 (97)
|194.4 (23.1)
|-
|
|11 (93)
|197.5 (25.2)
|-
|
|12 (102)
|198.8 (25.1)
|-
|
|13 (89)
|197.0 (23.7)
|-
|
|14 (110)
|192.3 (25.0)
|-
|
|15 (99)
|193.4 (24.3)
|-
|
|16 (97)
|194.1 (24.9)
|-
|
|17 (103)
|192.8 (27.2)
|}


Female:2MWD(m)=108.278−[age(yr)×0.691]+[height(cm)×0.698]
== Clinical Significance of 2 MWT ==
 
[[:Category:Paediatrics|Paediatric]] Population
A fourth study reports a formula for predicting WD in  
# 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<ref>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.</ref>. This format of the test helps in neurologically affected children with [[Behavioral problems in children|behavioral problems]], limited ambulatory capacity, lower muscular [[Strength and Conditioning|strength]] and increased fatigue levels lower cognition levels to test their functional capacity<ref name=":7" />.
 
# 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.
Researchers have also more recently reported on equations for children and adolescents aged 3 - 17 years<ref>Bohannon RW, Wang Y, Bubela D, Gershon RC. [https://www.researchgate.net/publication/313018726_Normative_Two-Minute_Walk_Test_Distances_for_Boys_and_Girls_3_to_17_Years_of_Age 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.</ref>:
Adult Population
 
# It can be used in the aged population, individuals with lower extremity amputations, cystic fibrosis, [[Traumatic Brain Injury|traumatic brain injury]], and neurological disorders as a measure of endurance.
For boys; 39.69 + 16.11(age) - 0.58(age squared) + 53.56(height) - 0.54(body mass)
# It can be used as a measure of [[gait]] speed, and [[Aerobic Exercise|aerobic]] capacity in patients who are unable to complete 6MWT.
 
For girls; 56.56 + 18.04(age) - 0.67(age squared) - 0.64(body mass) + 36.08(height)
 
== Resources  ==
[https://www.sralab.org/sites/default/files/2017-07/2%20Minute%20Walk%20Test%20Instructions.pdf 2 Minute Walk Test] Shirley Ryan Ability Lab.
 
== References  ==


== References ==
<references />
<references />
[[Category:Rehabilitation Foundations]]
[[Category:Outcome Measures]]
[[Category:Outcome Measures]]
[[Category:Rehabilitation Foundations]]
[[Category:Older People/Geriatrics]]
[[Category:Older People/Geriatrics]]
[[Category:Older People/Geriatrics - Outcome Measures]]
[[Category:Paediatrics]]
[[Category:Paediatrics]]
[[Category:COPD]]
[[Category:Paediatrics - Outcome Measures]]
[[Category:Cardiopulmonary]]
[[Category:Cardiopulmonary - Outcome Measures]]
[[Category:Gait]]
[[Category:Gait]]
[[Category:Exercise Testing]]
[[Category:Exercise Testing]]
[[Category:Multiple Sclerosis]]
[[Category:Multiple Sclerosis - Outcome Measures]]
[[Category:Head]]
[[Category:Head - Outcome Measures]]
[[Category:Neurology]]
[[Category:Neurological - Outcome Measures]]

Latest revision as of 17:19, 3 April 2023

Original Editor - Ammar Suhail Top Contributors - Lauren Lopez, Kim Jackson, Jeremy Bryan, Ewa Jaraczewska, Rucha Gadgil, Lucinda hampton, George Prudden, Ammar Suhail, Yvonne Yap and Oyemi Sillo  

Objective[edit | edit source]

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

Intended Population[edit | edit source]

The 2MWT has been used as an outcome measure for patients with a variety of conditions and in multiple populations including:

General Information[edit | edit source]

The person is encouraged to walk as fast as they can, safely, without assistance for two minutes and the distance is measured[12].

  • Start timing when the individual is instructed to “Go”.
  • Stop timing at 2 minutes.
  • Assistive devices can be used but should be kept consistent and documented from test to test.
  • If physical assistance is required to walk, the test should not be performed.
  • Measuring wheel is helpful to determine distance walked.
  • Person should walk at the fastest speed possible.
  • Rest breaks are allowed if needed.

Equipment[edit | edit source]

A clear "out and back"course such as a hallway with cones or similar to mark an approximately 15m, stopwatch, pen and paper or a device to record distance walked. Other observations tools e.g. BORG scale may be used for additional assessment.[13]

Instructions and Guidelines[edit | edit source]

Before starting the test, observer gives initial instructions :

“Cover as much ground as possible over 2 minutes. Walk continuously if possible, but do not be concerned if you need to slow down or stop to rest. The goal is to feel at the end of the test that more ground could not have been covered in the 2 minutes” [12].

The observer provides encouragement after the first minute of the person walking with standardized responses: "You're doing well" and "One minute left"[9].

The 2MWT requires two practice walks before it is measured due to a training effect[1][9][14].

[15]

Psychometric Properties[edit | edit source]

  • Reliability:
    • Studies have shown that the 2MWT is consistently reproducible.[1][9][14][8]
  • Validity:
    • Construct validity:
      • The 2MWT has been shown to be strongly correlated with the six minute walk test across multiple populations (Multiple Sclerosis, pulmonary disease, and older adults).[16][8][17]
      • A study conducted in paediatric population with neuromuscular disorders showed that the 2 MWT had strong correlations with Motor Function Measure-32 and timed function tests and can be used interchangeably with 6MWT.[18]
    • Concurrent validity:
      • The 2MWT has been shown to produce results consistent with those of the Berg Balance Scale, Timed Up and Go, and six minute walk test when tested in the same patients at the same time.[17]
  • Responsiveness:
    • One study reported a minimum detectable change for the distance walked in the 2MWT was 42.5m[14].
    • In subjects with COPD undergoing pulmonary rehabilitation, a clinically meaningful change of 5.5m in distance walked has been reported[7].
    • A study of subjects post 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[edit | edit source]

  • Many factors can influence the distance that a participant is able to walk for the 2MWT.
  • A strong inverse relationship has been found between a participants age and the distance they are able to walk. This is represented in that, generally, as a participant gets older the distance they are able to walk decreases.[9][13][14]
  • It has also been established that, across all age groups, males tend to walk farther than females.[9][13][14]
  • One study found that participants height, weight, age, and gender were all predictive of distance walked.[14]
    • It was further determined that BMI was a better predictor of distance walked than height or weight alone.
    • As such, they derived equations for predicting the distance a participant (age 18-85) should be able to walk.
      • Women: 257.177 - (0.723 x age) - (1.688 x BMI)
      • Men: 279.096 - (0.998 x age) - (1.426 x BMI)
  • One study looked specifically at the paediatric/adolescent populations.
    • The authors were not only able to compile normative data for these populations, but also derive equations predicting the distance a participant (age 3-17) should be able to walk.[11]
      • Boys: 39.69 + 16.11(age) - 0.58(age squared) + 53.56(height) - 0.54(body mass)
      • Girls: 56.56 + 18.04(age) - 0.67(age squared) - 0.64(body mass) + 36.08(height)
Data from Bohannon, Wang, and Gershon, 2015[14]
Gender Age in years (# in study) Mean distance in meters
Male 18-54 (260) 200.9
55-59 (23) 191.0
60-64 (29) 179.1
65-69 (22) 184.2
70-74 (32) 172.2
75-79 (19) 157.6
80-85 (32) 144.1
Female 18-54 (539) 183.0
55-59 (30) 176.4
60-64 (48) 166.4
65-69 (22) 155.2
70-74 (33) 145.9
75-79 (14) 140.9
80-85 (34) 134.3
Data from Bohannon (2017) based on meta analysis including four studies[13]
Gender Age in years (total # in studies) Weight Mean Distance, in meters (SD)
Male 20-29 (108) 217.9 (5.4)
30-39 (98) 202.1 (3.0)
40-49 (116) 192.1 (2.7)
50-59 (98) 189.8 (2.6)
60-69 (94) 183.0 (7.0)
70-79 (1209) 163.1 (5.3)
Female 20-29 (203) 194.1 (8.4)
30-39 (248) 181.4 (1.7)
40-49 (189) 180.7 (10.4)
50-59 (130) 169.1 (10.0)
60-69 (99) 163.7 (6.9)
70-79 (1188) 150.3 (1.3)
Data from Bohannon, Wang, and Gershon, 2017 [11]
Gender Age in years (# in study) Mean distance in meters (SD)
Male 3 (63) 122.9 (26.6)
4 (70) 137.3 (23.6)
5 (72) 155.1 (25.2)
6 (68) 171.4 (20.6)
7 (99) 184.0 (29.8)
8(81) 193.3 (25.5)
9 (80) 196.9 (27.4)
10 (91) 195.4 (26.3)
11 (92) 200.9 (26.7)
12 (86) 202.6 (29.4)
13 (104) 201.1 (28.9)
14 (101) 201.8 (29.9)
15 (87) 202.9 (26.6)
16 (97) 209.0 (29.4)
17 (99) 204.2 (29.2)
Female 3 (54) 125.9 (24.9)
4 (88) 143.3 (23.4)
5 (80) 155.4 (22.9)
6 (84) 174.1 (22.7)
7 (89) 182.2 (24.3)
8 (81) 187.1 (26.6)
9 (75) 199.8 (23.0)
10 (97) 194.4 (23.1)
11 (93) 197.5 (25.2)
12 (102) 198.8 (25.1)
13 (89) 197.0 (23.7)
14 (110) 192.3 (25.0)
15 (99) 193.4 (24.3)
16 (97) 194.1 (24.9)
17 (103) 192.8 (27.2)

Clinical Significance of 2 MWT[edit | edit source]

Paediatric 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[19]. 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[18].
  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.

Adult Population

  1. It can be 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 can be used as a measure of gait speed, and aerobic capacity in patients who are unable to complete 6MWT.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 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. ↑ Upton CJ, Tyrrell JC, Hiller EJ. Two minute walking distance in cystic fibrosis. Arch Dis Child 1988;63:1444e8.
  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. ↑ Pin TW, Choi HL. Reliability, validity, and norms of the 2-min walk test in children with and without neuromuscular disorders aged 6–12. Disabil Rehabil. 2018: 40(11), 1266-1272.
  5. ↑ 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.
  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. ↑ 7.0 7.1 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.
  8. ↑ 8.0 8.1 8.2 Leung A, Chan KK, Sykes K, Chan KS. Reliability, Validity, and Responsiveness of a 2-Min Walk Test To Assess Exercise Capacity of COPD Patients. CHEST Journal. 2006; 130(1): 119-125.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 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.
  10. ↑ 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.
  11. ↑ 11.0 11.1 11.2 Bohannon, Wang, Gershan. Normative Two-Minute Walk Test Distances for Boys and Girls 3 to 17 Years of Age. Physical and Occupational Therapy in Pediatrics. 2017. (38)11:1-7.
  12. ↑ 12.0 12.1 sralab 2 Minute Walking test Available: https://www.sralab.org/sites/default/files/2017-07/2%20Minute%20Walk%20Test%20Instructions.pdf (accessed 7.10.20210
  13. ↑ 13.0 13.1 13.2 13.3 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.
  14. ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 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.
  15. ↑ Mac ICU Rehab. 2 Minute Walk Test Tutorial. Available from: http://www.youtube.com/watch?v=hhgQw7hd_RY
  16. ↑ Karle V, hartung V, Ivanovska K, Maurer M, Flachenecker P, Pfeifer K, Tallner A. The Two-Minute Walk Test in Persons with Multiple Sclerosis: Correlations of Cadence with Free-Living Walking Do Not Support Ecological Validity. International Journal of Environmental Research and Public Health. 2020; 17(23).
  17. ↑ 17.0 17.1 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. Physiotherapy Canada. 2009; 61(2); 78-87.
  18. ↑ 18.0 18.1 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
  19. ↑ 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.
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