2 Minute Walk Test

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

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.

Intended Population

The 2MWT has been used as an outcome measure in a variety of health conditions (in adults as well as pediatric populations) including

• Functionally restrictive conditions eg cystic fibrosis COPD
• Lower limb amputation
• Neuromuscular disease
• Cardiac disease
• Elderly, including those in long term care.

General Information

Individual walks without assistance for 2 minutes and the distance is measured

• 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, this should not be performed
• a measuring wheel is helpful to determine distance walked
• should be performed at the fastest speed possible
• Rest breaks are allowed if needed.

The person is encouraged to walk as fast as they can, safely, for two minutes.

Equipment

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

Intructions

“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.” The observer then gives encouragement after the first minute with standardised responses: "You're doing well" and "One minute left".

The 2MWT requires two practice walks before it is measured due to a training effect.

Evidence

1. Reliability: Studies have shown that the 2MWT is consistently reproducible.
2. 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 and those with respiratory disease or Multiple Sclerosis. 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.
3. Responsiveness: Research shows the 2MWT does not discriminate as well as the longer six and 12 minute walk tests in subjects with respiratory disease.
   • One study reported a minimum detectable change for the distance walked (DW) in the 2MWT was 42.5m.
   • In subjects with COPD undergoing pulmonary rehabilitation, a clinically meaningful change of 5.5m in distance walked has been reported.
   • 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.

Normative Data

Age and gender explain 51% of variance in the distance walked in the 2MWT, i.e. older age and female gender are associated with shorter distances walker.

Studies findings

• Correlations between DW and height, weight, age and gender.
• Subjects reached 70% of their maximum heart rate which was comparable with similar testing of the 6MWT. 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 (ie 2MWT is a useful measure instead of the 6MWT if it is not practical to perform).

Normative Values

Data from Bohannon (2017)

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)

Researchers have reported on equations for children and adolescents aged 3 - 17 years:

• 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:

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. 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
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 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.