2 Minute Walk Test
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.
The 2MWT has been used as an outcome measure in a variety of health conditions including COPD, lower limb amputation, neuromuscular disease in adults as well as pediatric population, cardiac disease, functionally restrictive conditions like cystic fibrosis and the elderly, including those in long term care.
Method of Use
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 are 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, stopwatch, pen and paper or a device to record distance walked and any other observations e.g BORG scale.
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" and to take a rest break if needed, but do not stop the timer. The observer then gives encouragement after the first minute with standardised responses: "You're doing well" and "One minute left".
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.
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 DW has been reported.
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.
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. Other studies have found some correlation between DW and height, weight, age and gender.
One study 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 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.
|Mean Distance with Standard Error
- One study 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.
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 fourth study 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:
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 :
- 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
- 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:
- 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.
- It is used as a measure of gait speed, aerobic capacity in patients who are unable to complete 6MWT.
2 Minute Walk Test Shirley Ryan Ability Lab.
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