Six Minute Walk Fitness Test Form
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1Site Name:
WF NCORP Research Base # 01213
Site MR #:
Staff Completing Form:
Study Title: Reducing Lung Cancer Survivors’
Patient Initials:
Date:
Anxiety (RELAX)
PID:
Appendix 12: Six Minute Walk
Visit:
Baseline
12 Week
SIX-MINUTE WALK
The six-minute walk is commonly used to test a participant’s ability to walk a distance that is functionally
important.
Equipment Needed: Stop Watch
White Tape/Measuring Wheel*
Finger Type Pulse Oximeter*
The walking course should be laid out in an unobstructed hallway or corridor. Use the white tape to place
a start line at one end of the hallway. Measure 20 meters (65.6 feet) from the start line and place white
tape for the stop line. Use the measuring wheel to measure the total distance the participant is able to
walk.
Always stand slightly behind the participant so as not to dictate the participant’s pace. The participant
should determine his/her own pace during the test. Provide encouragement at 60-second intervals.
Include statements like “You are doing well,” or “Keep up the good work.”
Immediately prior to the 6-minute walk, the participant’s heart rate and O
saturation should be checked
2
using the finger type pulse oximeter.
Document the results here:
Heart Rate _____
O
Sat _____
2
Participant Instructions: "This test is called the 6-minute walk. You will begin when I say ‘GO.’ I want
you to walk from this white line to the white line at the other end of the hallway. You should turn as tightly
as possible (demonstrate). Continue walking back and forth as quickly as you can.” If you become
uncomfortable, please let me know and we can stop the test at any time. Try to pace yourself in order to
complete as many laps as you can in six minutes. Keep walking until I say 'stop.' At that point, STAY
EXACTLY WHERE YOU ARE, and I will record your total distance.
Position the participant so that his/her feet are just behind the start line. Begin timing with the stopwatch
when the participant takes his/her first step over the start line and stop the test when 6 minutes have
elapsed. Record the distance walked below.
Distance Walked in Feet _____________
or
Distance Walked in Meters _____________
Immediately following the 6-minute walk the participant’s heart rate and O
saturation should be checked.
2
Document the results here:
Heart Rate _____
O
Sat _____
2
If the participant used an assistive or other device during the 6-minute walk, record the type of device
used (one cane, two canes, crutches, walker, other).
Check all types of devices that apply: ____ Cane
____ Walker
____ IV poles
____ Oxygen tanks
Other (Specify) ________________________________________
When measuring wheel is not available for 6-minute walk:
Between the start and stop line, mark every meter using white tape so that the examiner can measure the
meters during the test. Count the number of laps and the number of meters completed on the final lap for
the total distance walked.
* Measuring Wheel and Finger Type Pulse Oximeter provided.
1 meter = 3.28 feet
20 meters = 65.6 feet
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