6MWT COURSE

f u n ct i o n a l a s s e s s m e n t i n p a h

Guidelines for the 6-Minute Walk Test

The 6-minute walk test (6MWT) is one of the most widely used

tests for assessing the functional status of patients with pulmonary arterial
hypertension (PAH).1,2 Along with the symptom-based WHO functional
classification and other elements of the clinical picture, results of baseline
and serial 6-minute walk testing have prognostic value and may suggest
approaches to treatment.3,4
Although simple in concept, the 6MWT requires adherence to a

standardized protocol to produce consistent results. Elimination of variability

allows comparisons over time for a single patient, as well as across patients

METERS

and across PAH centers.5 This summary of the American Thoracic Society (ATS)

6MWT
COURSE MARKERS
The course markers are an
excellent way to aid in tracking
patient progress during the test.
Simply place a marker every
3 meters in your 30-meter
course. See the guidelines for
complete details.

guidelines for the 6MWT is provided by Gilead Sciences, Inc. as an educational

service to help encourage Best Practices in PAH care.

References: 1. Gali N, Torbicki A, Barst R, et al, for the Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. ESC guidelines:
guidelines on diagnosis and treatment of pulmonary arterial hypertension. Eur Heart J. 2004;25(24):2243-2278. 2. Snow JL, Kawut SM. Surrogate end points in pulmonary arterial
hypertension: assessing the response to therapy. Clin Chest Med. 2007;28(1):75-89. 3. McGoon M, Gutterman D, Steen V, et al. Screening, early detection, and diagnosis of pulmonary
arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004;126(1, suppl):14S-34S. 4. Lee SH, Rubin LJ. Current treatment strategies for pulmonary arterial
hypertension. J Intern Med. 2005;258(3):199-215. 5. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute
walk test. Am J Respir Crit Care Med. 2002;166(1):111-117. 6. Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the measurement properties of functional walk
tests used in the cardiorespiratory domain. Chest. 2001;119(1):256-270. 7. Miyamoto S, Nagaya N, Satoh T, et al. Clinical correlates and prognostic significance of six-minute walk test in
patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2000;161(2, pt 1):487-492. 8. Barst RJ, McGoon M, Torbicki A,
et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2004;43(12, suppl S):40S-47S.

2008 Gilead Sciences, Inc. All rights reserved. ABS3103 April 2008
Gilead and the Gilead logo are trademarks of Gilead Sciences, Inc.

Printed on recycled paper 50TRF/25PCW

(50% totally recycled fiber, 25% post-consumer waste)

Functional Assessment in PAH :

The 6-Minute Walk Test
Guidelines for ensuring accurate functional assessment

The 6MW T measures the distance a patient can walk on a

flat, hard surface in a period of 6 minutes 5

The 6MWT, a submaximal exercise test, is:

Easy to administer, well tolerated, and reflective of activities of daily living6
Reproducible3,7
Technically simple and inexpensive to perform1,7
The 6-minute walk distance (6MWD) is a primary endpoint in many PAH clinical studies because it
is correlated to clinical outcomes and to other markers of disease severity1-3

 Serial determinations of functional class and exercise capacity

assessed by the [6MWT] provide benchmarks for disease severity,
response to therapy, and progression. 3

ATS guidelines for the 6MW T 5

P
 ublished in 2002, the ATS statement provides practical guidelines for the 6MWT with the aim of
encouraging Best Practices and uniformity of results
Covered topics include indications and limitations, contraindications, safety issues, technical aspects of
the test, required equipment, patient preparation, measurements, quality assurance, and interpretation
of results; standardized phrases for instructing the patient are also provided
Standardization of the 6MWT is critical: a standardized approach
reduces variability, which can markedly influence test results. 5

Guideline highlights 5
safety

Interpreting 6MW T results

The 6MWD correlates3,8:
Inversely with WHO functional status severity and pulmonary vascular resistance
Directly with cardiac output, peak oxygen consumption, and other measures of pulmonary
gas exchange

Mean 6MWD of Healthy Volunteers vs. Patients With PAH

in NYHA Functional Classes II, III, and IV 7
p<0.05 for each NYHA Class vs. healthy control
p<0.05 for NYHA Class III vs. NYHA Class II
and for NYHA Class IV vs. NYHA Class III

Trained emergency personnel and resuscitation equipment should be readily available

The test should be stopped immediately for any of the following: chest pain, intolerable dyspnea,
leg cramps, staggering, diaphoresis, and pale or ashen appearance
course layout

R
 ecommended: a long, flat, straight, enclosed corridor with a hard surface, 30 m in length, with
turnaround points at each end clearly marked with cones
A permanent, dedicated course is ideal
Not recommended: a continuous course or treadmill
parameters to be recorded

Primary:
Distance in meters completed in 6 minutes
Secondary:
Pre-test blood pressure
Pre- and post-test heart rate and SpO2 (no intra-test measurements)
Pre- and post-test patient perception of fatigue and dyspnea (Borg scale)

Patient prep

The patient should:

Wear comfortable clothes and walking shoes and use his or her regular walking aid (e.g., cane or walker)
Continue his or her usual medical regimen, including supplemental oxygen
conducting the test

Performance on the 6MWT is predictive of survival in patients with idiopathic PAH (IPAH)3:
Patients walking <332 m at baseline have a significantly lower survival rate than those
walking farther7
There is an 18% reduction in the risk of death per additional 50 m walked1
Arterial oxygen desaturation >10% during 6MWT increases mortality risk by a factor of 2.9
(median follow-up 26 months)1

There is no warm-up period; the patient should be seated for at least 10 minutes before the test
The person conducting the test should not walk with the patient or offer any physical or verbal
encouragement other than pre-scripted phrases
Instructions to the patient should be delivered in an even tone of voice and limited to set phrases
described in the guidelines
Any supplemental oxygen source should be carried or pulled by the patient in his or her usual fashion
The 6-minute timer should continue to run even if the patient stops to rest
Practice tests are unnecessary but may be considered; typically, they improve performance by increasing the
distance walked. Allow at least 1 hour between a practice test and follow-up test; report the highest 6MWD

6MWT COURSE

f u n ct i o n a l a s s e s s m e n t i n p a h

Guidelines for the 6-Minute Walk Test

The 6-minute walk test (6MWT) is one of the most widely used

tests for assessing the functional status of patients with pulmonary arterial
hypertension (PAH).1,2 Along with the symptom-based WHO functional
classification and other elements of the clinical picture, results of baseline
and serial 6-minute walk testing have prognostic value and may suggest
approaches to treatment.3,4
Although simple in concept, the 6MWT requires adherence to a

standardized protocol to produce consistent results. Elimination of variability

allows comparisons over time for a single patient, as well as across patients

METERS

and across PAH centers.5 This summary of the American Thoracic Society (ATS)

6MWT
COURSE MARKERS
The course markers are an
excellent way to aid in tracking
patient progress during the test.
Simply place a marker every
3 meters in your 30-meter
course. See the guidelines for
complete details.

guidelines for the 6MWT is provided by Gilead Sciences, Inc. as an educational

service to help encourage Best Practices in PAH care.

References: 1. Gali N, Torbicki A, Barst R, et al, for the Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. ESC guidelines:
guidelines on diagnosis and treatment of pulmonary arterial hypertension. Eur Heart J. 2004;25(24):2243-2278. 2. Snow JL, Kawut SM. Surrogate end points in pulmonary arterial
hypertension: assessing the response to therapy. Clin Chest Med. 2007;28(1):75-89. 3. McGoon M, Gutterman D, Steen V, et al. Screening, early detection, and diagnosis of pulmonary
arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. 2004;126(1, suppl):14S-34S. 4. Lee SH, Rubin LJ. Current treatment strategies for pulmonary arterial
hypertension. J Intern Med. 2005;258(3):199-215. 5. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute
walk test. Am J Respir Crit Care Med. 2002;166(1):111-117. 6. Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the measurement properties of functional walk
tests used in the cardiorespiratory domain. Chest. 2001;119(1):256-270. 7. Miyamoto S, Nagaya N, Satoh T, et al. Clinical correlates and prognostic significance of six-minute walk test in
patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2000;161(2, pt 1):487-492. 8. Barst RJ, McGoon M, Torbicki A,
et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2004;43(12, suppl S):40S-47S.

2008 Gilead Sciences, Inc. All rights reserved. ABS3103 April 2008
Gilead and the Gilead logo are trademarks of Gilead Sciences, Inc.

Printed on recycled paper 50TRF/25PCW

(50% totally recycled fiber, 25% post-consumer waste)