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Six-Minute Walk Distance in Chronic Obstructive Pulmonary Disease

Reproducibility and Effect of Walking Course Layout and Length

Johns Hopkins University, Baltimore, Maryland; Cedars Sinai-University of California, Los Angeles, California; Temple University School of Medicine, Philadelphia; and University of Pittsburgh, Pittsburgh, Pennsylvania

Correspondence and requests for reprints should be addressed to Robert A. Wise, M.D., Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: rwise{at}jhmi.edu

The 6-minute walk test is used in clinical practice and clinical trials of lung diseases; however, it is not clear whether replicate tests need to be performed to assess performance. Furthermore, little is known about the impact of walking course layout on test performance. We conducted 6-minute walks on 761 patients with severe emphysema (mean ± SD FEV₁% predicted = 26.3 ± 7.2) who were participants in the National Emphysema Treatment Trial. Four hundred seventy participants had repeated walks on a separate day. The second test was improved by an average of 7.0 ± 15.2% (66.1 ± 146 feet, p < 0.0001, by paired t test), with an intraclass correlation coefficient of 0.88 between days. The course layout had an effect on the distance walked. Participants tested on continuous (circular or oval) courses had a 92.2-foot longer walking distance than those tested on straight (out and back) courses. Course length had no significant effect on walking distance. The training effect found in these patients with severe emphysema is less than in previous reports of patients with chronic obstructive pulmonary disease. Furthermore, the layout of the track may influence the 6-minute walk performance.

Key Words: emphysema • exercise tests • reproducibility of results • diagnostic techniques • clinical trials

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