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A review of the six-minute walk test: Its implication as a self-administered assessment tool

Ingle, Lee



I read with interest the review article by Du and colleagues published in the European Journal of Cardiovascular Nursing in July 2008. The concept that the six-minute walk test (6-MWT) could be adapted as a patient-reported outcome measure of functional capacity is interesting and the authors should be congratulated for pursuing this line of enquiry. However, after reading the manuscript I felt compelled to write this letter to highlight a number of inaccuracies and omissions that pervade the article.

The authors claim in the preamble that the 6-MWT “has been devised as a practical sub-maximal walk test”. Whilst it is true that the 6-MWT is self-paced and may be submaximal in some patients (dependent upon age, sex, type and severity of co-morbidities, and degree of cardiac dysfunction, among others), a number of studies have indicated that it is a maximal test in some patients with chronic heart failure (CHF), left ventricular assist devices, and coronary artery disease. This means that patients would be exercising above their anaerobic threshold during the completion of the 6-MWT. In Part 2 of their review the authors discuss data from two studies yet fail to report this crucial finding. Ingle and colleagues reported that in elderly patients with left ventricular systolic dysfunction (LVSD) and in another cohort of patients with no major structural heart disease (MSHD), the 6-MWT should not be considered a maximal test of exercise capacity but rather a test of submaximal exercise performance. This study demonstrated that the 6-MWT takes place at a higher proportion of peak oxygen uptake in patients with LVSD compared to those with no MSHD, and may be one reason why fatigue is a more prominent symptom in these patients.


Ingle, L. (2009). A review of the six-minute walk test: Its implication as a self-administered assessment tool. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 8(3), 232-234.

Journal Article Type Letter
Acceptance Date Jan 18, 2009
Online Publication Date Aug 1, 2009
Publication Date Aug 1, 2009
Deposit Date May 7, 2019
Publicly Available Date
Journal European Journal of Cardiovascular Nursing
Print ISSN 1474-5151
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 8
Issue 3
Pages 232-234
Item Discussed
Public URL