way. For example, “You are doing well; you have 5 minutes to go.” They are allowed to slow down, stop, and rest without sitting down, as needed, but the timer does not pause for the duration of the test. If the patient does require a seated rest break, the test is terminated and the distance is recorded along with the amount of time the test lasted. The number of laps plus any extra distance should be recorded. For example, a patient who walks 2 complete laps during the test, plus an additional 9 meters, has walked 129 meters ([2 × 60] + 9). Normative values for the 6-minute walk for older adults can be found in Table 11. The average 6MWT distance for adults is between 400 and 700 meters (Casano & Anjum, 2021). The minimal clinically important difference, or the difference that reflects meaningful change for the patient, is approximately 50 meters for healthy older adults and 14 to 30.5 meters for those with cardiac and/or pulmonary disease (Casano & Anjum, 2021).
It has been used to determine fitness in a variety of older adult populations, including frail individuals and those with chronic conditions (Casano & Anjum, 2021). The benefit of using the 6-minute walk test is that even individuals with very low fitness can complete the test because they are able to take rest breaks as needed (American Thoracic Society , 2002). The 6-minute walk test should be performed indoors along a long, straight, flat surface to minimize the need to navigate obstacles during the test. The walking course should be 30 meters long, with marks every 3 meters, and each end of the course should be marked with a cone. This will provide a 60-meter walking course (30 meters down and 30 meters back) for the patient to walk around. Patients are allowed to use their usual walking aids during the test. Patients should be instructed to walk as far as they can during the 6-minute period. They should be informed when each minute has passed in the same Table 11: Normal Values for Aerobic and Resistance Measures
Grip Strength (lb) Left
6-Minute Walk Test (m)
2-Minute Step Test (#)
Gait Speed (m/sec)
30-Second Chair Stand (#)
Age
Right
Men
60 to 69
572
86 to 116
1.34
12 to 19
85.4
92.0
70 to 79
527
73 to 110
1.26
11 to 17
68.5
72.7
80 to 89
417
59 to 103
0.97
8 to 15
59.6
66.4
Women
60 to 69
538
73 to 107
1.24
11 to 17
50.6
57.1
70 to 79
471
68 to 101
1.13
10 to 15
42.5
47.6
80 to 89 38.2 Note . Adapted from Barthuly, Bohannon & Gorack, 2012; Bohannon 2009; Braden et al., 2012; Casanova et al., 2011 Shirley Ryan Ability Lab, 2022. 2-minute step test 392 55 to 91 0.94 8 to 14 37.6
11 are only for those individuals who did not touch another object during the test. Using hands during this test causes an individual to score a 0. In those instances, if the individual puts a fingertip on the wall, a measurement of where the fingertip was placed or how many fingers were used from one point in time to another will be used to indicate progress. The use of fingertips to balance initially and progressing to not needing any upper extremity support would also be significant. Self-selected gait speed Self-selected gait speed is increasingly recognized as an important measure of overall health in older individuals (Studenski et al., 2011). It can be used in a variety of settings and with a wide range of diagnoses, making it an ideal measure for many therapists (Middleton et al., 2015). Slow gait speed is a predictor of functional decline, disability, falls, and mortality in older adults (Guralnik et al., 2000; Hardy et al., 2007; Studenski et al., 2011). Improvements in gait speed are associated with decreased mortality (Hardy et al., 2007), and physical therapy interventions can result in improved gait speed (Barthuly et al., 2012; Braden et al., 2012; Middleton et al., 2015). Gait speeds of less than 1 meter per second identify older adults at high risk of negative health-related outcomes and increased mortality (Studenski et al., 2011). Self-selected gait speed is not a traditional measure of aerobic fitness. However, because gait speed is both a measure of overall health in older adults and an easy, short, and simple test to administer, it should be included in all fitness assessments and is an appropriate test for almost all settings. Self-selected gait speed can be assessed over any distance, but 4 meters is most commonly used. Ideally, 2 meters should be allowed for acceleration and deceleration on either side of the test. This means that if gait speed is tested over 4 meters, an 8-meter course should be used to allow for 2 meters for acceleration, 4 meters for testing, and 2 meters for deceleration. When testing self-selected gait speed, patients should be instructed to start walking at their normal speed. Timing begins once they cross the 2-meter mark and ends when they cross the
If there is not sufficient room to complete the 6-minute walk test, one alternative measure is the 2-minute step test (2MST). The 2MST is an outcome measure that is a component of the Senior Fitness Test, a battery that consists of the 30-Second Chair Stand, Arm Curl, 6MWT, Chair Sit-and-Reach, Back-Scratch, and 8-Foot Up-and-Go (Caughlin et al., 2022). The benefit of the 2MST is that it measures “functional fitness,” which is defined as the physiologic capacity to independently and safely perform everyday activities such as stair climbing, dressing, and personal hygiene without excessive fatigue (Caughlin et al., 2022). The 2-minute step test has been administered to a variety of populations, including those with heart disease, pulmonary disease, stroke, dementia, and frailty (Shirley Ryan Ability Lab, 2022). Like the 6-minute walk test, the 2-minute step test is self- paced, which allows individuals to take rest breaks as needed, and it can therefore be used with individuals with very low fitness. In the 2-minute step test, the knee stepping height needs to be, at a minimum, halfway between the kneecap and the iliac crest. Once this distance is measured, it can be marked on the wall with a piece of tape. Upon starting the test, the patient will be marching in place as many times as possible in 2 minutes. For this test, only the number of times the right knee reaches the target height is counted. If patients become fatigued and can no longer reach the target height, they are asked to slow down or rest until they can once again reach the target height. However, even with a slowdown or rest, the timing of the test continues without pausing. The final score is the number of times the right knee reaches the target height within the 2-minute period. If patients have balance difficulties, this test can be done with an assistive device nearby in case of a loss of balance, but patients should be discouraged from using their arms continuously during the test because this may alter the results. The normal range of values for the 2-minute step test can be found in Table 11. The 2MST does have poor predictive validity for obese older adults (Shirley Ryan Ability Lab, 2022). The norms presented in Table
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