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Walk Test

Why and how to perform 6 minute walk test with Cardio Efficiency,
how to interpret results

Walking is more than just a way to get from point A to point B—it’s a powerful tool for assessing and improving your heart and overall health. Among the many tools used by health professionals to measure fitness and functional capacity, two stand out: the 6-Minute Walk Test (6MWT) and heart rate monitoring during walking. Let’s explore how these two approaches work together to give us a clearer picture of our physical condition—and how you can use them to unlock your full health potential.

 

What Is the 6-Minute Walk Test?

Developed by the American Thoracic Society (ATS) and formally introduced in 2002 [1], the 6-Minute Walk Test (6MWT) is a simple, sub-maximal exercise used to evaluate a person’s endurance and aerobic capacity. The idea is straightforward: you walk as far as you can in six minutes, and the distance covered helps indicate your overall functional health.

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Originally designed for patients with heart and lung conditions, the 6MWT has since proven useful across a wide range of medical situations. It’s now commonly used to assess people with:

  • Arthritis
     

  • Stroke
     

  • Multiple Sclerosis
     

  • Parkinson’s Disease
     

  • Spinal Cord Injury
     

  • Fibromyalgia
     

  • Muscle disorders (including Duchenne/Becker Muscular Dystrophy and Spinal Muscular Atrophy) [2][3][4]
     

It’s appropriate for nearly every age group—from preschoolers to older adults [1]. We integrated the 6-minute walk test calculator into our website so you can get an initial assessment with just a regular watch. No other equipment needed. 

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You can use the heart rate monitor of the BreathNow app to enhance the walk test by taking a heart rate measurement at the end of the test as explained below. 

 

How Does the Test Work?

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The setup is simple:

  • A flat 30-meter path is marked with cones.
     

  • A stopwatch, a distance-measuring tool, and sometimes a pulse oximeter are used.
     

  • Chairs are placed nearby for rest if needed [1].
     

During the test, participants walk back and forth for six minutes. The total distance walked is recorded and used to track physical performance over time. Improvements in the distance walked can signal better mobility or recovery from injury or illness. A change of at least 45 meters is often seen as a “real” improvement [3].

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A Window Into More Than Just Walking

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The 6MWT doesn't just test your legs. It reflects how well your heart, lungs, muscles, and even your nervous system work together under physical stress [1]. For instance, in people with neuromuscular diseases like Spinal Muscular Atrophy, breaking down each minute of the test can help detect subtle muscle fatigue or neuromuscular junction problems [4].

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And because the test is reproducible and safe, it's widely used in rehabilitation for strokes [8][9][10][11], brain injuries [13][14], Parkinson’s disease [15], Alzheimer’s [5][16], and spinal cord injuries [17][18].

 

How To Enhance The Walk Test With Measuring Heart Rate?

You can calculate  "cardiac effort", a measure calculated by dividing the total number of heartbeats during the test by the distance walked. It essentially quantifies how much heart work is needed to cover each unit of distance.

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  • Lower Cardiac Effort: A lower cardiac effort (fewer beats per meter) suggests the heart is working more efficiently to move the body. This could be seen in individuals with better cardiovascular health or after successful treatment of conditions like heart failure or pulmonary hypertension. 

  • Higher Cardiac Effort: A higher cardiac effort (more beats per meter) suggests the heart is working harder for each meter walked. This may indicate reduced exercise capacity, a greater cardiovascular burden, or the presence of underlying heart or lung conditions. 

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A shorter 6-minute walk distance (6MWD) combined with a higher heart rate is a particularly concerning combination, as it suggests both poor functional capacity and a significant cardiac workload [26]. 

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To display a more complete picture our walk test calculator above displays the outcome of the 6-minute walk test together with the cardiac efficiency. Enter the distance covered, your age range, gender and heart rate after the test during and receive the results as compared to your peers. See below on how to measure your heart rate if you do not have a heart rate monitor or a smartwatch. 

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How Walking Affects Your Heart: The Role of Heart Rate

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While the 6MWT gives a snapshot of your physical capacity, monitoring your heart rate while walking helps you optimize your health during regular exercise.

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When you walk, your heart rate rises. To maximize health benefits, it’s important to walk at an intensity that keeps your heart rate within a target zone, typically 50% to 85% of your maximum heart rate. You can estimate your maximum heart rate by subtracting your age from 220. For example, a 40-year-old’s max heart rate would be 180 bpm (beats per minute), with a target walking zone of 90 to 153 bpm.

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As your fitness improves, your heart becomes more efficient—it needs fewer beats to deliver blood and oxygen, so your heart rate at the same walking pace may decrease. This is a good sign! It means you're getting healthier, though you might need to increase your intensity to stay in the right zone.

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Why Monitor Your Walking Heart Rate?

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Keeping tabs on your heart rate during walks is one of the smartest ways to ensure you're exercising safely and effectively.

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Benefits include:

  • Accurate intensity control: Avoid undertraining or overtraining by staying in your optimal heart rate zone.
     

  • Cardiovascular improvement: Boost heart function, lower blood pressure, and improve cholesterol.
     

  • Better weight management: Higher heart rates mean higher calorie burn.
     

  • Reduced disease risk: Regular moderate-intensity walking improves insulin sensitivity and reduces inflammation, which helps prevent conditions like diabetes and heart disease.
     

Easy Ways to Monitor Your Heart Rate

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You don’t need to be a tech whiz to track your heart rate. Options include:

  • Heart rate monitors: Chest straps are most accurate, but smartwatches work well for most people.
     

  • Smartphone apps: Apps like BreathNow use your phone camera to measure pulse. It is a free feature. The additional benefit is that BreathNow also measures your stress with the phone's camera so you get two data points during one short measurement.
     

Combining 6MWT and Heart Rate for Total Health Insight

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Using the 6MWT alongside heart rate monitoring gives you a full picture of your fitness and recovery. The 6MWT tells you how far you can go; heart rate monitoring tells you how hard your body is working to get you there.

For example, in patients with chronic lung disease, researchers found that walking distance in the 6MWT helped predict future health outcomes [23]. But combining this distance with heart rate data provides an even deeper understanding of cardiac efficiency, endurance, and recovery over time.

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Final Thoughts

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Walking is one of the most accessible, effective tools we have for maintaining and measuring health. The 6-Minute Walk Test is a trusted method used by professionals to assess functional capacity, while monitoring your heart rate during everyday walks can help you maximize cardiovascular benefits and track your fitness progress.

Together, these two tools empower you to take charge of your health—one step (and one beat) at a time. Also BreathNow app includes guiding videos which help to improve the results of the 6-minute walk test and cardiac efficiency. Please give it a try. 

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References:

  1. Laboratories, A. T. S. C. o. P. S. f. C. P. F. (2002). "ATS statement: guidelines for the six-minute walk test." Am J Respir Crit Care Med 166(1): 111-117.

  2. YSUMediaAcademicComp. Six Minute Walk Test 2012. Available from: http://www.youtube.com/watch?v=JHzsgeudQ1I[last accessed 10/10/14]

  3. Resnik, L. and Borgia, M., (2011). Reliability of outcome measures for people with lower-limbfckLRamputations: distinguishing true change from statistical error. Physical Therapy, 91(4), pp. 555-565.

  4. Pera, M. C., et al. (2017). "6MWT can identify type 3 SMA patients with neuromuscular junction dysfunction." Neuromuscul Disord 27(10): 879-882.

  5.  Ries, J. D., Echternach, J. L., et al. "Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease." Phys Ther 2009 89(6): 569-579

  6. Harada, N., Chiu, V., et al. "Mobility-related function in older adults: assessment with a 6-minute walk test." Archives of physical medicine and rehabilitation 1999 80(7): 837-841

  7. Steffen, T. M., Hacker, T. A., et al. "Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds." Physical Therapy 2002 82(2): 128-137

  8. Kennedy, D. M., Stratford, P. W., et al. "Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty." BMC Musculoskelet Disord 2005 6: 3

  9. Eng, J. J., Dawson, A. S., et al. "Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption." Arch Phys Med Rehabil 2004 85(1): 113-118

  10. Flansbjer, U. B., Holmback, A. M., et al. "Reliability of gait performance tests in men and women with hemiparesis after stroke." J Rehabil Med 2005 37(2): 75-82

  11. Fulk, G. D. and Echternach, J. L. "Test-retest reliability and minimal detectable change of gait speed in individuals undergoing rehabilitation after stroke." J Neurol Phys Ther 2008 32(1): 8-13

  12. Wevers, L. E., Kwakkel, G., et al. "Is outdoor use of the six-minute walk test with a global positioning system in stroke patients' own neighbourhoods reproducible and valid?" J Rehabil Med 2011 43(11): 1027-1031

  13. Mossberg, K. A. "Reliability of a timed walk test in persons with acquired brain injury." Am J Phys Med Rehabil 2003 82(5): 385-390; quiz 391-382

  14. van Loo, M. A., Moseley, A. M., et al. "Test-re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study." Brain Inj 2004 18(10): 1041-1048

  15. Steffen, T. and Seney, M. "Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism." Physical Therapy 2008 88(6): 733-746

  16. Tappen, R. M., Roach, K. E., et al. "Reliability of physical performance measures in nursing home residents with Alzheimer's disease." J Gerontol A Biol Sci Med Sci 1997 52(1): M52-55

  17. Scivoletto, G., Tamburella, F., et al. "Validity and reliability of the 10-m walk test and the 6-min walk test in spinal cord injury patients." Spinal Cord 2011 49(6): 736-740

  18. van Hedel, H. J., Wirz, M., et al. "Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests." Archives of Physical Medicine and Rehabilitation 2005 86(2): 190-196

  19. Szekely, L., Oelberg, D., et al. "Preoperative predictors of operative morbidity and mortality in COPD patients undergoing bilateral lung volume reduction surgery." Chest 1997 111(3): 550

  20. Harada, N., Chiu, V., et al. "Mobility-related function in older adults: assessment with a 6-minute walk test." Archives of physical medicine and rehabilitation 1999 80(7): 837-841

  21. Lam, T., Noonan, V., et al. "A systematic review of functional ambulation outcome measures in spinal cord injury." Spinal Cord 2007 46(4): 246-254

  22. Flansbjer, U. B., Holmback, A. M., et al. "Reliability of gait performance tests in men and women with hemiparesis after stroke." J Rehabil Med 2005 37(2): 75-82

  23. Casanova, C., Cote, C. G., et al. "The 6-min walking distance: long-term follow up in patients with COPD." Eur Respir J 2007 29(3): 535-540

  24.  Perera, S., Mody, S., et al. "Meaningful change and responsiveness in common physical performance measures in older adults." Journal of the American Geriatrics Society 2006 54(5): 743-749

  25. Cardiac effort and 6‐min walk distance correlate with stroke volume measured by cardiac magnetic resonance imaging, Pulm Circ. 2024 Apr 1;14(2):e12355. doi: 10.1002/pul2.12355

  26. The association of 6-minute walk performance and outcomes in stable outpatients with heart failure, Journal of Cardiac Failure, p9-14February 2004

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