Form Printable 6 Minute Walk Test Score Sheet Record the post test vital signs and the number of laps on the worksheet plus the additional distance covered Calculate the total distance walked rounding to the nearest foot and record
6 Minute Walk Test Instructions General Information 1 individual walks without physical assistance for 6 minutes and the distance is measured 2 start timing when the individual is instructed to Go 3 stop timing at 6 minutes 4 assistive devices can be used but should be kept consistent and documented from test to test SIX MINUTE WALK TEST 6MWT Purpose To assess the aerobic capacity of adults Equipment Walking area of at least 100 feet Blood pressure cuff and stethoscope Pulse oximeter Stopwatch Borg Scale Chair s 6MWT Recording Form Instructions Say to the patient You are now going to do a six minute walking test The object of this
Form Printable 6 Minute Walk Test Score Sheet
Form Printable 6 Minute Walk Test Score Sheet
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21 Rockport Walk Test Calculator EevaRozlin
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6 Minute Walk Test Worksheet PDF
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Patient should attempt to walk for six minutes however if he cannot the test does not require the full 6 minutes Document the total distance walked 6 Minute Walk Test Recording Sheet Initial Assessment Name Date Age Predicted HRmax 220 age Medications FEV 1 FVC Date Time Bronchodilator time since last dose Date Time Bronchodilator time since last dose Limiting factor to the test SOB Low SpO 2 Leg fatigue Other Limiting factor to the test SOB Low SpO 2 Leg fatigue Other Distance Distance WALK 1
You do not need to record SpO2 heart rate and dyspnoea every minute but there is space on the table above if you wish to American Thoracic Society ATS Guidelines for the Six Minute Walk Test Note Link must be opened in Google Chrome Submit this sheet and any other supporting documentation to your AME or to the FAA
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SIX MINUTE WALK TEST WORKSHEET Name DOB Test date Gender M F Race Stopped or paused before 6 minutes completed No Yes reason Other symptoms at the end of test angina dizziness hip knee calf pain other Number of laps x100 meters final partial lap meters total distance walked in 6 minutes 6 Minute Walk Test Number of laps Distance of incomplete lap m Visit Date mm dd yyyy After 5 minutes With 15 seconds to go Timepoint Keep up the good work You have 4 minutes to go You are doing well You are halfway done After 1 minute After 2 minutes When timer rings After 3 minutes After 4 minutes Keep up the good work You have 2
6 Minute Walk Test 6 MWT Description The 6 Minute Walk Test is a measure of endurance Equipment Stopwatch rolling tape measure long hallway or loop walkway Patient Instructions I am going to measure how far you can walk in 6 minutes When I say go I want you to walk around the hallway track for 6 minutes Keep walking until Use our Six Minute Walk Test template to accurately assess your patient s fitness and exercise capacity with ATS and ANPT recommended guidelines and values
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Table 1 From Repeatability Of The Six Minute Walk Test And Relation To
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Record the post test vital signs and the number of laps on the worksheet plus the additional distance covered Calculate the total distance walked rounding to the nearest foot and record
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6 Minute Walk Test Instructions General Information 1 individual walks without physical assistance for 6 minutes and the distance is measured 2 start timing when the individual is instructed to Go 3 stop timing at 6 minutes 4 assistive devices can be used but should be kept consistent and documented from test to test
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Form Printable 6 Minute Walk Test Score Sheet - The form includes spaces to record patient details and medical history contraindications to the test supplemental oxygen use and mobility aids measurements taken every minute including blood pressure heart rate oxygen saturation and distance walked and
