6 Minute Push Test
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6 Minute Push Test

Last Updated

Purpose

The 6 Minute Push Test (6MPT) is a clinic-friendly approach to assess cardiovascular fitness in people who are not ambulatory. It is a field-based assessment of VO2 functional change developed from the American Thoracic Society’s Six Minute Walk Test protocol.

Acronym 6MPT

Area of Assessment

Aerobic Capacity

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Cost Description

Free

Populations

Spinal Injuries
Pediatric Disorders
Cerebral Palsy

Key Descriptions

  • Participants propel themselves in their wheelchairs at a comfortable pace while an assessor records the total distance travelled in 6 minutes.
  • Prior to the test, the assessor will measure a fixed distance (30 meters is recommended) on a hard, flat surface. The participant should have a 5-10 minute rest period before starting the test, and the assessor should record the participant’s pre-test heart rate during this time.
  • The assessor will count the number of laps completed to calculate the total distance covered in 6 minutes. This is a self-paced test where participants may slow down and take breaks to rest as needed and resume propelling for whatever time remains. Once the 6 minutes are up, the participant should stop propelling, and the assessor will take a post-test measure of heart rate.
  • VO2 max is calculated using the velocity (distance per 6 minutes) and change in heart rate (pre- versus post-test heart rate).

Number of Items

1

Equipment Required

  • Stopwatch
  • Marking tape

Time to Administer

6 minutes

Required Training

No Training

Required Training Description

No training

Age Ranges

Children

0 - 18

years

Adults

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Melisa Smith, PT, DPT

Rebekah Smith, SPT

Shahnaz Bhayani, SPT

Samuel Huh, SPT

Measurement Domain

Motor

Spinal Injuries

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Cut-Off Scores

Spinal Cord Injury: (Cowan, 2012; N = 40; 63% Paraplegia, 37% Tetraplegia; Mean (SD) Age = 34 (10) years)

  • Tetraplegia: 6MPT distance less than 445 meters indicates low fitness
  • Paraplegia: 6MPT distance less than 604 meters indicates low fitness

 

Spinal Cord Injury: (Solanki et al., 2016; N = 47; paraplegia mean (SD) age = 42.6 (12.3) years, tetraplegia mean (SD) age = 39.5 (9.8) years)

    • Tetraplegia: 6MPT distance less than 148 meters indicates low fitness
    • Paraplegia: 6MPT distance less than 280 meters indicates low fitness

 

Normative Data

Spinal Cord Injury: (Van der Westhuizen, 2017; N = 60; mean age = 38.4 years; 81.66% of sample classified as ASIA A [complete injury])

 

Population

Mean distance (meters)

Minimum distance (meters)

Maximum distance (meters)

Male (n = 50)

608.08

30

1412

Female (n = 10)

430.7

200

744

Paraplegia (n = 39)

692.92

252

1412

Tetraplegia (n = 21)

380.86

30

868

 

Spinal Cord Injury: (Solanki et al., 2016; N = 47; 74% paraplegia, 26% tetraplegia; paraplegia mean (SD) age = 42.6 (12.3) years, tetraplegia mean (SD) age = 39.5 (9.8) years)

  • Mean (SD) 6MPT distance for participants with paraplegia = 280 (71.36) meters
  • Mean (SD) 6MPT distance for participants with tetraplegia = 148 (34.87) meters 

Interrater/Intrarater Reliability

Spinal Cord Injury: (Cowan, 2012; N = 40; 63% Paraplegia, 37% Tetraplegia; Mean (SD) Age = 34 (10) years)

  • Excellent interrater reliability (ICC > 0.90)

 

Spinal Cord Injury: (Solanki et al., 2016; N = 47; 74% paraplegia, 26% tetraplegia; paraplegia mean (SD) age = 42.6 (12.3) years, tetraplegia mean (SD) age = 39.5 (9.8) years)

  • Excellent interrater reliability of whole sample (ICC = 0.97)
    • Excellent interrater reliability for participants with tetraplegia (ICC = 0.93)
    • Excellent interrater reliability for participants with paraplegia (ICC = 0.97)

Criterion Validity (Predictive/Concurrent)

Predictive validity:

 

Spinal Cord Injury: (Cowan, 2011; N = 26; SCI complete C5-L1)

  • Excellent predictive validity of 6MPT in predicting functional independence (r^2 = 0.79)

 

Spinal Cord Injury: (Baattaiah, 2017; N = 15; mean (SD) age = 34.5 (10.5) years; mean (SD) BMI = 25.5 (3.6) kg/m^2; 80% paraplegia, 20% tetraplegia; 33% incomplete injury, 67% complete injury)

  • 6MPT distance is correlated with several measures of cardiovascular fitness:
    • Adequate correlation between 6MPT distance and O2peak (r = 0.58)
    • Excellent correlation between 6MPT distance and RER (r = 0.70)
    • Excellent correlation between 6MPT distance and peak exercise time (r = 0.70)
    • Excellent correlation between 6MPT distance and peak workload (r = 0.66)

 

Spinal Cord Injury: (Van der Westhuizen, 2017; N = 60; mean age = 38.4 years; 81.66% of sample classified as ASIA A [complete injury])

  • Excellent predictive validity of the 6MPT in predicting scores on the Reintegration to Normal Living Index (RNLI), which evaluates satisfaction with the participant’s engagement with the community (r = 0.637)
  • Adequate predictive validity of Borg scales after the 6MPT, measuring physical exertion, and RNLI scores (r = -0.325)

 

Spinal Cord Injury: (Solanki et al., 2016; N = 47; paraplegia mean (SD) age = 42.6 (12.3) years, tetraplegia mean (SD) age = 39.5 (9.8) years)

  • Excellent predictive validity of 6MPT distance in predicting  heart rate recovery (r = 0.87)

 

Pediatric Disorders

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Standard Error of Measurement (SEM)

Youth with Spina Bifida: (Damen, 2020; N = 53; mean age: 13 years, 7 months)

  • SEM for Heart Rate: 8.5bpm
  • SEM for Total Distance: 21.9m
  • SEM for 6 min of work: 1.41kg/km

Minimal Detectable Change (MDC)

Youth with Spina Bifida: (Damen, 2020; N = 53; mean age: 13 years, 7 months)

  • MDC for Heart Rate: 23.5
  • MDC for Total Distance: 60.7
  • MDC for 6 min of work: 7.45

Normative Data

Youth with Spina Bifida: (Damen, 2020; N = 53; mean age: 13 years, 7 months)

  • Mean (SD) peak heart rate on first and second assessments of the 6MPT: 158 (19) bpm, 152 (20) bpm
  • Mean (SD) total distance on first and second assessments of the 6MPT: 424.9 (101.5) meters, 406.7 (100.2) meters
  • Mean (SD) 6 minutes of work on first and second assessments of the 6MPT: 30.5 (8.2) kg/km, 29.4 (8.4) kg/km

Test/Retest Reliability

Youth with Spina Bifida: (Damen, 2020; N = 53; mean age: 13 years, 7 months)

  • Excellent test-retest reliability of peak heart rate between first and second assessments of 6MPT (r = 0.81)
  • Excellent test-retest reliability of total distance between first and second assessments of 6MPT (r = 0.95)
  • Excellent test-retest reliability of 6 minutes of work between first and second assessments of 6MPT (r = 0.97)

Cerebral Palsy

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Standard Error of Measurement (SEM)

Children with Cerebral Palsy: (Verschuren, 2012; N = 73; 70% male, 30% female; mean (SD) age = 11 years, 9 months (3 years, 7 months); age range = 4-18 years; 4% unilateral, 96% bilateral; Gross Motor Functional Classification System (GMFCS) levels: 10% level II, 49% Level III, 41% Level IV)

  • SEM for 6 Minute Push Test = 20.9m
    • SEM for GMFCS level II = 16.0m
    • SEM for GMFCS level III = 17.1m
    • SEM for GMFCS level IV = 26.0m
    • SEM for Age 7-12y = 14.0m
    • SEM for Age 13-18y = 24.4m

Minimally Clinically Important Difference (MCID)

Children with Cerebral Palsy: (Verschuren, 2012; N = 73; 70% male, 30% female; mean (SD) age = 11 years, 9 months (3 years, 7 months); age range = 4-18 years; 4% unilateral, 96% bilateral; Gross Motor Functional Classification System (GMFCS) levels: 10% level II, 49% Level III, 41% Level IV)

  • SDD for 6 Minute Push Test = 57.9m
    • SDD for GMFCS level II = 44.3m
    • SDD for GMFCS level III = 47.4m
    • SDD for GMFCS level IV = 72.1m
    • SDD for Age 7-12y = 38.8m
    • SDD for Age 13-18y = 67.3m

Test/Retest Reliability

Children with Cerebral Palsy: (Verschuren, 2012; N = 73; 70% male, 30% female; mean (SD) age = 11 years, 9 months (3 years, 7 months); age range = 4-18 years; 4% unilateral, 96% bilateral; Gross Motor Functional Classification System (GMFCS) levels: 10% level II, 49% Level III, 41% Level IV)

  • Excellent test-retest reliability of 6 Minute Push Test (r = 0.97, limit of agreement = -54.8 to 62.2)
    • Excellent test-retest reliability of 6MPT scores among GMFCS level II (r = 0.97)
    • Excellent test-retest reliability of 6MPT scores among GMFCS level III (r = 0.98)
    • Excellent test-retest reliability of 6MPT scores among GMFCS level IV (r = 0.96)
    • Excellent test-retest reliability of 6MPT scores among participants aged 7-12 years (r = 0.98)
    • Excellent test-retest reliability of 6MPT scores among participants aged 13-18 years d(r = 0.97)

 

Construct Validity

Convergent validity:

 

Children with Cerebral Palsy: (Verschuren, 2012; N = 73; 70% male, 30% female; mean (SD) age = 11 years, 9 months (3 years, 7 months); age range = 4-18 years; 4% unilateral, 96% bilateral; Gross Motor Functional Classification System (GMFCS) levels: 10% level II, 49% Level III, 41% Level IV)

  • Excellent convergent validity between 6MPT and One-Stroke Push Test results (r = 0.73)
  • Poor convergent validity between 6MPT and heart rate (r = 0.29)

Bibliography

Baattaiah, B. A., Murray, D., Cowan, R. E., Groah, S. L., Liungberg, I. H., Rounds, A. K., Guccione, A. A., & Keyser, R. E. (2017). Association of Six Minute Push Test Distance and Measures of Cardiorespiratory Fitness in Spinal Cord Injury: 1472 Board #147 June 1 9: 00 AM - 10: 30 AM. Medicine & Science in Sports & Exercise, 49(5S Suppl 1), 409. https://doi.org/10.1249/01.mss.0000518002.99303.73

Cowan, R., Callahan, M., Nash, M. S. (2011). Six Minute Push Test: Association with injury level, mobility disability and functional independence in SCI. Medicine Science in Sports & Exercise Volume: 43 (2011) ISSN: 0195-9131 Online ISSN: 1530-031

Cowan, R., Callahan, M. K., & Nash, M. S. (2012). The 6-min push test is reliable and predicts low fitness in spinal cord injury. Medicine & Science in Sports & Exercise, 44(10), 1993–2000. https://doi.org/10.1249/MSS.0b013e31825cb3b6

Damen, K., Takken, T., de Groot, J. F., Backx, F., Radder, B., Roos, I., & Bloemen, M. (2020). 6-Minute Push Test in Youth Who Have Spina Bifida and Who Self-Propel a Wheelchair: Reliability and Physiologic Response. Physical therapy, 100(10), 1852–1861. https://doi.org/10.1093/ptj/pzaa121

Solanki, R., Chaudhari P., & Bhise A. (2016). Cardio respiratory fitness testing in spinal cord injury patients using 6 minute push test. Healthline Journal of Indian Association of Preventive and Social Medicine, 7(1), 60-63.

Van der Westhuizen, L., Mothabeng, D. J., & Nkwenika, T. M. (2017). The relationship between physical fitness and community participation in people with spinal cord injury. South African Journal of Physiotherapy, 73(1), 1–5. https://doi.org/10.4102/sajp.v73i1.354

Verschuren O, Ketelaar M, De Groot J, Vila Nova F, Takken T. Reproducibility of two functional field exercise tests for children with cerebral palsy who self-propel a manual wheelchair. Dev Med Child Neurol. 2013;55(2):185-190. doi:10.1111/dmcn.12052

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