The only thing I can think of to increase the distance walked on the walk test is exercise. Can you perhaps ask the transplant team to send you to pulmonary rehab to increase your stamina and then try again?
How much were you short?

It is my understanding that the 6 minute walk test determines when you get put on the transplant list.

"The 6-minute walk test is a useful tool in the assessment of when to list patients for transplantation. A 6-minute walk test result of less than 400 meters appears to be a reasonable marker with regard to when a patient should be listed for transplantation."

http://www.ncbi.nlm.nih.gov/pubmed/9087875

If you don't do well, you get on the transplant list sooner! Passing the test keeps you off the transplant list. Or at least that's the way I understand it.

Bold..I read up on it a few weeks ago. The way I understood it-
if someone walks too far, they are not ready for transplant yet, but someone does not walk far enough, there is a higher chance that they don't survive the transplant and they don't get put on the list either. I don't know what the minimum of distance to walk is that would qualify someone. I have been looking for that info, but can't find anything that specific.

Here is a University of Michigan article that states that a patient will be taken off the transplant list if they are not able to walk 450 Ft on the 6 minute walk test. That's all I can find.
http://www.med.umich.edu/trans/public/pdf/lung/2-BeforeLungTra
Pete, it would be good to know how far you walked and what distance is required for your hospital. I would also ask on EFFORTS, maybe you can get an answer from people who were in a similar situation as yours.
I really hope you can get this straightened out.

Roe, you are asking a question that I bet all potential transplant patients people would like to ask. There seems to be, and my guess, that it is actually a reality and that is...... it depend on the Transplant center and what their board decides based on the lungs available and the list they have.

I believe that the only answer that would serve you well is to ask the team that you are applying at. They are doctors and mechanics that install the new lungs. I am not being disrespectful but unless they have had an actually transplant patient they could not possible know how we patients approach this procedure.

I know because my doctor thought I was a good candidate for TX and I was Turned down via letter from the coordinator because I was past the age limit that particular TX Unit applied.

SO just ask the question from the team and see what answer you get.

The very best of a good result for you.

Anna

wow! i didn't realize that so much could be dependent on that one test that, to me, could have so many variables.
from my readings here, a person has to walk approximatly 1/4 mile in the 6 minutes? (about 2mph for 6 minutes?)
is that with or without wearing supplemental 02?
if with 02 are you allowed to turn it up to higher LPM?
do they adjust for age, sex, height etc? (a 6'4' man would have faster than 5' woman, just because of leg legnth)
interesting, please share more.
(heike your link didn't work for me but boldprints did)

roepete; do they tell you how far in the time that you need to do to pass it?
do they give you time to try to excersise & reach that goal?

sorry, i am so full of questions; i'm just surprised that there is a "fail" point.
my prayers are with you ((((HUGS))))

TECHNICAL ASPECTS OF THE 6MWT
Location
The 6MWT should be performed indoors, along a long, flat,
straight, enclosed corridor with a hard surface that is seldom
traveled. If the weather is comfortable, the test may be performed
outdoors. The walking course must be 30 m in length.
A 100-ft hallway is, therefore, required. The length of the corridor
should be marked every 3 m. The turnaround points should
be marked with a cone (such as an orange traffic cone). A starting
line, which marks the beginning and end of each 60-m lap,
should be marked on the floor using brightly colored tape.
Rationale.
A shorter corridor requires patients to take more
time to reverse directions more often, reducing the 6MWD.
Most studies have used a 30-m corridor, but some have used
20- or 50-m corridors (5255). A recent multicenter study
found no significant effect of the length of straight courses
ranging from 50 to 164 ft, but patients walked farther on continuous
(oval) tracks (mean 92 ft farther) (54).
The use of a treadmill to determine the 6MWD might save
space and allow constant monitoring during the exercise, but
the use of a treadmill for 6-minute walk testing is not recommended.
Patients are unable to pace themselves on a treadmill.
In one study of patients with severe lung disease, the
mean distance walked on the treadmill during 6 minutes (with
the speed adjusted by the patients) was shorter by a mean of
14% when compared with the standard 6MWD using a 100-ft
hallway (57). The range of differences was wide, with patients
walking between 4001,300 ft on the treadmill who walked
1,200 ft in the hallway. Treadmill test results, therefore, are
not interchangeable with corridor tests.
REQUIRED EQUIPMENT
1. Countdown timer (or stopwatch)
2. Mechanical lap counter
3. Two small cones to mark the turnaround points
4. A chair that can be easily moved along the walking course
5. Worksheets on a clipboard
6. A source of oxygen
7. Sphygmomanometer
8. Telephone
9. Automated electronic defibrillator
PATIENT PREPARATION
1. Comfortable clothing should be worn.
2. Appropriate shoes for walking should be worn.
3. Patients should use their usual walking aids during the test
(cane, walker, etc.).
4. The patients usual medical regimen should be continued.
5. A light meal is acceptable before early morning or early afternoon
tests.
6. Patients should not have exercised vigorously within 2 hours
of beginning the test.
MEASUREMENTS
1. Repeat testing should be performed about the same time
of day to minimize intraday variability.
2. A warm-up period before the test should not be performed.
3. The patient should sit at rest in a chair, located near the
starting position, for at least 10 minutes before the test
starts. During this time, check for contraindications, measure
pulse and blood pressure, and make sure that clothing
and shoes are appropriate. Compete the first portion
of the worksheet (
see
the A
PPENDIX
).
4. Pulse oximetry is optional. If it is performed, measure and
record baseline heart rate and oxygen saturation (SpO
2
)
and follow manufacturers instructions to maximize the signal
and to minimize motion artifact (56, 57). Make sure the
readings are stable before recording. Note pulse regularity
and whether the oximeter signal quality is acceptable.
The rationale for measuring oxygen saturation is that although
the distance is the primary outcome measure, improvement
during serial evaluations may be manifest either
by an increased distance or by reduced symptoms with the
same distance walked (39). The SpO
2
should not be used for
constant monitoring during the exercise. The technician
must not walk with the patient to observe the SpO
2
. If worn
during the walk, the pulse oximeter must be lightweight (less
than 2 pounds), battery powered, and held in place (perhaps
by a fanny pack) so that the patient does not have to hold
or stabilize it and so that stride is not affected. Many pulse
oximeters have considerable motion artifact that prevents
accurate readings during the walk. (57)
5. Have the patient stand and rate their baseline dyspnea
and overall fatigue using the Borg scale (
see
Table 2 for
the Borg scale and instructions [58]).
6. Set the lap counter to zero and the timer to 6 minutes. Assemble
all necessary equipment (lap counter, timer, clipboard,
Borg Scale, worksheet) and move to the starting
point.
7. Instruct the patient as follows:
The object of this test is to walk as far as possible for 6
minutes. You will walk back and forth in this hallway. Six
minutes is a long time to walk, so you will be exerting yourself.
You will probably get out of breath or become exhausted.
You are permitted to slow down, to stop, and to
rest as necessary. You may lean against the wall while resting,
but resume walking as soon as you are able.
You will be walking back and forth around the cones.
You should pivot briskly around the cones and continue
back the other way without hesitation. Now Im going to
show you. Please watch the way I turn without hesitation.
Demonstrate by walking one lap yourself. Walk and
pivot around a cone briskly.
Are you ready to do that? I am going to use this
counter to keep track of the number of laps you complete. I
will click it each time you turn around at this starting line.
Remember that the object is to walk AS FAR AS POSSIBLE
for 6 minutes, but dont run or jog.
Start now, or whenever you are ready.
TABLE 2. THE BORG SCALE
0 Nothing at all
0.5 Very, very slight (just noticeable)
1 Very slight
2 Slight (light)
3 Moderate
4 Somewhat severe
5 Severe (heavy)
6
7 Very severe
8
9
10 Very, very severe (maximal)
This Borg scale should be printed on heavy paper (11 inches high and perhaps laminated)
in 20-point type size. At the beginning of the 6-minute exercise, show the scale
to the patient and ask the patient this: Please grade your level of shortness of breath
using this scale. Then ask this: Please grade your level of fatigue using this scale.
At the end of the exercise, remind the patient of the breathing number that they
chose before the exercise and ask the patient to grade their breathing level again. Then
ask the patient to grade their level of fatigue, after reminding them of their grade before
the exercise.

8. Position the patient at the starting line. You should also
stand near the starting line during the test. Do not walk
with the patient. As soon as the patient starts to walk,
start the timer.
9. Do not talk to anyone during the walk. Use an even tone
of voice when using the standard phrases of encouragement.
Watch the patient. Do not get distracted and lose
count of the laps. Each time the participant returns to the
starting line, click the lap counter once (or mark the lap
on the worksheet). Let the participant see you do it. Exaggerate
the click using body language, like using a stopwatch
at a race.
After the first minute, tell the patient the following (in
even tones): You are doing well. You have 5 minutes to
go.
When the timer shows 4 minutes remaining, tell the patient
the following: Keep up the good work. You have 4
minutes to go.
When the timer shows 3 minutes remaining, tell the patient
the following: You are doing well. You are halfway
done.
When the timer shows 2 minutes remaining, tell the patient
the following: Keep up the good work. You have only
2 minutes left.
When the timer shows only 1 minute remaining, tell the
patient: You are doing well. You have only 1 minute to
go.
Do not use other words of encouragement (or body language
to speed up).
If the patient stops walking during the test and needs a
rest, say this: You can lean against the wall if you would
like; then continue walking whenever you feel able. Do
not stop the timer. If the patient stops before the 6 minutes
are up and refuses to continue (or you decide that they
should not continue), wheel the chair over for the patient to
sit on, discontinue the walk, and note on the worksheet the
distance, the time stopped, and the reason for stopping prematurely.
When the timer is 15 seconds from completion, say this:
In a moment Im going to tell you to stop. When I do, just
stop right where you are and I will come to you.
When the timer rings (or buzzes), say this: Stop! Walk
over to the patient. Consider taking the chair if they look
exhausted. Mark the spot where they stopped by placing a
bean bag or a piece of tape on the floor.
10. Post-test: Record the postwalk Borg dyspnea and fatigue
levels and ask this: What, if anything, kept you from walking
farther?
11. If using a pulse oximeter, measure SpO
2
and pulse rate
from the oximeter and then remove the sensor.
12. Record the number of laps from the counter (or tick marks
on the worksheet).
13. Record the additional distance covered (the number of meters
in the final partial lap) using the markers on the wall as distance
guides. Calculate the total distance walked, rounding to
the nearest meter, and record it on the worksheet.
14. Congratulate the patient on good effort and offer a drink
of water.
QUALITY ASSURANCE
Sources of Variability
There are many sources of 6MWD variability (
see
Table 3).
The sources of variability caused by the test procedure itself
should be controlled as much as possible. This is done by following
the standards found in this document and by using a
quality-assurance program.
Practice Tests
A practice test is not needed in most clinical settings but
should be considered. If a practice test is done, wait for at least
1 hour before the second test and report the highest 6MWD as
the patients 6MWD baseline.
Rationale.
The 6MWD is only slightly higher for a second
6MWT performed a day later. The mean reported increase
ranges from 0 to 17% (23, 27, 40, 41, 54, 59). A multicenter
study of 470 highly motivated patients with severe COPD performed
two 6MWTs 1 day apart, and on average, the 6MWD
was only 66 ft (5.8%) higher on the second day (54).
Performance (without an intervention) usually reaches a
plateau after two tests done within a week (8, 60). The training
effect may be due to improved coordination, finding optimal
stride length, and overcoming anxiety. The possibility of a
practice or training effect from tests repeated after more than
a month has not been studied or reported; however, it is likely
that the effect of training wears off (does not persist) after a
few weeks.
Technician Training and Experience
Technicians who perform 6MWTs should be trained using the
standard protocol and then supervised for several tests before
performing them alone. They should also have completed cardiopulmonary
resuscitation training.
Rationale.
One multicenter study of older people found
that after correction for many other factors, two of the technicians
had mean 6MWDs that were approximately 7% lower
than the other two sites (31).
Encouragement
Only the standardized phrases for encouragement (as specified
previously here) must be used during the test.
Rationale.
Encouragement significantly increases the distance
walked (42). Reproducibility for tests with and without
encouragement is similar. Some studies have used encouragement
every 30 seconds, every minute, or every 2 minutes. We
have chosen every minute and standard phrases. Some studies
(53) have instructed patients to walk as fast as possible. Although
larger mean 6MWDs may be obtained thereby, we recommend
that such phrases not be used, as they emphasize initial
speed at the expense of earlier fatigue and possible
excessive cardiac stress in some patients with heart disease.
TABLE 3. 6MWD SOURCES OF VARIABILITY
Factors reducing the 6MWD
Shorter height
Older age
Higher body weight
Female sex
Impaired cognition
A shorter corridor (more turns)
Pulmonary disease (COPD, asthma, cystic fibrosis, interstitial lung disease)
Cardiovascular disease (angina, MI, CHF, stroke, TIA, PVD, AAI)
Musculoskeletal disorders (arthritis, ankle, knee, or hip injuries, muscle wasting, etc.)
Factors increasing the 6MWD
Taller height (longer legs)
Male sex
High motivation
A patient who has previously performed the test
Medication for a disabling disease taken just before the test
Oxygen supplementation in patients with exercise-induced hypoxemia
Definition of abbreviations
: COPD

chronic obstructive pulmonary disease; 6MWD

6-minute walking distance.

Supplemental Oxygen
If oxygen supplementation is needed during the walks and serial
tests are planned (after an intervention other than oxygen
therapy), then during all walks by that patient oxygen should
be delivered in the same way with the same flow. If the flow
must be increased during subsequent visits due to worsening
gas exchange, this should be noted on the worksheet and considered
during interpretation of the change noted in 6MWD.
The type of oxygen delivery device should also be noted on
the report: for instance, the patient carried liquid oxygen or
pushed or pulled an oxygen tank, the delivery was pulsed or
continuous, or a technician walked behind the patient with the
oxygen source (not recommended). Measurements of pulse
and SpO
2
should be made after waiting at least 10 minutes after
any change in oxygen delivery.
Rationale.
For patients with COPD or interstitial lung disease,
oxygen supplementation increases the 6MWD (17, 59,
61, 63). Carrying a portable gas container (but not using it for
supplemental oxygen) reduced the mean 6MWD by 14% in
one study of patients with severe respiratory disability, but using
the container to deliver supplemental oxygen during the
exercise increased the mean 6MWD by 2035% (59).
Medications
The type of medication, dose, and number of hours taken before
the test should be noted.
Rationale.
Significant improvement in the distance walked,
or the dyspnea scale, after administration of bronchodilators
has been demonstrated in patients with COPD (62, 63), as well
as cardiovascular medications in patients with heart failure (19).
INTERPRETATION
Most 6MWTs will be done before and after intervention, and
the primary question to be answered after both tests have
been completed is whether the patient has experienced a clinically
significant improvement. With a good quality-assurance
program, with patients tested by the same technician, and after
one or two practice tests, short-term reproducibility of the
6MWD is excellent (37). It is not known whether it is best for
clinical purposes to express change in 6MWD as (
1
) an absolute
value, (
2
) a percentage change, or (
3
) a change in the percentage
of predicted value. Until further research is available,
we recommend that change in 6MWD be expressed as an absolute
value (e.g., the patient walked 50 m farther).
A statistically significant mean increase in 6MWD in a
group of study participants is often much less than a clinically
significant increase in an individual patient. In one study of
112 patients (half of them women) with stable, severe COPD,
the smallest difference in 6MWD that was associated with a
noticeable clinical difference in the patients perception of exercise
performance was a mean of 54 m (95% confidence interval,
3771 m) (64). This study suggests that for individual
patients with COPD, an improvement of more than 70 m in
the 6MWD after an intervention is necessary to be 95% confident
that the improvement was significant. In an observational
study of 45 older patients with heart failure, the smallest difference
in 6MWD that was associated with a noticeable difference
in their global rating of worsening was a mean of 43 m
(20). The 6MWD was more responsive to deterioration than
to improvement in heart failure symptoms.
Reported Mean Changes in 6MWD After Interventions
Supplemental oxygen (4 L/min) during exercise in patients with
COPD or interstitial lung disease increased mean 6MWD by
approximately 95 m (36%) in one study (59). Patients taking
an inhaled corticosteroid experienced a mean 33 m (8%) increase
in 6MWD in an international COPD study (16). Patients
with COPD in a study of the effects of exercise and diaphragmatic
strength training experienced a mean increase in
6MWD of 50 m (20%) (65). Lung volume reduction surgery in
patients with very severe COPD has been reported to increase
6MWD by a mean of 55 m (20%) (13).
Cardiac rehabilitation in patients referred with various heart
diseases increased 6MWD by a mean of 170 m (15%) in a recent
study (66). In 25 older patients with heart failure, an angiotensinconverting
enzyme inhibitor medication (50 mg captopril per
day) improved 6MWD a mean of 64 m (39%) compared with a
mean increase of only 8% in those receiving a placebo (19).
Interpreting Single Measurements of Functional Status
Optimal reference equations from healthy population-based
samples using standardized 6MWT methods are not yet available.
In one study, the median 6MWD was approximately 580
m for 117 healthy men and 500 m for 173 healthy women (50).
A mean 6MWD of 630 m was reported by another study of 51
healthy older adults (55). Differences in the population sampled,
type and frequency of encouragement, corridor length,
and number of practice tests may account for reported differences
in mean 6MWD in healthy persons. Age, height, weight,
and sex independently affect the 6MWD in healthy adults;
therefore, these factors should be taken into consideration
when interpreting the results of single measurements made to
determine functional status. We encourage investigators to publish
reference equations for healthy persons using the previously
mentioned standardized procedures.
A low 6MWD is nonspecific and nondiagnostic. When the
6MWD is reduced, a thorough search for the cause of the impairment
is warranted. The following tests may then be helpful:
pulmonary function, cardiac function, anklearm index,
muscle strength, nutritional status, orthopedic function, and
cognitive function.

A bit long but typical of literature you must read and understand......Peter

Sorry for the bad link earlier!
Don't want to hijack the thread but I have a quesiton.
I just read what Peter send and according to the article the results of my 6 minute walk test were higher than the average for healthy women. I'm in the severe stage (Fev1 40 %) walked 539 m and had no decline in O2. ????-I guess I'm still hoping I got misdiagnosed:(

good one peter :)
yup; lots of variables.
they do try to set it up for the best possible results.
i like the part that they can't talk to you other than to tell you how long left---i have noticed that i cannot walk & talk at the same time as i get too SOB.

roepete; how far is required for the lung transplant & did you get close?
do you have time before the next test to try to excercise & reach the goal?

interesting stuff ty peter for printing it for me

you're in my prayers roepete (((HUGS)))

My Word Peter !!! I could not even finish reading that !! When I took my 6mw for transplant testing, I was taken to the pulmonary center, into the hallway, with a nurse or aide, she was pushin the o2 canister, and timing me. I had on the spo2 thingy and when she said start, i did, and she walked right beside me, went to the end of the hall, turned round and returned to the starting end of the hall, turned and walked back to the other end of the hall, and all this time, another aide was standing about mid point and she would call out time and my aide would right down my spo2 reading at that time, and this went own till it was over....
Doctors say basically the results of your 6mw determines how well you will survive , so they want you to pass, but not like a healthy 20 year old, however you must have the stamina to go the entire 6 minutes.
It was easy (but tiring) for me as long as i had the 02 on.Just pace your self and you can stop and take a deep breath, and I recommend purse lip breathing.
I had one hand on the handle of the oxygen canister the lady was pushing, so it kind of helped steady me.
The only time they do a 6mw , to my knowledge, without 02, is when you are a new pulmonary patient and they have to find your base line with out oxygen.
So if you are not strong enough to finish the 6 minutes , with oxygen, then you need more exercising those legs. I agree to ask your transplant team and discuss the problem with them.
They are the ones that can help you or adjust things so you can make it , if everything else was good.
If that is the only thing holding you back, and all other tests came out good, I am sure they will work out something for you.
I did not get the TX because I was to high risk because of age and blood type. I chose not to risk it, but cheers to you if you make it...
BJ

my pulmonary Dr.just told me recently that he doesnt think the 6 minute walk test is very accurate....he has seen patients with severe fev.reading who do well in that walk....so who knows

I agree.....my Fev1 sounds low at 23% and in the severe category...my lungs are too holed for reduction surgery and only options are a d/ble transplant or just continue my life...

YET I breezed thru my 6min walk on 3 occasions with oxygen not dropping below 96% and I could do another 6mins no problems at all....

So this whole disease is a pretty personal thing....

I'm beginning to truly believe that.

It sure seems to be inaccurate sometimes. But research says otherwise. How well you do on the walk test gives an indication of our functional status, how likely one is to get an exacerbation and be hospitalized and it also is supposed to be an indicator of life expectancy.

Good Morning,
Peter, I did read that entire information on the 6 min walk, and that is very correct information. So mine was done basicaly like that, except there was a person with me, because I have a danger of falling, and they do not want that incident to deal with.
I think the test is accurate according to the purpose they are giving it to you. (Well, except for you, mr speedy ...) Lung transplant can indicate how well you will survive surgery, and the one's doing best on the tests survive longer. This is according to the transplant team lecture I attended.
Your pulmonary doctor an give you to test to see if the oxygen you are on is sufficient or have things changed to the point you need an increase, judged by your decrease in O2 during the walk.
The ultimate deciding vote on the transplant will be decided by the medical transplant board, who will decide if you make the list or not from the medical records and tests results given them by your lung doctor.
How important this walk is, to the scheme of things, is really up to them. The lung doctor would know and would also know if there was a "passing" grade if you get 4 min, or 5 min, ...so I suggest all this be taken to the lung doctor and discussed.
Ask what do I need to do if I keep getting under 6 min?
Ask,If I can not make the 6 minutes, am I disqualified, or do I get another chance?
Ask, how do you recommend I go about getting this test completed to your satisfaction?
What do I have to do to improve my chances?
BJ