Impact of Pathway Shape and Length on the Validity of the 6-Minute Walking Test: A Systematic Review and Meta-Analysis

Although guidelines are established for performing the six-minute walking test (6MWT), it is not always possible to implement this test in any setting, due to physical and space limitations. Yet, variations in the conditions of the test could be responsible for heterogeneous outcomes. However, the impact of the condition of the 6MWT is not clearly established in literature. The objective is to determine the influence of different implementation conditions on the validity of the 6MWT. Seventeen articles were retained after a literature review, including 597 participants. Seven articles mention that performing the test on a predetermined short back-and-forth pathway led to lower performance than when the test was performed on pathways of greater distances. The walking distance covered on a rectangular path or on a 10-m eight-form path is greater than with the back and forth on a five- to ten-meter path. Seven articles suggest that the performance achieved on a treadmill is generally lower than that obtained while walking on the ground. Evidence shows that the conditions while performing the 6MWT significantly influence the score, hence the validity of the results. The use of a ground pathway, comprising the longest linear distance possible, seems critical to ensure good validity.