Six Minute Walk Test (6MWT) Instructions

Source: Heart Online resource • Reviewed 11/2014

Set up

Ideally the test should be conducted on a straight 30 metre track. If the track needs to be adapted or shortened due to lack of space, ensure that the patient walks the same course on each re-test.

Suggested Equipment

• 6MWT recording form
• Rate of perceived exertion - Borg scale
• Pulse oximeter with appropriate sensor
• Stop watch or timer
• Chairs (number will depend on patient’s condition and risk)
• Sphygmomanometer and stethoscope, or similar method of accurately assessing BP
• Trundle wheel for measuring the 6MWT track and the distance walked
• Clip board and recording sheet
• Portable oxygen if required

Repeat measures

Two 6MWTs are often recommended for initial assessments due to a learning effect when performing the test. Recent studies have demonstrated however that a single measure is often acceptable.

Should you choose to do repeat measures in succession, this should be done each time so that measures are consistent and a duration of at least 15 minutes provided between tests to allow adequate recovery.

Administering test

1. Prior to walking, say to patient:

The object of this test is to walk as FAR AS POSSIBLE for 6 minutes. You will walk back and forth along this course (demonstrate one lap) for six minutes.

You may slow down if necessary. If you stop, I want you to continue to walk again as soon as possible.

You will be informed of the time and encouraged each minute.

Please do not talk during the test unless you have a problem or I ask you a question. You must let know if you have any chest pain or dizziness.

When six minutes is up I will ask you to STOP where you are. Do you have any questions?

2. To begin, say to patient:

Start now, or whenever you are ready (start stopwatch when walking starts).

3. During the test

Provide the following standard encouragements in even tones. Do not use other words of encouragement or body language to speed up.

• At 1 minute: You are doing well. You have 5 minutes to go.
• At 2nd minute: Keep up the good work. You have 4 minutes to go.
• At 3rd minute: You are doing well. You are halfway done.
• At 4th minute: Keep up the good work. You have only 2 minutes left.
• At 5th minute: You are doing well. You have only 1 minute to go.
• At 6th minute: Please stop where you are.

If the patient stops during the test

Allow the patient to rest or sit in a chair if they wish, and check SpO2 and heart rate. Ask the patient why they stopped.

Keep the stopwatch running and advise: Please resume walking whenever you feel able.

Six Minute Walk Test (6MWT) instructions — continued

4. At the end of the test

• Record the total distance walked.
• Record heart rate, blood pressure and Rating of Perceived Exertion (RPE).
• Record recovery time to gain additional information.

The patient should remain in a clinical area for at least 15 minutes following an uncomplicated test.

Scoring

Change in 6MWT distance can be measured in several ways. The most common include:

• Absolute change (post program distance – pre-program distance). The minimum important distance (MID) is 25 metres in patients with coronary artery disease and chronic respiratory disease.
• Percentage change may be a more relevant measure for frail patients whose baseline distance is very short, for example less than 100 metres. Calculate as follows: (post program distance – pre-program distance) / pre-program distance × 100.

Reference equations to adjust for variables such as height, weight, age and gender to predict clinical progress are available; however, they are no better than simply using 6MWT distance alone.

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References

1. Holland, A., Spruit, M., Troosters, T., Puhan, M., Pepin, V., Saey, D., … Singh, S. (2014). An official European Respiratory Society/American Thoracic Society Technical Standard: field walking tests in chronic respiratory disease. Eur Respir J.
2. Bellet, R. N., Francis, R., Jacob, J. S., Healy, K. M., Bartlett, H. J., Adams, H. J., & Morris, M. (2011). Repeated six-minute walk tests for outcome measurement and exercise prescription in outpatient cardiac rehabilitation: a longitudinal study. Arch Phys Med Rehabil, 92(9), 1388-1394.
3. Adsett, J., Mullins, R., Hwang, R., Hogden, A., Gibson, E., Houlihan, K., ... Mudge, A. (2011). Repeated Six Minute Walk Tests in Patients with Chronic Heart Failure: Are They Clinically Necessary? Eur J Cardiovasc Prev Rehabil, 18(4), 601-606.
4. Shoemaker, M. J., Curtis, A. B., Vangsnes, E., & Dickinson, M. G. (2013). Clinically meaningful change estimates for the six-minute walk test and daily activity in individuals with chronic heart failure. Cardiopulm Phys Ther J, 24(3), 21-9.
5. Gremeaux, V., Troisgros, O., Benaim, S., Hannequin, A., Laurent, Y., Casillas, J. M., & Benaim, C. (2011). Determining the Minimal Clinically Important Difference for the Six-minute Walk Test and the 200-Meter Fast-Walk Test During Cardiac Rehabilitation Program in Coronary Artery Disease Patients after Acute Coronary Syndrome. Arch Phys Med Rehabil, 92, 611-619.
6. Frankenstein, L., Zugck, C., Nelles, M., Schellberg, D., Katus, H., & Remis, A. (2008). Sex-specific predictive power of 6 minute walk test in chronic heart failure is not enhanced using percent achieved of published reference equations. J Heart Lung Transplant, 27(4), 427-434.

Berg Balance Scale

This scale measures balance in older adults.

Overview

Items: 14

Highest possible score: 56

Scoring: 0–4 per item

Meaning: 0 = lowest level of function, 4 = highest level of function

Equipment

• Yardstick
• One standard chair with arm rests
• One standard chair without arm rests
• Footstool/step
• Stopwatch or wristwatch
• 15 foot walkway

Reliability

Cronbach's alphas were greater than 0.83 for stroke patients and 0.97 for elderly residents.

Fall Risk Interpretation

• Score of < 45 indicates a greater risk of falling
• 41–56 = low fall risk
• 21–40 = medium fall risk
• 0–20 = high fall risk

Reference

Berg K, Wood-Dauphinee S, Williams JI, Maki B (1992). Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health, July/August supplement 2:S7-11.

Norms

Lusardi, M.M. (2004). Functional Performance in Community Living Older Adults. Journal of Geriatric Physical Therapy, 26(3), 14-22.

Summary Score Sheet

1. Sitting to standing ________
2. Standing unsupported ________
3. Sitting unsupported ________
4. Standing to sitting ________
5. Transfers ________
6. Standing with eyes closed ________
7. Standing with feet together ________
8. Reaching forward with outstretched arm ________
9. Retrieving object from floor ________
10. Turning to look behind ________
11. Turning 360 degrees ________
12. Placing alternate foot on stool ________
13. Standing with one foot in front ________
14. Standing on one foot ________
15. Total: ____________________

General Instructions

Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item.

In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if:

• the time or distance requirements are not met
• the subject’s performance warrants supervision
• the subject touches an external support or receives assistance from the examiner

Subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring.

Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item #12.

Detailed Items and Scoring

1. Sitting to Standing | Score: ______ / 4

Instructions: Please stand up. Try not to use your hand for support.

• 4 able to stand without using hands and stabilize independently
• 3 able to stand independently using hands
• 2 able to stand using hands after several tries
• 1 needs minimal aid to stand or stabilize
• 0 needs moderate or maximal assist to stand

2. Standing Unsupported | Score: ______ / 4

Instructions: Please stand for two minutes without holding on.

• 4 able to stand safely for 2 minutes
• 3 able to stand 2 minutes with supervision
• 2 able to stand 30 seconds unsupported
• 1 needs several tries to stand 30 seconds unsupported
• 0 unable to stand 30 seconds unsupported

If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item #4.

3. Sitting with Back Unsupported but Feet Supported on Floor or on a Stool | Score: ______ / 4

Instructions: Please sit with arms folded for 2 minutes.

• 4 able to sit safely and securely for 2 minutes
• 3 able to sit 2 minutes under supervision
• 2 able to able to sit 30 seconds
• 1 able to sit 10 seconds
• 0 unable to sit without support 10 seconds

4. Standing to Sitting | Score: ______ / 4

Instructions: Please sit down.

• 4 sits safely with minimal use of hands
• 3 controls descent by using hands
• 2 uses back of legs against chair to control descent
• 1 sits independently but has uncontrolled descent
• 0 needs assist to sit

5. Transfers | Score: ______ / 4

Instructions: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair.

• 4 able to transfer safely with minor use of hands
• 3 able to transfer safely definite need of hands
• 2 able to transfer with verbal cuing and/or supervision
• 1 needs one person to assist
• 0 needs two people to assist or supervise to be safe

6. Standing Unsupported with Eyes Closed | Score: ______ / 4

Instructions: Please close your eyes and stand still for 10 seconds.

• 4 able to stand 10 seconds safely
• 3 able to stand 10 seconds with supervision
• 2 able to stand 3 seconds
• 1 unable to keep eyes closed 3 seconds but stays safely
• 0 needs help to keep from falling

7. Standing Unsupported with Feet Together | Score: ______ / 4

Instructions: Place your feet together and stand without holding on.

• 4 able to place feet together independently and stand 1 minute safely
• 3 able to place feet together independently and stand 1 minute with supervision
• 2 able to place feet together independently but unable to hold for 30 seconds
• 1 needs help to attain position but able to stand 15 seconds feet together
• 0 needs help to attain position and unable to hold for 15 seconds

8. Reaching Forward with Outstretched Arm While Standing | Score: ______ / 4

Instructions: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.)

• 4 can reach forward confidently 25 cm (10 inches)
• 3 can reach forward 12 cm (5 inches)
• 2 can reach forward 5 cm (2 inches)
• 1 reaches forward but needs supervision
• 0 loses balance while trying/requires external support

9. Pick Up Object from the Floor from a Standing Position | Score: ______ / 4

Instructions: Pick up the shoe/slipper, which is place in front of your feet.

• 4 able to pick up slipper safely and easily
• 3 able to pick up slipper but needs supervision
• 2 unable to pick up but reaches 2-5 cm (1-2 inches) from slipper and keeps balance independently
• 1 unable to pick up and needs supervision while trying
• 0 unable to try/needs assist to keep from losing balance or falling

10. Turning to Look Behind Over Left and Right Shoulders While Standing | Score: ______ / 4

Instructions: Turn to look directly behind you over toward the left shoulder. Repeat to the right. Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.

• 4 looks behind from both sides and weight shifts well
• 3 looks behind one side only other side shows less weight shift
• 2 turns sideways only but maintains balance
• 1 needs supervision when turning
• 0 needs assist to keep from losing balance or falling

11. Turn 360 DegreesScore: ______ / 4

Instructions: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.

• 4 able to turn 360 degrees safely in 4 seconds or less
• 3 able to turn 360 degrees safely one side only 4 seconds or less
• 2 able to turn 360 degrees safely but slowly
• 1 needs close supervision or verbal cuing
• 0 needs assistance while turning

12. Place Alternate Foot on Step or Stool While Standing Unsupported | Score: ______ / 4

Instructions: Place each foot alternately on the step/stool. Continue until each foot has touch the step/stool four times.

• 4 able to stand independently and safely and complete 8 steps in 20 seconds
• 3 able to stand independently and complete 8 steps in > 20 seconds
• 2 able to complete 4 steps without aid with supervision
• 1 able to complete > 2 steps needs minimal assist
• 0 needs assistance to keep from falling/unable to try

13. Standing Unsupported One Foot in Front | Score: ______ / 4

Instructions: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subject’s normal stride width.)

• 4 able to place foot tandem independently and hold 30 seconds
• 3 able to place foot ahead independently and hold 30 seconds
• 2 able to take small step independently and hold 30 seconds
• 1 needs help to step but can hold 15 seconds
• 0 loses balance while stepping or standing

14. Standing on One Leg | Score: ______ / 4

Instructions: Stand on one leg as long as you can without holding on.

• 4 able to lift leg independently and hold > 10 seconds
• 3 able to lift leg independently and hold 5-10 seconds
• 2 able to lift leg independently and hold ≥ 3 seconds
• 1 tries to lift leg unable to hold 3 seconds but remains standing independently
• 0 unable to try or needs assist to prevent fall

Total Score

Total Score (Maximum = 56): ____________________

BESTest

• What it is for: This test is used to identify which balance systems are impaired, such as biomechanical constraints, postural responses, sensory orientation, and gait stability.
• How to explain it to a patient: “I’m going to have you do several balance activities so I can see which parts of balance are strong and which parts need work.”
• Equipment needed:
  1. stopwatch,
  2. firm chair,
  3. foam surface,
  4. incline ramp if required,
  5. measuring tape or ruler,
  6. obstacles or markers,
  7. gait belt,
  8. open walking area.
• How to do it: Follow the standardized BESTest item sequence. Administer each task exactly as instructed and score each item according to the test directions.
• How it is used: Use the item and section scores to identify specific balance system deficits.
• Normal / safer: Higher score or higher percent score = better balance performance.
• Abnormal / red flag: Lower score or clear weakness in one or more balance systems is concerning.
• Positive sign: Low score indicates impairment in one or more balance systems.
• Negative sign: Higher score indicates better balance system performance.

Mini-BESTest

• What it is for: This test is used to assess dynamic balance, anticipatory balance, reactive postural control, sensory orientation, and gait stability.
• How to explain it to a patient: “I’m going to guide you through a short set of balance and walking activities to see how your balance is doing during movement.”
• Equipment needed:
  1. stopwatch,
  2. firm chair,
  3. foam surface,
  4. incline ramp if required,
  5. gait belt,
  6. markers or obstacles,
  7. open walking area.
• How to do it: Administer the standardized Mini-BESTest items in order. Score each item from 0 to 2 and total the score out of 28.
• How it is used: Use the score to assess dynamic balance and fall risk.
• Normal / safer: Higher score = better; closer to 28 is better.
• Abnormal / red flag: Less than 20 is commonly a concern for fall risk.
• Positive sign: Low score suggests impaired dynamic balance and fall risk.
• Negative sign: Higher score suggests better dynamic balance.

• What it is for: This test is used to assess gait, balance, and the ability to adapt walking to different challenges.
• How to explain it to a patient: “I’m going to have you walk and do a few different walking tasks, like changing speed, turning your head, and stepping around objects, so I can see how steady you are while moving.”
• Equipment needed:
  1. stopwatch,
  2. measured walkway,
  3. shoe box or obstacle,
  4. cones or markers,
  5. stairs if required by your version,
  6. gait belt.
• How to do it: Have the patient perform the 8 standardized walking tasks. Score each item from 0 to 3, then total the score out of 24.
• How it is used: Use the total score to assess dynamic gait ability and fall risk.
• Normal / safer: 19 or more out of 24 is generally safer.
• Abnormal / red flag: Less than 19 out of 24 suggests increased fall risk.
• Positive sign: Low score suggests impaired gait adaptability and increased fall risk.
• Negative sign: Higher score suggests safer dynamic gait.

Tinetti Performance-Oriented Mobility Assessment

• What it is for: This test is used to assess gait and balance together and help identify fall risk.
• How to explain it to a patient: “I’m going to watch how you stand, balance, and walk so I can see how safe and steady you are with movement.”
• Equipment needed:
  1. firm armless chair,
  2. walkway,
  3. stopwatch,
  4. gait belt,
  5. assistive device if usually used.
• How to do it: Administer the balance section first, then the gait section. Score each item according to the test criteria and total the score.
• How it is used: Use the total score to assess mobility safety and fall risk.
• Normal / safer: 24 or more out of 28 is generally safer.
• Abnormal / red flag: 19 to 23 = moderate fall risk; less than 19 = high fall risk.
• Positive sign: Lower score suggests impaired gait and balance with increased fall risk.
• Negative sign: Higher score suggests safer gait and balance.

2 Minute Step Test

• What it is for: “This test measures endurance by seeing how many steps the patient can complete in place in 2 minutes.”
• How to explain it to a patient: “I’m going to have you march in place for 2 minutes, lifting your knees to the target height, so we can check your endurance.”
• Equipment needed:
  1. stopwatch,
  2. wall and tape to mark target knee height,
  3. chair nearby for safety,
  4. gait belt if needed,
  5. blood pressure cuff if required.
• How to do it: Mark the midpoint between the patella and iliac crest on the wall as the target height. Start the timer and count the number of times the right knee reaches the required height in 2 minutes.
• How it is used: Use the step count to estimate endurance and functional capacity.
• Normal / safer: Higher step count = better.
• Abnormal / red flag: Low step count, early fatigue, or symptoms during testing are concerning.
• Positive sign: Low step count suggests decreased endurance.
• Negative sign: Higher step count suggests better endurance.

Fullerton Advanced Balance Scale (FAB)

• What it is for: This test is used to assess higher-level balance in more active older adults.
• How to explain it to a patient: “I’m going to have you perform several balance tasks that are a little more challenging so I can see how your higher-level balance is doing.”
• Equipment needed:
  1. stopwatch,
  2. firm chair,
  3. step,
  4. foam if needed by version,
  5. measuring tape,
  6. gait belt.
• How to do it: Administer the standardized FAB tasks and score them according to the scale directions.
• How it is used: Use the total score to assess advanced balance ability.
• Normal / safer: Higher score = better; closer to 40 is better.
• Abnormal / red flag: Lower score or difficulty with advanced balance tasks is concerning.
• Positive sign: Lower score suggests advanced balance impairment.
• Negative sign: Higher score suggests better higher-level balance.

Functional Gait Assessment (FGA)

• What it is for: This test is used to assess postural stability during walking and dynamic gait performance.
• How to explain it to a patient: “I’m going to have you walk and perform a few different walking activities so I can see how steady you are during movement.”
• Equipment needed:
  1. stopwatch,
  2. measured walkway,
  3. shoe box or obstacle,
  4. stairs if used in your version,
  5. cones or markers,
  6. gait belt.
• How to do it: Administer the 10 standardized walking tasks. Score each from 0 to 3, then total the score out of 30.
• How it is used: Use the score to assess dynamic gait performance and fall risk.
• Normal / safer: Above 22 out of 30 is generally safer.
• Abnormal / red flag: 22 or below suggests increased fall risk.
• Positive sign: Lower score suggests impaired gait stability and fall risk.
• Negative sign: Higher score suggests better gait stability.

Timed Up and Go (TUG)

• What it is for: This test is used to assess functional mobility and fall risk.
• How to explain it to a patient: “When I say go, stand up from the chair, walk to the line, turn around, walk back, and sit down at your safe normal speed.”
• Equipment needed:
  1. standard chair with back,
  2. stopwatch,
  3. measured 3-meter walkway,
  4. marker or cone,
  5. gait belt,
  6. assistive device if usually used.
• How to do it: Place the chair and measure 3 meters to the turnaround point. On “go,” start timing. Stop timing when the patient returns and sits back down.
• How it is used: Use the completion time to assess mobility and fall risk.
• Normal / safer: 12 seconds or less is generally safer.
• Abnormal / red flag: More than 12 seconds suggests increased fall risk.
• Positive sign: Slower time suggests impaired mobility and increased fall risk.
• Negative sign: Faster time suggests safer mobility.

Functional Reach Test (FRT)

• What it is for:  “This test measures balance and how far a patient can safely reach without losing stability.”
• How to explain it to a patient: “I’m going to have you stand still and reach forward as far as you can without stepping or losing your balance.”
• Equipment needed:
  1. yardstick or measuring tape mounted at shoulder height,
  2. wall space,
  3. gait belt,
  4. chair nearby for safety if needed.
• How to do it: Have the patient stand next to the wall without touching it. Raise one arm to 90 degrees. Record the starting position at the third metacarpal. Have the patient reach forward as far as possible without stepping, then record the ending position and calculate the difference.
• How it is used: Use the reach distance to assess stability and fall risk.
• Normal / safer: More than 10 inches is generally safer; more than 18 inches is very good.
• Abnormal / red flag: 6 to 10 inches is concerning; less than 6 inches is high fall risk.
• Positive sign: Short reach distance suggests impaired balance and increased fall risk.
• Negative sign: Longer reach suggests better stability and balance.

Activities-specific Balance Confidence Scale (ABC)

• What it is for: This test is used to assess a patient’s confidence in maintaining balance during daily activities.
• How to explain it to a patient: “I’m going to ask how confident you feel doing different activities without losing your balance or becoming unsteady.”
• Equipment needed:
  1. ABC questionnaire,
  2. pen or pencil.
• How to do it: Have the patient rate confidence for each listed activity, usually from 0% to 100%, then average the responses.
• How it is used: Use the average score to assess balance confidence and possible fear-related activity limitation.
• Normal / safer: Higher percentage = better confidence.
• Abnormal / red flag: Less than about 67% suggests balance confidence concerns and possible fall risk.
• Positive sign: Low confidence suggests fear of falling or decreased balance confidence.
• Negative sign: Higher confidence suggests better self-perceived balance ability.

_________________________________________________________________

Source: Powell LE & Myers AM • Journal of Gerontology Medical Sciences, 1995; 50(1): M28–34

Instructions to Participants

For each of the following activities, please indicate your level of confidence in doing the activity without losing your balance or becoming unsteady by choosing one of the percentage points on the scale from 0% to 100%.

If you do not currently do the activity in question, try and imagine how confident you would be if you had to do the activity. If you normally use a walking aid to do the activity or hold onto someone, rate your confidence as if you were using these supports.

Balance Confidence Items

How confident are you that you will not lose your balance or become unsteady when you…

1. …walk around the house? _____ %

2. …walk up or down stairs? _____ %

3. …bend over and pick up a slipper from the front of a closet floor?_____ %

4. …reach for a small can off a shelf at eye level?_____ %

5. …stand on your tip toes and reach for something above your head?_____ %

6. …stand on a chair and reach for something?_____ %

7. …sweep the floor?_____ %

8. …walk outside the house to a car parked in the driveway?_____ %

9. …get into or out of a car?_____ %

10. …walk across a parking lot to the mall?_____ %

11. …walk up or down a ramp?_____ %

12. …walk in a crowded mall where people rapidly walk past you?_____ %

13. …are bumped into by people as you walk through the mall?_____ %

14. …step onto or off of an escalator while you are holding onto a railing?_____ %

15. …step onto or off an escalator while holding onto parcels such that you cannot hold onto the railing?_____ %

16. …walk outside on icy sidewalks?_____ %

Scoring

Total ABC Score: __________

Scoring: _____________ / 16 = __________% of self confidence

Reference

Powell LE & Myers AM. The Activities-specific Balance Confidence (ABC) Scale. Journal of Gerontology Medical Sciences. 1995; 50(1): M28-34.

Lower Extremity Functional Scale (LEFS)

• What it is for: This test is used to assess the patient’s perceived lower extremity functional ability.
• How to explain it to a patient: “I’m going to have you rate how much difficulty you have with different activities that involve your legs.”
• Equipment needed:
  1. LEFS questionnaire,
  2. pen or pencil.
• How to do it: Have the patient answer each item based on their current difficulty level, then total the score out of 80.
• How it is used: Use the score to assess perceived lower extremity limitations and track progress over time.
• Normal / safer: Higher score = better function.
• Abnormal / red flag: Lower score suggests greater lower extremity limitation.
• Positive sign: Low score suggests perceived lower extremity dysfunction.
• Negative sign: Higher score suggests better perceived lower extremity function.

Modified Falls Efficacy / Modified Falls Scale

• What it is for: This test is used to assess fear of falling or confidence performing activities without falling.
• How to explain it to a patient: “I’m going to ask how confident you feel doing certain activities without falling.”
• Equipment needed:
  1. questionnaire form,
  2. pen or pencil.
• How to do it: Have the patient rate confidence or concern for each activity according to the version your class uses, then total or average the score.
• How it is used: Use the score to assess fear of falling, confidence, and possible activity avoidance.
• Normal / safer: Higher confidence = better.
• Abnormal / red flag: Low confidence or strong fear of falling is concerning.
• Positive sign: Low confidence suggests fear of falling and possible activity restriction.
• Negative sign: Higher confidence suggests better perceived safety with activity.

6-MINUTE WALK TEST

What for: Measures aerobic endurance and functional walking capacity.

Equipment: Stopwatch, measured walkway/hallway, cones/markers, chair, vital signs equipment, pulse oximeter if needed, gait belt.

BERG BALANCE SCALE

What for: Measures static and dynamic balance and fall risk.

Equipment: Chair with armrests, chair without armrests, stopwatch, ruler/yardstick, step/stool, object to pick up, gait belt.

BESTEST

What for: Identifies which balance system is impaired and helps guide balance treatment.

Equipment: Stopwatch, measuring tape, foam pad, incline/ramp, step/stairs, chair, obstacle, gait belt.

MINI-BESTEST

What for: Measures dynamic balance and fall risk.

Equipment: Stopwatch, foam pad, incline/ramp, obstacle, chair, measuring tape, gait belt.

DYNAMIC GAIT INDEX

What for: Measures balance during walking tasks and identifies fall risk.

Equipment: Marked walkway, obstacle/shoebox, stairs, stopwatch if needed, gait belt.

TIMED UP AND GO

What for: Measures functional mobility, transfers, gait, turning, and fall risk.

Equipment: Standard chair, 3-meter walkway, stopwatch, gait belt.

2-MINUTE STEP TEST

What for: Measures aerobic endurance when space is limited.

Equipment: Stopwatch, wall marker/tape for knee height, chair nearby, gait belt.

FUNCTIONAL AMBULATION CATEGORIES

What for: Classifies how much assistance a patient needs for walking.

Equipment: No special equipment; use gait belt and assistive device if needed.

FUNCTIONAL GAIT ASSESSMENT

What for: Measures dynamic walking balance and fall risk.

Equipment: Marked walkway, obstacle/shoebox, stairs, stopwatch, gait belt.

TIMED UP AND DOWN STAIRS

What for: Measures stair mobility, lower-extremity function, and fall risk.

Equipment: Stairs, stopwatch, gait belt.

FUNCTIONAL REACH TEST

What for: Measures dynamic standing balance and fall risk during reaching.

Equipment: Yardstick/measuring tape, wall, tape, marker, gait belt.

Geriatric / Fall Risk Tests