DOI Number: 10.5958/0973-5674.2019.00076.

Comparison of the Two Minute Step Test with Six Minute

Walk Test in Chronic Obstructive Pulmonary Disease Patients

P. Shanmuga Priya1, Anwar K. Nazar2, S. Azarudheen2, N. Saranya2, A. Thenmozhi2, V. Vaishnavi2

1
Associate Professor, PSG College of Physiotherapy, 2PSG College of Physiotherapy

ABSTRACT
Background: The patients who have COPD face difficulty in their functional activities especially during
climbing stairs, walking uphill. In view of assessing the maximal functional capacity, we need a short term
functional stress test over the gold standard 6MWT. So this was done to find out the applicability of Two
minute step test which is fulfilling the criteria of the functional walk test.
Specific objective: To find out the applicability of Two minute step test by comparing the Six minute walk
test with the Two minute step test.
Methodology: Crossover Study Design was adopted for the study.
Results: There is a moderate correlation exists among distance walked in six minute walk test and number of
steps taken in two minute step test in mild to moderate COPD patients (r = 0.690). There is a high correlation
exists between the mean values of Heart rate(r=0.752), Respiratory rate (r=0.754), Dyspnoea (r=0.701) and
Fatigue (r=0.729) in six minute walk test and two minute step test. There is moderate correlation exists
between the mean values of Oxygen saturation (r= 0.475), Systolic blood pressure (r=0.472) and Diastolic
blood pressure (r=0.563).
Conclusion: The study results show that a correlation exists between Two minute step test and Six minute
walk test

Keywords: Chronic obstructive pulmonary disease, Six minute walk test, Two minute step test

INTRODUCTION There will be reduction in airflow which is quantified

Chronic Obstructive Pulmonary Disease is a lung
disease characterised by airflow limitation that is not
fully reversible, is usually progressive and is associated
with an inflammatory response of the lungs to inhaled
noxious particles or gases.–The Global initiative for
Chronic Obstructive Lung Disease (GOLD).
Chronic bronchitis is defined as presence of
productive cough for three months in each of two
consecutive years. It is a condition associated with
chronic swelling and inflammation of the bronchi and
bronchioles with the symptoms of chronic cough and
sputum production. Patients with COPD experience
acute exacerbations or periods of worsening symptoms.
Emphysema is defined as the abnormal permanent
enlargement of air spaces from distal to the terminal
bronchioles accompanied by destruction of their walls.
by using results of Pulmonary Function Test (PFT), with
FEV1 being one of the standard used to assess disease
severity and monitor disease history. The FEV1, FVC,
FEV1/FVC and single breath diffusing capacities are
primary PFT recommended to aid in diagnosis of COPD.12
Most of the patients with COPD have a reduced
exercise capacity in the face of an increased ventilatory
demand, because exercise places an increased demand
on respiratory system. Exercise testing provides an
objective evaluation of the functional capacity of the
COPD patient.
Exercise testing is an integral component in
evaluation of patients with COPD. In patients with mild
to moderate COPD, symptoms generally do not present
until increased demand is placed on respiratory system,
such as with exercise. In severe cases, even simple
activities may cause symptoms9.
 216 Indian Journal of Physiotherapy and Occupational Therapy, April-June 2019, Vol.13, No. 2

Assessment of exercise tolerance is an important zz Able to follow up commands in English and Tamil.
component of the comprehensive evaluation of COPD zz BMI < 30
patients8. Time limited walk test and step test occupy the
important position among many instruments used for Exclusion Criteria
monitoring of functional status. zz Concomitant heart failure
The six minute level walk test has been a gold zz Unstable angina
standard in the assessment of functional capacity. The zz Recent Myocardial Infarction
six minute walk test has close similarities to daily life zz Uncontrolled hypertension
activities and can be carried out even by elderly and
zz Severe COPD, Asthmaticus and ILD
severely limited patients who are not able to perform
symptom-limited exercise tests (bicycle/treadmill)11. zz Patients with mobility impairment

The 2 minute step test evaluate exercise tolerance and Study Setting: Department of Pulmonary Medicine,
does not need expensive equipments, with the advantage PSG Hospitals, Coimbatore.
that it can be used in limited amount of space and time.
Study Duration: Six months

AIMS & OBJECTIVES Treatment Duration:

To show the validity of two minute step test and to
prove that it can be used as an alternative for six minute
walk test in COPD patients.
To find out the applicability of Two minute step test
by comparing the Six minute walk test with the Two
minute step test.
zz 30 participants were received six minute walk test
with duration of 20 minutes.
zz Interval period of 30 minutes.
zz 30 participants were received two minute step test
with duration of 10 minutes.
Instrument and Tool for Data Collection

Six minute walk test

METHODOLOGY
zz 30 meter hallway
Study Design: Cross over study was adopted for the zz Two small traffic cones to mark turnaround points
study. In the current study, the participants are assigned
zz Stop watch
for six minute walk test and two minute step test with
interval time of 30 minutes between the tests. zz Pulse oximeter
zz Sphygmomanometer
Population and Sampling: Patients with mild to
zz Inch tape
moderate COPD who were referred from the department
of pulmonary medicine in PSG hospitals, Coimbatore zz Assessment chart
were chosen as population for this study. A total of 30 zz Chair
patients were selected by purposive sampling method. zz Oxygen cylinder
The nature, risks and benefits of the study were explained
to the patients. The patients were allocated after obtained Two minute step test
the informed consent form. zz Steps
Criteria for Sample Selection: zz Stop watch
zz Pulse oximeter
Inclusion Criteria
zz Sphygmomanometer
zz Individuals with age 20 – 75 years
zz Inch tape
zz Mild to moderate (FEV1 >80% or 50-79%) COPD
patients (according to GOLD criteria) zz Assessment chart

zz Berg balance scale score 41 – 56 (low fall risk) zz Chair

zz Patients with stable vitals zz Oxygen cylinder
 Indian Journal of Physiotherapy and Occupational Therapy, April-June 2019, Vol.13, No. 2 217

Technique of Data Collection: Patients with COPD Table 2: Summarized Vital Parameters Difference
were screened by surgeon/physician in the mild to
S. Paired t Test Variables t
moderate COPD for risks and clearance for field walk p Value
No. (Vitals) Value
test. Baseline assessment was taken before the first test
for all the 30 participants who met the inclusion criteria. 1. Mean HR difference of
2.481 p <0.05
Mild to moderate COPD patients are assigned for six 2MST vs 6MWT
minute walk test. After 30 minutes of washout time 2. Mean RR difference of 2MST
1.748 p >0.05
the two minute step test will be administered. Distance vs 6MWT
walked in Six minute walk test, number of steps in Two 3. Mean SpO2 difference of
0.576 p >0.05
minute step test, Heart rate, Respiratory rate, SpO2, Pulse 2MST vs 6MWT
rate, Blood pressure, Fatigue, Dyspnoea with MBRPE 4. Mean SYSTOLIC BP
scale was the parameters assessed during the test. The difference of 2MST vs 2.362 p <0.05
data are collected before, during and immediately after 6MWT
the first minute of completion of each test. 5. Mean DIASTOLIC BP
difference of 2MST vs 1.095 p >0.05
Both pre-test and post-test measurement of six 6MWT
minute walk test and two minute step test were noted
6. Mean DYSPNEA difference
and analyzed. 0.828 p >0.05
of 2MST vs 6MWT
The data collected in each tests are 7. Mean FATIGUE difference of
2.055 p <0.05
zz Distance covered in 6 minute walk test 2MST vs 6MWT

zz Number of steps in 2 minute step test

zz Heart rate
zz Blood pressure
zz Respiratory rate
zz SpO2
zz Dyspnoea with MBRPE scale
zz Leg fatigue

Table 1: Summarised Vital Parameters Correlation

Pearson
S.
Variables Correlation
No.
(r Value)
1. Correlation of Distance and Steps 0.690 Graph 1: Correlation of Number of Steps and
2. Correlation of HR between Distance Covered
0.752
6MWT and 2MST
3. Correlation of RR between DISCUSSION
0.754
6MWT and 2MST
4. Correlation of SpO2 between The aim of this study is to find out the correlation
0.475 between the six minute walk test and two minute step
6MWT and 2MST
5. Correlation of SYSTOLIC BP test in patients with mild to moderate chronic obstructive
0.472 pulmonary disease.
between 6MWT and 2MST
6. Correlation of DIASTOLIC BP
0.563 A total of 30 patients with mild to moderate COPD
between 6MWT and 2MST
in stable condition were included in the study. Both
7. Correlation of DYSPNEA
0.709 males and females were included in both the tests
between 6MWT and 2MST
8. Correlation of FATIGUE between All the 30 patients completed the six minute walk
0.729
6MWT and 2MST test and two minute step test. The selected outcome
 218 Indian Journal of Physiotherapy and Occupational Therapy, April-June 2019, Vol.13, No. 2
measures were numbers of steps taken in two minute
step test, distance covered in six minute walk test, heart
rate, respiratory rate, oxygen saturation, systolic and
diastolic blood pressure, dyspnoea and fatigue. Data
were collected before and after each test.
None of the patients are experienced angina pain,
arrhythmia or deterioration of general cardiac and
physical status during the testing.
The obtained data were analysed by using Pearson
correlation and paired ‘t’ test. Paired ‘t’ test was
performed between the mean difference of the parameters
of two minute step test and six minute walk test. Pearson
correlation was performed between the number of steps
and distance walked. Pearson correlation was also
performed between the mean difference of the parameters
of two minute step test and six minute walk test.
There is a moderate correlation exists among
distance walked in six minute walk test and number of
steps taken in two minute step test in mild to moderate
COPD patients (r = 0.690) (graph 1). There is a high
correlation exists between the mean values of Heart
rate(r=0.752), Respiratory rate (r=0.754), Dyspnoea
(r=0.701) and Fatigue (r=0.729) in six minute walk test
and two minute step test. There is moderate correlation
exists between the mean values of Oxygen saturation (r=
0.475), Systolic blood pressure (r=0.472) and Diastolic
blood pressure (r=0.563) (table 1). The mean difference
between vital parameters of each test were analyzed
through paired ‘t’ test. The parameters heart rate,
systolic blood pressure and fatigue (p<0.05) shows high
significance. The parameters respiratory rate, oxygen
saturation, diastolic blood pressure and dyspnoea (p
>0.05) shows minimal significance (table 2).
This indicates that there is a correlation exists between
the two minute step test and six minute walk test.
CONCLUSION
A total of 30 patients with mild to moderate COPD
patients were included in the study. All the patients had
completed six minute walk test and two minute step test.
The study result shows that there exists a similar
response between two minute step test and six minute
walk test in patients with COPD.
Thus, the two minute step test can be used as an
alternative for six minute walk test by comparing the
two minute step test and six minute walk test.
Therefore, it is proved that, “Comparison of the Two
Minute Step Test with Six Minute Walk Test in Chronic
Obstructive Pulmonary Disease Patients”.
Conflict of Interest: None
Source of Funding: Self
Ethical Clearance: Institutional Review Committee of
Research, College of Physiotherapy and Human Ethics
Committee of PSG Institute of Medical Science and
Research
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