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RehabMeasures Instrument

Six Minute Arm Test

Last Updated

Purpose

The 6-MAT assesses cardiovascular fitness in individuals with spinal cord injury (SCI).

Link to Instrument

Instrument Details

Acronym 6-MAT

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Spinal Cord Injury

Populations

Key Descriptions

  • The 6-MAT involves 6 minutes of submaximal arm ergometry at a constant power output. Power output is determined individually with the goal of maintaining a steady state heart rate of 60-70% age-predicted maximum heart rate or RPE of 11-15. Recommendations are provided in the original publication; however, power output may need adjustment to find the correct one.
  • Clinicians should collect heart rate during the final 30 seconds of the test and an RPE at the end of the test. Following intervention, with a goal to increase cardiovascular fitness, the test should be repeated at the same power output and the same outcomes reported. A decrease in HR or RPE may indicate an increase in VO2peak.
  • Standard arm ergometers are used.

Number of Items

1

Equipment Required

  • Arm ergometer
  • Heart rate monitor
  • RPE scale

Time to Administer

6 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Jennifer H. Kahn, PT, DPT, NCS; Candy Tefertiller, PT, DPT, ATP, NCS; and the SCI EDGE task force of the Neurology Section of the APTA in 5/2012.

ICF Domain

Body Structure
Body Function

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

LS

LS

 

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

No

Not reported

Considerations

  • Lewis et al (2007) challenge the use of RPE as a valid tool in people with spinal cord injury during upper extremity ergometry. 
  • Reported difficulty setting initial power output, but authors of Hol et al (2007) have supplied clinical guidelines which resulted in correct initial setting for 11/13 (85%) individuals with paraplegia and 11/17 (65%) for individuals with tetraplegia. 

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Spinal Injuries

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Standard Error of Measurement (SEM)

Chronic SCI:

(Hol et al, 2007; = 30; mean age 36.3 (9.3) years; 13 with paraplegia, 17 with tetraplegia; time since injury 12.0 (9.8) years; activity ranged from full time power w/c users to those who ambulate for exercise) 

 

  • SEM = 7.12 (95% confidence interval (CI): 0.75-0.96) for Heart rate during 6-MAT 
  • SEM = 1.62 (95% CI: 0.58-0.92) for VO2 during 6-MAT

Minimal Detectable Change (MDC)

Chronic SCI:

(Hol et al, 2007)

  • Heart Rate: 19.68
  • VO2: 4.48

Normative Data

Chronic SCI:

(Hol et al, 2007)

6-MAT Variable Means in Persons with SCI

 

Variable (units)

Mean (SD)

6-MAT PO (W)

27.8 (17.0)

Heart Rate (beats/min)

103 (21.0)

Percent heart rate max*

56.0 (10.2)

VE (L/min)

25.0 (5.7)

VO2 (mL*kg-1*min-1)

13.1 (4.2)

VO2 (L/min)

0.95 (0.28)

Percentage VO2 peak

74.5 (13.0)

RER

0.89 (0.07)

Blood lactate (mmol/L) (n = 28)

3.0 (1.3)

*based on 220-age

 

Test/Retest Reliability

Chronic SCI:

(Hol et al, 2007)

  • 6-MAT performed 1 week apart. Test-retest reliability measured for heart rate and VO2 during the 2 different 6-MAT tests 
  • Excellent test-retest reliability for heart rate (ICC = 0.90) 
  • Excellent test-retest reliability for VO2, (ICC = 0.81) 
  • Bland Altman plots utilized to see distribution of subjects. When an outlier (individual with tetraplegia) was removed from the data, the ICC’s increased: 
    • Excellent test-retest reliability for heart rate (ICC = 0.92) 
    • Excellent test-retest reliability for VO2 (ICC = 0.86)

Construct Validity

Convergent Validity 

Chronic SCI:

(Hol et al, 2007) 

  • Excellent correlation between 6-MAT VO2 and VO2peak (= 0.92) 
  • Adequate correlation between 6-MAT power output and VO2peak (= 0.73)
  • Adequate correlation between 6-MAT heart rate and VO2peak (= 0.63)

Bibliography

Hol, A. T., Eng, J. J., Miller, W. C., Sproule, S., & Krassioukov, A. V. (2007). Reliability and validity of the six-minute arm test for the evaluation of cardiovascular fitness in people with spinal cord injury. Arch Phys Med Rehabil, 88(4), 489-495. doi: 10.1016/j.apmr.2006.12.044 

Lewis, J. E., Nash, M. S., Hamm, L. F., Martins, S. C., & Groah, S. L. (2007). The relationship between perceived exertion and physiologic indicators of stress during graded arm exercise in persons with spinal cord injuries. [Research Support, Non-U S Gov't Research Support, U S Gov't, Non-P H S]. Archives of Physical Medicine and Rehabilitation, 88(9), 1205-1211.