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Run: Six-Minute Walk Test Documentation

Six-Minute Walk Test Documentation template for recording baseline vitals, walk distance, oxygen saturation, symptoms, interruptions, and post-test recovery ...

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Test Details

Test Date (required)

Test Time

Test Location

Performed By

Protocol Used (required)

Pre-Test Baseline

Baseline Heart Rate (bpm) (required)

Baseline Systolic Blood Pressure (mmHg) (required)

Baseline Diastolic Blood Pressure (mmHg) (required)

Baseline Oxygen Saturation (%) (required)

Baseline Symptoms

Walk Performance

Distance Walked (required)

Enter the total distance walked during the six-minute test.

Distance Unit (required)

Were any rest breaks taken? (required)

Number of Rest Breaks (required)

Was the test interrupted or stopped early? (required)

Reason for Interruption (required)

During and Post-Test Vitals

Lowest Oxygen Saturation During Test (%)

Post-Test Heart Rate (bpm) (required)

Post-Test Systolic Blood Pressure (mmHg) (required)

Post-Test Diastolic Blood Pressure (mmHg) (required)

Post-Test Oxygen Saturation (%) (required)

Symptoms, Notes, and Follow-Up

Symptoms Observed During or After Test

Did an adverse event occur? (required)

Adverse Event Details (required)

Additional Notes

I confirm this documentation is accurate and complete to the best of my knowledge. (required)

Yes No N/A

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