Strength in DMD is typically assessed through manual muscle testing (five-point Medical Research Counsel Scale). However, objective measures of strength may include hand dynamometry (grip strength). Due to the rapid degeneration of muscle, strength and flexibility (range of motion assessed via goniometer) testing should occur frequently in this population. Most standard endurance tests of aerobic capacity are unisuitable in this population. However, Jansen et al. has demonstrated that an assisted six-minute cycling test (A6MCT), which entails the use of both the legs and arms, is a feasible method to assess endurance for boys with DMD. While other studies have suggested a modified six-minute walk test to be achievable in children with DMD, some studies have reported cases of falls during testing.  When endurance testing children with DMD clinicians should be aware of severe dysrhythmia, chest pain, T-wave inversion, hypotensive responses, hypertensive responses (systolic blood pressure >250, diastolic blood pressure >110), and be open to volitional exhaustion by the client. Twelve-lead ECG monitoring during endurance testing is mandatory in this population.