Nielsen originally planned to call his Sixth Symphony Sinfonia semplice (Simple Symphony). When he began working on it in August 1924, he expressed the desire to make it "completely idyllic" and "different from the others, gliding more amiably." Sixteen months passed before he finished the symphony, and during that time it underwent a complete transformation from its original intent, one that caused Nielsen to change the title before publication. Of the six symphonies, this last is the most emotionally ambiguous, full of quizzical humor and grim irony.

Instead of actively seeking the tonic key, this work insistently attempts to escape its clutches. When the final resolution arrives, there is a sense of having accepted the inevitable with resigned humor. The first movement, marked Tempo giusto, begins with four gentle notes from the glockenspiel. The violins enter serenely, in G major. Almost immediately, however, the idyll is broken by the introduction of clarinet and bassoon, which interject first an alien B flat, then E flat, D flat and A flat, in a rapid, unsettling succession. Though the violins attempt to restore their original serenity, they do so in F sharp major, as though reaching for, and almost touching their initial serenity, ultimately unable to recapture it. The effect is a combination of beauty and melancholy. This, too, is short lived, interrupted suddenly by calamity: a crash of drums, a panicked fanfare, then frantic strings and woodwinds in the key of B flat—the key that had originally disrupted the violins' brief playfulness. Dissonance, punctuated by the alarm of the glockenspiel, leads to dreary lament; and after another frantic interlude the violins again hint at their opening melody.

Nielsen spoke of the necessity to actively awaken each instrument, urging each to life. Of the second movement, "Humoreske," barely four minutes long, Nielsen said, "I have in my new symphony a piece for small percussion instruments—triangle, glockenspiel, and side drum—that quarrel, each sticking to his own tastes and inclinations. Times are changing. Where is music going? What is permanent? We don't know! This idea is found in my little Humoreske." After an almost rude polyphony in which several mismatched instruments convene, two bassoons are overwhelmed by a disdainful trombone. The music then succumbs to quiet confusion, as though humbled.

The almost equally brief third movement, marked Adagio and entitled "Proposta seria" (Serious Proposition), begins with stark, longing lamentation from the strings. Keys—A flat, D flat—are hinted at and drawn away from, the resultant contrasts merging eventually and softly into a gentle, melancholy close.

A brief flurry starts off the fourth movement, "Tema con variazione," after which the flute and clarinet join on a long, anticipatory note. With the stage thus set, a theme is gravely presented on bassoon, and a series of variations on this theme follows. Among these is a startling and short-lived waltz variation in the strings. While variations and keys by turns overwhelm one another, there are moments of sardonic humor as well as bitter conflict. As the snare drum barks from within a climactic rushing of frantic strings, quite suddenly the conflict ends in a resigned but unmistakably humorous final cadence, firmly rooted in B flat major.

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