Step Test
What is Step Test?
Step Test is an inexpensive modality used for predicting the Cardiorespiratory Fitness of an indiviual. This is performed by measuring the Heart Rate Response to stepping at a fixed rate and/or a fixed step height or by measuring the post exercise recovery HR.
The Step Test (ST) can also be used to measure lower extremity function, dynamic balance and stability. [1]Originally, the ST was developed in the late 90s as an outcome measure of dynamic standing balance for stroke patients. [2]
Benefits of using Step Test
Bneefits[3]:
- Step tests require little or no equipment
- Steps are easily transportable
- Stepping skill requires little practice
- The test is of short duration
- Stepping is advantageous for mass testing
- Post exercise HR decreases with improved Cardio respiratory fitness and the test results are easy to explain to the participants.
Disadvantages of using Step Test
Following are the disadvantages[3]:
- Special precautions may be needed for those who have balance problems or are extremely deconditioned.
- Some single-stage step tests require an energy cost of 7-9 metabolic equivalents (METS), which may exceed the maximal capacity of the participants.
- Protocol must be chosen according to participant's fitness level.
- Inadequate compliance to the step cadence and excessive fatigue is the lead limb may diminish the value of step test.
- Most tests do not monitor HR and BP while stepping because of the difficulty of these measures during the test.
Formulae to Calculate VO2max
VO2max is calculated using the formulas below[3] :
For men:
- VO2max (mL · kg−1· min−1) = 111.33 − (0.42 × HR)
For women:
- VO2max (mL • kg−1• min−1) = 65.81 − (0.1847 × HR), where HR = heart rate (beats · min−1)
Types of Step Test
A Step Test is a simple physical exercise used to assess cardiorespiratory fitness, specifically estimating an individual’s VO2max (maximal oxygen uptake) under submaximal conditions. The test involves stepping on and off a platform of a specific height at a set pace for a predetermined period, usually followed by measuring heart rate during recovery. The goal is to evaluate how efficiently the cardiovascular and respiratory systems deliver oxygen to muscles during exercise.
How It Works
The individual steps up and down on the platform for a fixed time, then their heart rate is monitored to estimate their cardiovascular efficiency. The test is practical, requiring minimal equipment (a step, a metronome, and a stopwatch), making it suitable for use outside laboratory settings in homes, schools, or gyms.
There are various types of step tests, each differing in platform height, stepping cadence, and duration. Some commonly used tests include:
Astrand and Ryhming Step Test
Astrand and Ryhming employed a single-step height of 33 cm (13 in) for women and 40 cm (15.7 in) for males, counting just the leading leg, at a rate of 22.5 steps · min-1 for five minutes. For these tests, approximately 25.8 and 29.5 mL · kg−1· min−1 of O2 are needed, respectively. Step tests are therefore not a suitable modality for clients who are less fit or who are ill. The Astrand-Rhyming cycle ergometer test is used to quantify HR in the final minute, and a nomogram is used to estimate VO2max. Step tests with multiple stages are also feasible.[4]
Maritz Step Test
Maritz steadily increased the work rate using four-step rates and a single-step height of 12 in (30.5 cm). Age-predicted HRmax is calculated by extrapolating a line from the steady state HR values for each step rate. The YMCA cycle test is used to assess the maximum work rate. It is possible to estimate VO2max using the stepping in formula. To fit the demographic being examined, these step tests ought to be adjusted. [3]
The Canadian Home Fitness Test
The Canadian Home Fitness Test (CHFT) is a self-administered, submaximal exercise test designed to evaluate cardiovascular fitness in adults. The CHFT requires a staircase with at least two steps and a long-playing record or audio device that provides a rhythm for stepping.
The cadence, or stepping rhythm, is age- and sex-specific, allowing for tailored exercise intensity.Participants begin by completing a Physical Activity Readiness Questionnaire to identify any contraindications to exercise, ensuring the test is suitable for their health status. The test begins with a 3-minute warm-up stage. The participant steps up and down at a rhythm that corresponds to 65-70% of the aerobic capacity for a person in the next age group. This warm-up allows participants to gradually adjust to the exercise intensity. After the warm-up, participants measure their heart rate by palpating their pulse for 10 seconds. This pulse check helps determine if they are within safe exercise limits. The exercise will be stopped if heart rates exceed predetermined limits specific to age and sex. If the participant’s pulse rate is within the acceptable range, they proceed to a more intense 3-minute exercise stage. During this stage, participants step at a rhythm equivalent to 65-70% of the aerobic capacity expected for their age group. The goal is to maintain this rhythm without exceeding safe heart rate thresholds. Immediately after completing the main exercise stage, participants take another 10-second pulse count to assess their recovery rate. Recovery heart rate is a critical metric, as a quicker return to baseline is indicative of better cardiovascular fitness.
The test results categorize participants into fitness levels ranging from "very poor" to "very good" based on pulse rates, stepping cadence, and age. This assessment can encourage individuals to improve their physical fitness or continue a regular activity regimen. CHFT uses conservative thresholds for pulse rates to ensure safety, especially when administered unsupervised. With over 14,000 participants validated in trials, the CHFT has proven generally safe and accessible for self-administration in diverse populations.
This structured yet simple test offers a reliable approximation of aerobic fitness, with validation studies showing a high correlation between CHFT results and traditional laboratory-based fitness tests.[5]
Queens College Step Test (also called the McArdle Step Test)
Test requires participants to step at a rate of 24 steps · min−1 for men and 22 steps · min−1 for women for 3 min. The bench height is 16.25 in (41.25 cm). After stepping is completed, the subject remains standing. Wait 5 s, take a 15-s HR count, and multiply the HR by 4 to convert to beats · min−1.[6]
Harvard Step Test
The Harvard Step Test is a physical endurance assessment designed to evaluate cardiovascular fitness by measuring recovery pulse rates. The test involves a platform or bench set at a height of 20 inches (50.8 cm), with participants instructed to step up and down continuously at a steady pace of 30 steps per minute. The duration of the test is typically until the participant reaches exhaustion or completes the maximum duration, which is usually around 5 minutes. After the stepping session, the participant’s recovery pulse is measured at specific intervals, such as 1, 2, and 3 minutes post-exercise. These pulse measurements are then used to calculate a fitness index, with lower pulse rates indicating faster recovery and thus higher levels of endurance and cardiovascular fitness. The Harvard Step Test is widely used due to its simplicity and ability to provide insight into an individual’s aerobic capacity and overall fitness level.[7]
Chester Step Test
The Chester Step Test is a progressive fitness test that assesses an individual’s aerobic capacity and overall fitness level by gradually increasing exercise intensity. It begins with an adjustable platform, typically starting at a height of 12 inches, which can be modified to accommodate the participant’s height and fitness level. The test is structured into 2-minute stages, with each stage involving a steady stepping rate that increases in pace as the test progresses. Participants are instructed to maintain the stepping rate for each stage, following a metronome or timing device. At the end of each 2-minute stage, heart rate is recorded, and the participant is encouraged to continue until they reach a target heart rate or can no longer keep up with the pace. The Chester Step Test provides an accessible yet effective way to evaluate cardiovascular fitness by progressively challenging the participant's endurance.[8]
StepTest4all -
This is a standardized protocol developed to improve cardiovascular fitness assessment in young adults by predicting VO₂ max accurately and efficiently. Participants step up and down on a 15-40 cm platform, adjusting height and intensity to their fitness level, aiming to reach 80% of their estimated maximum heart rate. The duration is 4-10 minutes, and factors such as heart rate recovery (HRR), physical activity level, and participant sex are recorded to refine VO₂ max predictions. This test prioritizes accessibility, providing an individualized cardiovascular assessment tool for diverse populations.[9]
Six Spot Step test
The patient stands at the start circle at the end line of the field. wooden block is placed at each of the circle apart from the start circle. The patient crisscross from one circle to the next circle and shoves the blocks out of the circle. One leg is used to shove all the wooden blocks in one walk. Then the same thing is repeated with another leg. The test is performed twice on each leg.[10]
Intended Population
Method of Use
Equipment:
- Stopwatch.
- A step (7.5cm in height).
Instructions:
- Instruct your patient to stand with both feet facing the step at an appropriate distance
- Begin your timing through your stopwatch and count the total number of times your patient can place their flat foot on the step and back down on the floor in 15 seconds
Evidence
Total Knee Arthroplasty:
- Excellent Test-retest reliability. [11]
- Significantly moderate correlation between ST and Timed Up and Go and 10 meter walk test. [11]
Hip Osteoarthritis:
- Highly reliable test with acceptable measurement error for assessing standing balance in patients with Hip Osteoarthritis. [12]
Stroke:
- Strong correlation between ST outcomes and physical function and disability during the first 6 months following stroke.
- Each additional step with the affected lower extremity on the ST corresponded to a 0.07-m/s to 0.09-m/s increase in gait speed. Meanwhile each additional step with the non-affected lower extremity was associated with a 0.07-m/s to 0.08-m/s gait speed increase.[1]
References
- ↑ 1.0 1.1 Mercer VS, Freburger JK, Chang SH, Purser JL. Step test scores are related to measures of activity and participation in the first 6 months after stroke. Physical Therapy [Internet]. 2009 Oct 1;89(10):1061–71.
- ↑ Hill KD. A New Test of Dynamic Standing Balance for Stroke Patients: Reliability, Validity and Comparison with Healthy Elderly. Physiotherapy Canada [Internet]. 1996 Oct 1;48(4):257–62.
- ↑ 3.0 3.1 3.2 3.3 American College of Sports Medicine. *ACSM's Guidelines for Exercise Testing and Prescription*. 10th ed. Philadelphia: Wolters Kluwer; 2018.
- ↑ Astrand PO, Ryhming I. A nomogram for calculation of aerobic capacity (physical fitness) from pulse rate during sub-maximal work. J Appl Physiol. 1954;7(2):218–21.https://journals.physiology.org/doi/pdf/10.1152/jappl.1954.7.2.218
- ↑ Shephard RJ, Bailey DA, Mirwald RL. Development of the Canadian Home Fitness Test. Canadian Medical Association Journal.* 1976;114(8):675-9. https://pmc.ncbi.nlm.nih.gov/articles/PMC1956906/
- ↑ MACKENZIE, B. (2001) Queen's College Step Test [WWW] Available from: https://www.brianmac.co.uk/queens.htm [Accessed 31/10/2024]
- ↑ PT direct Harvard Step Test Available:https://www.ptdirect.com/training-delivery/client-assessment/harvard-step-test-a-predictive-test-of-vo2max (accessed 31.10.2024)
- ↑ Sykes K, Roberts A. The Chester Step Test - a simple yet effective tool for the prediction of aerobic capacity. *Physiotherapy*. 2004;90(4):183-8. Available from: https://chesterstests.com/wp-content/uploads/2020/11/CSTPaperPhysiotherapy1.pdf
- ↑ Sampaio T, Morais JE, Bragada JA. StepTest4all: Improving the prediction of cardiovascular capacity assessment in young adults. J Funct Morphol Kinesiol. 2024;9(1):30. doi:https://doi.org/10.3390/jfmk9010030
- ↑ Nieuwenhuis, M. M., Van Tongeren, H., Sørensen, P. S., & Ravnborg, M. (2006). The six spot step test: a new measurement for walking ability in multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England), 12(4), 495–500. https://doi.org/10.1191/1352458506ms1293oa
- ↑ 11.0 11.1 Eymir M, Yuksel E, Unver B, Karatosun V. Reliability, validity, and minimal detectable change of the Step Test in patients with total knee arthroplasty. Irish Journal of Medical Science [Internet]. 2022 Jan 13;191(6):2651–6.
- ↑ Choi YM, Dobson F, Martin J, Bennell KL, Hinman RS. Interrater and intrarater reliability of common clinical standing balance tests for people with hip osteoarthritis. Physical Therapy [Internet]. 2014 May 1;94(5):696–704.