Cardiovascular Fitness: Clinical Assessment’s

The health benefits of cardiovascular exercise cannot be disputed! Cardiovascular exercise has been shown to reduce the risk of all manner of conditions, illnesses but also at improving pain and psychological well being. But how can cardiovascular fitness be easily and accurately measured? This blog goes through easy to administer, evidence based, cardiovascular fitness assessment’s that can be performed anywhere and with minimal equipment, so that a patient’s fitness level can be measured and then assessed after exercise interventions (1-11). For all of the below mentioned tests, it is important to record and standardise the step height used, time of day the test was taken and instruct the subject not to eat or smoke for 3 hours before the test. Water may be taken as needed at any time. Subjects should dress appropriately for exercise, especially with regard to footwear. No unusual physical efforts should be performed for at least 12 hours before testing.

Siconolfi Step Test

Equipment needed: Step (25 cm), heart rate monitor, metronome and stopwatch (smartphone apps)

Method: This sub-maximal test consists of stepping up and down from a portable 10 inch (25.4 cm) step for 3 minutes per stage, for a maximum of three stages. Initially, the stepping rate for stage 1 is 17 steps per minute; if required, this is increased to 26 and 34 steps per minute for stages 2 and 3, respectively. Stepping rate is kept constant for each stage using a metronome. During the last 30 seconds of the third minute of each stage of stepping, heart rates are recorded at 2:30, 2:45 and 3:00 minutes. If the average of these three heart rates did not equal or exceed 65% of the age predicted maximum heart rate (estimated as 220 — age in years), then the subject was instructed to complete stage 2. Similarly, if the heart rates did not reach the 65% target level at the completion of stage 2, subjects then completed stage 3. Each stage is separated by 1 minute of rest (1,2,3).

Result: Each individual’s VO2 max is estimated from the exercise heart rate at the end of the test according to the equations below and can be used as a baseline measurement for future assessment.

Stage 1: VO2 (1/min) = 16.287 X Wt (kg)/l,000

Stage 2: VO2 (1/min) = 24.910 X Wt (kg)/l,000

Stage 3: VO2 (1/min) = 33.533 X Wt (kg)/l,000

Chester Step Test

Equipment Needed: Adjustable height step, heart rate monitor, rating of perceived exertion scale,rpe scale metronome and stopwatch (smartphone apps).

Method: The height of step can be varied between 15-30 cm high. This is dependent of the functional ability and fitness of the subject you are testing. But once the initial step height is chosen this must stay the same every time the test is used with that subject. The initial step rate is 15 steps per minute and every 2 minutes the step rate increases by 5 steps per minute. The stepping rate is set using a metronome and verbal instructions to guide the performance of the test. When the subject reaches 80% of age estimated heart rate maximum (220 – age / 80%) and/or a Rating of Perceived Exertion of 14 on Borg’s 6 – 20 scale, they are told to stop the test (4,5).

Result: The time is recorded as a baseline measurement for future testing.

 

Queen’s College Step Test

Equipment needed: Step (41 cm), metronome and stopwatch (smartphone apps)

Method: This test requires the subject to step up and down on a step for 3 minutes at the following rate: male 24 steps/minute and female 22 steps/minute. The subject warms up for 10 minutes and a metronome to the required steps/minute pace (Male 24 and Female 22) is set and started. The subject starts the test on the command “GO” and a stopwatch started. The subject is advised by verbal encouragement to maintain the required steps/minute pace. The test stops after 3 minutes and the subject’s heart rate for 15 seconds is recorded (6,7).

Result: The heart rate for 15 secs immediately post the test can be used as a baseline measure for future testing and can also be used to calculate VO2 max using this calculator, and again used for assessing the subject’s fitness.

 

Harvard Step Test

Equipment needed: Step (45 cm), heart rate monitor, metronome and stopwatch (smartphone apps)

Method: This test requires the subject to step up and down off a gym bench for 5 minutes at a rate 30 steps/minute. The subject warms up for 10 minutes and is given the command “GO” and the stopwatch starts. The subject steps up and down onto a standard gym bench once every two seconds for five minutes (150 steps). The test is stopped after 5 minutes. The subject’s heart rate (bpm) is recorded one minute after finishing the test (Pulse 1) and then at two (Pulse 2) and three minutes after finishing the test (Pulse 3) (8,9).

Result: Using the three pulse rates (bpm) an estimate of your level of fitness can be determined as follows:

Result = 30000 ÷ (pulse 1 + pulse 2 + pulse 3)

This result can be used as a baseline measure for future testing and can also be used to calculate VO2 max using this calculator, and again used for assessing the subject’s fitness.

 

The Canadian Home Fitness Test

This test was specifically developed for a fitness survey of the Canadian people in the early 1980s. It is a test of aerobic fitness which people could perform themselves at home.

Equipment needed: 2 x Step (20 cm) or staircase, heart rate monitor, metronome and stopwatch (smartphone apps)

Method: The test is a simple, progressive, submaximal aerobic test. Subjects step up and down a double step (40 cm height), following the instructions and stepping rhythm as determined by metronome which is based on their age and sex (see data table below for rhythms). Stepping is performed with a six pace cycle: one foot on the middle step, two on the top step, one on the middle step, and both feet on the ground. The subject starts with a warm up, stepping for 3 minutes at a rhythm appropriate to a person who is 10 years older than themselves (from table below). Pulse rate is measured for 10 seconds (between 5 & 15 seconds after stepping). If the pulse rate is within a specified safety zone (see table of halting criteria), stepping is recommenced at 3 minutes 25 seconds, using a rhythm appropriate to the individual’s age. After another 3 minutes of stepping, the pulse is taken again. If the pulse ceiling still has not been reached, the subject continues for a third stage, at a stepping rate appropriate to a person who is 10 years younger than themselves (10,11).

Result: A simple categorization of fitness (undesirable, minimum or recommended) is based upon the number of test stages the subject can complete and the heart rate count over 10 seconds between 5 – 15 seconds after finishing the final test stage. The table below shows the rating of aerobic fitness from the performance on the test, based on the heart rate count (number of beats) between 5 – 15 sec following the final test stage.

harvard step test table

Results calculation: It is also possible to convert the test result to a predicted VO2 max score, using the equation by Jetté et al. (1976): VO2max = 42.5 + 16.6 (E) – 0.12 (M) – 0.12 (HR) – 0.24 (A)

where VO2max is the aerobic power in ml.kg-1.min-1, E is the energy cost of the final test stage in l.min-1 (see table below), M is the body mass in kg, HR is the heart rate in beats per minute and A is the subject’s age in years.

candian step test 1

candian step test 2


 

References

1, Siconolfi SF, Garber CE, Lasater TM, Carleton RA. A simple, valid step test for estimating maximal oxygen uptake in epidemiologic studies. Am J Epidemiology, 1985;121(3):382-90.

2, Cooney JK, Moore JP, Ahmad YA, Jones JG, Lemmey AB, Casanova F, Thom JM. A Simple Step Test to Estimate Cardio-Respiratory Fitness Levels of Rheumatoid Arthritis Patients in a Clinical Setting. International Journal of Rheumatology, 2013';174541. 

3, Marcora SM, Casanova F, Fortes MB, Maddison PJ. Validity and reliability of the Siconolfi Step Test for assessment of physical fitness in patients with systemic lupus erythematosus. Arthritis Rheum. 2007 15;57(6):1007-11.

4, Buckley JP, Sim J, Eston RG, Hession R, Fox R. Reliability and validity of measures taken during the Chester step test to predict aerobic power and to prescribe aerobic exercise. Br J Sports Med, 2004;38:197–205.

5, Sykes K and Roberts A. The Chester step test—a simple yet effective tool for the prediction of aerobic capacity, Physiotherapy, 90, 4, 2004, Pages 183-188.

6, Chatterjee S, Chatterjee P, Bandyopadhyay A. Validity of Queen’s College Step Test for estimation of maximum oxygen uptake in female students. Indian J Med Res 2005; 121, pp 32-35.

7, Bandyopadhyay, A. Queen’s college step test as an alternative of Harvard step test in young Indian women. International Journal of Sport and Health Science, 2008; 6, p. 15-20.

8, Ryhming, I. A modified Harvard step test for the evaluation of physical fitness. European Journal of Applied Physiology and Occupational Physiology, 1953; 15 (3), p. 235-250.

9, Keen EN. and Sloan AW. Observations on the Harvard step test. Journal of Applied Physiology. 1958; 13:241-243.

10, Shephard RJ. Blood lactate and the Canadian Home Fitness Test.Can J Sport Sci. 1992;17(1):72-3.

11, Shephard RJ, Bouchard C. A new approach to the interpretation of Canadian Home finess Test scores. Can J Appl Physiol. 1993;18(3):304-16.