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Cardiovascular Step Test


Cardiovascular Step Test

  Reason for performing test:

The submaximal test protocol provides an estimate of aerobic fitness. The test procedure requires minimal equipment and minimal time to complete.

This test has been chosen based on simplicity and cost, not because it provides the highest accuracy.

If your facility has the ability to perform a more sophisticated submaximal evaluations of cardiovascular fitness, this is advised.

  Coronary Risk Factors

Prior to any exercise testing and functional tasks, the evaluator should determine if the client has any risk factors commonly associated with coronary artery disease. There are 7 major risk factors that are as follows:

Individuals who are asymptomatic with no more than one coronary risk factor above are termed Apparently Healthy.

Individuals who have signs or symptoms suggestive of possible cardiopulmonary or metabolic disease and/or two or more coronary risk factors are termed Increased Risk.

Individuals with known cardiac, pulmonary or metabolic disease are called Known Disease. It would be wise to check with the client’s physician prior to any exercise or functional testing to determine if client is safe and appropriate for testing.

wpe25.gif (961 bytes)  Procedure (detail)

wpe26.gif (914 bytes) UP


wpe27.gif (914 bytes) UP


wpe28.gif (918 bytes) DOWN


wpe29.gif (919 bytes) DOWN


Ideally the client should keep up with the beat as closely as possible throughout the test.



wpe32.gif (906 bytes) Onset of angina or angina-like symptoms

  Significant drop in systolic pressure (20 mmHg) or a failure of the systolic pressure to rise with an increase in exercise intensity

Excessive rise in blood pressure: systolic > 260 mmHg or diastolic > 115 mm Hg.

  Signs of poor perfusion: light-headedness, confusion, ataxia, pallor, cyanosis, nausea, or cold and clammy skin.

  Failure of heart rate to increase with increased exercise intensity.

  Noticeable change in heart rhythm.

  Client requests to stop

  Physical or verbal manifestations of severe fatigue.

  Failure of testing equipment.

  Unusual or severe shortness of breath

  Other central nervous system problems including vertigo, visual or gait problems, and/or confusion.

  Any chest pain that is increasing or suspicious of myocardial infarction.

  Leg/calf cramps or intermittent claudication


wpe25.gif (961 bytes) Data collection and correlation (what is being measured, observed, and how):

    1) Compare one minute recovery to table of norms

    2) Compare appropriate Male and Female percentile ranking.

Males Percentile Rank Females Fitness Level
< 71 90th < 97 Excellent
71 - 102 75th 97 - 127 Good
103 - 117 50th 128 - 142 Average
118 - 147 25th 143 - 171 Fair
148+ 10th 172+ Poor

*Resource: Y’s Way to Physical Fitness, 1989


Digital monitors are recommended for this activity.

Clients may need periodic reminders throughout the evaluation to maintain the correct cadence

Because this is a stepping activity, it can be used as a comparison to stair climbing as a functional activity, if similar cadence is used


wpe34.gif (959 bytes)  Contraindications:

The evaluator should take time to determine if there are any physical conditions which would be contraindicated for exercise and functional testing. Absolute contraindications would include:

wpe35.gif (906 bytes)  Client reporting recent complicated myocardial infarction.

wpe36.gif (906 bytes)  History of unstable angina

wpe37.gif (906 bytes)  History of uncontrolled ventricular arrhythmia.

wpe38.gif (906 bytes)  Uncontrolled atrial arrhythmia which can compromise cardiac function.

wpe39.gif (906 bytes)  Third degree AV heart block without pacemaker.

wpe3B.gif (906 bytes)  Acute congestive heart failure

wpe3C.gif (906 bytes)  Severe aortic stenosis.

wpe3D.gif (906 bytes)  Suspected or known dissecting aneurysm

wpe3E.gif (906 bytes)  Suspected or known myocarditis or pericarditis.

wpe3E.gif (906 bytes)  Thrombophlebitis or intra cardiac thrombi.

wpe3E.gif (906 bytes)  Recent systemic or pulmonary embolus.

wpe3E.gif (906 bytes)  Acute infections.

wpe3E.gif (906 bytes)  Significant emotional distress (psychosis).

There are also relative contraindications that the evaluator would be wise to follow up with the physician before proceeding with the step test and functional assessment. These include but are not limited to:

wpe3F.gif (908 bytes)  Resting diastolic blood pressure > 115 mmHg, or resting systolic > 200 mmHg

wpe40.gif (908 bytes)Moderate valvular disease

wpe41.gif (908 bytes)Known electrolyte abnormalities

wpe42.gif (908 bytes) Fixed rate pacemaker - rarely used nowadays but may still appear in some clients

wpe43.gif (908 bytes) Ventricular aneurysm or other ventricular dysrhythmias, or ectopy.

wpe44.gif (908 bytes) Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis, or myxedema).

wpe45.gif (908 bytes) Chronic infectious disease (e.g., mononucleosis, hepatitis, AIDS).

wpe46.gif (908 bytes) Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise

wpe47.gif (908 bytes) Advanced or complicated pregnancy

wpe48.gif (908 bytes) Recent uncomplicated myocardial infarction

Any candidate with a resting pressure of 200/115 mmHg or higher should be cleared by medical practitioner prior to testing.

Pressures between 145/95 mmHg and 200/120 mmHg should be considered on the basis of professional judgement of the evaluator based on individual cases, referral information, available medical information, and client's report.


wpe49.gif (959 bytes)  Articles to Review

ACSM’s Guidelines For Exercise Testing and Prescription, pg. 33, 5th ed., 1995.

wpe4A.gif (959 bytes)  Equipment required


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