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 clients physician prior to any exercise or
functional testing to determine if client is safe and appropriate for testing.
Ideally the client should keep up with the beat as closely as possible throughout the test.
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
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|
*Resource: Ys Way to Physical Fitness, 1989Hint:
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
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:
Client reporting recent complicated myocardial infarction.
History of unstable angina
History of uncontrolled ventricular arrhythmia.
Uncontrolled atrial arrhythmia which can compromise cardiac function.
Third degree AV heart block without pacemaker.
Acute congestive heart failure
Severe aortic stenosis.
Suspected or known dissecting aneurysm
Suspected or known myocarditis or pericarditis.
Thrombophlebitis or intra cardiac thrombi.
Recent systemic or pulmonary embolus.
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:
Resting diastolic blood pressure > 115 mmHg, or resting systolic > 200 mmHg
Moderate valvular disease
Known electrolyte abnormalities
Fixed rate pacemaker - rarely used nowadays but may still appear in some clients
Ventricular aneurysm or other ventricular dysrhythmias, or ectopy.
Uncontrolled metabolic disease (e.g., diabetes, thyrotoxicosis, or myxedema).
Chronic infectious disease (e.g., mononucleosis, hepatitis, AIDS).
Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
Advanced or complicated pregnancy
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.
Articles to Review
ACSMs Guidelines For Exercise Testing and Prescription, pg. 33, 5th ed., 1995.