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Health, 2016, 8, 1402-1410
http://www.scirp.org/journal/health
ISSN Online: 1949-5005
ISSN Print: 1949-4998
DOI: 10.4236/health.2016.813141 October 28, 2016
Practical Use of Stairs to Assess Fitness, Prescribe
and Perform Physical Activity Training
Jasem Ramadan Al Kandari1*, Salman Mohammad2, Ruqayyah Al-Hashem1,
Girma Telahoun1, Mario Barac-Nieto1
1Department of Physiology, Faculty of Medicine, Kuwait University, Al-Khaldiya, Kuwait
2Department of Physical Education, College of Basic Education, The Public Authority of Applied Education and Training,
Adailiyah, Kuwait
Abstract
Aim:
Evaluating climbing stairs for prescription and implementation of physical a
c-
tivity regimes.
Methods:
Healthy females (F, n = 14), and males (M, n = 15) partic
i-
pated. By climbing 100 steps of stairs with 0.173 m height, Heart rate (HR) and ox
y-
gen uptake were measured throughout the floors; Blood pressure (BP) was
measured
at ground and the 5th floors only.
Results:
Energy increased from 2 to 7.6 was m
e-
tabolic equivalents (METs = 3.5 ml O2/min∙kg) at 17.3 m elevation in 2 min. at
the
5th floor, and percent Heart Rate R
eserve (%HRR) was 66.17% in F and 48.7% in M,
proportional to their aerobic efforts. Average climbing efficiency was 15.8 ± 2.3% (n
= 29). Aerobic capacity estimated dividing the highest work rate (17.3 Kg∙m/2
min∙Kg
× 0.00239 = 0.0207 Kcal/min∙Kg), by
fractional effort (F = 0.6617, M = 0.487) and
fractional efficiency (0.158), at 5 Kcal/L O2 was 0.040 in F and 0.054 L O2
/Kg∙min in
M. Minimum training intensity reached at the 3rd floor by F. In M
the
highest %HRR reached was 48.7% at the 5th floor, insuf
ficient for training.
Conclusions:
Stairs used for submaximal evaluation of aerobic capacity
and for
target intensity prescription. Training, levels climbed, repetitions per day (if 5, 100
Kcal per day, ascending) and number of days/week are adjusted. Full
regime requires
up to 7.6 METs, a total of 532 and 140 MET.min/week ascending and descending,
respectively. Intensities >7.6 MET, climbing rate should be >8.65 m/min. Limiting
ascent to 1 (3.5 METs) or 2 (5.5 METs) floors or only descents (2 - 3 METs) may
be
used for unfit subjects. This method is useful for those with no access to
sophisticated facilities.
Keywords
Stair Climbing, Descent, Heart Rate Reserve, Aerobic Effort, Oxygen Cost,
Work Output, Efficiency, Aerobic Capacity, Exercise Prescription, Training
How to cite this paper:
Al Kandari, J.R
.,
Mohammad, S
., Al-Hashem, R.,
Telahoun,
G
. and Barac-Nieto, M. (2016)
Practical Use
of Stairs to Assess Fitness, Prescribe and
Per
-
form Physical Activity Training
.
Health
,
8,
1402
-1410.
http://dx.doi.org/10.4236/health.2016.813141
Received:
July 1, 2016
Accepted:
October 25, 2016
Published:
October 28, 2016
Copyright © 201
6 by authors and
Scientific
Research Publishing Inc.
This
work is licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
J. R. Al Kandari et al.
1403
1. Introduction
The Gulf Cooperation Council Countries have very high percentages of non-commu-
nicable diseases, namely, obesity, diabetes and cardiovascular diseases [1]. The United
Nations identified inactivity, one of the four main risk factors for these chronic diseases
[2]. The aim of this study was to explore whether climbing stairs can be used by the
family physician and other healthcare professionals for evaluation, prescription and
implementation of physical activity regimes (training) in various types of patients.
Purpose: To measure the physiological responses in ascending stairs for both male and
female subjects, and to explore the possibility of using the stairs for exercise fitness
evaluation, prescription and training.
2. Methods
Healthy male and female volunteers (fourteen females F, 30.9 ± 2.86 years of age, and
fifteen males M, 33.3 ± 2.72 years old) with no physical nor mental disabilities partici-
pated in the study (Table 1). The tests were conducted at Kuwait University Faculty of
Medicine. Subjects ascended and descended the Faculty of Medicine, Kuwait Universi-
ty’s five floors stairs (100 steps of 17.3 cm each, at 50% grade, total ascent of 17.3 m in 2
min, on average). Heart Rate and time elapsed were measured at every floor using Polar
Watches. Energy expenditure was measured indirectly using a portable gas flow meter
(Quark-b2) and gas analyzer (Cosmed, Rome, Italy) and expressed in ml O2 Kg−1∙min−1
or in metabolic equivalents (1 MET = 3.5 ml O2 Kg−1∙min−1), at rest and at each floor.
Blood Pressure was measured at the ground and fifth floors using a sphygmomanome-
ter and auscultation. HRmax for each subject was estimated as: 220 minus age (years).
Heart rate reserve (HRR) was estimated as HRmax-resting HR for each subject. Percent
HRR (%HRR) was calculated as [(measured HR − resting HR)/HRR] × 100.
3. Results
This stairs had 17.3 cm/step, 50% grade and a total of 100 steps, but any stairs can be
used as long as the height per step and the number of steps are known. The subject’s
descriptive anthropometric data are shown in Table 1. Females were shorter, lighter
and had slightly higher HR max and rest HR than males. HRR was similar in F and M.
Table 1. Anthropometry and Heart rates (HR) in males and female subjects.
Variable
Male (15) Mean ± SD
Female (14) Mean ± SD
Age
33.60 ± 10.53 30.93 ± 10.69
Height
1.72 ± 0.05 1.59 ± 0.08
Weight
82.27 ± 13.04 67.93 ± 10.99
HR Rest
74.33 ± 7.18 76.64 ± 11.30
HR Max
186.40 ± 10.53 189.07 ± 10.69
HR Reserve
112.07 ± 11.62 112.43 ± 11.09
J. R. Al Kandari et al.
1404
Subjects climbed at their chosen natural rate. Statistical comparisons of HR and METS,
between male and female groups in ascending and descending stairs are shown in Ta-
ble 2. The MET levels increased as subjects ascended the stairs but were lower and ap-
proximately constant during descent, F exhibiting higher METs than males at each
floor during descent. Comparing MET used during ascent between floors, there were
significant and gradual increases at all five stair levels up to 7.6 METs in F (Figure 1).
In M, the increases were significant at the first and second levels, smaller at the 3rd and
4th, reaching also 7.6 METs at the fifth floor (Figure 1). METs used at each elevation
(m) are shown in Figure 2. The rate of ascent in F and M was similar and constant at
each floor (8.65 m/min) and is shown in Figure 3.
Figure 1. Energy cost (in Metabolic Equivalents (METs); 1 METs = 3.5 ml O2 Kg−1∙min−1) of as-
cending 5 floors of stairs of 20 steps/floor, 0.173 m/step.
Figure 2. Energy expenditure while ascending a 17.3 m elevation stair in 2 min.
J. R. Al Kandari et al.
1405
Table 2. Heart rates (HR) and energy costs (METs and ml O2/Kg.min) of males and females while ascending and descending 5 floors of
stairs with 100 steps of 0.173 m each, in 2 min after 10 min rest.
Heart Rate
METs
VO2 (ml/Kg/min)
Floor
Male ± SD
Female ± SD
Sig
Male ± SD
Female ± SD
Sig
Male ± SD
Female ± SD
Sig
Ascending
0
74.33 ± 7.18 76.64 ± 11.30 0.514 1.74 ± 0.21 1.40 ± 0.32
0.300 6.10 ± 1.75 4.89 ± 1.13 0.068
1
103.40 ± 10.68 114.57 ± 13.33 0.019 3.47 ± 1.23 3.47 ± 1.33 0.199 12.14 ± 4.29 12.16 ± 4.67 0.992
2
115.00 ± 11.72 126.50 ± 12.12 0.015 5.80 ± 1.54 4.81 ± 1.71 0.931 20.31 ± 5.39 16.85 ± 5.99 0.113
3
120.13 ± 17.17 138.50 ± 12.73 0.003 6.28 ± 1.34 6.73 ± 1.57 0.933 21.99 ± 4.68 23.55 ± 5.51 0.415
4
123.27 ± 16.43 148.57 12.01 0.000 6.55 ± 1.42 7.45 ± 1.34 0.066 22.93 ± 4.98 26.07 ± 4.71 0.092
5
127.47 ± 20.73 151.29 ± 11.60 0.001 7.55 ± 1.32 7.58 ± 0.99 0.539 26.41 ± 4.63 26.54 ± 3.47 0.712
Descending
5r
96.33 ± 14.45 121.29 ± 12.83 0.003 2.98 ± 0.55 2.79 ± 0.32 0.574 10.44 ± 2.93 9.76 ± 2.43 0.500
4
102.13 ± 22.80 114.93 ± 13.85 0.081 3.21 ± 0.49 3.43 ± 0.57 0.401 11.23 ± 2.99 12.02 ± 2.62 0.458
3
99.07 ± 20.23 116.64 ± 14.30 0.012 3.27 ± 0.66 3.79 ± 0.54 0.150 11.44 ± 2.81 13.28 ± 3.14 0.107
2
98.40 ± 18.45 117.86 ± 13.54 0.003 3.59 ± 0.75 3.57 ± 0.75 0.926 12.57 ± 3.88 12.50 ± 3.10 0.959
1
100.33 ± 18.60 117.71 ± 14.75 0.010 3.19 ± 2.78 3.62 ± 0.61 0.210 11.17 ± 3.44 12.68 ± 2.90
0.216
Figure 3. Time spent to ascend a 17.3 m 5 floors stairs with 20 steps/floor.
No difference in resting HR were found between F and M. HR were significantly
higher after climbing each of the five stair levels in F than in M (Table 2, Figure 4(a)).
The mean HR as percentage of estimated maximal at the end of each of five increasing
stair levels were 55.7%, 61.9%, 64.8%, 66.6% and 68.8% in M and 60.6%, 66.9%, 73.2%,
78.6%, 80.1% in F (Figure 4(b)). Figure 4(a) shows the relationship found between the
average %HRR and METs measured at each floor. The linear equations shown were the
best fits found to the data.
The maximal METs that would be reached at 100%HRR, are calculated from the
measured METs reached at the 5th level (7.6) divided by the fractional effort (derived
from the %HRR reached for F = 0.6617 and M = 0.487), at 11.48 METs for F and at 15.6
METs for M, similar to those derived from the indicated equations (Figure 4(a)).
Maximal mechanical work output is estimated from the mechanical work at the 5th
floor (17.3 m × 1 Kg/2 min) divided by the measured fractional effort (from the %HRR
J. R. Al Kandari et al.
1406
(a)
(b)
Figure 4. (a) Heart rate reserve reached at each level of energy expenditure (Mean METs) while
ascending a 5 floor, 17.3 m stair; (b) Percent of maximal heat rate reached at each average level of
energy expenditure while ascending a 5 floor stair.
reached F, 8.65/0.6617 = 12.98 and M, 8.65/0.487 = 17.76 Kg.m/min per Kg body
weight lifted) which (×0.00239 to convert [3] Kg∙m/min to Kcal/min) are 0.031 and
0.042 Kcal/Kg∙min in F and M, respectively.
Efficiency of stair climbing for each subject (n = 29) is calculated dividing the meas-
ured highest rate of mechanical work output reached (8.65 Kg∙m/min per Kg body
weight lifted × 0.00239 = 0.021 Kcal/min per Kg body weight lifted) by the measured
highest rate of energy expenditure reached (on average 0.0266 L O2/Kg∙min × 5 Kcal/L
J. R. Al Kandari et al.
1407
O2 = 0.133 Kcal/min∙Kg for both F and M) yielding an average ± SE of 0.158 ± 0.023
(fractional efficiency) or 15.8% for both F and M.
Figure 5 shows the linear relationship found between %HRR and % of VO2max
(aerobic effort) in males and females indicating that %HRR is directly proportional to
the aerobic effort, in both sexes.
Aerobic capacity can be estimated, when oxygen uptake is not measured, from the
calculated maximal rate of work output: 0.031 (for F) and 0.042 (for M) Kcal/Kg.min.
Dividing by the measured fractional efficiency of stair climbing (0.158), gives estimates
of the mean maximal rate of required energy input (expenditure) in Kcal/Kg.min: 0.197
(for F) and 0.269 (for M).These divided by 5 Kcal/L O2 result in 0.039 (in F) and 0.054
L/Kg∙min (in M) maximal O2 uptake, similar to those estimated by extrapolation of the
data in Figure 4(a).
The average target training intensity in METs for females in this group, was esti-
mated at 6.3 METS (Figure 4), using 60% of HRR, as the minimum recommended ex-
ercise training target [4]. Even if the energy costs are not measured, the elevation (m) at
which 60% of HRR is reached can be easily determined. On average, females reached
this training target slightly above the 3d floor (10.3 m elevation) (Figure 4(a)) but
males on average, reached only 48.75% HRR at the 5th floor (17.3 m elevation), indi-
cating that their climbing rate (8.65 m/min) should be faster (such as 10.6 m/min) if
they want to use these stairs to reach 60% HRR (9.6 MET, 10.6 Kg∙m/min∙Kg) for effec-
tive aerobic training. The %HRR reached at the top, should be verified by direct mea-
surement in each subject to insure that an adequate training intensity is achieved.
Systolic blood pressure increased to 140 mmHg at the 5th floor in both males and
females.
Figure 5. Relationship between percent aerobic effort (%Vo2max) and % Heart rate reserve
reached while ascending a 17.3 m, 5 floor stair in 2 min.
J. R. Al Kandari et al.
1408
During stairs descent the HR was 110 to 120; %HRR was 15% and the METs used 2
to 3, in F higher than in M. F have higher HR after 10 min rest recovery than M. By al-
ternating ascents and descents the subject practices in addition to aerobic training, a
form of interval training helpful to improve balance and flexibility.
4. Discussion
Health professionals may use stairs for submaximal evaluation of physical fitness (with
estimate of MET max and aerobic capacity). This is readily done when HR and VO2 are
directly measured (Figure 4(a)), by extrapolation to 100% HRR and reading the cor-
responding VO2 from the derived equations (Figure 4(a)). When oxygen uptake is not
measured, for each individual, aerobic capacity is estimated, from the highest rate of
work output reached (in Kg∙m/min per Kg lifted, the corresponding fractional effort
(from the highest %HRR reached), converted (×0.00239 Kcal/Kg.m) into Kcal/Kg.min
and divided by the fractional efficiency of stair climbing (0.158 for these stairs), to es-
timate maximal energy expenditure in Kcal/min.Kg, which when divided by the caloric
equivalent of oxygen, 5 Kcal/L O2 yields the maximal L/min O2 uptake per Kg body
weight. The climbing efficiency changes little in stairs with different percent grades as
the cost of horizontal displacement at each step depends on stepping rate but negligibly
on horizontal displacement [5].
The rate of oxygen consumption reached after 2 min at the highest (17.3 m) level
climbed by both F and M was 0.0266 L/min∙Kg (0.133 Kcal/min∙Kg or 9.04 Kcal/min in
F weighing 68 Kg and 10.90 Kcal/min in M weighing on 82 Kg) which compared well
with those in the manual of Bioenergetics for Exercise Sciences [5] and those previously
reported in several studies (7.8 - 13 Kcal/min) evaluating the energy cost of stair
climbing [6]. The Kcal used per min and per Kg lifted was independent of sex (0.133)
and comparable with previously reported [6] stair climbing values (0.110 - 0.185). In
this study, we also used the measured highest attained work rate, the fractional effort
(from the %HRR reached, which we show in Figure 5 that is directly proportional
to %VO2max) and the stair climbing fractional work efficiency (at 0.158 ± 0.023 in both
males and females) to estimate the aerobic capacity of the subjects, since directly mea-
suring oxygen uptake is rarely available to the healthcare worker. The Kcal spent per
step was lower in females (0.18) than in males (0.219), given their lower body weight,
and again within range of previously reported values (0.2) [7].
For patients with limitations, it is likely that they would reach efforts higher than
60% (as reflected by their %HRR) at the 3rd floor compared to the healthy females in
this study. Their stair climbing should be more limited (one or two floors). This can be
assessed by monitoring their HR and not allowing it to reach more than 60% of HRR.
Severely limited subjects may benefit by stair descents which require only 2 - 3 METs.
For exercise prescription, %HRR is plotted against cumulated floor elevation (m).
The elevation at which 60% of HRR is reached [4] is estimated, for example, at 10.3 m
(the 3rd floor) for an average female in this study. For the healthy males, or athletes, the
velocity of stair climbing may have to be adjusted so that at the top floor at least 60% of
HRR is reached.
J. R. Al Kandari et al.
1409
Using a minimum recommended weekly physical activity volume of 600 MET.min
per week for health maintenance [8], at an average exercise intensity of 6 METs, 100
min/week is the minimum total weekly duration of physical activity to be recommend-
ed for health maintenance. This can be broken down into sessions of about 20 min/day
(5 ascents per day × 2min/ascent = 10 min going up at 7.6 METs = 76 MET.min/day
and 10 min going down × 2 METs = 20 MET.min/day, for a total of 96 MET.min/day),
7 days/week frequency for a workout of 96 × 7 = 672 MET.min/week, higher than pre-
viously suggested [9]. For health enhancing effects (to lower blood pressure, reduce
cholesterol, weight loss, and enhance aerobic capacity) at least double the minimum
physical activity volume recommended per week (at least 1200 MET.min/week) should
be used and the subject retested after 3 months.
Elevations of systolic blood pressure during stair climbing much greater or smaller
than 140 mmHg, decreases in diastolic blood pressures (DBP) or increases of DBP to
values higher than at rest may indicate additional pathology.
Climbing stairs can thus safely be used as a mode of physical activity and exercise
training by adjusting elevation (floors) climbed, the rate of climbing (time per floor)
and the repetition rate while monitoring heart rate and timing. This can be used by
healthcare providers or subjects that have no access to more sophisticated facilities.
Funding
By Department of Physiology, Faculty of Medicine, Kuwait University.
References
[1] World Health Organization (2014) Global Status Report on Noncommunicable Diseases.
http://www.who.int/nmh/publications/ncd_report_full_en.pdf
[2] Lee, I.M., Shiroma, E.J., Lobelo, F., Puska, P., Blair, S.N. and Katzmarzyk, P.T. (2012) Lan-
cet Physical Activity Series Working Group. Effect of Physical Inactivity on Major Non-
Communicable Diseases Worldwide: An Analysis of Burden of Disease and Life Expectan-
cy.
The Lancet
, 380, 219-229. http://dx.doi.org/10.1016/S0140-6736(12)61031-9
[3] Compendium of Physical Activities: Power Conversions (2011)
https://sites.google.com/site/compendiumofphysicalactivities/help/unit-conversions
[4] Mann, T., Lamberts, R.P. and Lambert, M.I. (2013) Methods of Prescribing Relative Exer-
cise Intensity: Physiological and Practical Considerations.
Sports Medicine
, 43, 613-625.
http://dx.doi.org/10.1007/s40279-013-0045-x
[5] Kang, J. (2008) Bioenergetics Primer for Exercise Sciences. Human Kinetcs Ed., p. 76, Part
5, Fig. 5.5: Metabolic Equations for Various Activities. Bench Stepping.
[6] Halsey, L.G., Watkins, D.A.R. and Duggan, B.M. (2014) The Energy Expenditure of Stair
Climbing One Step and Two Steps at a Time: Estimations from Measures of Heart Rate.
PLoS One
, 9, e100658.
[7] Plowman, S.A. and Smith, D. (2014) Physiology for Health Fitness and Performance. 4th
Edition, Chapter 5, William and Wilkens Publishing, Lippincot, p. 127.
[8] Kaminsy, L.A. and Montoye, A.H.K. (2014) Physical Activity and Health. What Is the Best
Dose?
Journal of the American Heart Association
, 3, e001430.
J. R. Al Kandari et al.
1410
[9] Boreham, C., Wallace, W. and Nevill, A. (2000) Training Effects of Accumulated Daily
Stair-Climbing Exercise in Previously Sedentary Women.
Preventive Medicine
, 30, 277-
281.
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