Are fixed-rate step tests medically safe to assess physical fitness?

Jessa Hospital/Heart Centre Hasselt, Rehabilitation and Health Centre, Stadsomvaart 11, Hasselt, Belgium.
Arbeitsphysiologie (Impact Factor: 2.19). 03/2011; 111(10):2593-9. DOI: 10.1007/s00421-011-1886-3
Source: PubMed


Maximal oxygen uptake (VO(2max)) can be predicted by fixed-rate step tests. However, it remains to be analyzed as to what exercise intensities are reached during such tests to address medical safety. In this study, we compared the physiological response to a standardized fixed-rate step test with maximal cardiopulmonary exercise testing (CPET). One hundred and thirteen healthy adults executed a maximal CPET on bike, followed by a standardized fixed-rate step test 1 week later. During these tests, heart rate (HR) and VO(2) were monitored continuously. From the maximal CPET, the ventilatory threshold (VT) was calculated. Next, the physiological response between maximal CPET and step testing was compared. The step test intensity was 85 ± 24% CPET VO(2max) and 88 ± 11% CPET HR(max) (VO(2max) and HR(max) were significantly different between CPET and step testing; p < 0.01). In 41% of the subjects, step test exercise intensities >95% CPET VO(2max) were noted. A greater step testing exercise intensity (%CPET VO(2max)) was independently related to higher body mass index, and lower body height, exercise capacity (p < 0.05). Standardized fixed-rate step tests elicit vigorous exercise intensities, especially in small, obese, and/or physically deconditioned subjects. Medical supervision might therefore be required during these tests.

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    • "Moreover, such step test could be used in epidemiological studies/projects to estimate exercise tolerance with a relative low cost. However, when executing these step tests, supervision by a physician or properly trained/educated healthcare professional is warranted because vigorous exercise intensities (>75% VO 2max or >80% maximal heart rate) are elicited in the majority of patients/subjects (especially in elderly, women and/or deconditioned patients) (Hansen et al., 2011; Beutner et al., 2014). "
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    ABSTRACT: Healthcare professionals with limited access to ergospirometry remain in need of valid and simple submaximal exercise tests to predict maximal oxygen uptake (VO2max ). Despite previous validation studies concerning fixed-rate step tests, accurate equations for the estimation of VO2max remain to be formulated from a large sample of healthy adults between age 18-75 years (n > 100). The aim of this study was to develop a valid equation to estimate VO2max from a fixed-rate step test in a larger sample of healthy adults. A maximal ergospirometry test, with assessment of cardiopulmonary parameters and VO2max , and a 5-min fixed-rate single-stage step test were executed in 112 healthy adults (age 18-75 years). During the step test and subsequent recovery, heart rate was monitored continuously. By linear regression analysis, an equation to predict VO2max from the step test was formulated. This equation was assessed for level of agreement by displaying Bland-Altman plots and calculation of intraclass correlations with measured VO2max . Validity further was assessed by employing a Jackknife procedure. The linear regression analysis generated the following equation to predict VO2max (l min(-1) ) from the step test: 0·054(BMI)+0·612(gender)+3·359(body height in m)+0·019(fitness index)-0·012(HRmax)-0·011(age)-3·475. This equation explained 78% of the variance in measured VO2max (F = 66·15, P<0·001). The level of agreement and intraclass correlation was high (ICC = 0·94, P<0·001) between measured and predicted VO2max . From this study, a valid fixed-rate single-stage step test equation has been developed to estimate VO2max in healthy adults. This tool could be employed by healthcare professionals with limited access to ergospirometry. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.
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    • "This limitation could be partially overcome by a low speed adopted as a " baseline " for the ST. In the incremental test, the adoption of a step of fixed height also imposes certain limitations, since the ideal would be to adjust the height of the step to the subjects' body height (Hansen et al., 2011). Without this, the result could be very large differences in exercise time, because the load theoretically applied on ST depends on the height of the step (see Eq. (2)). "
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    ABSTRACT: To date little is known about the reliability of peak oxygen consumption (V˙O2PEAK) in incremental metronome paced step tests (IST) and the reliability of on-kinetics V˙O2 has never been studied. We aimed to study the reliability of both tests. Eleven healthy subjects performed two IST until exhaustion. On two different days two duplicate four minute constant metronome paced step tests (CST) were performed. V˙O2PEAK, mean response time (MRT) and phase II time constant (τ) were tested for reproducibility using the paired t-tests, in addition to the limits of agreement (LOA) and within subject coefficient of variation (COV). With a 95% LOA of 0.38 to 0.26 L.min(-1), -8.7 to 9.1s and -9.9 to 10.5s they exhibit a COV of 3%, 4.5% and 6.9% for V˙O2PEAK, MRT and τ respectively. ST are sufficiently reliable for maximal and submaximal aerobic power assessments in healthy subjects and new studies of oxygen uptake kinetics in selected patient groups are warranted. Copyright © 2014 Elsevier B.V. All rights reserved.
    Full-text · Article · Dec 2014 · Respiratory Physiology & Neurobiology
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    • "In either case, this assessment allows a more accurate exercise prescription when looking for significant benefits with regard to fitness and health (Anton et al., 2011). Furthermore VO2max is a useful parameter to assess the effects of physical training on the cardiorespiratory system (Hansen et al., 2011). Such tests are sometimes based on the linear relationship between the heart rate and oxygen uptake (Wicks et al., 2011), typically during submaximal steady-state exercise tests. "
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    ABSTRACT: Laboratory ergometers have high costs, becoming inaccessible for most of the population, hence, it is imperative to develop affordable devices making evaluations like cardiorespiratory fitness feasible and easier. The objective of this study was to develop and validate an Automated Step Ergometer (ASE), adjusted according to the height of the subject, for predicting VO2max through a progressive test. The development process was comprised by three steps, the theoretical part, the prototype assembly and further validation. The ASE consists in an elevating platform that makes the step at a higher or lower level as required for testing. The ASE validation was obtained by comparing the values of predicted VO2max (equation) and direct gas analysis on the prototype and on a, treadmill. For the validation process 167 subjects with average age of 31.24 ± 14.38 years, of both genders and different degrees of cardiorespiratory fitness, were randomized and divided by gender and training condition, into untrained (n=106), active (n=24) and trained (n=37) subjects. Each participant performed a progressive test on which the ASE started at the same height (20 cm) for all. Then, according to the subject's height, it varied to a maximum of 45 cm. Time in each stage and rhythm was chosen in accordance with training condition from lowest to highest (60-180 s; 116-160 bpm, respectively). Data was compared with the student's t test and ANOVA; correlations were tested with Pearson's r. The value of α was set at 0.05. No differences were found between the predicted VO2max and the direct gas analysis VO2max, nor between the ASE and treadmill VO2max (p= 0.365) with high correlation between ergometers (r= 0.974). The values for repeatability, reproducibility, and reliability of male and female groups measures were, respectively, 4.08 and 5.02; 0.50 and 1.11; 4.11 and 5.15. The values of internal consistency (Cronbach's alpha) among measures were all >0.90. It was verified that the ASE prototype was appropriate for a step test, provided valid measures of VO2max and could therefore, be used as an ergometer to measure cardiorespiratory fitness.
    Full-text · Article · Sep 2014 · Journal of Human Kinetics
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