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:
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Age - Men greater than 45 years. Women greater than 55 years are at greater risk of coronary problems than their younger counterparts. Family History - Heart attack or sudden death before 55 years of age in father or other male first degree relative, or before 65 years of age in mother or other female first degree relative Current Smoker – Again, greater risk of coronary artery disease than nonsmokers. Hypertension - Blood pressure higher than 140/90 confirmed by measurements on at least two separate occasions or on anti-hypertensive medication Hypercholesterolemia - Total serum cholesterol greater than 200 mg/dl or HDL less than 35mg/dL Diabetes Mellitus - Persons with insulin dependent diabetes (IDDM) who are over 30 yrs of age or have had IDDM for more than 15 yrs. Also persons with noninsulin dependent diabetes (NIDDM) who are over 35 yrs of age. Sedentary Lifestyle/Physical Inactivity - Persons comprising the least active as defined by the combination of sedentary jobs involving sitting for a large part of the day and no regular exercise or active recreational pursuits.

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.

The evaluation is based on the step test protocol of the "Resource Manual for Guidelines for Exercise Testing and Prescription." ACSM’s Guidelines For Exercise Testing and Prescription. Demonstrate to the client how to perform the test by stepping up and down on the step keeping time with the beat of the metronome. record the resting heart rate. At the end of three (3) minutes record max heart rate achieved and have the client stand or walk quietly. Cadence on the metronome is set at 96 beats per minute (24 step-ups per minute).Individuals with known cardiac. as well as the functional simulation tasks. Record heart rate after one minute. Procedure (detail)        The three (3) minute step test is an evaluation of recovery to a functional activity (step climbing). This one (1) minute recovery Heart rate is used to determine Performance Level.     Monitor heart rate throughout testing Record heart rate every 30 seconds. pulmonary or metabolic disease are called Known Disease. The cardiovascular testing. The stepping should be performed as follows: UP Right UP Left DOWN Right DOWN Left Ideally the client should keep up with the beat as closely as possible throughout the test. 1995 The step height used for this evaluation is 12" (300 mm).. testing should be terminated if any of the following occur: 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 . record pulse reading from Pulse monitor. Test time is 3 minutes. can be stressful to the body. 33. 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. One minute after testing. pg. Before beginning the test. Therefore. Make sure the metronome is set at 96 bpm. 5th ed.

Unusual or severe shortness of breath Other central nervous system problems including vertigo. Leg/calf cramps or intermittent claudication Data collection and correlation (what is being measured. and how): 1) Compare one minute recovery to table of norms 2) Compare appropriate Male and Female percentile ranking. and/or confusion. pallor.127 128 . or cold and clammy skin. Signs of poor perfusion: light-headedness. cyanosis.117 Percentile Rank 90th 75th 50th Females < 97 97 .102 103 . confusion.142 Fitness Level Excellent Good Average . ataxia. Noticeable change in heart rhythm. Any chest pain that is increasing or suspicious of myocardial infarction. Client requests to stop Physical or verbal manifestations of severe fatigue. Failure of heart rate to increase with increased exercise intensity.Excessive rise in blood pressure: systolic > 260 mmHg or diastolic > 115 mm Hg. Failure of testing equipment. Males < 71 71 . observed. visual or gait problems. nausea.

171 172+ Fair Poor *Resource: Y’s Way to Physical Fitness. Acute congestive heart failure Severe aortic stenosis.118 .147 148+ 25th 10th 143 . Suspected or known dissecting aneurysm Suspected or known myocarditis or pericarditis. 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. History of unstable angina History of uncontrolled ventricular arrhythmia. Third degree AV heart block without pacemaker. it can be used as a comparison to stair climbing as a functional activity. . 1989 Hint: 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. Uncontrolled atrial arrhythmia which can compromise cardiac function. Absolute contraindications would include: Client reporting recent complicated myocardial infarction.

g. Acute infections. Chronic infectious disease (e. thyrotoxicosis. musculoskeletal. diabetes. hepatitis. Uncontrolled metabolic disease (e. Significant emotional distress (psychosis). 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. Neuromuscular.Thrombophlebitis or intra cardiac thrombi.g. Recent systemic or pulmonary embolus. 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. AIDS). or ectopy. or resting systolic > 200 mmHg Moderate valvular disease Known electrolyte abnormalities Fixed rate pacemaker . mononucleosis..rarely used nowadays but may still appear in some clients Ventricular aneurysm or other ventricular dysrhythmias. .. These include but are not limited to: Resting diastolic blood pressure > 115 mmHg. or myxedema).

. referral information. Articles to Review ACSM’s Guidelines For Exercise Testing and Prescription. 5th ed. available medical information.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. 1995. Equipment required     12 in (300mm) step Metronome Recommended heart-rate monitor Stopwatch . 33. and client's report. pg.

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