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 FactorsPrior 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: 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. 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. Procedure (detail) The three (3) minute step test is an evaluation of recovery to a functional activity (step climbing). The evaluation is based on the step test protocol of the "Resource Manual for Guidelines for Exercise Testing and Prescription," ACSMs Guidelines For Exercise Testing and Prescription, pg. 33, 5th ed., 1995 The step height used for this evaluation is 12" (300 mm). Cadence on the metronome is set at 96 beats per minute (24 step-ups per minute). Test time is 3 minutes. One minute after testing, record pulse reading from Pulse monitor. Before beginning the test, record the resting heart rate. 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. Make sure the metronome is set at 96 bpm. The stepping should be performed as follows:UPRightUPLeftDOWNRightDOWNLeft

Ideally the client should keep up with the beat as closely as possible throughout the test. Monitor heart rate throughout testing Record heart rate every 30 seconds. At the end of three (3) minutes record max heart rate achieved and have the client stand or walk quietly. Record heart rate after one minute. This one (1) minute recovery Heart rate is used to determine Performance Level. The cardiovascular testing, as well as the functional simulation tasks, can be stressful to the body. Therefore, 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 intensityExcessive 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 claudicationData 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.MalesPercentile RankFemalesFitness Level

< 7190th< 97Excellent

71 - 10275th97 - 127Good

103 - 11750th128 - 142Average

118 - 14725th143 - 171Fair

148+10th172+Poor

*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 cadenceBecause 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. Acute infections. 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 diseaseKnown electrolyte abnormalitiesFixed rate pacemaker - rarely used nowadays but may still appear in some clientsVentricular 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 exerciseAdvanced or complicated pregnancyRecent uncomplicated myocardial infarctionAny 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 ReviewACSMs Guidelines For Exercise Testing and Prescription, pg. 33, 5th ed., 1995. Equipment required 12 in (300mm) step Metronome Recommended heart-rate monitor Stopwatch