Difficulties in administering and evaluating a 3-minute step test modified for a clinical population.

Joseph J Sudano, Gail M Huber, Adam T Perzynski, Steven A Lewis, Patrick K Murray


Objective:  Measurement of aerobic capacity is an important issue in clinical and research settings. We report on the design, use and attrition rate of a 3-minutes step test modified from the Queens College Step test that we hoped to use as an inexpensive and brief indicator of cardiovasular endurance. Design:  We conducted a cohort survey and epidemiological study. Setting:  Two academic medical practices and three community clinics in Cleveland Ohio and Chicago Illinois. Participants:  Study population included a clinical sample of 1,234 White, Black, English-speaking and Spanish-speaking Hispanic adults aged 45-64. Methods: After two modifications of the Queens College Step test we used a 10 inch step height and a cadence of 23 steps per minute to represent our 3-minute step test. Subjects were stopped when they a) completed three minutes, b) when heart rates exceeded 80% of maximal predicted heart rate or reported nausea, dizziness or chest pain, or c) if they requested to stop. Main Outcome Measurements: Main outcome measures were completion, dropout and stop rates. Results: A total of 28% of subjects were able to complete the test, 36% had to be stopped when heart rates were excessive. The remainder either refused to attempt the test (13%) or requested to stop for symptoms of pain or fatigue (23%). Men and non-Hispanic whites were more likely to complete the test. Conclusion:  Existing fixed cadence step tests that are ungraded are particularly problematic for assessing aerobic capacity/fitness in a clinical population because of high dropout rates during testing. Further exploration of self-paced tests should focus on the ability of subjects to complete the tests and the validity of those tests to predict aerobic capacity.


performance testing, aerobic capacity, step-test, clinical population

Full Text:



Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., ... & Bauman, A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081.

Warms C. Physical activity measurement in persons with chronic and disabling conditions. Fam Community Health. 2005; 29:785-885.

Heimmel J, Patel S, Cody R, Bachmann G. Evaluation of physical fitness in an ambulatory setting. Am J Obstet Gynecol. 2007; 196:522.e1-524.e4.

American College of Sports Medicine (ACSM). ACSM’s Guidelines for Exercise Testing and Prescription (9th ed). Philadelphia: Lippincott, Williams & Wilkins. 2013.

Enright PL. The six-minute walk test. Respir Care. 2003 Aug;48(8):783-5.

American Thoracic Society (ATS). ATS Statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-117.

Simonsick EM. Fan E. Fleg JL. Estimating cardiorespiratory fitness in well-functioning older adults: treadmill validation of the long distance corridor walk. J Am Geriatr Soc . 2006; 54(1):127-32.

Astrand P-O, Rodahl K, Dahl HA, Stromme SB, . Textbook of Work Physiology, 4th edition. New York: Mcgraw-Hill, 2003.

VanSwearingen JM and Brach JS..Making geriatric assessment work: selecting useful measures. Phys Ther 2001;81:1233-1252.

Buckley JP, Sim J, Eston RG, Hession R, Fox R. Reliability and validity of measures taken during the Chester step test to predict aerobic power and to prescribe aerobic exercise. Br J Sports Med. 2004;38:197-205.

Chen S, Wang J, Lee W, HOu C, Chen C, Laio Y, Lin C, Kuo C. Validity of the 3 min step test in moderate altitude: environmental temperature as a confounder. Appl Physiol Nutr Metab. 2006;31:726-730.

McArdle, W. D., Katch, F. I., Pechar, G. S., Jacobson, L., & Ruck, S. (1972). Reliability and interrelationships between maximal oxygen intake, physical work capacity and step-test scores in college women. Medicine and science in sports, 4(4), 182.

D'Alonzo KT, Stevenson JS, Davis SE. Outcomes of a program to enhance exercise self-efficacy and improve fitness in Black and Hispanic college-age women. Res Nurs Health. 2004 Oct;27(5):357-69.

Fox K, Borer JS, Camm AJ, et al. Resting heart rate in cardiovascular disease. J Am Coll Cardiol. 2007; 50: 823-830.

Canadian Society for Exercise Physiology. Patient Activity Readiness Questionnaire (PAR-Q). Accessed June 24, 2013 at: www.csep.ca/cmfiles/publications/parq/par-q.pdf

Smidt N, van der Windt DA, Assendelft WJ, Mourits AJ, Deville WL, deWinter AF, Bouter LM. Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. Arch Phys Med Rehabil. 2002; 83:1145-1150.

National Institute for Occupational Safety and Health (NIOSH). Pre-employment strength testing. Washington, DC: US Department of Health and Human Services. 1977.

Sherrington C, Lord SR. Reliability of simple portable tests of physical performance in older people after hip fracture. Clin Rehabil. 2005 Aug;19(5):496-504.

Malmberg JJ, Miilunpalo SI, Vuori IM, Pasanen M, Oja P, and Haapanen-Niemi N. A health-related fitness and functional performance test battery for middle-aged and older adults: feasibility and health-related content validity. Arch Phys Med Rehabil. 2002;83:666-677.

Jones CJ, Rikli RE, Beam WC. A 30-second chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999; 70:113-119.

Lechner DE, Page JJ, Sheffield G. Predictive validity of a functional capacity evaluation:The physical work performance evaluation. Work. 2008;31(1):21-25.

Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. J Aging Phy Act. 1999;7:129-161.

Golding LA. YMCA Fitness Testing and Assessment Manual. 4th ed. Champaign, IL: Human Kinetics. 2000.

Suni JH, Oja P, et al. Health-related fitness test battery for adults: aspects of reliability. Arch Phys Med Rehabil. 1996;77:399-405.

Bovend’Eerdt TJH, Dawes H, Johansen-Berg H, Wade DT. Evaluation of the modified Jebsen test of hand function anf the University of Maryland Arm questionnaire for stroke. Clin Rehabil. 18:195-202 (2004)

Siconolfi SF, Garber CE, Lasater TM, Carleton RA. A simple, valid step test for estimating maximal oxygen uptake in epidemiologic studies. Am J Epidemiol. 1985;121:382-390.

Lim P, Shiels P, Anderson J, MacDonald T. Dundee step test: a simple method of measuring the blood pressure response to exercise. J Hum Hypertens. 1999 Aug; 13(8):521-6.

Tammelin T, Nayha S, Rintamaki H. Cardiorespiratory fitness of males and females of northern Finland birth cohort of 1966 at age 31. Int J Sports Med. 2004; 25(7):547-552.

Tanaka, H., Monahan, K. D., Seals, D. R. Age-Predicted Maximal Heart Rate Revisited. J Am Coll Cardiol 2001; 37:53-6.

Tufte, ER. The Visual Display of Quantitative information. Cheshire, CT: Graphics Press. 1986.

Petrella RJ, Wight D. An office-based instrument for exercise counseling and prescription in primary care. Arch Fam Med. 2000; 9:339-344.

Petrella RJ, Koval JJ, Cuningham DA, Paterson DH. Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. J Prev Med. 2003; 24: 316-322.

Petrella RJ, Koval JJ, Cuningham DA, Paterson DH. A self-paced step test to predict aerobic fitness in older adults in the primary care clinic. J Am Geriatr Soc. 2001;49:632-638.

DOI: https://doi.org/10.12922/jshp.v2i3.46


  • There are currently no refbacks.


 JSHP is hosted by the Mary and Jeff Bell Library, at Texas A&M University- Corpus Christi.