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Critical Reviews™ in Physical and Rehabilitation Medicine

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ISSN Print: 0896-2960

ISSN Online: 2162-6553

SJR: 0.141 SNIP: 0.129 CiteScore™:: 0.6 H-Index: 18

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The Step Test and Exercise Prescription Tool in Primary Care: A Critical Review

Volume 24, Issue 1-2, 2012, pp. 109-123
DOI: 10.1615/CritRevPhysRehabilMed.2013006823
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Melanie Stuckey
Western University
Emily Knight
Lawson Health Research Institute, Aging Rehabilitation and Geriatric Care Research Centre, Western University Faculty of Health Sciences, London, Ontario, Canada
Robert J. Petrella
Lawson Health Research Institute, Aging Rehabilitation and Geriatric Care Research Centre; Western University, Faculty of Health Sciences; Western University, Schulich School of Dentistry and Medicine, Western University, London, Ontario, Canada

ABSTRACT

It is well established in the literature that regular physical activity aids in the prevention and treatment of many chronic diseases. Despite this, it also has been reported that physical fitness assessment and exercise prescription are not readily employed in the primary care setting, which led to the development of the Step Test and Exercise Prescription (STEP) tool. STEP involves stepping up and down a set of standardized steps 20 times at a self-selected pace and calculating predicted maximum oxygen consumption based on age, sex, body weight, stepping time, and heart rate after exercise. A written, individualized exercise prescription, including target training heart rate, is provided. This review provides the STEP protocol, clarifies discrepancies in the literature, and summarizes outcomes. Interventions employing STEP have demonstrated beneficial effects for aerobic fitness, exercise compliance, exercise self-efficacy, and risk factors associated with cardiovascular disease. STEP has been particularly successful in improving the cardiometabolic risk profile associated with the metabolic syndrome. Based on existing evidence, STEP is an effective office-based tool for use by physicians or allied health care professionals to assess aerobic fitness effectively and provide individualized exercise counseling.

KEY WORDS: exercise prescription, primary care, aerobic fitness, physical activity
CITED BY

  1. Noble Earl, Melling Jamie, Shoemaker Kevin, Tikkanen Heikki, Peltonen Juha, Stuckey Melanie, Petrella Robert J., Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection of Discovery, Prevention and Knowledge Exchange, Canadian Journal of Diabetes, 37, 5, 2013. Crossref

  2. Knight Emily, Stuckey Melanie I., Petrella Robert J., Validation of the Step Test and Exercise Prescription Tool for Adults, Canadian Journal of Diabetes, 38, 3, 2014. Crossref

  3. Gregory Michael A., Gill Dawn P., Zou Guangyong, Liu-Ambrose Teresa, Shigematsu Ryosuke, Fitzgerald Clara, Hachinski Vladimir, Shoemaker Kevin, Petrella Robert J., Group-based exercise combined with dual-task training improves gait but not vascular health in active older adults without dementia, Archives of Gerontology and Geriatrics, 63, 2016. Crossref

  4. Stuckey Melanie I., Kiviniemi Antti, Gill Dawn P., Shoemaker J. Kevin, Petrella Robert J., Associations between heart rate variability, metabolic syndrome risk factors, and insulin resistance, Applied Physiology, Nutrition, and Metabolism, 40, 7, 2015. Crossref

  5. Stuckey Melanie I., Gill Dawn P., Petrella Robert J., Does Systolic Blood Pressure Response to Lifestyle Intervention Indicate Metabolic Risk and Health-Related Quality-of-Life Improvement Over 1 Year?, The Journal of Clinical Hypertension, 17, 5, 2015. Crossref

  6. Knight Emily, Stuckey Melanie I., Petrella Robert J., Prescribing Physical Activity Through Primary Care: Does Activity Intensity Matter?, The Physician and Sportsmedicine, 42, 3, 2014. Crossref

  7. Clark Ilana B., Vandermorris Susan, Heisz Jennifer J., Physical Fitness and Sociocognitive Engagement are Associated with Different Aspects of Cognition in Older Adults, Journal of the American Geriatrics Society, 63, 1, 2015. Crossref

  8. GILL DAWN P., GREGORY MICHAEL A., ZOU GUANGYONG, LIU-AMBROSE TERESA, SHIGEMATSU RYOSUKE, HACHINSKI VLADIMIR, FITZGERALD CLARA, PETRELLA ROBERT J., The Healthy Mind, Healthy Mobility Trial, Medicine & Science in Sports & Exercise, 48, 2, 2016. Crossref

  9. Gill Dawn P., Blunt Wendy, De Cruz Ashleigh, Riggin Brendan, Hunt Kate, Zou Guangyong, Sibbald Shannon, Danylchuk Karen, Zwarenstein Merrick, Gray Cindy M., Wyke Sally, Bunn Christopher, Petrella Robert J., Hockey Fans in Training (Hockey FIT) pilot study protocol: a gender-sensitized weight loss and healthy lifestyle program for overweight and obese male hockey fans, BMC Public Health, 16, 1, 2016. Crossref

  10. Petrella Robert J, Stuckey Melanie I, Shapiro Sheree, Gill Dawn P, Mobile health, exercise and metabolic risk: a randomized controlled trial, BMC Public Health, 14, 1, 2014. Crossref

  11. Stevens Matthew L, Lin Chung-Wei C, Hancock Mark J, Latimer Jane, Buchbinder Rachelle, Grotle Margreth, van Tulder Maurits, New Charles H, Wisby-Roth Trish, Maher Chris G, TOPS: Trial Of Prevention Strategies for low back pain in patients recently recovered from low back pain—study rationale and protocol, BMJ Open, 6, 5, 2016. Crossref

  12. Gregory Michael A., Boa Sorte Silva Narlon C., Gill Dawn P., McGowan Cheri L., Liu-Ambrose Teresa, Shoemaker J. Kevin, Hachinski Vladimir, Holmes Jeff, Petrella Robert J., Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1, Journal of Alzheimer's Disease, 57, 3, 2017. Crossref

  13. Heisz Jennifer J., Kovacevic Ana, Clark Ilana B., Vandermorris Susan, Evaluation of a Community-Based Exercise Program for Managing Alzheimer's Disease, Journal of the American Geriatrics Society, 64, 4, 2016. Crossref

  14. Gavarkovs Adam G., Blunt Wendy, Petrella Robert J., A protocol for designing online training to support the implementation of community-based interventions, Evaluation and Program Planning, 72, 2019. Crossref

  15. McEwan Gary, Buchan Duncan, Cowan Daryl, Arthur Rosie, Sanderson Mark, Macrae Eilidh, Recruiting Older Men to Walking Football: A Pilot Feasibility Study, EXPLORE, 15, 3, 2019. Crossref

  16. Boa Sorte Silva Narlon C., Gregory Michael A., Gill Dawn P., McGowan Cheri L., Petrella Robert J., The Impact of Blood Pressure Dipping Status on Cognition, Mobility, and Cardiovascular Health in Older Adults Following an Exercise Program, Gerontology and Geriatric Medicine, 4, 2018. Crossref

  17. Boa Sorte Silva Narlon Cassio, Gill Dawn P., Owen Adrian M., Liu-Ambrose Teresa, Hachinski Vladimir, Shigematsu Ryosuke, Petrella Robert J., Ginsberg Stephen D, Cognitive changes following multiple-modality exercise and mind-motor training in older adults with subjective cognitive complaints: The M4 study, PLOS ONE, 13, 4, 2018. Crossref

  18. Boa Sorte Silva Narlon C., Gill Dawn P., Gregory Michael A., Bocti John, Petrella Robert J., Multiple-modality exercise and mind-motor training to improve mobility in older adults: A randomized controlled trial, Experimental Gerontology, 103, 2018. Crossref

  19. Freene Nicole, Davey Rachel, McPhail Steven M, Frequency of a very brief intervention by physiotherapists to increase physical activity levels in adults: a pilot randomised controlled trial, BMC Sports Science, Medicine and Rehabilitation, 11, 1, 2019. Crossref

  20. Boa Sorte Silva Narlon C., Nagamatsu Lindsay S., Gill Dawn P., Owen Adrian M., Petrella Robert J., Memory Function and Brain Functional Connectivity Adaptations Following Multiple-Modality Exercise and Mind–Motor Training in Older Adults at Risk of Dementia: An Exploratory Sub-Study, Frontiers in Aging Neuroscience, 12, 2020. Crossref

  21. Jukic Tomislav, Ihan Alojz, Strojnik Vojko, Stubljar David, Starc Andrej, The effect of active occupational stress management on psychosocial and physiological wellbeing: a pilot study, BMC Medical Informatics and Decision Making, 20, 1, 2020. Crossref

  22. Stuckey Melanie I, Shapiro Sheree, Gill Dawn P, Petrella Robert J, A lifestyle intervention supported by mobile health technologies to improve the cardiometabolic risk profile of individuals at risk for cardiovascular disease and type 2 diabetes: study rationale and protocol, BMC Public Health, 13, 1, 2013. Crossref

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