BACKGROUND:The 5-stage Chester step test assesses aerobic capacity in healthy subjects. It has not been tested in patients with COPD. OBJECTIVE: To determine the reliability of the Chester step test in patients with COPD and correlation with pulmonary function test and exercise test results. METHODS: Thirty-two patients (mean ؎ SD FEV 1 46 ؎ 15% of predicted) undertook 2 Chester step tests and two 6-min walk tests, on different days, in random order. A subgroup of 11 patients performed incremental cycle ergometry. RESULTS: Thirty-one patients performed stage 1 of the Chester step test. Nineteen patients performed stage 2 of the Chester step test. The number of steps was highly reproducible: 66 ؎ 41 steps vs 68 ؎ 41 steps. There was no difference in heart rate or S pO 2 between the 2 Chester step tests at the peak of exercise or at the end of each stage. There was a significant correlation between number of steps and FEV 1 (r ‫؍‬ 0.43, P ‫؍‬ .02), and 6-min walk distance (r ‫؍‬ 0.60, P ‫؍‬ .001). Heart rate increased according to advanced stages of the Chester step test, up to 81 ؎ 13% of predicted. There was a significant correlation between number of steps and peak heart rate (r ‫؍‬ 0.55, P ‫؍‬ .001). In the 11 patients who performed the incremental cycling test there was a significant correlation between number of steps and peak work load (r ‫؍‬ 0.69, P ‫؍‬ .02). In the 6 patients in whom oxygen uptake could be estimated from the Chester step test, oxygen uptake was higher than that measured at the peak of the cycling test (30.8 ؎ 5.1 mL/kg/min vs 17.4 ؎ 4.5 mL/kg/min, respectively, P ‫؍‬ .001). CONCLUSIONS: Despite being highly reproducible, the Chester step test had a very short duration in patients with COPD. The number of steps incremented in each stage seems to be too large for these patients. An adaptation of the Chester step test should be considered for patients with COPD.

The slower the work rate increment during step test, the higher the exercise tolerance. Regardless of the work rate increment, cardiopulmonary stress and exertion effort at peak exercise were equivalent between tests.

Introdução: A doença de Parkinson (DP) é uma patologia neurodegenerativa que leva a perda progressiva de neurônios na substância negra, resultando em disfunções nos padrões de movimento. Objetivo: Analisar os efeitos da hidroterapia no equilíbrio de indivíduos com DP. Métodos: Foram estudados sete indivíduos (54,00 ± 6,08 anos) com diagnóstico de DP. Para avalição do equilíbrio funcional foram aplicados a escala de equilíbrio de Berg (EEB) e o teste timed up and go (TUGT) antes e após o protocolo de hidroterapia. O protocolo foi aplicado durante quatro semanas, sendo três sessões semanais com 40 minutos de duração cada sessão. Resultados: Foi observado um aumento significante na pontuação da EEB (25,3 ± 10,0 vs 37,0 ± 8,5) e redução do tempo do TUGT (13,2 ± 1,8 vs 11,4 ± 1,7; p < 0,05) após a execução do programa de hidroterapia. Conclusão: O protocolo de hidroterapia promoveu melhora do equilíbrio dos indivíduos com DP.

Step tests are typically used to assess exercise capacity. Given the diversity of step tests, the aim of this review was to describe the protocols that have been used in healthy subjects and in patients with chronic lung disease. Step tests for use in healthy subjects have undergone a number of modifications over the years. In most step tests, the duration is variable (90 s-10 min), but the step height (23.0-50.8 cm) and stepping rate (22.5-35.0 steps/min) remain constant throughout the test. However, the use of a fixed step height and constant stepping rate might not provide adequate work intensity for subjects with different levels of fitness, the workload therefore being above or below individual capacity. Consequently, step test protocols have been modified by introducing changes in step heights and stepping rates during the test. Step tests have been used in patients with chronic lung diseases since the late 1970s. The protocols are quite varied, with adjustments in step height (15-30 cm), pacing (self-paced or externally paced), and test duration (90 s-10 min). However, the diversity of step test protocols and the variety of outcomes studied preclude the determination of the best protocol for use in individuals with chronic lung disease. Shorter protocols with a high stepping rate would seem to be more appropriate for assessing exercise-related oxygen desaturation in chronic lung disease. Symptom-limited testing would be more appropriate for evaluating exercise tolerance. There is a need for studies comparing different step test protocols, in terms of their reliability, validity, and ability to quantify responses to interventions, especially in individuals with lung disease.