The STEP Test™: The foundation for HealtheSteps™
The foundation for the HealtheSteps™ Program began in the early 2000s when Dr. Rob Petrella developed a groundbreaking, simple method to measure one’s fitness in order to prescribe exercise in a primary care setting.
The STEP Test™, as it has been called since, is a sub-maximal assessment of one’s fitness or VO2 Max, which is essentially how well an individual’s muscles can use oxygen while being physically active. This is the purest measures of fitness, and as such is an important number to have when trying to prescribe the duration and intensity of exercise that is safe and will lead to the greatest cardiovascular benefit. Up to this point however, VO2 Max scores had been measured while at maximal physical exertion (as opposed to sub-maximal).
Check out this video of members of the Reading Professional Football Club in England demonstrating a maximal-exertion VO2 Max test:
Although this might be appropriate for professional athletes, this type of test is not feasible to conduct in a primary care setting with a range of patients. With this barrier in mind, Dr. Petrella developed a method of measuring an individual’s VO2 Max score without requiring them to exert themselves maximally. In fact, while taking the STEP Test™, participants only need to walk up and down a set of 2 steps 20 times (most tests take around 1.5-2 minutes) without the need of expensive, bulky equipment. That’s it. Check out the video below to see a demonstration:
Quite the difference between the two videos, right? To test how well this measure of VO2 Max stacked up against the more established maximal test, Dr. Petrella and colleagues recruited 240 older adults and had their VO2 Max score measured through both the maximal and new sub-maximal tests. The researchers found that the sub-maximal STEP Test™ agreed highly with the maximal test, and concluded that this is a valid way of measuring an individual’s fitness level.
Importantly, Dr. Petrella had developed a measure of physiological fitness that could easily be completed using a staircase or one of our proprietary ‘STEP Units™’, in any primary care clinic across the country. Another important aspect of this test is that, using an individual’s VO2 Max score as well as their gender and age, it could calculate an individual’s ideal target heart rate during exercise that maximizes their cardiovascular benefit but also keeps them safe.
Further foundational work
Validating the STEP Test™ was an important achievement, but only represented the first step towards establishing the HealtheSteps™ Program. The test allowed for the accurate measure of VO2 Max in the primary healthcare setting, although Dr. Petrella recognized the importance of the healthcare professional in using the outcomes of the STEP Test™ to collaboratively set exercise and physical activity goals with their patient. Consequently, he designed a coaching protocol around the STEP Test™ where a healthcare professional would use the results of the test as a basis for a goal setting conversation with their patient in the primary healthcare setting. In addition to their target exercise heart rate, the patient would set goals related to the duration and frequency of weekly exercise, the activities they would engage in, as well as a target daily step count.
Towards the later part of the 2000s and into the 2010s, the research team led by Dr. Petrella and supported by international colleagues in Finland, the United Kingdom, and the United States, evaluated several iterations of this exercise prescription program, including the Diabetes and Technology for Increased Activity (DaTA) Study, the ARTEMIS Study, and the Staged Nutrition and Activity Counselling (SNAC) Study. These studies were supported by leading national research entities including the Canadian Institutes of Health Research, the Canadian Diabetes Association, and the Heart and Stroke Foundation of Canada, who contributed around four million dollars in total to support the development of this important program. Along the way, technology tools were introduced as a way for participants to remotely monitor their progress towards their goals. Additionally, healthy eating was introduced as another focus area, given the importance of nutrition in tackling chronic disease risk.
HealtheSteps™: A National Diabetes Strategy
After years of incremental development and research, in 2013 our team was awarded $1.2 million from the Public Health Agency of Canada to launch the newly branded HealtheSteps™ Program across Canada as part of its Canadian Diabetes Strategy. The program in its current form has been a summation of all the work our team had done previously, and includes the STEP Test™, and exercise, physical activity, and healthy eating prescriptions, as well as innovative technological support tools. This project was broken down into three discrete steps:
1. Launch the HealtheSteps™ Program in rural and remote communities in Ontario, British Columbia, Quebec, and the Northwest Territories
3. Evaluate the efficacy of the program through a rigorous randomized, controlled trial implemented in communities across Southwest Ontario
The first two steps of this project have been competed, and we have received excellent feedback from coaches and participants across the country. Our randomized control trial will be concluding by the end of 2016. The hard data from each project is yet to be analyzed and published, but we are expecting to see positive results as it related to improved health behaviours. In the meantime, we have presented some aspects of the program at several academic and professional conferences across the country. Check out some of the posters we have presented:
Work in Men’s Health
At the same time we were implementing the national-scale study sponsored by the Public Health Agency of Canada, the HealtheSteps™ team also received funding from the Canadian Institutes of Health Research to conduct a series of studies related to strategies to engage men in rural men in chronic disease and prevention programs. It turns out that it is particularly challenging to engage rural men in such interventions, so we were challenged to explore some potential solutions for this issue. The results of these studies have been used to adapt HealtheSteps™ and other programs to be more accessible and attractive to potential male participants.
In fact, the results of these studies were used to create a brand new program, called Hockey Fans in Training™, which was sponsored by the Movember Foundation’s Canadian Men’s Health and Wellbeing Innovation Challenge. This program has been quite successful and we are planning on bringing the intervention to hockey clubs across the country. Check out an interactive presentation we have developed to share our results below:
Curious and want to learn more? Feel free to check out our original research articles.
Note: Most articles require a journal subscription for access to the full text.
The Step Test Exercise Prescription (STEP) Projects
Petrella, R. J., Koval, J. J., Cunningham, D. A., & Paterson, D. H. (2001). A self‐paced step test to predict aerobic fitness in older adults in the primary care clinic. Journal of the American Geriatrics Society, 49(5), 632-638.
Petrella, R. J., Koval, J. J., Cunningham, D. A., & Paterson, D. H. (2003). Can primary care doctors prescribe exercise to improve fitness?: The step test exercise prescription (STEP) project. American Journal of Preventive Medicine, 24(4), 316-322.
Petrella, R. J., Lattanzio, C. N., Shapiro, S., & Overend, T. (2010). Improving aerobic fitness in older adults: Effects of a physician-based exercise counseling and prescription program. Canadian Family Physician, 56(5), e191-e200.
Knight, E., Stuckey, M. I., & Petrella, R. J. (2014). Validation of the step test and exercise prescription tool for adults. Canadian Journal of Diabetes, 38(3), 164-171. http://www.ncbi.nlm.nih.gov/pubmed/24909087
The Diabetes and Technology for Increased Activity (DaTA) Study
Stuckey, M., Russell-Minda, E., Read, E., Munoz, C., Shoemaker, K., Kleinstiver, P., & Petrella, R. (2011). Diabetes and Technology for Increased Activity (DaTA) study: Results of a remote monitoring intervention for prevention of metabolic syndrome. Journal of Diabetes Science and Technology, 5(4), 928-935. http://www.ncbi.nlm.nih.gov/pubmed/21880236
The Staged Nutrition and Activity Counselling (SNAC) Study
Petrella, R. J., Aizawa, K., Shoemaker, K., Overend, T., Piche, L., Marin, M., … & Atkin, S. (2011). Efficacy of a family practice-based lifestyle intervention program to increase physical activity and reduce clinical and physiological markers of vascular health in patients with high normal blood pressure and/or high normal blood glucose (SNAC): Study protocol for a randomized controlled trial. Trials, 12(1), 1.
The ARTEMIS Study
Stuckey, M. I., Shapiro, S., Gill, D. P., & Petrella, R. J. (2013). 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), 1.
Petrella, R. J., Stuckey, M. I., Shapiro, S., & Gill, D. P. (2014). Mobile health, exercise and metabolic risk: A randomized controlled trial. BMC Public Health, 14(1), 1.
Stuckey, M. I., Gill, D. P., & Petrella, R. J. (2015). 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), 375-380. http://www.ncbi.nlm.nih.gov/pubmed/25757039
HealtheSteps™ & Rural Men
Gavarkovs, A. G., Burke, S. M., & Petrella, R. J. (2015). Engaging men in chronic disease prevention and management programs: A scoping review. American Journal of Men’s Health, 1557988315587549.
Gavarkovs, A. G., Burke, S. M., & Petrella, R. J. (2015). The physical activity–related barriers and facilitators perceived by men living in rural communities. American Journal of Men’s Health, 1557988315598368.
Gavarkovs, A. G., Burke, S. M., Reilly, K. C., & Petrella, R. J. (2015). Barriers to recruiting men into chronic disease prevention and management programs in rural areas: Perspectives of program delivery staff. American Journal of Men’s Health, 1557988315596226.