HealtheSteps® Research

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).

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:


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.


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


2. Create and evaluate the HealtheSteps™ mobile app for Android and iOS devices developed in partnership with the Dietitians of Canada


3. Evaluate the efficacy of the program through a rigorous randomized, controlled trial implemented in communities across Southwest Ontario




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 now bringing the intervention to hockey clubs across the country.


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.


HealtheSteps® & Rural Men

Gill, D. P., Blunt, W., Silva, N. B. S., Stiller-Moldovan, C., Zou, G. Y., & Petrella, R. J. (2019). The HealtheSteps™ lifestyle prescription program to improve physical activity and modifiable risk factors for chronic disease: a pragmatic randomized controlled trialBMC public health19(1), 841.

Blunt, W., Gill, D. P., Riggin, B., Brown, J. B., & Petrella, R. J. (2019). Process evaluation of the Health e Steps™ lifestyle prescription programTranslational behavioral medicine9(1), 32-40.

Gill, D. P., Blunt, W., Bartol, C., Pulford, R. W., De Cruz, A., Simmavong, P. K., … & Law, B. (2017). HealtheSteps™ study protocol: a pragmatic randomized controlled trial promoting active living and healthy lifestyles in at-risk Canadian adults delivered in primary care and community-based clinicsBMC Public Health17(1), 173.

Gavarkovs, A. G., Blunt, W., & Petrella, R. J. (2019). A protocol for designing online training to support the implementation of community-based interventionsEvaluation and program planning72, 77-87

Simmavong, P. K., Hillier, L. M., & Petrella, R. J. (2019). Lessons Learned in the Implementation of HealtheSteps: An Evidence-Based Healthy Lifestyle ProgramHealth promotion practice20(2), 300-310.

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.





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.


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.


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.



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.


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