Measurement Properties of the Modified Incremental Step Test for Assessing Exercise Capacity in Individuals With Type 2 Diabetes.
Larissa Barbosa de Carvalho, Renata Cruzeiro Ribas, Maria Clara Noman de Alencar and 3 others
The step test did not validate as a replacement for the cardiopulmonary exercise test in people with type 2 diabetes.
It correlated moderately with the 6-minute walk test, but gave inconsistent results when repeated on a second visit.
Key findings
1The number of steps climbed on the step test correlated with peak oxygen uptake from the cardiopulmonary exercise test at r = 0.53, below the 0.70 threshold the authors set for criterion validity.
2The number of steps climbed on the step test correlated with the distance covered in the 6-minute walk test at r = 0.65, which the authors classified as moderate and sufficient for convergent validity.
3The step test gave different step counts on the first and second attempt (ICC 0.64, 95% CI 0.44 to 0.78), below the 0.70 threshold for acceptable test-retest reliability.
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What it does not show
Only 18 of the 50 participants completed the cardiopulmonary exercise test, so the criterion validity comparison rests on a very small subsample. The step test was stopped at 85% of age-predicted maximum heart rate for safety, which the authors note likely reduced the cardiovascular stress and may have lowered the correlation with the maximal test. Participants were recruited by convenience from two centres in Brazil, and those with mobility, cognitive, hearing, or visual impairments were excluded, so the findings may not generalise to a broader type 2 diabetes population. The authors acknowledge the sample size was below the COSMIN recommendation for this type of validation study.
Declared interests
Partly funded by CAPES, a Brazilian government agency for postgraduate education. The authors declare no conflicts of interest.
The easy way to misread this
Do not use the step test as a replacement for the cardiopulmonary exercise test in type 2 diabetes. The correlation with peak oxygen uptake (r = 0.53) fell below the 0.70 validity threshold, and test-retest reliability was also below threshold (ICC 0.64). The authors state it should not substitute CPET.
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