HARVARD STEP TEST

Effect on Blood Pressure, Pulse Rate &

Respiratory Rate with Mild & Moderate
Grades of Exercise Using Harvard Step Test

Dr. Maria Pauline

 Harvard step test
• The Harvard step test was devised at Harvard University
during World War II to evaluate cardiac health and to
develop heart health regimens for athletes and military
personnel.

• The test consists of a person stepping up and down from a

step and then measuring heart rates.

• The Harvard step test can be performed repeatedly

to evaluate and gauge cardiovascular health over time.
 The Heart
 The heart pumps blood throughout the body. The blood travels
through the aorta and supplies oxygen to the muscles and organs.

 Adenosine triphosphate (ATP) is a complex organic chemical that

participates in many processes in all forms of life. (ATP is referred to as
the "molecular unit of currency" of intracellular energy transfer)

 During exercise, muscles require more ATP. Anaerobic ATP regeneration

requires high oxygen supply from blood flow.

 This makes the heart works faster by increasing the stroke volume and
heart rate and pumps more blood out with each beat.

 The stroke volume reaches to a maximum and remains constant.

 The Respiratory System

Functions of the respiratory system is to bring

oxygen into the body and remove carbon dioxide

When exercising-
breathing occurs faster and deeper
This allows more oxygen to be inhaled and
transferred to the blood and muscles
Oxygen is used to help fuel exercise
 Harvard step test is Important for

• Athletes….
• Helps identify weakness in an athlete…
• Corrects weakness by modifying training…
• Screening for specific occupation eg. Armed forces
• Monitor training effectiveness
 In clinical medicine…

Harvard step test is used to detect –

• Ventilatory and Cardiovascular limitations to work

• Maximal tolerable workload & safe levels of daily

exercise

• Extent of disability for rehabilitation purpose

Isotonic exercise Isometric exercise

Jogging Ergoreflexes

Harvard step test

Bicycle ergometer

Other methods - by measuring

VO2 Max using exercise on
bicycle ergometer or tread mill
 Resting Heart Rate (RHR)
Before you begin the isotonic exercise –

- Record two basal reading of heart rate after the

subject has been sitting quietly (rested) for 5 minutes

• Normal ranges -
– Untrained RHR: 60 to 80 beats/min
– Trained RHR: as low as 30 to 40 beats/min

It can be affected by neural tone, temperature,

altitude
 Maximal Heart Rate

• In a normal subject, the Heart Rate increases

linearly with the severity of exercise till maximum
heart rate (MHR) is reached.

• MHR – for an individual is 220 – age (yrs)

• MHR is a surrogate of FITNESS
Effect of Mild & Moderate Grades of Exercise on Blood Pressure,
Pulse Rate & Respiratory Rate Using Harvard Step Test

 Cardiovascular fitness (heart, lungs) is a measure of the body’s

ability to utilise oxygen.

 It is an indicator of how fast somebody is able to breathe in

oxygen into the lungs, transport it through the body to the
muscles and use it to provide energy for the exercise that the
person is doing.

 As cardiovascular fitness improves, the heart gets larger and

stronger and is able to pump more blood and with it more
oxygen to the muscles. The muscles can also take more oxygen
from the blood and become better at using oxygen to produce
energy.
 Harvard Step Test
• Effect on Blood Pressure, Pulse Rate and Respiratory
Rate during Mild & Moderate Grades of Exercise
Using Harvard Step Test
 Harvard Step Test
Mild Exercise Procedure:
1. Record two basal reading of -
• Heart rate, Respiratory rate and Blood pressure (after the subject has
been sitting quietly (rested) for 5 minutes, using digital BP apparatus.)

Training session: Subject practices stepping with the BP cuff as the

metronome rings every 2 secs.
This completes one cycle of steps in 6 rings (step rate =30/min)

• Normal ranges of Respiratory rate and Heart rate (RHR) -

– In Untrained RHR: 60 to 80 beats/min
– Trained RHR: as low as 30 to 40 beats/min
– Affected by neural tone, temperature, altitude
 Harvard Step Test
Moderate Exercise Procedure

• The subject rests till the cardiorespiratory parameters

return to normal resting levels

• The step test is repeated with the metronome set to

ring every second

• The subject completes 10 cycles of stepping in 1

minute (step rate = 60/min)
Training session of Harvard step test

Will be demonstrated in each group

 Harvard step test Training Session
• Check the rate of metronome ….with a watch
• Let the subject practice stepping up in the following
manner against the ticking of the metronome

• Initial position – both feet on the ground

• 1st ring – Right foot on 1st step
• 2nd ring – Left foot on 2nd step
• 3rd ring – Both feet on 2nd step
• 4th ring – Left foot on 1st step
• 5th ring – Right foot on the ground
• 6th ring – Left foot on the ground

This completes one cycle of steps in 6 rings (ie., 5 cycles in 1

min (step rate = 30/min).
 Mild and Moderate Exercise

• Observations and Calculations

 Heart Rate During Exercise

• Directly proportional to exercise intensity

• Maximum HR (HRmax): It is the highest HR achieved in

an all-out effort

– Declines slightly with age

– Estimated HRmax = 220 – age in years
– Better estimated HRmax = 208 – (0.7 x age in years)
 Steady state Heart rate

• Defined as a the condition of a system or physiological

function that remains relatively constant.

• For example after a few minutes of submaximal

exercise the person reaches a state when the heart
rate and oxygen tend to remain constant.
 Heart Rate During Exercise
• If exercise intensity , the
steady-state HR also 

• Adjustment to new
intensity takes 2 to 3 mins

• Steady-state HR is the
basis for simple exercise
tests that estimate aerobic
fitness and HRmax Steady-state HR:
At the point of plateau, it is the optimal
HR to meet circulatory demands at a given
submaximal intensity
 Few Recommended Exercises
• Walking Test
• Spot Jogging
• Cycle Ergometer
• Tread Mill (Bruce Protocol)
• Thank You
ISOMETRIC EXERCISE
 Isometric exercise
• The term "isometric" means that in these exercises the length
of the muscle and the angle of the joint do not change,
though contraction strength may be varied

• An isometric exercise is a form of exercise involving the static

contraction of a muscle without any visible movement in the
angle of the joint.
 Types of isometric exercise

The three main types of isometric exercise include –

• Isometric presses, pulls, and holds.

• Strength training to improve the body’s ability to
apply power from a static position or
• To improve the body’s ability to maintain a position
for a period of time.
 Response to Isometric Exercise
On Heart Rate
• Withdrawal of the inhibiting vagal effect
• Activation of cardiac sympathetic nerve fibers
• Hormonal effect- high level of circulating (Adrenaline, a
hormone & noradrenaline, acts as hormone on CVS when
circulating in high levels)

Blood pressure
• Systolic BP rises sharply (around 180 mmHg)
• Diastolic does not change much, may fall during sustained
exercise
• Pulse pressure increases
 Method
Ergoreflexes using – Hand Dynamometer

In practical session will use an improvised BP

apparatus
 Response to Isometric Exercise
• HR is lesser than in Isotonic exercise
• SBP is greater than dynamic exercise and DSP also rises
• Rise in DBP is related to ‘ERGOREFLEX’
• Strong Isometric contraction in muscle occludes blood flow in vessels
passing within the muscle (complete occlusion at 70% maximal
contraction)
• This builds up metabolites in the muscle stimulates
chemosensitive afferent nerves in the muscle Central Processing
sympathetic
efferent outflow to Heart & Blood vessels CO (systolic BP) & TPR
(diastolic BP)
Absence of rise in heart rate & DBP with sustained contraction is seen in autonomic failure
 Assessment of Physical Fitness

Methods:

• By simple walking test (2 km track, 5 rounds)

• Harvard step test (upto maximum of 5 minutes)

• Other methods - by measuring VO2 Max using

exercise on bicycle ergometer or tread mill
Take your record book ….

Grading of Physical fitness using Harvard step test

Your physical fitness index = 100 x test duration in seconds

(Harvard step test) 2 x (total heart beats in the recovery periods)

eg: 100x5x60 = 78.94

2x 190
• Thank You
 Isotonic Exercises
1. Jogging
- Spot jogging for 3 mins
- Immediately, sit down and record pulse rate for 10
sec’s and BP recording

2. Harvard step test

Will be demonstrated in each group

3. Bicycle ergometer