Modified Harvard Step Testing within a Clinic Setting Enables Exercise Prescription for Cancer Survivors

Purpose To evaluate the utility of modified Harvard Step tests within the context of a comprehensive physical examination for fitness evaluation and exercise prescription for cancer survivors. Methods A retrospective chart review of initial cancer survivor clinic visits over a ten-year period (n=169) was conducted to evaluate correlations between demographic factors, clinical characteristics, step and strength test performance, and exercise prescriptions. Results Clinic population was 94% female, aged 27-79 years, predominantly breast cancer (87%), presenting within two years of cancer diagnosis with current exercise history significantly less vigorous than past exercise (p=0.00; 34% sedentary). Fifty-two percent completed a 3-minute-9-inch step test at pace (96 steps per minute). Fourteen percent required slower self-pacing, 12% both a slower pace and shortened time, and 5% a flat test. Younger age (p=0.04) and more vigorous exercise histories (p<0.04) correlated with ability to complete the at pace test but all formats led to exercise prescriptions more vigorous than current activity (p<0.0002). Stratified fitness ratings using YMCA normative data yielded associations between higher fitness levels and lower BMI (F(1,86)=4.149, p<0.05), office pulse (F(1,87)=7.677, p<0.05), and systolic blood pressure (F(1,18)=6.58, p<0.05). Conclusions Office-based fitness evaluation with a panel of modified step test options accommodating different baseline fitness levels enabled personalized exercise prescriptions more vigorous than current activity. Implications for Cancer Survivors Cancer patients frequently engage in less vigorous activity as they enter into survivorship. Modified step tests are a means for office-based evaluation of cardiovascular fitness within the context of a comprehensive physical examination.