A Simple Step Test to Estimate Cardio-Respiratory Fitness Levels of Rheumatoid Arthritis Patients in a Clinical Setting

Abstract

Purpose. Exercise tests represent an important clinical tool to evaluate cardio-respiratory fitness and to predict future adverse cardiovascular events. However, use of such tests in patients with rheumatoid arthritis (RA) is relatively uncommon despite well-established evidence that low exercise capacity and high CVD mortality are features of this disease. Therefore, this study examined the validity and reliability of a sub-maximal step test for use in RA patients. Methods. Thirty patients (24 females) (mean ± SD age 53±10 years) performed a sub-maximal step test on two occasions to estimate the criterion measure of cardio-respiratory fitness (V.O2max). A further maximal cycling test provided a direct fitness measurement (V.O2 peak). Pearson correlation coefficient, intraclass correlation coefficient (ICC), Bland and Altman plots, and 95% limits of agreement (LOA) were used to determine the validity and reliability of the sub-maximal test. Results. Estimated V.O2max correlated well with directly measured V.O2 peak (r=0.79, LoA ±5.7 mL·kg−1·min−1). Test-retest reproducibility for estimated V.O2max was excellent (ICC=0.97, LoA ±2.2 mL·kg−1·min−1). Conclusion. The sub-maximal step test studied here represents a valid and reproducible method to estimate cardio-respiratory fitness in RA patients. This test may be useful for the assessment and management of CVD risk in a clinical setting.