• The effect of beta blockers on heart rate response during the Chester Step Test

      Buckley, John P.; Gilchrest, Joanne (University of ChesterCountess of Chester Hospital, 2011-10)
      The objective of this study is to ascertain that as the intensity of exercise increases through the stages of the Chester Step Test (CST) does the difference between the beta blocked(BB) and the non beta blocked(NBB) participants heart rate(HR) response increase. The study utilised a repeated measures design. Twenty males with a mean age of 58.9 (±6.1) taking Beta Blocker medication completed the CST on two occasions within one week of another. A further Seven males and thirteen females with mean age 61.5 (± 6.3) who were not taking Beta Blockers data from previous study data using the Chester Step Test was used to compare the HR and Rating of Perceived Exertion(RPE) responses at each stage of the CST. Each stage of the CST lasted two minutes after which HR and RPE were collected until the participant achieved 80% of predicted Maximum Heart Rate or RPE 15. HR was significantly different between the two groups at each stage of the CST p=<0.05. RPE was significantly different between the two groups at each stage of the CST p=<0.05. Limits of Agreement suggested test-re-test reliability of the CST for BB participants with the worse case HR being 11bpm above the mean in the final stage of the CST. The data suggests that as intensity of exercise increases as does the difference between the BB and NBB HR response. The data implies there may be some sex differences which will need investigating further. RPE was shown to be significantly different between the two groups. The data also showed that the CST is reliable for participants taking BB.
    • An intergroup analysis investigating the effects of holding a side handrail support on oxygen uptake values during the completion of the Chester Step Test

      Buckley, John P.; Reid, Graham (University of Chester, 2012-01-03)
      This dissertation investigates what effects a side handrail support has on oxygen uptake during the completion of the Chester Step Test (CST) in younger healthy individuals, older healthy individuals and in cardiac patients who are participating in a cardiac rehabilitation programme. This study was an intergroup analysis project which collaborated with two other University of Chester MSc research projects. Fifteen young healthy participants (5 males, 10 females), ten older healthy participants (3 males, 7 females) and seven cardiac patients (7 males, 0 females) were recruited for this study. The study followed a repeated measures design. The younger healthy participants completed three test protocols; performing the CST hands free, holding onto a side handrail with one hand and holding onto a side handrail with two hands. Due to time limitations, the older healthy participants and cardiac patients completed two CSTs; hands free and holding onto a side handrail with one hand. Oxygen uptake ( O2), heart rate (HR), metabolic equivalents (METs) and ratings of perceived exertion (RPE) were recorded at each stage of the CST. The exercise test was terminated if the participant: managed to complete all five stages of the CST, appeared to be stressed and indicated that they wanted to stop, reached their target heart rate point of 80% HR maximum or recorded an RPE value ≥ 15. Results: In all three testing groups, handrail support was found to have no statistically significant effects (p < 0.05) on O2 values at each stage of the CST. Handrail support was also found to have no statistically significent effects (p < 0.05) on MET, HR and RPE values in the three testing groups at each stage of the CST. The majority of participants found that handrail support made the test feel easier with 93% of the healthy young individuals, 57% of the older healthy participant group, and 86% of the cardiac patients stating that they preferred the test when handrail holding was allowed in comparison to hands free. Conclusion: In accordance with the findings by Barnett (2010), the current study found that handrail support had no statistically significant effect on oxygen uptake values when individuals performed the CST. Results from the current study provide encouraging support for the use of a side handrail support during the CST when testing both healthy individuals and cardiac patients in a cardiac rehabilitation setting.
    • Reliability of the incremental shuttle walk test and the Chester step test in cardiac rehabilitation

      Fallows, Stephen; Reardon, Melanie (University of Chester, 2008-09)
      Background: Cardiac Rehabilitation at Southport and Ormskirk NHS Trust has been in operation since 1998 and is carried out on two different sites. The latter has a very small exercise area and at this site the Chester Step Test (CST) is used to measure changes in exercise capacity after an eight week exercise programme and also to prescribe exercise for that patient. The former site has a much larger exercise area and historically has always used the incremental shuttle walk test (ISWT) for the same purpose. At both sites a practice test has not been routinely used to familiarise the patient with the test although anecdotally this seemed to show a difference in results. The results of performing a practice test would be analysed to look at the reliability. Objective: To evaluate the reliability of the Incremental Shuttle Walk Test (ISWT) and the Chester Step Test (CST). To compare results from the Incremental Shuttle Walk Test (ISWT) and the Chester Step Test (CST) as measures of change in exercise capacity in patients following an 8-week, hospital-based cardiac rehabilitation exercise programme. Setting: Gymnasia at Southport & Ormskirk NHS Trust. Methods: 33 subjects (26 males and 7 females, mean age 57.3) attended an 8-week cardiac rehabilitation exercise programme. All were assessed using ISWT and CST on three separate occasions: firstly at the patient assessment appointment prior to attendance at the programme, secondly on commencement of the programme (within one week of the first test) and thirdly during the final session of the programme. Both ISWT and CST tests were performed on the same day with a rest period of at least 20 minutes between them, to allow the heart rate to return to normal. The patients were taken to either 80% of their maximum heart rate or RPE 15. The ISWT distance walked in metres was measured. The CST measures predicted VO2max which was worked out by plotting the heart rates on the appropriate graph. Results: The results demonstrated the ISWT showed an element of learning, there was a difference between the practice test and that carried out on the first session of the cardiac rehabilitation exercise programme. The difference between the practice test and the final test carried out after the eight week programme was 125.2m, and between the baseline test and final test was 74.3m, there was therefore an increase of 50.9m within one week. The CST did not show the same element of learning and the results from the two tests carried out within one week did not show a significant difference. The results also showed that the ISWT and the CST showed no significant difference in the percentage increase of parameters measured between the two tests. ISWT showed mean improvement of 21.3% whilst CST showed a mean improvement of 24.7%. The O2 Pulse showed a difference between the two tests, it did not improve in the ISWT but did in the CST. Conclusion: The ISWT requires a practice test to familiarise the participant with the running of the test whereas the CST does not. The ISWT and CST, in this study, showed no significant difference between the two tests in percentage increase of meters (ISWT) and predicted VC>2max (CST) measured and could be used on the two different sites to show changes in exercise capacity. The Patients preferred the ISWT. Relevance to practice: The CST can be used where space and/or time are limited. A practice test at the assessment to attend the cardiac rehabilitation would be performed for the ISWT to familiarise the patients with the test but not for the CST.