The Harvard Step Test is used to measure a client’s aerobic fitness as a predictive test of their VO2max. It tests the cardiovascular system and reflects the body’s general ability to cope with and recover from an increased physical workload .
This test is easy to perform and requires minimal equipment. Participants walked at a pace of 30 steps per minute for 5 minutes or until exhaustion. There are many other variations of the ladder test. 
It was originally developed for physical fitness testing by military personnel, but has since been used by civilian individuals as well . The step test can be performed in children  adolescents  adults  and athletes . See re-modified testing and usage below.
Equipment Required: Pedal or Platform (Men: 20″/50.8cm Female: 16″/40cm) Stopwatch Metronome or Rhythm Belt.
- Explain the testing procedure and sign the consent form
- Recording anthropometric data
- Individual should rest/sit down for 3-5 minutes
- Resting Heart Rate is measured
Clients walk up and down steps at a rate of 30 steps per minute (one second up and one second down) for 5 minutes or until exhaustion. Burnout is defined as the client’s inability to maintain pace for 15 consecutive seconds.
Clients sit down immediately after completing the test and count their heartbeat totals 1 to 1½ minutes after completion, 2 to 2½ minutes after completion, and 3 to 3½ minutes after completion.
The client’s heartbeat is counted by feeling the pulse on the client’s wrist .
Fitness Index Scoring
Scoring: The customer’s health index score is then determined by the following equation.
Fitness Index = (100 x test duration in seconds) divided by (2 x sum of recovery heartbeats).
For example, if the total test time was 300 seconds (if the client completed the full 5 minutes) and their heartbeats were 90 between 1-1½ minutes, 80 between 2-2½ minutes, and 70 between 3-3½ minutes Then the fitness index score is: (100 x 300) / (240 x 2) = 62.5. 
RatingFitness Index> 96Excellent83-96Good68-82Average54-67Low Average< 54Poor
The Harvard Step Test is a fitness assessment tool. Since the original development of the Harvard ladder test used to evaluate recruits during World War II, the basic technique has been evaluated with different modifications and successfully applied in different settings. E.g:
- The Modified Harvard Step Test is a modification of the original Harvard Step Test to make it easier to administer across all age groups. The height of the steps/platforms in the apparatus has been changed to 30 cm, and the rest of the protocol remains the same.
- YMCA Develops Age- and Gender-Adjusted Criteria for Fitness Ratings for the One-Minute Pulse Recovery Criteria in the 12-Inch 3-Minute 96 Steps/Minute Format
- A modified Harvard ladder test for health assessment in cancer survivors. Use the 9-inch step test height and the option to self-adjust at a slower rate and/or stop the test three minutes before. 
- The Tecumseh ladder test is a modified version of the Harvard ladder test. The main differences from the original protocol are a lower step height (8 inches instead of 20 inches), a more moderate pace (24 steps/min instead of 30), and a shorter duration (3 minutes instead of 5 minutes) . These Changes made the test easier to perform and suitable for epidemiological studies .
This 4 3/4 minute video summarizes the Harvard ladder test protocol:
Validity & Reliability
- Effectively predicts VO2 max and showed test-retest reliability in a study of college students .
- In a study of adolescents, reliability was acceptable at ICC = 0.6 .
- ↑ Brouha L. The step test: A simple method of measuring physical fitness for muscular work in young men. Research Quarterly. American Association for Health, Physical Education and Recreation. 1943 Mar 1;14(1):31-7.
- ↑ Top end sports Harvard Step Test Available:https://www.topendsports.com/testing/tests/step-harvard.htm (accessede 8.4.2022)
- ↑ https://en.wikipedia.org/wiki/Lucien_Brouha
- ↑ Sandstedt E, Fasth A, Eek MN, Beckung E. Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial. Pediatric Rheumatology. 2013 Dec;11(1):1-1.
- ↑ Jump up to:5.0 5.1 Toumpakari Z, Jago R, Howe LD, Majid HA, Papadaki A, Mohammadi S, Jalaludin MY, Dahlui M, Nahar Azmi Mohamed M, Su TT, Johnson L. Cardiometabolic risk factors and physical activity patterns maximizing fitness and minimizing fatness variation in Malaysian adolescents: a novel application of reduced rank regression. International journal of environmental research and public health. 2019 Jan;16(23):4662.
- ↑ Marshall AR, Rimmer JE, Shah N, Bye K, Kipps C, Woods DR, O’Hara J, Boos CJ, Barlow M. Marching to the Beet: The effect of dietary nitrate supplementation on high altitude exercise performance and adaptation during a military trekking expedition. Nitric Oxide. 2021 May 27.
- ↑ Quinto G, Neunhaeuserer D, Gasperetti A, Battista F, Foccardi G, Baioccato V, Gobbo S, Bergamin M, Ermolao A. Can exercise test intensity and modality affect the prevalence of arrhythmic events in young athletes?. Research in Sports Medicine. 2021 Jun 5:1-9.
- ↑ Jump up to:8.0 8.1 PT direct Harvard Step Test Available:https://www.ptdirect.com/training-delivery/client-assessment/harvard-step-test-a-predictive-test-of-vo2max (accessed 8.4.2022)
- ↑ White KR, Lu J, Ibrahim Z, Furth PA. Modified Harvard Step Testing within a Clinic Setting Enables Exercise Prescription for Cancer Survivors. medRxiv. 2020 Jan 1.Available:https://www.medrxiv.org/content/10.1101/2020.09.30.20204776v1.full (accessed 8.4.2022)
- ↑ Wiki Tecumseh step test Available:https://en.wikipedia.org/wiki/Tecumseh_step_test#cite_note-1 (accessed 8.4.2022)
- ↑ Stacie. Harvard Step Test. Available from: https://youtu.be/mekPTS_LVv4 [last accessed 28/11/2021]
- ↑ Soliman Ismail W. Evaluating the validity and reliability of Harvard step test to predict VO2max in terms of the step height according to the knee joint angle. Journal of Applied Sports Science. 2011 Jul 1;1(2):126-32.
- ↑ Domaradzki J, Cichy I, Rokita A, Popowczak M. Effects of tabata training during physical education classes on body composition, aerobic capacity, and anaerobic performance of under-, normal-and overweight adolescents. International Journal of Environmental Research and Public Health. 2020 Jan;17(3):876