Assessing Maximal Oxygen Uptake: Influence of Leg Length in the
Harvard Step Test and Queen’s College Step Test
JIN-SEOP KIM, JONG-SEON OH, SEONG-GIL KIM*
Department of Physical Therapy,
Sun Moon University,
Chungnam 31460, Republic of Korea,
SOUTH KOREA
*Corresponding Author
Abstract: - Maximal oxygen uptake (VO2max) indicates cardiovascular endurance in evaluating overall health
and physical performance. The CPX method is accurate, but accessibility is lower due to issues related to cost
and complexity. For this reason, the Harvard Step Test and Queen's College Step Test are drawing interest.
Step-based tests are influenced by factors such as leg length, requiring an investigation into the correlation
between leg length and VO₂max estimation using these methods. This study investigates the influence of leg
length on predicted VO₂max (pVO2max) determined through both the Harvard Step Test and the Queen's
College Step Test. The assessment of VO2max was carried out using CPX on a treadmill. Measurements were
obtained through the Harvard Step Test and Queen's College Step Test on steps. The participants were
informed about the experimental procedure, and the experiment was conducted 24 hours later. The experiment
maintained controlled conditions, and each measurement was conducted as a single trial, repeated three times
for accuracy. The study found a significant positive correlation (r = 0.595, P < 0.05) between CPX VO2max
and lower leg length. Lower leg length was found to significantly influence exercise intensity as determined by
both the Harvard Step Test pVO2max (explaining 35.4% of the variance, P < 0.05) and the Queen's College
Step Test pVO2max (explaining 30% of the variance, P < 0.05). It is recommended to adjust the step height to
the individual's body size when estimating exercise difficulty or pVO2max using step-based exercises.
Key-Words: - pVO2max, CPX, Harvard step test, Queen's step test, Leg Length, Tibia Length
Received: August 29, 2023. Revised: February 15, 2024. Accepted: March 16, 2024. Published: May 23, 2024.
1 Introduction
Maximal Oxygen Uptake (VO2max) is a key
measure of cardiovascular endurance, reflecting the
body's utmost capacity to consume oxygen during
intense exercise. It serves as an essential indicator of
overall health and physical performance,
highlighting the maximal capacity of the
cardiovascular system, [1].
The exercise load is paramount in assessing
VO2max. It denotes the level of stress the body
undergoes during exercise and impacts the accuracy
of VO2max. Despite ongoing increases in exercise
load, the cessation of oxygen uptake increases
marks the endpoint for the measurement process.
Cardiopulmonary Exercise Testing (CPX) utilizes
this methodology to ascertain maximum oxygen
consumption, featuring gradual increases in load,
[2].
The CPX VO2max method is the most accurate,
but it has the limitation of requiring expensive
equipment. Accordingly, there is an increasing
demand for strategies that can easily measure an
individual's cardiorespiratory endurance, [3], [4], [5].
There has been a need in the past for a method to
measure cardiorespiratory endurance or measure
predicted VO2max (pVO2max) related to
cardiorespiratory endurance without high costs. The
methods for assessing pVO2max were initially used
to select military candidates. Cardiopulmonary
endurance has evolved to become a measure of
health, [6]. The Harvard Step Test and the Queen's
College Step Test have also evolved into essential
indicators of health, [7], [8], [9]. The Harvard step
test is a method designed to measure heart rate. It is
an evaluation method that checks recovery speed by
measuring heart rate while sitting immediately after
5 minutes of up and down exercise, [8], [9]. Queens
College step test calculates resting heart rate and
85% of maximum heart rate after exercise. It is
conducted at 22 steps/min for 3 minutes and is a
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widely used evaluation method due to its low
height, slow speed, and short exercise time
compared to other step tests, [10], [11].
pVO2max measurement methods using steps can
be affected by various parameters. Factors such as
an individual's walking habits, similar stride length,
and gait, as well as body-related factors like leg
length, [11], [12] and leg length discrepancy, [13],
can influence the accuracy of the results. Based on
prior studies, pVO2max measurements can vary
depending on the height of the step box, [14] and
the comfort level while stepping on the box can also
affect pVO2max measurements, [15].
The Step Test can result in variations between
individuals of different heights due to its fixed
height nature, [16]. One method to address this issue
is the Modified Queen's College Step Test, which
customizes the step height based on individual body
size, [17]. Studies have suggested that individual
body size affects the exercise load and VO2max
when using steps. The extent of this relationship has
not been established. To address this gap, there is a
need to analyze the relationship between body size
and pVO2max using steps. Therefore, this study
aims to investigate the influence of leg length on
pVO2max measured using the Harvard Step Test
and the Queen's College Step Test.
2 Subjects and Methods
2.1 Subjects
The study selected young men in their 20s who
reside in City A in South Korea. The required
sample size was determined using G*Power 3.1.9.7
(Heine Heinrich University, Düsseldorf, German),
assuming a significance level (α) of 0.05, a power of
0.80, and an effect size of 0.6 based on previous
research. The sample size for correlation analysis
was 17 participants. Considering potential dropout
rates during the experimental measurements, 20
participants were recruited (Table 1).
Table 1. General characteristics of subjects
Variable
N=18
Age(year)
22.17±2.66a
Height(㎝)
173.89±5.41
Weight(㎏)
69.59±5.80
upper leg length(cm)
38.28±3.32
lower leg length(cm)
40.22±3.20
Mean ± SD
The criteria for selecting research participants are
as follows: Males in their twenties. Individuals
without significant impairment in vision or
somatosensation that could affect the experiment.
Individuals without lower limb pain could affect the
experiment during its execution. Individuals are not
taking medication related to muscle strength or
mental disorders—individuals without heart or lung
diseases.
By the ethical standards outlined in the Helsinki
Declaration, all participants were provided with a
comprehensive explanation of the general details
regarding the purpose and procedures of this study
before the experiment. They voluntarily agreed to
participate in the experiment.
This study was performed with 18 (M) college
students attending S University in Chung-
cheongnam-do. The age was 22.17 ± 2.66 years;
height was 173.89 ± 5.41 cm, and body weight was
69.59 ± 5.80 kg.
2.2 Study Protocol
Before conducting the experiments, the participants
were instructed about the procedures, and
measurements of height, age, weight, and leg
lengths (both upper leg length and lower leg length
measured from the patella) were obtained. Upper
and lower leg lengths were measured using the
landmark according to Standards for Anthropometry
Assessment, [18].
Each participant performed VO2max
measurements using CPX equipment while running
on a treadmill during the experiment. pVO2max was
measured using the Harvard Step Test and the
Queen's College Step Test, both performed using
steps.
Before the experiments, participants received
thorough explanations from researchers and were
allowed to practice. To ensure adequate rest
between different types of tests, a 24-hour break
was provided after each examination.
The laboratory environment was maintained at a
temperature of 23 degrees Celsius and 50%
humidity, [19]. The research was conducted in a
calm environment to minimize the influence of the
sympathetic nervous system. Each measurement
was performed three times, and the average value
was used. All measurement results are presented as
mean ± standard deviation.
2.3 Harvard Step test’s and Queen`s College
Step Test’s pVO2max
Before commencing the Harvard Step Test and the
Queen's College Step Test, the participants practiced
stepping to the rhythm of each step test’s
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metronome for 20 seconds. Then, they rested for 5
minutes while seated in a chair. After the rest
period, the test was conducted, and at the 15-second
mark immediately following the test, the heart rate
was measured using oximetry (finger pulse
oximeter, IlJin Medical, Korea). The measured heart
rate was then used in the (1) to calculate pVO2max,
[8].
VO2max(males) = 111.3 – (0.42 * HR) (1)
For the Harvard Step Test, participants
performed the stepping movement on the step box
for a maximum of 5 minutes at a rate of 120
steps/min, corresponding to 60 steps per minute,
synchronized with a metronome. The test continued
until either the 5-minute duration was completed or
the participant voluntarily discontinued due to
fatigue. The step box's height was 50.8 cm, [6].
In the Queen's College Step Test, the step box
was set at a height of 41.27 cm, and participants
repeated the stepping movement for 3 minutes at a
metronome rate of 22 steps/min, [11].
2.4 CPX VO2max
The CPX VO2max were measured using the Bruce
protocol on a motorized treadmill (Quinton TM 55
Treadmill, Cardiac Science, US).
Participants were equipped with a standard 12-
lead electrocardiogram and put on a mask covering
their nose and mouth. A metabolic cart (TrueOne
2400, Parvo Medics, US) was utilized to measure
Oxygen consumption, and heart rate was
continuously monitored through an electronic
monitor (Tango M2 stress test monitor, Sun Tech
Medical, US). The protocol was deemed complete
when participants met the following three
conditions, indicating maximum exercise capacity:
1) Respiratory Exchange Ratio (RER) > 1.1, 2)
Maximal Heart Rate (HRmax) not less than 15 beats
below the predicted maximum Heart Rate (HRmax
= 220 – age), 3) Levelling off of VO2 despite an
increase in workload, [2]
2.5 Statistical Analysis
For the data analysis in this study, SPSS for
Windows (version 22.0) was employed. Descriptive
statistics were used to obtain the typical
characteristics of the participants.
The Pearson correlation coefficient was utilized
to investigate the correlation between height, upper
leg length, lower leg length, and VO2max measured
using CPX. To understand the impact of these
variables on static balance ability, simple linear
regression analysis was employed.
Before performing the simple linear regression
analysis, the selection of variables for analysis was
determined through the Pearson correlation
coefficient. The statistical significance level was set
at α = .05.
3 Result
3.1 Correlation between Exercise Intensity
Using CPX VO2max and Upper Leg Length,
Lower Leg Length, and Height
A significant positive correlation was found
between CPX VO2max and lower leg length (r =
0.595, P < 0.05). However, no significant
correlations were observed with the other variables
(P > 0.05) (Table 2).
Table 2. Correlation between Exercise Intensity
Using CPX VO2max and Upper Leg Length, Lower
Leg Length, and Height
Height
upper leg
length
lower leg
length
173.47±
5.41
38.28±
3.32
40.22±
3.20
0.376
0.060
0.595**
0.124
0.814
0.009
Mean±SD, *p<.05, **p<.01
3.2 Simple Linear Regression Analysis
Results for Lower Leg Length and
Exercise Intensity using the Havard
Step Test pVO2max
A simple linear regression analysis was conducted
after confirming a significant correlation between
exercise intensity using Havard Step Test pVO2max
and lower leg length. The results of a simple linear
regression analysis where the independent variable,
X, represents the lower leg length(measured in
centimeters) and the dependent variable, Y,
represents the pVO2max value obtained from the
Havard Step Test(measured in ml/kg/min). The
analysis demonstrated an explanatory power of
35.4%, indicating that lower leg length significantly
influenced exercise intensity using the Havard Step
Test pVO2max (P < 0.05).
The regression equation is (2) suggesting that as
lower leg length increases, exercise intensity using
Havard Step Test pVO2max decreases (Table 3).
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Y = 0.935X + 84.88, (2)
Table 3. Simple linear regression analysis results of
Tibia length on exercise intensity using the Harvard
Step Test’s pVO2max
R2
B
Significance ( p )
Constant
0.354
84.88
0.000**
Lower leg
length
0.935
0.009**
Regression
equation
Y= 0.935 X + 84.88
Mean±SD, *p<0.05,** p<0.01
3.3 Simple Linear Regression Analysis
Results for Lower Leg Length and
Exercise Intensity Using Queen's
College Step pVO2max
A simple linear regression analysis was performed
following the identification of a significant
correlation between exercise intensity using Queen's
College Step pVO2max and lower leg length. The
results of a simple linear regression analysis where
the independent variable, X, represents the lower leg
length(measured in centimeters) and the dependent
variable, Y, represents the pVO2max value obtained
from the Queen's College Step Test(measured in
ml/kg/min). The analysis demonstrated an
explanatory power of 30%, indicating that lower leg
length significantly influenced exercise intensity
using the Queen's College Step pVO2max (P <
0.05).
The regression equation is (3) suggesting that as
lower leg length increases, exercise intensity using
Queen's College Step pVO2max decreases (Table
4).
Y = 0.836X + 79.05 (3)
Table 4. Simple linear regression analysis results of
Tibia length on exercise intensity using Queen's
College step test’s pVO2max.
R2
B
Significance ( p )
Constant
0.300
79.05
0.000**
lower leg
length
0.836
0.019*
Regression
equation
Y= 0.836 X + 79.05
Mean±SD, *p<0.05, **p<0.01
4 Discussion
In this study, we conducted an investigation of the
correlation between VO2max measured through
CPX, height, and leg length. Additionally, we
analyzed the impact of leg length on equations
based on widely used clinical tests, the Harvard Step
Test and Queen's College Step Test.
The first result demonstrated a significant positive
correlation between the VO2max and the lower leg
length. Various studies have investigated the impact
of leg length on oxygen consumption and exercise
performance, emphasizing that longer lower leg
lengths correlate with higher VO2max among long-
distance runners, which is noteworthy, [20]. An
increase in VO2max indicates enhanced endurance,
[21], [22]. Additionally, research has shown that
longer bone lengths in the lower limbs are positively
associated with running performance and contribute
to performance improvements in activities like
jumping due to enhanced neuromuscular activation
and biomechanical adaptations, [23], [24].
Moreover, research indicates a strong positive
correlation between lower limb length and
maximum walking speed, emphasizing its
significance in performance and walking, [25].
Studies not considering VO2max have shown that
longer leg lengths are associated with improved
exercise performance. From the perspective of
exercise efficiency, these findings could support the
positive correlation between lower leg length and
VO2max, as observed in our findings. However, the
absence of a significant correlation between
VO2max and upper leg length or height suggests
that, aside from leg length, various factors such as
individual exercise patterns, gait, walking speed,
and stride length can influence energy consumption
and exercise efficiency, [13].
In the regression analysis for pVO2max using the
Harvard step test and the Queen's College step test,
it was observed that as lower leg length increased,
pVO2max values also increased. Notably, in the
Harvard Step Test, the B value was 0.935,
indicating a more significant influence on lower leg
length. This result is attributed to the higher step
height used in the Harvard Step Test than the
Queen's College step test, [6], [11]. In the Harvard
Step Test, where the step height is higher,
individuals with shorter lower leg lengths may face
increased difficulty in performance compared to
those with longer lower leg lengths. This introduces
a potential issue of performance difficulty due to the
difference in step height.
Previous studies, such as the one conducted by
Shahnawaz with ten male participants, set the step
box height to 30-60% of the participants' lower leg
length and observed a trend where lower step box
heights were associated with higher VO2max, and
conversely, higher step box heights were associated
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with lower VO2max values, [16]. In a study by [15]
using the Queen’s College Step Test, the height of
the step box was adjusted based on the knee angle.
Higher VO2max values were observed when the
knee angle was 60° compared to angles exceeding
90°. It indicates that a knee angle of 60° was
associated with more manageable difficulty levels
[15]. These previous research findings align with
our study results, providing support for our findings.
Individual body sizes highly influence methods
using a fixed step height to estimate exercise
difficulty or VO2max. For individuals with
significant differences in body size, it is
recommended to use methods that involve adjusting
the step height to accommodate these variations. In
conclusion, customizing the step height based on
individual body size is recommended when
estimating exercise difficulty or VO2max through
stepping exercises. Because step height varies
among individuals, it is essential to develop new
methodologies to estimate cardiorespiratory
capacity unaffected by the step box. This allows for
a more personalized and accurate assessment of
cardiopulmonary function.
This study has several limitations. It only
explored methods utilizing steps to assess the
impact of individual body size on exercise load
differences, and the sample size of the participants
is limited. Future research should address these
limitations to conduct more comprehensive studies
related to VO2max.
Acknowledgement:
We would like to express our gratitude to all
participants for their cooperation and dedication to
the study. Additionally, we appreciate the support
provided by the research team and the conducive
laboratory environment.
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Please, indicate the role and the contribution of
each author:
- Jin-Seop Kim has conceptualized the research
framework and providing the overarching research
direction and guidance.
- Seong-Gil Kim organized and executed the
experiments.
- Jong-Seon Oh was responsible for the Statistics.
Sources of Funding for Research Presented in a
Scientific Article or Scientific Article Itself
No funding was received for conducting this study.
Conflict of Interest
The authors have no conflicts of interest to declare.
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