Symbolic representation of COPD patient climbing stairs at different paces.

COPD Exercise: Is a Slower Step Test the Key to Better Endurance?

Lena Voss in Health & Wellness December 2025 • 4 min read.

"Research reveals how adjusting the pace of step tests can significantly impact exercise tolerance for individuals with Chronic Obstructive Pulmonary Disease."

For individuals with Chronic Obstructive Pulmonary Disease (COPD), reduced functional capacity is a significant challenge, impacting their ability to perform daily activities and overall quality of life. Assessing exercise tolerance becomes a crucial part of managing COPD, helping healthcare professionals tailor pulmonary rehabilitation programs to meet individual needs.

Field tests, such as the step test, have become popular due to their low cost, simplicity, and portability. These tests can be self-paced or externally paced, offering different ways to measure a patient's functional capacity. The Chester step test (CST), an externally paced incremental test, has been widely used, but its intensity may be difficult for some COPD patients.

A recent study compared the standard Chester step test (CST) with a modified incremental step test (MIST) to determine which method provides a better assessment of exercise tolerance in COPD patients. The findings shed light on how adjustments in the step rate and increment size can significantly affect a patient's ability to complete the test and achieve maximum benefits.

Decoding the Step Test: How Pace Impacts Performance

Symbolic representation of COPD patient climbing stairs at different paces.

The research involved 32 COPD patients who underwent both the CST and MIST tests on the same day. The CST follows a rhythm of 15 steps per minute, increasing every two minutes, while the MIST starts at a slower pace of 10 steps per minute, with smaller increments. Throughout both tests, researchers continuously measured pulmonary gas exchange using a portable metabolic system.

The study revealed that participants were able to continue the modified incremental step test (MIST) for a longer duration and completed more steps than during the Chester step test (CST). Despite these differences, both tests resulted in similar cardiopulmonary responses at peak exercise. Data indicated that the slower work rate increment during the MIST led to a higher exercise tolerance among the COPD patients.

Longer Duration: MIST allowed participants to exercise for a more extended period.
More Steps: Participants completed a higher number of steps with MIST.
Equivalent Peak Responses: Both tests yielded similar cardiopulmonary stress levels at peak exercise.

The findings suggest that a slower, more gradual increase in work rate during a step test may be better tolerated by individuals with COPD. This approach allows patients to exercise for longer periods, potentially leading to greater improvements in their functional capacity. The MIST provides a valuable alternative for assessing exercise tolerance and tailoring rehabilitation programs.

The Future of COPD Exercise Testing

This research underscores the importance of personalized exercise assessments for individuals with COPD. By adjusting the intensity and pace of step tests, healthcare professionals can better accommodate the unique needs and limitations of each patient, optimizing their rehabilitation outcomes.

The modified incremental step test (MIST) offers a promising alternative to the standard Chester step test (CST), particularly for patients who struggle with higher intensity exercise protocols. Its slower, more gradual approach can improve exercise tolerance and encourage greater participation in pulmonary rehabilitation programs.

Further studies are needed to explore the long-term benefits of MIST and its potential to enhance the effectiveness of exercise training in COPD patients. By continuing to refine and personalize exercise assessments, we can empower individuals with COPD to live more active, fulfilling lives.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4187/respcare.01742, Alternate LINK

Title: Comparison Of Cardiopulmonary Responses During 2 Incremental Step Tests In Subjects With Copd

Subject: Critical Care and Intensive Care Medicine

Journal: Respiratory Care

Publisher: Daedalus Enterprises

Authors: Carlos Henrique Silva De Andrade, Anderson Alves De Camargo, Brenda Pitman De Castro, Carla Malaguti, Simone Dal Corso

Published: 2012-11-01

Everything You Need To Know

What is the Chester step test (CST), and why might it be difficult for some people with Chronic Obstructive Pulmonary Disease (COPD)?

The Chester step test (CST) is an externally paced incremental test commonly used to assess exercise tolerance. However, its intensity might be too challenging for some COPD patients. The modified incremental step test (MIST) offers an alternative by starting at a slower pace with smaller increments, potentially making it more manageable for individuals with Chronic Obstructive Pulmonary Disease.

How does the modified incremental step test (MIST) improve exercise tolerance in individuals with Chronic Obstructive Pulmonary Disease (COPD) compared to the Chester step test (CST)?

The modified incremental step test (MIST) allows individuals to exercise for a longer duration and complete more steps compared to the Chester step test (CST). Despite these differences, both tests result in similar cardiopulmonary responses at peak exercise. This suggests that the MIST's slower work rate increment enables higher exercise tolerance among COPD patients without compromising the intensity of the exercise.

What's the fundamental difference between the standard Chester step test (CST) and the modified incremental step test (MIST) mentioned?

The key difference lies in the pace and increment size. The Chester step test (CST) follows a rhythm of 15 steps per minute, increasing every two minutes. In contrast, the modified incremental step test (MIST) starts at a slower pace of 10 steps per minute, with smaller increments. This slower, more gradual increase in work rate during the MIST appears to be better tolerated by individuals with Chronic Obstructive Pulmonary Disease.

What are the implications of using the modified incremental step test (MIST) in pulmonary rehabilitation for Chronic Obstructive Pulmonary Disease (COPD) patients?

Using the modified incremental step test (MIST) to assess exercise tolerance allows healthcare professionals to design pulmonary rehabilitation programs tailored to the individual needs and limitations of each patient with Chronic Obstructive Pulmonary Disease. By adjusting the intensity and pace of the step test, it can optimize rehabilitation outcomes, leading to greater improvements in their functional capacity and overall quality of life.

Beyond the Chester step test (CST) and the modified incremental step test (MIST), are there other potential avenues for research in COPD exercise testing, and what questions remain unanswered?

While the study focuses on the Chester step test (CST) and the modified incremental step test (MIST), other field tests exist, and further research could explore how other variations of step tests or different types of exercise assessments compare in assessing and improving exercise tolerance in COPD patients. Additionally, future studies could investigate the long-term effects of using the MIST in pulmonary rehabilitation programs and its impact on patients' daily lives and disease progression.