Validation of a Novel Incremental Step Test for Assessment of Cardiopulmonary Fitness and Ventilatory Thresholds in Adults (VALID-IST)

September 14, 2026 updated by: David King, Heriot-Watt University
The purpose of this single-group diagnostic validation and test-retest reliability study is to determine whether a novel Incremental Step Test (IST) can accurately assess cardiorespiratory fitness and ventilatory thresholds in healthy adults compared with an established laboratory-based cycle ergometer Cardiopulmonary Exercise Test (CPET). The main questions are whether the step test can elicit reliable physiological responses sufficient to identify the anaerobic threshold and respiratory compensation point, and whether it produces reproducible results when repeated under standardised conditions. The study will compare the incremental step test (IST) with CPET to assess whether the IST provides similar peak and submaximal physiological measures and agreement with CPET comparator. Participants will complete three laboratory exercise tests across separate visits: one maximal CPET on a cycle ergometer, followed by two repeated ISTs performed on a 25 cm step board following the audio metronome.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Enrolling by invitation

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Participants will attend three laboratory visits separated by at least 3 days and conducted at similar times of the day. The first visit will include screening, anthropometric assessment, and a maximal CPET on an electronically braked cycle ergometer using a ramp protocol of 25 W/min for males and 20 W/min for females. Participants will complete 3 minutes of unloaded cycling followed by incremental protocol while maintaining the cadence at least 60 rpm, and the test will be terminated if they can no longer can sustain this cadence. Following CPET, participants will complete a 6-minute familiarisation session to practise the stepping activity, including the up-up-down-down stepping technique and alternation of the leading leg every 2 minutes. The second and third visits will involve repeated IST trials performed on 25 cm step board, with cadence progressed from 20 beats per minute and increased by 4 beats per minute every 20 seconds until volitional exhaustion. The IST will be terminated if the participant is unable to maintain the prescribed stepping rhythm for more than 15 seconds. Continuous breath-by-breath gas exchange, ECG, and heart rate monitoring will be used during testing to characterise peak performance and ventilatory threshold responses. Agreement between the step test and CPET, as well as test-retest reproducibility of the IST, will be evaluated to determine whether the new protocol could support more individualised exercise prescription in stepping-based activities.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
      • Edinburgh, United Kingdom, EH14 4AS
        • Oriam Scotlant Performance Centre

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  1. Healthy adults aged 18 to 55 years.
  2. Body mass index between 18.5 and 29.9 kg/m².
  3. Non-smoker.
  4. No known cardiovascular, respiratory, metabolic, neurological, or musculoskeletal conditions that would contraindicate maximal exercise testing.
  5. Able to provide written informed consent.
  6. Willing and able to complete one Cardiopulmonary Exercise Test and two Incremental Step Test sessions.

Exclusion Criteria:

  1. Age younger than 18 years or older than 55 years.
  2. Body mass index below 18.5 kg/m² or above 29.9 kg/m².
  3. Current smoker or use of nicotine products.
  4. Known cardiovascular, respiratory, metabolic, neurological, or musculoskeletal conditions that may affect exercise performance or make maximal exercise testing unsafe.
  5. Any contraindication to maximal exercise testing according to established exercise testing guidelines.
  6. Use of medications known to significantly affect cardiovascular, respiratory, or metabolic responses to exercise.
  7. Current injury, illness, or infection that may limit participation in exercise testing.
  8. Pregnancy.
  9. Inability to provide informed consent.

  10. Inability to complete study procedures or attend all required study visits.

    -

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Incremental Step Test Validation Protocol
Participants will complete one laboratory-based Cardiopulmonary Exercise Test followed by two Incremental Step Test sessions conducted on separate visits. The first visit will include screening, anthropometric measurements, and a maximal incremental CPET on an electronically braked cycle ergometer using an individualised ramp protocol set at 25 W/min for males and 20 W/min for females, after 3 minutes of unloaded cycling. The second and third visits will involve two repeated incremental step tests on a standardised 25 cm step, with cadence starting at 20 beats per minute and increasing by 4 beats per minute every 20 seconds until volitional exhaustion. The CPET will be terminated if participants could not maintain a cadence of at least 60 rpm, and the step test will be terminated if participants could not maintain the prescribed stepping rhythm for 15 consecutive seconds. Exercise ECG, continuous heart rate, and breath-by-breath gas exchange will be recorded during all exercise tests.
Diagnostic test: Cardiopulmonary Exercise Test
A maximal incremental exercise test performed on a cycle ergometer with continuous breath-by-breath gas exchange and heart rate monitoring to assess cardiorespiratory fitness and physiological response
Diagnostic test: Incremental Step Test
A progressive step test using a standardised 25 cm step platform. Participants will complete a 3-minute warm-up at 20 beats per minute before cadence increases by 4 beats per minute every 20 seconds until volitional exhaustion or predefined termination criteria are reached.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Between-method agreement in oxygen uptake at Anaerobic Threshold (AT)
Time Frame: Baseline (Day 1-CPET) and IST assessments at Visits 2 and 3, scheduled at 3-7-day intervals.
Agreement between the Incremental Step Test and the established laboratory-based cycle ergometer Cardiopulmonary Exercise Test comparator for oxygen uptake at Anaerobic Threshold (mL/min), will be assessed using intraclass correlation coefficients and Bland-Altman analysis.
Baseline (Day 1-CPET) and IST assessments at Visits 2 and 3, scheduled at 3-7-day intervals.
Between-method agreement in oxygen uptake at Respiratory Compensation Point (RCP)
Time Frame: Baseline (Day 1-CPET) and IST assessments at Visits 2 and 3, scheduled at 3-7-day intervals.
Agreement between the Incremental Step Test and the established laboratory-based cycle ergometer Cardiopulmonary Exercise Test comparator for oxygen uptake at Respiratory Compensation point / Ventilatory Threshold 2 (mL/min), will be assessed using intraclass correlation coefficients and Bland-Altman analysis.
Baseline (Day 1-CPET) and IST assessments at Visits 2 and 3, scheduled at 3-7-day intervals.
Between-method agreement in Peak Oxygen Uptake (VO2peak)
Time Frame: Baseline (Day 1-CPET) and IST assessments at Visits 2 and 3, scheduled at 3-7-day intervals.
Peak oxygen uptake will be defined as the highest 30-second rolling average value recorded prior to test termination.
Baseline (Day 1-CPET) and IST assessments at Visits 2 and 3, scheduled at 3-7-day intervals.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Test-retest reliability of oxygen uptake at Anaerobic Threshold (AT)
Time Frame: (Day 3-IST Visit 2) and IST Visit 3, scheduled 3-7 days apart.
Test-retest reliability of oxygen uptake at AT (mL/min) derived from the Incremental Step Test (IST) between the first and second IST visits.
(Day 3-IST Visit 2) and IST Visit 3, scheduled 3-7 days apart.
Test-retest reliability of oxygen uptake at Respiratory compensation point (RCP)
Time Frame: (Day 3-IST Visit 2) and IST Visit 3, scheduled 3-7 days apart.
Test-retest reliability of oxygen uptake at RCP (mL/min) derived from the Incremental Step Test (IST) between the first and second IST visits.
(Day 3-IST Visit 2) and IST Visit 3, scheduled 3-7 days apart.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Heriot-Watt University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: David King, BSc, MSc, PhD, Heriot-Watt University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
July 20, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 30, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
October 30, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 8, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 14, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
September 18, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 18, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 14, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • Ref: 2025-12928-16897

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

No individual participant data will be shared publicly. The study will report findings using aggregated and de-identified data. Individual participant data will be retained securely by the research team in accordance with Heriot-Watt University research governance and data protection requirements.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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