Peak Cardiorespiratory and Metabolic Responses during the Six-Minute Stepper Test in People with COPD: A Pre-Planned Cross-Sectional Ancillary Study
Abstract
BACKGROUND: The six-minute stepper test (6MST) is increasingly used to assess functional exercise capacity in people with chronic obstructive pulmonary disease (COPD). However, the physiological responses elicited during the 6MST and their relationship to those obtained during cardiopulmonary exercise testing (CPET) remain incompletely characterised. RESEARCH QUESTION: How do peak cardiorespiratory and metabolic responses obtained during the 6MST compare with those measured during CPET, and does the 6MST elicit maximal physiological responses? STUDY DESIGN AND METHOD: This pre-planned ancillary cross-sectional study included individuals with COPD who performed incremental CPET and two 6MSTs with breath-by-breath gas exchange analysis. Peak responses as well as symptoms were compared between tests. RESULTS: 1.3 (IQR 0.9 to 1.7) L). Most peak physiological responses were comparable and moderately to strongly correlated between the 6MST and CPET, with marked intraindividual variability in responses. Heart rate and symptom burden were similar to slightly higher during the 6MST, while systolic arterial blood pressure was clinically higher. Peak oxygen uptake corresponded to approximately 60% of predicted values during both tests, and about 10% of participants achieved conventional criteria for maximal cardiac and metabolic exercise during the 6MST. Ventilatory limitation was the predominant limiting factor during both tests. INTERPRETATION: The 6MST elicits substantial but generally submaximal cardiac and metabolic stress, and provides complementary, rather than interchangeable, information to CPET. These findings support the clinical utility of the 6MST while highlighting the need for cautious cardiovascular monitoring. CLINICAL TRIAL REGISTRATION: NCT04008615.
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BibTeX
@article{hinfray2026peak,
title = {{Peak Cardiorespiratory and Metabolic Responses during the Six-Minute Stepper Test in People with COPD: A Pre-Planned Cross-Sectional Ancillary Study}},
author = {Arthur Hinfray and Astrid Vanheule and Adrien Kerfourn and Antoine Cuvelier and Catherine Viacroze and David Debeaumont and Francis-Edouard Gravier and Tristan Bonnevie},
journal = {Pulmonology},
year = {2026},
month = oct,
doi = {10.1080/25310429.2026.2683324},
url = {https://normandie-univ.hal.science/hal-05835602v1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Peak Cardiorespiratory and Metabolic Responses during the Six-Minute Stepper Test in People with COPD: A Pre-Planned Cross-Sectional Ancillary Study
AU - Arthur Hinfray
AU - Astrid Vanheule
AU - Adrien Kerfourn
AU - Antoine Cuvelier
AU - Catherine Viacroze
AU - David Debeaumont
AU - Francis-Edouard Gravier
AU - Tristan Bonnevie
PY - 2026
DA - 2026/10/22
JO - Pulmonology
DO - 10.1080/25310429.2026.2683324
UR - https://normandie-univ.hal.science/hal-05835602v1
AB - BACKGROUND: The six-minute stepper test (6MST) is increasingly used to assess functional exercise capacity in people with chronic obstructive pulmonary disease (COPD). However, the physiological responses elicited during the 6MST and their relationship to those obtained during cardiopulmonary exercise testing (CPET) remain incompletely characterised. RESEARCH QUESTION: How do peak cardiorespiratory and metabolic responses obtained during the 6MST compare with those measured during CPET, and does the 6MST elicit maximal physiological responses? STUDY DESIGN AND METHOD: This pre-planned ancillary cross-sectional study included individuals with COPD who performed incremental CPET and two 6MSTs with breath-by-breath gas exchange analysis. Peak responses as well as symptoms were compared between tests. RESULTS: 1.3 (IQR 0.9 to 1.7) L). Most peak physiological responses were comparable and moderately to strongly correlated between the 6MST and CPET, with marked intraindividual variability in responses. Heart rate and symptom burden were similar to slightly higher during the 6MST, while systolic arterial blood pressure was clinically higher. Peak oxygen uptake corresponded to approximately 60% of predicted values during both tests, and about 10% of participants achieved conventional criteria for maximal cardiac and metabolic exercise during the 6MST. Ventilatory limitation was the predominant limiting factor during both tests. INTERPRETATION: The 6MST elicits substantial but generally submaximal cardiac and metabolic stress, and provides complementary, rather than interchangeable, information to CPET. These findings support the clinical utility of the 6MST while highlighting the need for cautious cardiovascular monitoring. CLINICAL TRIAL REGISTRATION: NCT04008615.
SN - 2531-0429
SN - 2531-0437
ER -