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Am J Phys Med Rehabil. 2014 Jul;93(7):586-94. doi: 10.1097/PHM.0000000000000067.

Two-step stool aerobic training for smokers.

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  • 1From INSERM (Institut National de la Santé et de la Recherche Médicale), ex-Unité 14, Faculté de Médecine, BP 184, Vandoeuvre-les-Nancy Cedex, France (MG, EML, EP); Cátedra de Matemáticas e Informática, Campus Universitario de Tafira 35017-Las Palmas de Gran Canaria, Spain (PS); Hospital Universitario de Gran Canaria Dr. Negrín, Departamentos de Rehabilitación y de Fisioterapia Respiratoria-Las Palmas de Gran Canaria, Spain (MG, NM); and Rutgers New Jersey Medical School, Newark, NJ (JRB).At the time of this study, Manuel Gimenez was affiliated with INSERM, Nancy, France, and is now Adjunct Professor at the Hospital Universitario de Gran Canaria Dr. Negrín, Departamentos de Rehabilitación y de Fisioterapia Respiratoria-35010 Las Palmas de Gran Canaria, Spain.



The aim of this study was to analyze subjective, physical, and physiologic responses to a standardized incremental 30-min two-step stool test to create an individualized 45-min maximally intensive two-step stool endurance exercise regimen for home training.


This is a longitudinal study on 26 consecutively referred male smokers aged 39-66 yrs. Each performed the two-step stool test on two 15-cm steps at 10, 20, 30, 40, 50, and 60 climbs per minute. Exertional dyspnea, oxygen consumption per unit time, ventilation, respiratory rate, tidal volume, heart rate, capillary oxyhemoglobin saturation, physiologic cost index, and oxygen pulse were recorded and compared with those observed during incremental cycle exercise (30 W per 3 mins). Multivariate analysis for each parameter was undertaken as a mixed model.


All subjects attained 60 climbs per minute on the two-step stool test and performed 38-42 mins of two-step stool endurance. All parameters reached 80%-96% of cycle maximum oxygen consumption. The subjects found the two-step stool endurance simple and practical to perform at home. There were no complications.


The incremental two-step stool test is a simple, cost-effective way to establish a 45-min maximally intensive endurance exercise training program practical for use in the home.

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