Two-minute step test of exercise capacity: systematic review of procedures, performance, and clinimetric properties

Key points

1. 01The TMST requires no equipment, minimal space, and about 2 minutes, making it practical in nearly any setting.
2. 02Validity is supported by multiple studies: TMST scores correlate with treadmill performance, 6-minute walk distance, physical activity level, and functional measures.
3. 03Step counts vary widely by population, ranging from about 29 steps in chronic stroke patients to 111 steps in older women with osteoporosis.
4. 04Only one study has examined test-retest reliability (ICC = 0.90), and no study has formally evaluated responsiveness.
5. 05Test procedures varied substantially across studies, limiting cross-study comparisons.

How it was conducted

Design

Systematic review

Databases searched

PubMed, Scopus, CINAHL; plus hand-searching of reference lists

Search date

September 23, 2016

Included studies

30 articles meeting inclusion criteria (standing TMST of Rikli and Jones, adults, English language)

Populations studied

Community-dwelling healthy older adults and adults with heart failure, chronic kidney disease, osteoporosis, Parkinson disease, stroke, hypertension, depression, and Alzheimer disease

Quality assessment

Hybrid 6-item 12-point checklist; scores ranged from 2 to 9 out of 12

What they found

• 30 studies were included; sample sizes ranged from 10 to 3309 participants.
• Mean TMST steps (one side, full 2 minutes) ranged from 29.1 in chronic stroke patients to 110.8 in older women with osteoporosis.
• Original test-retest reliability ICC = 0.90 (Rikli and Jones, n = 82).
• TMST correlated significantly with 1-mile walk time (r = 0.73) and treadmill performance in the original validation study.
• TMST correlated significantly with 6-minute walk test distance and peak oxygen consumption in heart failure patients (Wegorzynowska-Teodorczyk et al, n = 168); however, the correlation with peak oxygen consumption was low, not supporting criterion validity in that population.
• Eight studies showed significant increases in TMST steps with training; calculated effect sizes or standardized response means exceeded 0.80 in most of these studies.
• In chronic stroke, area under the curve for discriminating community vs limited community ambulators = 0.81.
• Quality scores ranged from 2 to 9 out of a possible 12; no study met all checklist criteria.

Limitations

• Reliability has been evaluated in only one study with one population; no data on minimal detectable change or absolute reliability are available.
• No study formally assessed responsiveness, so clinically meaningful change thresholds cannot be determined.
• Test procedures varied widely across studies (knee height, instructions, time notifications, scoring), making cross-study comparisons difficult.
• Quality of included studies was generally low to moderate; none met all checklist standards.

Why it matters

For patients

Older adults and patients with chronic conditions can be tested with this simple marching-in-place test anywhere, but clinicians cannot yet say with confidence how much improvement represents a real change.

For clinicians

The TMST is a practical, broadly valid field test for exercise capacity, but standardized procedures should be followed and its reliability and responsiveness gaps mean change scores must be interpreted cautiously.

For readers

This review maps the current evidence base for the TMST and highlights that validity is reasonably established while reliability and responsiveness remain under-studied.