Cardiovascular responses to a 3-minute Harvard step test in Paediatric competitive athletes

The Italian pre-participation screening (PPS) program includes a simplified 3-min step test to assess cardiovascular responses in paediatric athletes, yet limited data exist on the cardiovascular response to this test in the paediatric population.

To evaluate heart rate (HR), blood pressure (BP), and arrhythmic responses to a step test in healthy children undergoing PPS.

We prospectively enrolled 647 athletes (mean age 13 ± 2 years, 51 % male) undergoing PPS from September 2023 to May 2024. All participants performed a 3-min step test with continuous ECG monitoring and BP measurements at rest, peak, and recovery. Subgroup analyses were performed by sex and age group. Regression analyses were used to assess predictors of HR_peak, % of predicted HR_peak and systolic BP.

The mean resting HR was 81 ± 17 bpm, with HR_peak of 169 ± 14 bpm (85 % of predicted). The most significant HR increase occurred in the first minute. BP_peak remained modest (128/60 mmHg). Female athletes had higher HRs but lower BP than males (p < 0.001). Resting HR declined with age, while HR_peak remained constant across groups. BP increased with age, though only systolic BP differed at peak. Regression analysis identified resting HR, sex, and BMI as predictors of HR_peak, while weight alone predicted systolic BP_peak. Exercise-induced premature ventricular beats (PVBs) occurred in 0.46 % of athletes, all with benign morphology and no underlying structural heart disease.

The step test elicits a strong HR response in paediatric athletes and has a low arrhythmic yield. However, it is not suitable for assessing hypertensive responses during exercise.