Why Train on Stairs?
By Richard Bohannon, PT, EdD, DPT, NCS, FAPTA, FAHA
"Training on stairs has real benefits beyond the fostering of functional independence in those whose daily activities include stairs. The muscular and cardiovascular stresses associated with stair negotiation typically exceed those accompanying level ground ambulation and can yield better results."
For individuals whose lives require the regular ascent and descent of stairs, the importance of stair training is self-evident. For individuals who may be able to “get by” without climbing stairs, the need is less obvious. Nevertheless, both groups of individuals may benefit greatly from stair-training programs as they can challenge a patient’s strength, range of motion, and cardiovascular capacity. While regular overground ambulation can also confront these variables, stair training can in many cases provide a potentially greater training stimulus. Hereafter, the magnitude of this stimulus is described. Where possible, comparisons are made between the challenges of stair and level ground ambulation. Several stair training studies will be highlighted.
Though varying between ascent and descent and with step height, stair negotiation tends to be a mechanically (strength) demanding activity, particularly for the elderly. Hortobágyi et al (2003) concluded that stair ascent required 54% and 78% of maximum knee extensor effort of young and old adults respectively. They concluded that stair descent demanded 42% and 80% of maximum knee extensor effort. Reeves et al (2007) reported that the proportion of maximum capacity at the knee during stair descent was 30% in the young and 42% in the elderly. Richards et al presented electromyographic data that clearly showed subjects’ quadriceps activity during stair negotiation to be high and much greater than during level ground ambulation. Specifically, the vastus medialis and vastus lateralis were functioning at over 50% of peak during stair ascent and over 40% of peak during stair descent.
During level ground ambulation the subjects’ vastus activation was less than 25% of peak. Lyons et al (1983), who examined activity in several muscles crossing the hip, found the gluteus medius to be more active (> 50% maximum) during stair ascent than during level ground ambulation ( maximum) or stair descent (~20% maximum). In the gluteus maximus, activity was similar during stair ascent and level ground walking (--‘35% maximum), but it was far less during stair descent <10% maximum). Some of these findings underlie the argument by Lin et a! (2004) and Andriacchi et al (1980) that stair locomotion places much higher loads on the lower limb than does level ground walking. The loads are sufficient to positively affect muscle performance of the lower limbs. Paillard et al (2004) found that 6 weeks of the stair climbing “improved the isometric and dynamic muscle strength of ageing healthy women.” Nishimoto et al (1999) demonstrated increases in the anide strength and motor time of elderly women who participated in an 8 week step exercise program. Incidentally, the women also increased the distance they walked in 6 minutes (73 meters, p<0.01). Bean et al (2002), who had patients either walk up to 45 minutes or climb 12 flights of stairs with a weighted vest during sessions over 12 weeks, showed leg press power to increase significantly more (16.5%, p= .0 13) in the stair trained group. Loy et al (1994) obtained significant increases in isokinetic torque and work among subjects participating in a 12 week stair climbing regimen.
Range of motion requirements at the hip, knee, and ankle tend to increase with step height during both ascent and descent (Riener et al, 2002). Range at the knee and ankle is relatively comparable during stair ascent and descent, but hip range of motion is notably greater during stair ascent. At the hip and knee, flexion is considerably greater during stair negotiation than during level walking. For the hip, maximum flexion is about 70 degrees for stair ascent and about 50 degrees for level walking; at the knee, maximum flexion is about 90 degrees for stair ascent and approximately 60 degrees for level walking (Riener et al, 2002).
The cardiovascular demand of stair climbing is reflected in the heart rate and oxygen consumption associated with it. Teh and Aziz (2000) observed mean heart rates of 154 and 165 beats/mm in 56 men and 47 women (respectively) who climbed 180 steps. Such rates far exceed those reported by Waters et al for young (mean 100 beats/mm) and older (mean 193 beats/mm) adults walking around a 60.5 meter outdoor track. Tsuji et al (1997), who documented the oxygen consumption of children during daily activities, found mean volumes of 18.1 mllkg/min during walking and 31.2 mllkg/min during stair ascent. By using a progressive stair climbing regimen over 8 weeks, subjects trained by Boreham et al (2005) were able to realize a 17.1 percent increase in VO relative to controls. Over 12 weeks of training, Loy et al (1994) provoked increases in VO of 9.6% in subjects who climbed stairs and 11.1% in subjects who climbed stairs with an additional external load.
In conclusion, training on stairs has real benefits beyond the fostering of functional independence in those whose daily activities include stairs. The muscular and cardiovascular stresses associated with stair negotiation typically exceed those accompanying level ground ambulation and can yield better results. By modifying weight, step height and the number of stairs climbed, training programs can be tailored to individual patients to optimize results.
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