Key result
Harvard Step Test detects ~34% more ventricular arrhythmias versus maximal exercise testing in paediatric athletes.
Why the study?
The relative efficacy of the Harvard Step Test versus maximal exercise testing for detecting arrhythmias and heart conditions in pre-participation screening remains unclear.
Does the Harvard Step Test detect arrhythmias more effectively than maximal exercise testing in pediatric athletes?
Observational (n=511)
No
Does the Harvard Step Test detect arrhythmias more effectively than maximal exercise testing in pediatric athletes?
Absolute Event Rate: 30.5% vs 22.7%
p-value: p=<0.001
The Harvard Step Test is more effective than maximal exercise testing at detecting supraventricular and ventricular arrhythmias in young male athletes, particularly during the recovery phase.
HST may detect more arrhythmias than MET in young male athletes; leaves open optimal test selection for paediatric pre-participation screening.
BACKGROUND: Sport practice may elevate the risk of cardiovascular events, including sudden cardiac death, in athletes with undiagnosed heart conditions. In Italy, pre-participation screening includes a resting ECG and either the Harvard Step Test (HST) or maximal exercise testing (MET), but the relative efficacy of the latter two tests for detecting arrhythmias and heart conditions remains unclear. METHODS: This study examined 511 paediatric athletes (8–18 years, 76.3% male) without known cardiovascular, renal, or endocrine diseases. All athletes underwent both HST and MET within 30 days. Absolute data and data relative to theoretical peak heart rates, arrhythmias (supraventricular and ventricular) and cardiovascular diagnoses were collected. RESULTS: HST resulted in a lower peak heart rate than MET (181.1 ± 9.8 vs. 187.5 ± 8.1 bpm, p < 0.001), but led to the detection of more supraventricular (18.6% vs. 13.1%, p < 0.001) and ventricular (30.5% vs. 22.7%, p < 0.001) arrhythmias, clustering during recovery (p = 0.014). This pattern was significant in males but not females. Among athletes diagnosed with cardiovascular diseases (22.3%), HST identified more ventricular arrhythmias (26.3% vs. 18.4%, p = 0.05), recovery-phase arrhythmias (20.2% vs. 14.0%, p = 0.035), and polymorphic arrhythmias (6.1% vs. 1.8%, p = 0.025). CONCLUSIONS: HST detects arrhythmias more effectively than MET in young male athletes, especially during recovery. More ventricular arrhythmias were highlighted even in athletes with cardiovascular conditions.
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Bianco et al. (2025) conducted an observational in Paediatric athletes undergoing pre-participation screening (n=511). Harvard Step Test (HST) vs. Maximal Exercise Testing (MET) was evaluated on Detection of ventricular arrhythmias (p=<0.001). The Harvard Step Test detected significantly more ventricular (30.5% vs 22.7%) and supraventricular (18.6% vs 13.1%) arrhythmias compared to maximal exercise testing in paediatric athletes.
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