Measuring the Impact of COVID-19 on Young Adult Functional Capacity: A Comparative Study of Walking and Step Endurance Tests

Authors

DOI:

https://doi.org/10.17309/tmfv.2025.1.10

Keywords:

COVID-19, physical fitness tests, functional fitness, cardiorespiratory endurance

Abstract

Objectives. This study aimed to evaluate and compare the functional capacity of young adults recovering from COVID-19 using the 6-Minute Walk Test (6MWT) and 2-Minute Step Test (2MST), focusing on cardiovascular parameters, and to examine correlations between these tests, demographic factors, and muscle strength.

Materials and methods. A cross-sectional study was conducted with 34 young participants (mean age: 20.62 years, 88.24 % female), all experiencing mild post-COVID-19 symptoms. Muscle strength (grip and quadriceps strength) was assessed, and functional capacity was evaluated using the 6MWT and 2MST, with the test order randomized by drawing lots. Hemodynamic responses, fatigue, and dyspnea were measured before and after both tests. Paired t-tests were used to compare cardiovascular parameters and leg fatigue between the 6MWT and 2MST. Pearson’s correlation coefficient assessed relationships between both tests, demographics, and muscle strength.

Results. The study revealed an increase in heart rate and leg fatigue after the 6MWT compared to the 2MST, whereas systolic blood pressure was elevated following the 2MST compared to the 6MWT. The 6MWT showed a significant positive correlation with the 2MST (r = 0.350, p = 0.043). Additionally, quadriceps strength was positively correlated with both the 6MWT (r = 0.372, p = 0.030) and the 2MST (r = 0.395, p = 0.021).

Conclusions. The findings of this study indicate that both the 6MWT and 2MST are effective in assessing functional capacity in young individuals recovering from COVID-19, showing distinct physiological responses. Furthermore, quadriceps strength is correlated with both tests, highlighting the importance of muscle strength in recovery.

Downloads

Download data is not yet available.

Author Biographies

Patchareeya Amput, University of Phayao

Department of Physical Therapy, School of Allied Health Sciences
19 Moo 2 Maeka, Phahonyothin Road, Mueang Phayao district, Phayao 56000, Thailand
patchareeya.am@up.ac.th

Arunrat Srithawong, University of Phayao

Department of Physical Therapy, School of Allied Health Sciences
19 Moo 2 Maeka, Phahonyothin Road, Mueang Phayao district, Phayao 56000, Thailand
arunrat.sr@up.ac.th

Sinthuporn Maharan, University of Phayao

Department of Physical Therapy, School of Allied Health Sciences
19 Moo 2 Maeka, Phahonyothin Road, Mueang Phayao district, Phayao 56000, Thailand
Sinthuporn.ma@up.ac.th

Puttipong Poncumhak, University of Phayao

Department of Physical Therapy, School of Allied Health Sciences
19 Moo 2 Maeka, Phahonyothin Road, Mueang Phayao district, Phayao 56000, Thailand
puttipong.po@up.ac.th

Patcharin Phrompao, University of Phayao

Department of Physical Therapy, School of Allied Health Sciences
19 Moo 2 Maeka, Phahonyothin Road, Mueang Phayao district, Phayao 56000, Thailand
patcharin.ph@up.ac.th

Eakarach Wongsaya, University of Phayao

Department of Physical Therapy, School of Allied Health Sciences
19 Moo 2 Maeka, Phahonyothin Road, Mueang Phayao district, Phayao 56000, Thailand
wongsaya.ea@up.ac.th

Tichanon Promsrisuk, University of Phayao

Division of Physiology, School of Medical Sciences
19 Moo 2 Maeka, Phahonyothin Road, Mueang Phayao district, Phayao 56000, Thailand
tichanon.pr@up.ac.th

Sahachat Aueyingsak, Christian University of Thailand

Department of Physical Therapy, College of Health Sciences
144 Don Yai Hom, Mueang Nakhon Pathom District, Nakhon Pathom 73000, Thailand
Audjand@gmail.com

References

Parotto, M., Gyöngyösi, M., Howe, K., Myatra, S. N., Ranzani, O., Shankar-Hari, M., & Herridge, M. S. (2023). Post-acute sequelae of COVID-19: understanding and addressing the burden of multisystem manifestations. The Lancet Respiratory Medicine, 11(8), 739-754. https://doi.org/10.1016/S2213-2600(23)00239-4 DOI: https://doi.org/10.1016/S2213-2600(23)00239-4

Weldon, E. J. t., Hong, B., Hayashi, J., Goo, C., Carrazana, E., Viereck, J., & Liow, K. (2023). Mechanisms and Severity of Exercise Intolerance Following COVID-19 and Similar Viral Infections: A Comparative Review. Cureus, 15(5), e39722. https://doi.org/10.7759/cureus.39722 DOI: https://doi.org/10.7759/cureus.39722

Alahmari, A., Krishna, G., Jose, A. M., Qoutah, R., Hejazi, A., Abumossabeh, H., Atef, F., Almutiri, A., Homoud, M., Algarni, S., AlAhmari, M., Alghamdi, S., Alotaibi, T., Alwadeai, K., Alhammad, S., & Alahmari, M. (2023). The long-term effects of COVID-19 on pulmonary status and quality of life. PeerJ, 11, e16694. https://doi.org/10.7717/peerj.16694 DOI: https://doi.org/10.7717/peerj.16694

Daynes, E., Mills, G., Hull, J. H., Bishop, N. C., Bakali, M., Burtin, C., McAuley, H. J. C., Singh, S. J., & Greening, N. J. (2024). Pulmonary Rehabilitation for People With Persistent Symptoms After COVID-19. CHEST, 166(3), 461-471. https://doi.org/10.1016/j.chest.2024.01.029 DOI: https://doi.org/10.1016/j.chest.2024.01.029

Wade, D. T. (2020). Rehabilitation after COVID-19: an evidence-based approach. Clinical Medicine, 20(4), 359-364. https://doi.org/10.7861/clinmed.2020-0353 DOI: https://doi.org/10.7861/clinmed.2020-0353

Torres-Castro, R., Núñez-Cortés, R., Larrateguy, S., Alsina-Restoy, X., Barberà, J. A., Gimeno-Santos, E., García, A. R., Sibila, O., & Blanco, I. (2023). Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen? Life, 13(3), 621. https://www.mdpi.com/2075-1729/13/3/621 DOI: https://doi.org/10.3390/life13030621

Harber, M. P., Myers, J., Bonikowske, A. R., Muntaner-Mas, A., Molina-Garcia, P., Arena, R., & Ortega, F. B. (2024). Assessing cardiorespiratory fitness in clinical and community settings: Lessons and advancements in the 100th year anniversary of VO2max. Progress in Cardiovascular Diseases, 83, 36-42. https://doi.org/10.1016/j.pcad.2024.02.009 DOI: https://doi.org/10.1016/j.pcad.2024.02.009

Kaminsky, L. A., Myers, J., Brubaker, P. H., Franklin, B. A., Bonikowske, A. R., German, C., & Arena, R. (2024). 2023 update: The importance of cardiorespiratory fitness in the United States. Progress in Cardiovascular Diseases, 83, 3-9. https://doi.org/10.1016/j.pcad.2024.01.020 DOI: https://doi.org/10.1016/j.pcad.2024.01.020

Ross, R., Blair, S. N., Arena, R., Church, T. S., Després, J.-P., Franklin, B. A., Haskell, W. L., Kaminsky, L. A., Levine, B. D., Lavie, C. J., Myers, J., Niebauer, J., Sallis, R., Sawada, S. S., Sui, X., & Wisløff, U. (2016). Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation, 134(24), e653-e699. https://doi.org/10.1161/CIR.0000000000000461 DOI: https://doi.org/10.1161/CIR.0000000000000461

Noonan, V., & Dean, E. (2000). Submaximal Exercise Testing: Clinical Application and Interpretation. Physical Therapy, 80(8), 782-807. https://doi.org/10.1093/ptj/80.8.782 DOI: https://doi.org/10.1093/ptj/80.8.782

Andrade, C., Cianci, R., Malaguti, C., & Corso, S. (2012). The use of step tests for the assessment of exercise capacity in healthy subjects and in patients with chronic lung disease. Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 38, 116-124. https://doi.org/10.1590/S1806-37132012000100016 DOI: https://doi.org/10.1590/S1806-37132012000100016

Cruz-Montecinos, C., Torres-Castro, R., Otto-Yáñez, M., Barros-Poblete, M., Valencia, C., Campos, A., Jadue, L., Barros, M., Solis-Navarro, L., & Resqueti, V. (2024). Which Sit-to-Stand Test Best Differentiates Functional Capacity in Older People? American Journal of Physical Medicine & Rehabilitation, 103(10). https://journals.lww.com/ajpmr/fulltext/2024/10000/which_sit_to_stand_test_best_differentiates.9.aspx DOI: https://doi.org/10.1097/PHM.0000000000002504

Medicine, A. C. o. S. (2013). ACSM’s guidelines for exercise testing and prescription. Lippincott williams & wilkins.

Singh, S. J., Puhan, M. A., Andrianopoulos, V., Hernandes, N. A., Mitchell, K. E., Hill, C. J., Lee, A. L., Camillo, C. A., Troosters, T., Spruit, M. A., Carlin, B. W., Wanger, J., Pepin, V., Saey, D., Pitta, F., Kaminsky, D. A., McCormack, M. C., MacIntyre, N., Culver, B. H.,…Holland, A. E. (2014). An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J, 44(6), 1447-1478. https://doi.org/10.1183/09031936.00150414 DOI: https://doi.org/10.1183/09031936.00150414

American Thoracic Society. (2002). ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 166(1), 111-117. https://doi.org/10.1164/rccm.166.4.518 DOI: https://doi.org/10.1164/ajrccm.166.1.at1102

Casillas, J. M., Hannequin, A., Besson, D., Benaïm, S., Krawcow, C., Laurent, Y., & Gremeaux, V. (2013). Walking tests during the exercise training: Specific use for the cardiac rehabilitation. Annals of Physical and Rehabilitation Medicine, 56(7), 561-575. https://doi.org/10.1016/j.rehab.2013.09.003 DOI: https://doi.org/10.1016/j.rehab.2013.09.003

Holland, A. E., Spruit, M. A., Troosters, T., Puhan, M. A., Pepin, V., Saey, D., McCormack, M. C., Carlin, B. W., Sciurba, F. C., Pitta, F., Wanger, J., MacIntyre, N., Kaminsky, D. A., Culver, B. H., Revill, S. M., Hernandes, N. A., Andrianopoulos, V., Camillo, C. A., Mitchell, K. E.,…Singh, S. J. (2014). An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J, 44(6), 1428-1446. https://doi.org/10.1183/09031936.00150314 DOI: https://doi.org/10.1183/09031936.00150314

Jones, C. J., & Rikli, R. E. (2002). Measuring functional. The Journal on active aging, 1(24-30).

Poncumhak, P., Amput, P., Sangkarit, N., Promsrisuk, T., & Srithawong, A. (2023). Predictive Ability of the 2-Minute Step Test for Functional Fitness in Older Individuals with Hypertension. Ann Geriatr Med Res, 27(3), 228-234. https://doi.org/10.4235/agmr.23.0070 DOI: https://doi.org/10.4235/agmr.23.0070

Bohannon, R. W., & Crouch, R. H. (2019). Two-Minute Step Test of Exercise Capacity: Systematic Review of Procedures, Performance, and Clinimetric Properties. J Geriatr Phys Ther, 42(2), 105-112. https://doi.org/10.1519/jpt.0000000000000164 DOI: https://doi.org/10.1519/JPT.0000000000000164

Węgrzynowska-Teodorczyk, K., Mozdzanowska, D., Josiak, K., Siennicka, A., Nowakowska, K., Banasiak, W., Jankowska, E. A., Ponikowski, P., & Woźniewski, M. (2016). Could the two-minute step test be an alternative to the six-minute walk test for patients with systolic heart failure? Eur J Prev Cardiol, 23(12), 1307-1313. https://doi.org/10.1177/2047487315625235 DOI: https://doi.org/10.1177/2047487315625235

Horn, K., Johnson, H., Williams, E., McQueeney, S., & Harrington, S. (2024). Validity and reliability of the takei hand dynamometeR. International Journal of Exercise Science: Conference Proceedings, 16(3), 130.

Available at: https://digitalcommons.wku.edu/ijesab/vol16/iss3/130

Savas, S., Kilavuz, A., Kayhan Koçak, F., & Cavdar, S. (2023). Comparison of Grip Strength Measurements by Widely Used Three Dynamometers in Outpatients Aged 60 Years and Over. J Clin Med, 12(13). https://doi.org/10.3390/jcm12134260 DOI: https://doi.org/10.3390/jcm12134260

Mentiplay, B. F., Perraton, L. G., Bower, K. J., Adair, B., Pua, Y.-H., Williams, G. P., McGaw, R., & Clark, R. A. (2015). Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PloS one, 10(10), e0140822. DOI: https://doi.org/10.1371/journal.pone.0140822

Brown, L. E., & Weir, J. P. (2001). ASEP procedures recommendation I: accurate assessment of muscular strength and power. Journal of Exercise Physiology Online, 4(3).

Poh, H., Eastwood, P. R., Cecins, N. M., Ho, K. T., & Jenkins, S. C. (2006). Six-minute walk distance in healthy Singaporean adults cannot be predicted using reference equations derived from Caucasian populations. Respirology, 11(2), 211-216. https://doi.org/10.1111/j.1440-1843.2006.00820.x DOI: https://doi.org/10.1111/j.1440-1843.2006.00820.x

Vaish, H., Ahmed, F., Singla, R., & Shukla, D. K. (2013). Reference equation for the 6-minute walk test in healthy North Indian adult males. Int J Tuberc Lung Dis, 17(5), 698-703. https://doi.org/10.5588/ijtld.12.0474 DOI: https://doi.org/10.5588/ijtld.12.0474

Tantibhaedhyangkul, P., Kuptniratsaikul, V., & Tosayanonda, O. (2020). Grip and Quadriceps Strength : Normative Values in the Thai Population. Siriraj Medical Journal, 53(4), 224-230. https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/244111

Wang, Y. C., Bohannon, R. W., Li, X., Sindhu, B., & Kapellusch, J. (2018). Hand-Grip Strength: Normative Reference Values and Equations for Individuals 18 to 85 Years of Age Residing in the United States. J Orthop Sports Phys Ther, 48(9), 685-693. https://doi.org/10.2519/jospt.2018.7851 DOI: https://doi.org/10.2519/jospt.2018.7851

Reychler, G., Boucard, E., Peran, L., Pichon, R., Le Ber-Moy, C., Ouksel, H., Liistro, G., Chambellan, A., & Beaumont, M. (2018). One minute sit-to-stand test is an alternative to 6MWT to measure functional exercise performance in COPD patients. Clin Respir J, 12(3), 1247-1256. https://doi.org/10.1111/crj.12658 DOI: https://doi.org/10.1111/crj.12658

Troosters, T., Vilaro, J., Rabinovich, R., Casas, A., Barberà, J. A., Rodriguez-Roisin, R., & Roca, J. (2002). Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease. European Respiratory Journal, 20(3), 564-569. https://doi.org/10.1183/09031936.02.02092001 DOI: https://doi.org/10.1183/09031936.02.02092001

Shephard, R. J., Bailey, D. A., & Mirwald, R. L. (1976). Development of the Canadian Home Fitness Test. Can Med Assoc J, 114(8), 675-679.

Srithawong, A., Poncumhak, P., Manoy, P., Kumfu, S., Promsrisuk, T., Prasertsri, P., & Boonla, O. (2022). The optimal cutoff score of the 2-min step test and its association with physical fitness in type 2 diabetes mellitus. J Exerc Rehabil, 18(3), 214-221. https://doi.org/10.12965/jer.2244232.116 DOI: https://doi.org/10.12965/jer.2244232.116

Casey, D. P., & Hart, E. C. (2008). Cardiovascular function in humans during exercise: role of the muscle pump. J Physiol, 586(21), 5045-5046. https://doi.org/10.1113/jphysiol.2008.162123 DOI: https://doi.org/10.1113/jphysiol.2008.162123

Fisher, J. P., & Secher, N. H. (2019). Chapter 24 - Regulation of Heart Rate and Blood Pressure During Exercise in Humans. In J. A. Zoladz (Ed.), Muscle and Exercise Physiology (pp. 541-560). Academic Press. https://doi.org/10.1016/B978-0-12-814593-7.00024-4 DOI: https://doi.org/10.1016/B978-0-12-814593-7.00024-4

Beutner, F., Ubrich, R., Zachariae, S., Engel, C., Sandri, M., Teren, A., & Gielen, S. (2015). Validation of a brief step-test protocol for estimation of peak oxygen uptake. Eur J Prev Cardiol, 22(4), 503-512. https://doi.org/10.1177/2047487314533216 DOI: https://doi.org/10.1177/2047487314533216

Zhao, Y., & Chung, P. K. (2016). Differences in Functional Fitness Among Older Adults With and Without Risk of Falling. Asian Nurs Res (Korean Soc Nurs Sci), 10(1), 51-55. https://doi.org/10.1016/j.anr.2015.10.007 DOI: https://doi.org/10.1016/j.anr.2015.10.007

Braghieri, H. A., Kanegusuku, H., Corso, S. D., Cucato, G. G., Monteiro, F., Wolosker, N., Correia, M. d. A., & Ritti-Dias, R. M. (2021). Validity and reliability of 2-min step test in patients with symptomatic peripheral artery disease. Journal of Vascular Nursing, 39(2), 33-38. https://doi.org/https://doi.org/10.1016/j.jvn.2021.02.004 DOI: https://doi.org/10.1016/j.jvn.2021.02.004

Chow, J. J. L., Fitzgerald, C., & Rand, S. (2023). The 2 min step test: A reliable and valid measure of functional capacity in older adults post coronary revascularisation. Physiotherapy Research International, 28(2), e1984. https://doi.org/10.1002/pri.1984 DOI: https://doi.org/10.1002/pri.1984

Ishigaki, T., Kubo, H., Yoshida, K., Shimizu, N., & Ogawa, T. (2024). Validity and reliability of the 2-min step test in individuals with stroke and lower-limb musculoskeletal disorders [Original Research]. Frontiers in Rehabilitation Sciences, 5. https://doi.org/10.3389/fresc.2024.1384369 DOI: https://doi.org/10.3389/fresc.2024.1384369

Kovarik, M., Joskova, V., Patkova, A., Koblizek, V., Zadak, Z., & Hronek, M. (2017). Hand grip endurance test relates to clinical state and prognosis in COPD patients better than 6-minute walk test distance. Int J Chron Obstruct Pulmon Dis, 12, 3429-3435. https://doi.org/10.2147/copd.S144566 DOI: https://doi.org/10.2147/COPD.S144566

Kyomoto, Y., Asai, K., Yamada, K., Okamoto, A., Watanabe, T., Hirata, K., & Kawaguchi, T. (2019). Handgrip strength measurement in patients with chronic obstructive pulmonary disease: Possible predictor of exercise capacity. Respiratory Investigation, 57(5), 499-505. https://doi.org/10.1016/j.resinv.2019.03.014 DOI: https://doi.org/10.1016/j.resinv.2019.03.014

Zhang, Q., Lu, H., Pan, S., Lin, Y., Zhou, K., & Wang, L. (2017). 6MWT Performance and its Correlations with VO₂ and Handgrip Strength in Home-Dwelling Mid-Aged and Older Chinese. Int J Environ Res Public Health, 14(5). https://doi.org/10.3390/ijerph14050473 DOI: https://doi.org/10.3390/ijerph14050473

Downloads

Published

2025-01-30

How to Cite

Amput, P., Srithawong, A., Maharan, S., Poncumhak, P., Phrompao, P., Wongsaya, E., Promsrisuk, T., & Aueyingsak, S. (2025). Measuring the Impact of COVID-19 on Young Adult Functional Capacity: A Comparative Study of Walking and Step Endurance Tests. Physical Education Theory and Methodology, 25(1), 77–84. https://doi.org/10.17309/tmfv.2025.1.10

Issue

Section

Original Scientific Articles

Most read articles by the same author(s)