What is the estimated Metabolic Equivalent (MET) level for a patient who can walk up 2 flights of stairs without stopping?

Metabolic Equivalent (MET) Level for Climbing Two Flights of Stairs

The metabolic equivalent (MET) level for a patient who can walk up 2 flights of stairs without stopping is approximately 4 METs. 1

Understanding METs and Stair Climbing

Metabolic equivalents (METs) are a standardized measure of energy expenditure, where:

• 1 MET equals the resting or basal oxygen consumption of 3.5 ml O2/kg/min
• METs provide a uniform way to express the aerobic demands for specific activities
• Higher MET values indicate greater energy expenditure

MET Classification for Stair Climbing

According to multiple ACC/AHA guidelines, climbing two flights of stairs is consistently classified as requiring 4 METs of energy expenditure 1. This activity serves as an important functional capacity benchmark in cardiovascular assessment.

The specific energy cost breakdown for stair climbing includes:

• Stair climbing (ascending): approximately 8.6 METs 2
• Stair descending: approximately 2.9 METs 2
• Combined activity (up and down): averages to approximately 4-5 METs

Clinical Significance of 4 METs Capacity

The ability to climb two flights of stairs without stopping has important clinical implications:

1. Perioperative Risk Assessment:

   • Patients who can climb two flights of stairs have moderate functional capacity (4-6 METs) 1
   • This level of functional capacity is associated with lower perioperative cardiac risk 1
   • Inability to climb two flights indicates poor functional capacity (<4 METs) and increased risk of perioperative complications 1

2. Cardiovascular Risk Stratification:

   • The ability to achieve ≥4 METs is a key threshold in cardiac risk assessment 1
   • Patients who can perform activities requiring ≥4 METs without symptoms generally have lower cardiac risk 1
   • In cardiac patients, achieving 3-5 METs without ischemia suggests sexual activity is reasonably safe 1

3. Transplant Evaluation:

   • In liver transplant candidates, the ability to achieve ≥4 METs (defined as climbing ≥1 flight of stairs without stopping) is used in cardiac risk stratification 1

Practical Applications

• Perioperative Assessment: The ability to climb two flights of stairs serves as a quick, practical assessment of whether a patient meets the important 4 MET threshold for perioperative risk stratification 1

• Functional Capacity Estimation: When formal exercise testing is not available, stair climbing capacity provides a reliable estimate of functional status 1

• Daily Activity Comparison: Other activities requiring similar energy expenditure (approximately 4 METs) include:

  • Walking at 4 mph on level ground
  • Moderate cycling
  • Light yard work
  • Moderate household chores 1

Limitations and Considerations

• The actual MET level may vary based on:

  • Patient's age, weight, and conditioning level
  • Speed of climbing
  • Height of stairs
  • Use of handrails

• For more precise measurement, formal exercise testing provides more accurate MET assessment than estimated functional capacity 1