CHAIR STAND Tests
This document reviews the one, five, and ten repetition timed sit to stand test, as well as those done in 30 seconds;
this test is also known as timed chair stands. Although most of the literature pertains to an adult population, a
section reviewing the test in a pediatric population is included in the One Time Sit to Stand section.
Type of test:


Time to administer: 5 minutes or less
Clinical Comments: Familiarity with stopwatch mechanism prior to administering test is important.
Placing chair against a wall or stable surface prior to beginning test improves patient safety. Rising from a
low chair may entail more than 100 degrees of knee flexion, 80 of hip flex and 25 degrees of ankle
dorsiflexion.1
Purpose/population for which tool was developed: The timed chair stand, with variations in directions given
to the subject has been referenced in literature more than 80 times since proposed by Csuka 2 as a simple measure of
lower extremity strength; there are multiple earlier, less validated references to sit to stand as a testing or exercise
technique. It has also been used to examine functional status 3-7 lower extremity muscle force/strength 8-14, 15 , 16, 17,
strength in subjects with CVA18-21 neuromuscular function 22-25 balance 26-29, vestibular dysfunction 30, and to
distinguish between fallers and non-fallers 22, 31-33 in an older population and a subpopulation of people with
Parkinson’s Disease (PD)34 and in chronic CVA18. Bohannon 200835 reports that the frequency of sit to stand is 43
to 49 times per day. Body weight (40%) is required of the knee extensors to stand without use of arm push-off.36, 37
When appropriate to use: This tool has been used to evaluate patients with LE proximal weakness, 2
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



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



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

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patients with chronic low back pain 33, 38
patients with knee osteoarthritis 6, 7, 16, 17, 39-43
hip osteoarthritis 17, 43
weight-bearing asymmetry 40
rheumatoid arthritis, and other chronic diseases,8
Parkinson’s Disease 34, 44
and after arthroscopy.14, 29
to compare methods of training, ,3, 45
as an assessment of fitness,10 or
frailty.46, 47,
as measures of function , strength and balance in CVA 18-21
as a tool to quantify the ability of people with balance disorders to perform transitional movements
to measure effects of supplementation 41
to help predict individuals with Parkinson’s Disease at risk of falling34.
after total knee arthroplasty 49-51
48
Scaling: Results of the test are reported as a ratio data, either as the number of stands completed in (up to) 2
minutes or the time it took in seconds to complete 1, 5, or 10 chair stands. If a client cannot do the test without use
of hands, timed results may be reported incorporating the amount of assistance required or as nominal data (Unable).
For example, in a study of 1500 subjects in which 3 trials were allowed, 52 87% were able to rise without use of
hands on the first trial, 11% required use of hands which was allowed on the second trial, 1% required an assistive
device which was allowed on the third trial, and 1% were unable to stand without the assistance of a person.
Equipment needed:


Stopwatch or clock with second hand
Sturdy, straight-backed, armless chair with seat height to attain knee angle of 90 degrees when subject’s
feet are on the floor. Chair heights, if reported, have varied from 35.56 cm to 46 cm. Clinicians
monitoring change over time with a client need to use a consistent chair or chair height for reliability of
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Page 1
CHAIR STAND Tests
results. Rising from a low chair may entail more than 100 degrees of knee flexion, 80 degrees of hip
flexion and 25 degrees of ankle dorsiflexion1
Test variations: There are multiple variations of the sit to stand maneuver as a test including
 total number possible in 10 seconds, 7, 53-55
 total number possible in 30 seconds,42, 56-59
 total number in 1 minute,60, 61 or

3 minutes.62

Other reported versions allow use of hands for push-off or descent, alter foot placement, or do not time the
maneuver.63-69

Another version records time to perform 3 sit to stands. 70
Clinically, the most common variations record time to perform one, five, or ten sit to stand repetitions. The
Center for Disease Control fall prevention task force, in the United States, included the 30 second sit to stand
test in the tool kit for health care providers. 71. Literature varies from no practice/test trials to a total of 3 trials
with best time recorded.72 5 total trials with 2 practice trials 3 test trials with the mean used for data analysis
20
two trials with the mean values for data analysis19



An additional variation includes placing the hands on the ASIS rather than crossed over the chest 45
Christiansen 2011 looked at weight-bearing asymmetry when subjects with knee osteoarthritis performed
5TSTS on a force plate.
Akram 201173looked at movement of the body and stability with 1TST
Directions: The subject is to sit in the chair with arms crossed over his/her chest. Instruct the subject to stand up
as quickly as possible safely without using his/her arms (1, 5, or 10 times or 30 seconds) on the word “Go.” Begin
timing on the word “Go” and stop timing when the person comes to the last complete stand or sits after the last
stand. Record the time in seconds or number of completed stands for the 30 second version12, 16, 17, CDC 2013, 22, 33, 34, 39,
41, 43, 50, 55, 64
Ceiling or floor effect: People need to be able to rise independently from a chair for the test; thus it would not be
appropriate for very low functioning and dependent individuals.
Interpreting results: This test has been interpreted as a measure of one component of balance and as a measure
of strength of knee extensor and back muscles.
Other: In one study of persons with Alzheimer Disease 74, instructions were modified.
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CHAIR STAND Tests
One Time Sit to Stand (1TSTS)
Directions: The subject is to sit in the chair with arms crossed over his/her chest. Instruct the subject to stand up
as quickly as possible safely without using his/her arms on the word “Go.” Begin timing on the word “Go” and stop
timing when the person comes to a complete stand. Record time in seconds.
Reliability:
Reference
N=
Sample Description
Intrarater Reliability: same rater within one session (or day)
Nevitt 1989 22
27
Community dwellers with 1 or more falls in
past 12 months
Interrater Reliability:
Nevitt 1989 22
27
Community dwellers with 1 or more falls in
past 12 months
Test-retest Reliability
Jette 1999 64
105
Frail community elders. Mean 14 days
between testing dates (range 0-132)
Reliability Statistic
ICC = .89 - .96
ICC = .93 - .99
ICC = .25
Validity
Construct/Concurrent Validity: It is difficult to always differentiate between these 2 types of validity. Evaluating
this property requires a “gold standard” measure with which to compare the test results. Such a “gold standard” is
often not available.
Population
N=
Support for Validity
Community-dwellers
50
Ratio of leg ext peak isometric torque to body wt explains
Age range 56 – 95 years13
33% of time variance in multiple regression model of
1TSTS performance; age and steadiness were not
predictive of 1TSTS.
Persons with chronic CVA23
22
Pearson correlations (p<0.05) between TSTS & paretic
ankle d-flex (-0.45), & knee ext (-0.72); greater weightbearing symmetry relates to faster TSTS
(-0.56) as well as to faster self-paced TSTS (-0.56)
Predictive Validity
Population
N=
Support for Validity
Community dwellers31
761
Risk of falling predicted by inability to perform 1TSTS:
Female: relative risk 2.5 (1.5 -4.3 95% CI); Male:
relative risk 5.0 (95% CI = 2.1-10.9). Age controlled.
Community dwelling individuals, mean
13
No difference in muscle activation (Quadriceps Femoris
age 71.5years, with Stage II Hoehn and
and Hamstrings) on EMG analysis, and no difference in
Yahr staging Parkinson’s Disease 44
peak force or kinematics on 1TSTS between individuals
with PD and matched population without. However,
significant within group differences were found for the
PD group with respect to peak torque and kinematics.
Community-dwellers with 1 or more
325
22% of subjects who were unable to complete 1TSTS in
falls in past 12 mos22
<2sec had 2 or more falls; Relative risk of falls 2.4 (95%
CI =1.8 -3.2). Adjusted Odds Ratio 3.0 (95% CI =1.27.2) as independent predictor of multiple falls
Responsiveness/Sensitivity to Change
Population
Community dwelling
adults
Age 66 – 97 years
N=
15
Intervention
Exercise Intervention n = 15
3x/wk x 8 week low to
moderate intensity group ex
Responsive
Yes/No
yes
Av change post intervention
Significant differences?
Pre: 1.7 (0.7)s;Post: 1.3(0.4)s;
29% improvement
No difference on 1 year
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CHAIR STAND Tests
75
Community dwelling
adults with Parkinson’s
Disease average
Hoehne and Yahr
Staging 2.7 45
52
Exercise (EX) intervention
(n= 19) consisting of 20
minutes, 3x/ week/ 4 weeks.
yes
AV Pre: 2.80s
AV Post:2.10s
Cued task specific audiovisual
(AV) training (n= 19)
consisting of 45 minutes, 2x /
week for 4 weeks.
Control Pre: 2.40s
Control Post: 2.41s
Control: no treatment (n=14)
Community dwelling
adults with cemented
post-lateral THA,
Age 60.3 (13)years
BMI 26.4(3.4)
Controls 60.3(12.9);
BMI 25.3(3.3)
Subjects
30 male
Controls
11 male
76
Baseline= 6 weeks pre-THA;
Intervention = 6 months postTHA
Control = healthy
20 computerized random
chair rises in own
environment from morning
until dark
follow-up of 9 subjects
Ex Pre: 2.50s
Ex Post:2.28s
yes
Exercise and AV group
significant improvement over
control (p<0.05 and 0.01
respectively).Maintained
gains at 2 week follow up.
CI (.95)
Pre: 3.0 (2.8-3.2)s
Post: 2.6 (2.5-2.8)s
P<0.0001
0.375s change p<0.0001
Dependent t test
Controls 2.3(2.2-2.5)s
P < 0.001
Independent t test
effect size large .85,
6mo post op to control
p=.001 one-tailed calculated
by CP
Ceiling or floor effect:
In a community-based prospective study of 761 adults over age 70, 90 women and 34 men were unable to perform a
single TSTS; of these 50 women and 19 men were identified as fallers. 31
In a study of 32 community dwelling individuals with PD, with stage II Hoehn and Yahr staging (Mean age not
given), failure to complete the sit to stand maneuver (backward fall to chair) was due to poor timing of peak forward
velocity of Center of Mass (COM) in relation to hip height off the chair. 77
Interpreting results: This test has been interpreted as a measure of one aspect of balance and as a measure of
strength of knee extensor and back muscles.
Reference Data
Subjects
N=
Healthy PT students; mean age 20.1
(2.8)years 25
Healthy subjects, mean age
60.1(12.9) years
years BMI: 26.4 + 3.4
47
20males
30
Male
Timed Chair Stand Scores
Mean (SD)
Range
2.04(0.39) seconds
1.30—3.18 seconds
2.3 (2.2-2.5) seconds
CI (.95) p = 0.001
76
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CHAIR STAND Tests
Other:
Untimed 1TSTS
Population Descriptor
Non-fallers in community (23-92yrs)
Fallers in a care facility (63-92years)
N=
23
Results
Rate of rising (as measured by force/time) identified 17 out of 21
fallers and 1 out of 23 non-fallers; retrospective study
32
22
Residents of an intermediate care
79
25/79 were repeat fallers; 20% of the fallers but none of the nonfacility 47
fallers had difficulty with arising; mean times not given.
Elderly persons with balance
14
TSTS correlates with 15 other balance test items; total
impairment 26
correlations of 0.90.
Pediatric Studies of 1TSTS
Cahill et.al. (1999)78 reported that healthy children exhibit more variability in STS patterns than adults with the
greatest variability seen in children < 5 years of age. By 9-10 years of age the STS patterns were similar to those of
healthy adults. Characteristics of sit-stand transfer in children with CP (time to stand through different phases, effect
of bench height, weight resistance) STS from neutral ankle and knee flex at 90º (low) and at 120º of this (high), 3
phases measured78
Population Descriptor
N=
Results
Children
15
Real time 5 phases of sit to stand ; Mean +SD seconds
w/diplegic cerebral palsy (CP)
Right side
Left side
(mean age 48.9+15.9 months)
Trunk hip flexion
.64 +.15
.69+.19
Max hip flexion
.21 + .12
.16 + .18
P < .05 Children with CP compared
Knee ext ankle DF
-.10 +.12
-.05+ .08
with normal children
Max ankle DF/just stand 1.21+ .22
1.23+.24
Just stand/stable stand
.45+ .19
.46+ .17
Total time
2.41
2.49
Plegic
Sound
Trunk hip flexion
.62 + .18
.70 + .30
Max hip flexion
.18 +.22
.15+.09
Knee ext ankle DF
.22+.76
.05 + .16
Max ankle DF /just stand
.69 + .63
.89 +.46
Just stand/stable stand
.37+.33
.30+.33
Total time
2.08
2.09
21
Trunk
hip
flexion
.32±.08
Normal children
Max hip flexion
.05±.07
(mean age 47.7 +7.9 months)79
Knee ext ankle DF
.10±.12
Max ankle DF/just stand
.38 +.14
Just stand/stable stand
.27 + .06
Total time
1.12
Children
20
Phase duration (seconds) Ave from low and high position measures
With hemiplegic or diplegic CP
10
Mean (+SD)
Mean (+SD)
SignifMean age 4.5 – 15.7 years
With CP.
Non disabled
icance
and
Flexion momentum
64 (.13)
.54 (.12)
NS
Without disabilities
10
Momentum transfer
22 (.94)
.21 (.14)
NS
Mean age 4.3 -11.8 years
Extension phase
.85 (.28)
.45 (.14)
P<.05
Low bench height (measured in
Total STS time
1.71 (.36)
1.24 (.18)
P<.05
prone): distance from bottom of heel Seat height had significant effect on duration of extension phase(F=19.64)
to popliteal crease, neutral ankle, 90o Extension Phase of STS was significantly longer for children with CP (.85s )
knee flexion. High bench height:
compared to children without disabilities (.45s ),
120% of low bench height 80
Children with CP took significantly longer to perform STS ( 1.71s ) than
children without disabilities ( 1.24s )
Children (with mean +SD weighted
1 High STS 1RM: 11.3(3.6)kg. Ascending time mean with high resistance
vest in kg based on max weight 5 1.7 sec as measured on reported x-y graph
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CHAIR STAND Tests
1RM (reliability ICC = .88-.97)
With CP (Mean age 8.5 +2.2 years)
Without CP(Mean age 8.9+ 1.7) 81
Critical Review of STS in children
with CP: 9 studies in which the N
ranged from 19-562,mean
91.77(176,86). Three of the studies
characterized STS movement in
children with CP. 82
Ascending time compared to control significantly different(more time)
with High STS 1RM t =3.1, p=.004
1 High STS 1RM 26.1(5.0)kg. Ascending time mean with high resistance
5 1.25 seconds as measured on reported x-y graph
CONCLUSIONs
Need to select standardized inclusion criteria
STS movement can be considered to better understand health conditions in
children with CP
Definitions of STS movement phases lack standardization
Analysis of STS movement enables further exploration of functionality
through biomechanical analysis of movement and effectiveness of
intervention protocols
Analysis methods of STS movement needs standardization
Decrease in% of children able to perform STS with increase in external
support according to following types: unilateral spastic; ataxic; bilateral
spastic; dyskinetic
Suggested that children with CP be divided into 4 groups based on
movement characteristics: 1) greater trunk forward movement 2)buttocks
movement forward along seat 3)buttocks forward movement to shift center
of mass forward 4)early knee extension presented
Children with CP took longer than controls to perform STS
Variations in STS similar to controls
Increased final pelvic tilting and obliquity angles, greater maximum flexion
of the hip joints and greater maximum ankle dorsi flexion was found in
children with CP
Maximum power of the hip and knee extensors and maximum moments of
the knee joint where significantly reduced in children with CP
Children with CP exhibit muscle weakness, poor postural control and
disturbances in balance
STS duration was shortened in CP children with the use of hinged AFO
There were improvements in kinematic variables involving increased initial
knee flexion and ankle dorsi flexion with AFO use
There were increased extension phase duration, maximal horizontal and
vertical velocity of the head and maximal vertical ground reaction force
when both normal and CP children stood from low seat heights
Children with CP took longer with STS from low seat height compared to
control
CP children had lower agonist contraction (vastus lateralus) when the load
was high
Extrinsic factors of STS can be modified to either facilitate or complicate
STS movement in CP children
STS can be incorporated into rehab protocols and to measure effect of
interventions in CP children
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CHAIR STAND Tests
Five Times Sit to Stand Test (5TSTS or FRSTST)
Directions: The subject is to sit in the chair with arms crossed over his/her chest. Instruct the subject to stand up
as quickly as possible safely five times without using his/her arms on the word “Go.” Begin timing on the word
“Go” and stop timing when the person sits after the fifth complete stand
.16-21, 33, 34, 39-41, 48, 55, 83-92
Some authors stop the test when the person completes the 5th stand 43, 93-98
Others do not specify end point.6, 17, 18, 30, 38, 99-107
Other authors score 3 trials, with rests between, and include only best trial.72
In the 5TSTS portion of the Life Space Assessment (LSA) 89 ordinal scores are assigned based on time to complete:
0 = Unable to do; 1 = > 16.7 seconds; 2 = 13.7 – 16.6 s; 3 = 11.2 – 13.6 s; 4 = < 11.1s.
In the FTSTS of the Intervention of Fit and Strong Study (Hughes, 2004) 17, time was measured to nearest tenth of a
second and raw scores were transformed into rate per minute in order to accurately assess change in those who were
unable to perform the test at any point.
Choose reference data that matches your directions on when to end the test. Time is recorded in seconds.
Reliability:
Reference
N=
Sample Description
Reliability Statistic
Intrarater Reliability: same rater within one session (or day)
Ostchega 200094
392
Community dwellers >age 60
ICC = 0.64
Blake 2004108
24
End stage renal dialysis patients and healthy
matched controls
ICC = 0.98
Mong et al 201020
36
12 subjects with chronic stroke, 12 healthy
elderly subjects and 12 young subjects
Ostchega 2000 94
392
Community dwellers > age 60
Duncan 2011 34
82
Seeman, 199484
1192
Subset of EPESE study, age 70-79, 2 weeks
ICC = 0.73
Duncan 2011 34
82
ICC (2,1) = 0.76
Hoeymans, 199793
99
Jette, 199964
Schaubert, 200591
89
10
Community dwelling individuals with
idiopathic PD
Men born between 1900 – 1920 & living in
Zutphen, Netherlands, 2 weeks
Frail elders from community, 2 weeks
Ambulatory community dwellers, mean age
ICC=.970-.976
Interrater Reliability
ICC =0.71
Community dwelling individuals with
ICC(1,1) = 0.99
idiopathic PD
Mong et al 201020
36
12 subjects with chronic stroke , 12 healthy
ICC=.999
elderly subjects and 12 young subjects
Test-Retest Reliability The reported range on test-retest reliability was .64 to .99; the current MDC is 2.3 and 1.6
and 1.24 (same day) seconds. It would be best to use 2 seconds as the MDC.
109
McCarthy, 2004
47
Community dwellers age 65 (3)
5TSTS 11(2) sec
r = .95
MDC (95) 1.24 sec
r = 0.82
ICC = .67
ICC = .81
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CHAIR STAND Tests
Lord, 200299
Sherrington, 2005110
30
27
Tiedmann, 2008107
Kim, 201133
43 cm height and barefoot
362
30
Lin, Y-C, 2001, chair height
44.5 cm, ending in standing
position.43
Mong et al 201020
106
Butler et al 200921
734
Bohannon, 2007111
94
36
Bohannon, 2011112
Schaubert, 2005 91 113
76(6) yrs (6 & 12 week intervals)
Community dwellers
Community dwellers, mean 11 days after
ORIF hip fracture; retests done at 3 and 6
weeks
Community dwelling elderly age 74-98
Lumbar spinal stenosis patients waiting for
surgery and matched bilateral knee
osteoarthritis patients waiting for surgery,
Sedentary community dwellers with hip or
knee OA
12 subjects with chronic stroke , 12 healthy
elderly subjects and 12 young subjects
50 young subjects (20-39)
684 OLDER(75-98)
Nondisabled community dwelling adults
aged 19-84
Summarizing 10 studies
21
Community dwelling adults aged 65-85 seen
at baseline 6 and 12 weeks
ICC = .89
ICC(3,1) =.92
ICC(3,1) =.89
ICC= .95
ICC=.96
ICC=.989-.999
ICC=0.89
95% CI =.79,.95
ICC = .96
Mean ICC = 0.81
ICC = .82
Validity: Body weight, BMI, knee extensor (quadriceps) strength and age all seem to correlate with FTSTS Construct/Concurrent Validity: It is difficult to always differentiate between these 2 types of validity. Evaluating
this property requires a “gold standard” measure with which to compare the test results. Such a “gold standard” is
often not available
Population
N
Support for Validity
Ambulatory, community-dwelling
50
On stepwise regression analysis, composite muscle strength
people with chronic stroke 92
measured by 5TSTS accounted for 43% of the variance in BBS,
64% of TUG variance.
Community dwelling, ambulatory
31
Failed to find significant relationship between knee extensor
persons with single ischemic CVA,
power or strength with 5TSTS time. In regression analysis,
6-24 mos since CVA98
self-perceived ability did predict 43% of 5TSTS.
People with Rheumatoid Arthritis,
135
Knee strength inversely correlated with 5TSTS ( -0.47).
age 62(10)101
Subjects 3 months post TKA for OA
14
Subjects shifted weight away from the operated leg during
102
5TSTS. Asymmetry in weight bearing and uninvolved hip
extension moment during 5TSTS are related to amount of quad
asymmetry (0.56)
Well-functioning, age 70-79,
2928
5TSTS and knee strength (–.0.26), 6MWT (-0.36), 400m walk
community dwellers with
(0.35) & standing balance (-0.16). Correlations controlled for
bone mineral density BMD 95
age, sex, race, bone site, height and weight.
Persons with and without balance or
174
5TSTS scores correlated inversely both with DGI test scores (vestibular disorders48
0.68) & ABC (-0.58)
Age> 65, ind ambulatory (58%
179
Correlations between 5TSTS and time to complete 360 0 turn
w/assist device) living in community
(0.26) and walking speed (-0.23)
or CBRF97
Community dwelling adults age 65 –
139
Correlations of 5TSTS with self-reported limitation in stair
9315
flights climbed ; one flight (0.38), several flights (0.26)
Non-disabled community-dwelling
104
Pearson correlations of 5TSTS with waist circum (0.34), W/H
women, age range 60-90114
ratio(0.28), BMI(0.40), & 25’ walk time(0.56); inversely
correlates w/one leg stance time (-0.29) &Phys FuncSF-36(-
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CHAIR STAND Tests
Residents of a retirement village,
ambulatory w/o AD115
176
Ambulatory, community dwellers;
mean age 76(6) years 91
Community dwelling > 65 89
Community dwelling Age > 75 99
10
1000
642
Community dwelling, medically
stable adults, age 75 -889
16
Community dwelling individuals
with idiopathic PD34
82
Ambulatory community dwelling
adults on hemodialysis, age 22-87104
Subjects with Chronic Hemiparesis20
Subjects scheduled for TKA
measuring asymmetry in weight
bearing pre and post-op for TKA.
Age=63.4±7.740
People with Balance disorders age
23-9048
Community dwelling adults aged
46
36
53
36 with
knee OA
to
undergo
unilateral
TKA
17 healthy
people
93
94
0.29). BMI is a predictor of 5TSTS time.
5TSTS time associated with high visual acuity (0.23), reaction
time (0.36), proprioception (0.27), and inversely associated
with visual contrast sensitivity (-0.31), ankle dorsiflexor (-0.49)
and knee extensor strength (-0.51). In regression analysis of
5TSTS Betas with ankle flexibility (-0.51), knee ex strength (0.39), age(0.19), hallux grip (-0.16) contrast sensitivity (-0.13)
5TSTS correlates with TUG (0.73 – 0.92) and inversely with
gait speed for 3 testing sessions (-0.78 to -0.94)
Correlation with Life Space Assessment, LSA, (0.51)
Visual contrast sensitivity, LE proprioception, tactile
sensitivity, foot reaction time, postural sway, body wt, pain
report, anxiety, & vitality, &strength of knee ext, flex, &
ankle DF are all significant, ind. predictors of 5TSTS times
(R2 = 35%). Knee ext strength (corrected for body wt)
accounted for the largest Beta in the 5TSTS regression
analysis.
Significant relationship between 5TSTS & combined hip
extension, knee extension, & plantar flexion strength when
chair ht 14”(0.64) but non-significant relationship from 18”
chair (-0.34). Non-significant associations observed between
5TSTS and individual muscles.
Correlation Coefficients Between FTSTS Test
Variable
Correlation
P
Age
.37
.001
PASE
.38
.001
PDQ-Mobility
.58
.001
FOGQ
.44
.001
PDQ-SI
.38
.001
ABC
.54
.001
Mini-BEST
.71
.001
Quadriceps MVIC
.33
.003
9HPT
.55
.001
6MWT
.60
.001
Correlation with gait speed (-.071), and stair climbing 12 steps,
7 inches tall (.059)(p<0.0001)
5TSST test scores had significant negative correlation after
Bonferroni correction with affected ( p= -.753;p=.005) and
unaffected (p=-.830;p=.001) knee flexors of subjects with
stroke. No significant association found between 5TSST score
with BBS and LOS performance in subjects with stroke
Greatest asymmetry in weight-bearing with sit to stand is at one
month post-op (r=-.33), returned to pre-op levels at 3 months
post-op(r=-.26), more symmetrical at 6 months post-op than at
pre-op(r=-.31).
at one month post-op=11.3 seconds
at three months post-op=8.8 seconds
at six months post-op=9.4 seconds
Greater symmetry with weight bearing during STS associated
with increased quad strength symmetry (range, .26-.39).
The Spearman rho between the 5TSTS and the DGI was -.68
Between 5TSTS and ABC was -.58
Greater age (.53), weight (.28), and BMI (.34) were
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Page 9
CHAIR STAND Tests
19-84111
Subjects in MA Male Aging Study,
mean age 68(8)116
Community dwellers in Netherlands
96
Healthy post-menopausal women;
mean age 68(7)88
Ambulatory community dwelling
adults on hemodialysis, age range
22-87, mean age 52104
684
1262
116
46
Males with osteoarthritis of the knee
age 50-69 (mean 59).6
54
Subjects with lumbar spinal stenosis
mean age 63(7) 33
People with unilateral knee pain
from Osteoarthritis Initiative Study39
People with unilateral knee OA
recruited from an orthopedic clinic40
40
Subjects of varied age 20-39 and 7598 and disability including RA and
CVA height of chair 43 cm and
barefoot 21
1344
67
734
CVA=48
NoCVA=
636
OA=283
No CVA=
401
Males with osteoarthritis of the knee
54
significantly correlated with longer STS time. STS time had
fair correlation with physical functioning (-.47) as reported on
the physical functioning subscale of the SF-36.
5TSTS time does not predict or correlate with testosterone
hormone levels
Apolipoprotein E e4 polymorphism associated with poor
5TSTS time, age and sex adjusted OR 1.94
5TSTS time doesn’t predict or correlate with bone mineral
density at any skeletal site.
Univariate association among predictor variables and 5TSTS.
Decline in performance associated with age (0.51). Improved
performance associated with a higher value for serum albumin
concentration g/dL (-.43), phase angle degree (-0.40), serum
creatinine concentration mg/dL (-0.29), and adequacy of
dialysis dose (Kt/V) (-0.23) (p<0.13).
Multivariate regression analysis performed using physical
performance as the outcome variable. Adequacy of dialysis
dose (Kt/V)(-11.9) and albumin g/dL (-7.1) significant in
predicting performance measures (r=0.68)(r 2=0.46).table 3
Multivariate regression analysis with physical performance as
the outcome variable and physical activity level (arbitrary
units) as an additional predictor. Physical activity level did not
significantly improve the model for rising from a chair.
(r=.70)(r2=0.49) page 1588 and page 1589 table 4
5TSTS is significantly correlated with all WOMAC subscales
and composite scores r = .485 to .529; muscle strength r = -.620 for knee extension; r = -.638 for knee flexion.
No significant correlation of 5TSTS with the Oswestry
Disability Index
Pearson correlation between isometric quad strength and
FTSTS= -.36. FTSTS not correlated with pain.
N=50 with knee OA
N=17 healthy people
Pearson correlation between weight-bearing asymmetry and
FTSTS=-.44
Significant age related difference in performance were found
with older women performing longer than older men
Median (IQR) sit to stand test scores
AGE
Male/N
Female/N
Total
20-39
7.9(6.9-9.4)
8.0(6.4-9.0)
7.9(6.5-9)
75-79
10.3(9 -12.9)
11.5(9.3-13.6)
80-84
11.5(9.4-14.5)
12 (10.5-15)
11.2(9.1 13.4)
11.9(9.7-14.7)
85-59
11.7(9.8-14.7)
12.1(10.2-15)
12(10.2-14.9)
90+
14.5(9.7-30)
14.6(10.7-15.2)
OA
No OA
CVA
14.5(10.520.6)
Times for FRSTS by subject’s medical diagnosis (seconds)
No CVA
12.5(10.3- 11.0(9.2-13.1) 12.1(10.6-14.7) 11.5(9.5-14.2)
15.9)
5TSTS is significantly correlated with all WOMAC subscales
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CHAIR STAND Tests
age 50-69 (mean 59).6
and composite scores r = .485 to .529; muscle strength r = -.620 for knee extension; r = -.638 for knee flexion.
Community dwelling age 65(3), seat 47
Low level of relative importance in explaining STS
height 43 cm 109
performance. The 30 sec test is highly correlated to the 5TSTS
(.83) Regression results using all 6 lower limb strength
variables explained 48% and 35% of the variance in 5TSTS
and 30 sec chair stand scores, respectively. These results
suggest that variables other than hip, knee, and ankle joint
strength influence sit to stand performance
Predictive Validity: With a cut-off time of 12 seconds,5TSTS may be a predictor of falls during transitional
movements but it doesn’t generalize to ambulation. It may be a better predictor of general disability 117
Population
N
Results
Ambulatory, community-dwelling
50 5TSTS scores were not predictive of non-fallers or fallers;
people with chronic stroke92
5TSTS explains 64% of the variance of the TUG.
Healthy, community dwellers over
189 No significant difference between non-fallers, one time fallers,
age 65118
and multi-fallers
Community dwellers
257 Increased 5TSTS times predictor of falls with OR 1.13.
(mean age 72)119
Persons with Balance Disorders48
174 65% of all subjects correctly identified for balance disorders
with 5TSTS on univariate and multivariate discriminant models
Healthy older (>60) women living in
402 5TSTS time increased with age (0.44); Time decreased with
rural Japan community 103
higher physical activity index (0.14).
Time increased with fallers: Fallers (n=85)10.8+ 4.0 sec;
non-fallers(n=317)9.9+ 3.1.
Non-disabled community dwellers
1122 Increased 5TSTS scores predictor of mobility related disability
over age 71; prospective study117
within 4 years: > 16.7 sec , relative risk 4.1
4 year Predictors (p<0.001) Chi-Square Test
(Note: Same scoring used in another
Scores:
No Disability
Mobility Dis
ADL Dis
study of elderly persons) 100
16.7s
60%
25 %
15%
13.7 – 16.6 s
67%
22 %
11%
11.2 – 13.6 s
75%
16 %
9%
< 11.1s
79%
14 %
7%
Ambulatory community dwelling
362 5TSTS, when combined with the alternate step test (AST) and
elderly age 74-98107
the six-metre-walk tests (SMWT) demonstrate reasonable
sensitivity and specificity in identifying multiple fallers. Poor
performance in 2 mobility tests increased risk of multiple falls,
more than poor performance on one test alone.
People with chronic CVA in the
27 STS was less accurate at predicting falls than the ABC and the
community18
SIS-16
Chronic Hemi-paretic community
68 Results show that balance ability is an independent predictor of
dwellers 19
5TSST scores in people with chronic stroke
Mean 5TSST score of the client with stroke (17.9+/-1.2 sec)
was consistent with those reported for clients with a stroke
with mild to moderate residual disability (17.9-19.3 sec) but
slower than those of the age matched healthy subjects( 11.3 +/2.4 sec) but comparable with the average times reported for
elderly subjects with balance disorders (16.4 +/-4.4) sec
Community dweller over the age of
999 Twice as likely to be recurrent fallers in those that were
65 living in France. 120
classified as moderate fall risk, p=.003, 15 sec cut-off score
Sensitivity/specificity: 12 seconds is usually used for a cut-off but sensitivity and specificity are not impressive
as a fall risk predictor: sensitivity is 66% for general community dwellers, 83% for those who have had a CVA. If
using 16 seconds cut-off in people with Parkinson disease the sensitivity is75%. Overall it appears it is not a good
test for predicting falls when used alone.
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CHAIR STAND Tests
Population
Identifying Balance
Disorders
<age 60
>age 60
Entire group
Identifying individuals
who fall in a population of
community dwellers with
idiopathic PD
Identifying Multiple fallers
Ambulatory community
dwelling adults on
hemodialysis, age range
22-87
Subjects, age 18-65 with
chronic low back pain
Discriminatory between
young
healthy elderly
stroke
Chronic CVA
N=
Cutoff Score/Description
Results
48
79
95
174
82
10.0 seconds
14.2 seconds
13.0 seconds
34
>16 seconds
Sensitivity 87%, specificity 84%
Sensitivity 61%, specificity 59%
Sensitivity 66%, specificity 67%
Sensitivity 0.75 specificity 0.68
362
46
107
104
≥12 sec
Separate multivariate
regression analysis performed
using physical activity arbitrary
units
Sensitivity 66%, specificity 55%
No significant improvement in model
of the 5TSTS. r=0.68, r2=0.46N
178
38
Sensitivity 73%, specificity 70%
14.1 seconds
20
12
12
12
27
9.4 seconds
10seconds
12 seconds
18
17.9 seconds
Sensitivity 83% Specificity 75%
Sensitivity 67%, Specificity 72%
Responsiveness/Sensitivity to Change: Clinically, the responsiveness of this test to interventions may be the
most important utility. The test is applicable to almost all patient populations and sit to stand is indicated for a
functional goal when time is >12 seconds. If the person is unable to arise independently, they may use their hands
initially (norms do not then apply) with goals adjusted to reach the “12 second time with no hands”.
Population
N=
Reference and Intervention
Responsive
Average change post
Yes/No
intervention
30
Clients with Central
12
custom designed Vestibular
Yes
6.8 (6.)
vestibular
PT; 5 visits over 5 months;
Persons with cerebellar
dysfunction at
retrospective study
disorders had least
hospital-based rehab
improvement (n=2)
center
108
Community
12
Yes
Dialysis: 10.1(1.6) s
dwelling renal
(12
1 time comparison testing, age
Control: 7.3(1.1) s
dialysis patients
healthy
& sex matched controls
(P<0.001)
controls)
121
Older adults without
2450
Yes
Persons w/severe MRI
cognitive or
longitudinal analysis over 4
white matter
physical disabilities
years; mean age 74 . Persons
hypersensitivity had inc rate
w/severe MRI white matter
of decline (mean change
hypersensitivity had slower
=0.3 s/yr vs 0.5s/yr,). Rate
5TSTS (13.7 vs 14.6 s)
of decline inc w/basal
ganglia infarct (mean
change = 0.3s/yr vs 0.4s/yr)
all ind of demographics,
risk factors, CVD, and
baseline performance.
122
Community
620
2x/wk x 12 months
Yes
EIG group:
dwellers > 75
Extensive Intervention Group
pre 13.7(6.4)sec
EIG; individualized
post 11.7(4.6)
interventions comprising ex and
Post-hoc test differences
strategies for max vision and
between EIG – CG &MIG-
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CHAIR STAND Tests
Healthy, not active
Communitydwelling, age 60 92
Community
dwellers,
Age 65-79
108
Community
dwelling adults
Age 66 – 97 years
15
Community
Dwelling frail
Elderly awaiting
THA mean age 76
+ 4 years
From7/07- 11/08
21
Adults undergoing
THA or TKA
Age 61.8 + 11.2
years
53
10
Treatment
11
Usual care
80
sensation
Minimal Intervention Group
MIG: brief advice
Control CG
no feedback until 12 mos
90
3x/week x 16 weeks
Cobblestone mat walking group
n=54
Conventional walking group;
72
24 weeks 3 sets of 8 ex
EX 1 n=14,: 1x/week
EX 2, n=14: 2x/week
EX 3, n=11: 3x/week
Control, n=14: no exercise
CG:
No significant differences
between
EIG and MIG
Yes
Mean difference
1.21(0.32)
Yes
5TSTS times decreased for
all exercise groups, no sig.
change in control improved
5TSTS assoc w/% quad
strength increase (-0.4): leg
press (-0.39)
Pre: 19.3(7.9)
Post: 14.5(4.2);
27% improvement. No
difference 1 year follow-up
Exercise:
Baseline 18.5 + 13.5s
Pre-op 15.0 +5.8s
Control:
Baseline 17.1 + 6.4s
Pre-op 17.4 + 5.9s
Between Group
d = -2.9(-6.2-0.4)s CI(.95)
ANCOVA effect size 0.43;
medium effect
p = 0.05
Pre-op (t0):
Total group 18.3(7.7-35.7)s
THA 18.5 (7.7-32.7)s
TKA 17.5(8.9-35.7)s
3 month post-op(t3):
THA 16.0 (5.6-32.8)s
TKA 16.7 (10.4-35.3)s
6month post-op (t6):
THA 13.4(5.0-23.0)
TKA 15.6 (10.0-33.0)
Total p value delta
Scores t3-t0/t6-t0=
0.44/0.03s
No significant improvement
in model of the 5TSTS.
r=0.68, r2=0.46
75
3x/week x 8 week low to
moderate intensity group
exercise
Yes
123
Yes
Exercise intervention n=10
2x/wk x 60 min x 3-6 wks preop 91% participation
Control group n=11
1 group information session
124
Yes
Intervention
Total hip arthroplasty
n = 36
Total knee arthroplasty
n= 44
pre-op, 3 and 6 month post-op
measured with Activity Monitor
(AM)
Ambulatory
community
dwelling adults on
hemodialysis, age
range 22-87
Community
dwelling adults on
hemodialysis, age
40-70
46
Ambulatory
33
79
104
Separate multivariate
regression analysis performed
using physical activity arbitrary
units
No
125
Yes
106
Yes
3 month supervised LE
resistive exercise program,
3x/week during hemodialysis
3 month supervised
No improvement in any of
the groups.2-way repeated
ANOVA comparing
baseline & outcome, 2tailed <.05. P ND=0.38,
EX 0.30
Significant improvement
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Page 13
CHAIR STAND Tests
community
dwelling adults with
end-stage renal
disease on
hemodialysis, age
range 31-71
Lumbar spinal
stenosis patients
waiting for surgery
moderate level aerobic training
on a cycle ergometer, 3x/week
pre-post for ex group (14.7
± 6.2 to 11.0 ±3.3) vs
control group (12.8 ± 4.4 to
12.7 ± 4.8) sec with f = 10.4
and p =0.003
40
33
1 time comparison testing age
and sex matched subjects with
bilateral knee osteoarthritis
Yes
Males with
osteoarthritis of the
knee age 50-69
(mean 59)
54
6
1 time comparison testing age
and sex matched controls
Yes
Knee osteoarthritis
subjects (OA) age=
63+/- 10 years
80
16
Exercise intervention (knee
OA subjects) n = 40 3- 4 x/wk
x 8 wk exercise program for hip
abductors HEP and booklet
Control group(age and sex
matched normals) n=40
Regular daily activity
Yes
Community
dwellers >60 y.o
with hip or knee OA
defined by Altman
170
17
No
Subjects with OA of
knee average age
65.3 years.
39
Chronic
nonspecific low back
pain subjects
Subjects scheduled
for TKA measuring
asymmetry in
weight bearing pre
and post-op for
TKA.
Age=63.4±7.740
134
53
36 with
knee OA
pre/post
unilateral
TKA
17 healthy
people
Exercise intervention n=80
3x/week for 90 minutes/8
weeks, resistance training,
walking for 30 minutes, 30
minutes of education to promote
exercise adherence
Control group n=70 on wait list
for surgery
41
39 subjects underwent course
of PT, evaluating therapist
determined treatment based on
signs and symptoms.
38
Chronic non-specific low back
pain subjects
10 week exercise program
1 month post-op=11.3 sec
3 months post-op=8.8 sec
6 months post-op=9.4 sec
Greater symmetry with weight
bearing during sit to stand was
associated with increased quad
strength symmetry (range, .26.39).
Lumbar spinal stenosis:
15.76(1.44) s
Knee osteoarthritis:
14.37 (2.25)s
(p<.001)
Mean difference between
groups 19%-26% in STS,
timed up and go, and
straight line walking
(p<.001). Specific values
not given per test.
Initial testing (95%CI)
OA: 15.2 (12.6-17.9)
Control: 10.1 (9.2-11.0)
Final testing 8 week
(95%CI)
OA: 12.5 (10.6-14.4)
Control: 9.3(8.4-10.2)
Between group comparison
of improvement: F=5.55
p=.021
No significant difference
between groups
No
Effect size=.36(small)
Yes
9.8seconds
improvement.
Yes
Greatest asymmetry in
weight-bearing with sit to
stand is at one month postop (r=-.33), returned to preop levels at 3 months postop(r=-.26), more
symmetrical at 6 months
post-op than at pre-op(r=.31).
for
Ceiling or floor effect: Floor effect, that is that persons were unable to complete five timed chair stands was
reported in two large studies of people over age 60 as 18% males, 24% females83 and 6% males, 9% females.94 In a
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Page 14
CHAIR STAND Tests
study of long term care residents only 83% were able to perform 5TSTS. 85 Sixty seven patients with unilateral knee
OA recruited from an orthopedic clinic. Eighteen of the fifty (36%) participants in OA group could not perform STS
test without upper extremity assistance.40 If clients cannot do a chair stand without use of arms, the test may be
performed as a baseline measure with arm support BUT do not compare it to normative data below.
Interpreting results: This test has been interpreted as a measure of balance and as a measure of strength of knee
extensor and back muscles. Univariate relationships between serum creatinine, phase angle and physical
performance test results among individuals on hemodialysis suggest muscle strength is important in the performance
of activities such as chair-rising time. 104
Reference Data (Note that how the test is administered makes a big difference in interpretation; ie, always ending
in sit or stand but staying consistent)
Subjects
People age> 65 living in MA, Iowa
& CT (EPESE Study)83
Ends with sit.
Community dwellers 99
Ends with stand.
Community dwellers > age 60
NHW (Non-Hispanic White)
NHB(Non-Hispanic Black)
MA (Mexican American)
Men faster than women (P<0.001)
NHW faster than MA females,
NHB males and female s (p<0.001)
Ends with sit.94
Community Dwellers (EPESE
study)84 Ends with sit
Community dwelling adults15
Ends with sit.
Healthy older (>60) women living in
rural Japan community103
Ends with stand.
Community dwelling individuals
with idiopathic PD34
Non-disabled community dwelling
females 114
Ends with sit.
Massachusetts Male Aging Study116
Ends with sit
Ambulatory w/o assist device,
residents of a retirement village115
Ends with stand
Well-functioning, age 70-79,
community dwellers
Measured bone mineral density
BMD 95 Ends with stand.
Ambulatory community dwelling
adults on hemodialysis, age range
22-87. Mean age 52, capable of
walking 50 feet with or/without an
N
5097
642
Total:5403
2592 Males
1192
139
402
82
104
Av Time Men
13.2 sec Age 71-79
15.9 sec Age 80+
Av Time Women
14.4 sec Age 71-79
16.1 sec Age 80+
75-79
12.1(5.4)
12.2(4.1)
80-84
12.9(5.5)
13.4(5.6)
85-89
13.7(7.2)
14.1(6.5)
90+
17.2(5.9)
15.1(6.5)
Total
12.8(5.9)
12.9(5.1)
60-69
12.65(.24) s
13.22(.22)sec
70-79
13.35(.29)
14.19(.29)
80+
14.70(.25)
16.58(.30)
NHW
13.08(.20)
13.7 (.22)
NHB
14.49(.26)
16.52(.48)
MA
12.96(.27)
15.27(.30)
Overall
mean
13.11(.19)
14.05(.72)
Age 70-79. 45% male
Mean time 12.3(2.9) with range 5.0 – 20.4 sec
Age 65 – 93, men (n=32)
Mean time 11.7(3.8) with range 5.5 – 27.0 sec
Time increased with fallers:
Fallers (n=85)10.8(4.0) sec;
non-fallers(n=317)9.9(3.1) s.
Average age 67(9) years. Mean time to complete 5TSTS
20.25 (14) sec
Ages 60 -90
Mean time 11.5(4.1) range 6.0 – 34.5 sec
659
176
2928
46
Mean age 68(8)
3.4(1.2)sec
Mean age 80(6); men (n = 56)
Mean time 19.32(10.72), range 6.09 – 46.02 sec
Adjusted for age, ht, wt, bone site by ANCOVA time
difference in 5TSTS by race: Wh Fe 15.0(0.2), Bl Fe
15.9(0.2); Wh Male 12.4(0.2) vs Bl Male 14.3(0.2).
31 male and 15 females
mean time for 5TSTS 16.6 (9.5) sec
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Page 15
CHAIR STAND Tests
assistive device. Two trials
performed with the faster of the two
recorded to the nearest 10th of a
second.104 End not specified
Community dwelling adults on
hemodialysis, University based
dialysis unit 105 End not specified
Ambulatory community dwelling
adults with end-stage renal disease
on hemodialysis,, age range 31-71106
End test position not specified
Community dwellers with chronic
Hemiparesis 19ends with sit
Community dwelling adults 19-84
79
49 males and 30 females, age 40-70 with mean age 55
5TSTS Mean time 16.3, range 6.3 – 29.4 sec
33
exercise n=18
mean age =
57.3
control n=15
mean age 50.5
68
94
111
Ends with sit
Community dwellers
119
Ends with sit.
All (257)
Mean age72
No indication of number of males/females.
Mean age 54.
Mean time (sec) 14.7 with range 8.4-20.9
Average time 17.9 +/- 9.6 (8.41-54.6)sec
Measurement (n) Mean ± SD Minimum-Maximum
Trial 1: all ages (94) 7.8 ( 2.8)
4.0–16.3
Trial 2: all ages (94) 7.5 ± 2.8
4.0–17.0
Mean: all ages (94) 7.6 ± 2.7
4.0–16.0
Mean: 19–49y (39) 6.2 ± 1.3
4.1–11.5
Mean: 50–59y (15) 7.1 ± 1.5
4.4–9.1
Mean: 60–69y (18) 8.1 ± 3.1
4.0–15.1
Mean: 70–79 y (16) 10.0 ± 3.1
4.5–15.5
Mean: 80–89 years (6) 10.6 ± 3.4 7. 8–16.0
Non-Fallers
Occasional
Frequent falls
(n = 129)
fallers (n=76)
(n = 52)
13.51(5.37)s
12.23(3.08)s
14.86(6.87)s
14.69(6.58)s
Senior Athletes126 Ends with sit
Age
N
Score
SD
(all of these groupings are times
significantly different than the
Bohannon 2006 data) 127
50-59
78
6.7 sec
(1.9)
60-69
106
7.3
(4.1)
70-79
68
8.1
(1.9)
80-89
21
9.2
(2.9)
Subjects of varied age 20-39 and 7598 and disability including RA and
CVA height of chair 43 cm and
barefoot21
CVA=48
Significant age related difference in performance were found
with older women performing longer than older men
Median (IQR) sit to stand test scores
AGE
Male/N
Female/N
Total
20-39
7.9(6.9-9.4)
8.0(6.4-9.0)
7.9(6.5-9)
No CVA=
636
75-79
10.3(9 -12.9)
11.5(9.3-13.6)
11.2(9.1 -13.4)
80-84
11.5(9.4-14.5)
12 (10.5-15)
11.9(9.7-14.7)
85-59
11.7(9.8-14.7)
12.1(10.2-15)
12(10.2-14.9)
90+
14.5(9.7-30)
14.6(10.7-15.2)
OA
No OA
CVA
734
OA=283
No OA=
401
14.5(10.520.6)
Times for FRSTS by subject’s medical diagnosis (seconds)
No CVA
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CHAIR STAND Tests
Independently ambulatory, with
and without use of assistive
device, community dwelling
adults87 Ends with sit.
Ambulatory community dwelling
elderly,107 Ends with sit
Community dwellers, with and
without known balance
dysfunction
48
Ends with sit.
Healthy, community dwellers118
Ends with stand
12.5(10.3- 11.0(9.2-13.1) 12.1(10.6-14.7) 11.5(9.5-14.2)
15.9)
AGE
N
Group
Mean
SD
95% CI
76
(sec)
1
Male
8.4
--3.6—20.5
60-69
5
Female
12.7
1.8
7.3—18.1
6
Overall
12.0
2.4
9.5—14.4
9
Male
11.6
3.4
7.6—15.6
70-79
10
Female
13.0
4.8
9.2—16.8
19
Overall
12.3
4.2
10.3—14.3
10
Male
16.7
4.5
12.9—20.5
80-89
24
Female
17.2
5.5
14.8—19.7
24
NoDevice
16.0
4.9
13.7—18.2
10
Device
19.8
4.9
16.3—23.3
34
Overall
17.1
5.2
15.3—18.9
2
Male
19.5
2.3
11.0—28.0
90-101
15
Female
22.9
9.6
19.8—26.0
7
NoDevice
18.0
7.0
13.8—22.2
10
Device
25.7
9.2
22.2—29.2
17
Overall
22.5
9.0
17.9—27.2
362
N
Group
Mean
SD
Rel. Risk
(sec)
(95% CI)
age
282
Single
12
4.8
2.0
range
fallers
(1.3, 3.0)
74-98
80
Multiple
15
6.2
fallers
Controls
With Balance
Older Controls
Older Balance
Age 41(11)
Dysfunction
Age 73(5)
Dysfunction
(n = 32)
Age 48(10)
(n = 49)
Age 75(7)
(n = 47)
(n=46)
8.2(1.7)
15.3(7.6)
13.4(2.8)
16.4(4.4)
189
AGE > 65
Non-fallers
(n = 132)
15.2(4.8) s
1x Fallers
(n = 38)
14.7(3.3)s
Multi-fallers
(n = 19)
14.6(4.3)s
Other:
Sometimes 5TSTS is combined with other timed-tests for an overall physical performance measure as in the
Longitudinal Aging Study of Amsterdam, in which serum Vitamin D levels were associated with 5TSTS
performance of 1234 participants age> 65.128
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Page 17
CHAIR STAND Tests
Ten Chair Stands (10TSTS or TTSTST)
Directions: The subject is to sit in the chair with arms crossed over his/her chest. Instruct the subject to stand up
and sit down ten times as quickly as safely possible without using his/her arms on the word “Go.” Begin timing on
the word “Go” and stop timing when the person comes to a complete stand. Record the time in seconds.
Reliability:
Reference
N=
Sample Description
Intrarater Reliability: same rater within one session (or day)
Suzuki 20015
34
Community-dwelling females,
mean age 75(5); evaluated 2x in one session
Hammaren 20054
6
Men ages 31-61 with Myotonia Congenita
(MC)
Segura-Orti 201161
37
Community dwelling individuals on
hemodialysis with adequate dialysis dose or
delivery (Kt/V greater or equal to 1.2) 1 tester.
Mean age=24 (10.4). Testing occurred twice
over a one to two week interval, before the
second hemodialysis session of the week.
Interrater Reliability
Netz 199710
41
Volunteers, Mean Age 72 (6).
2 sessions, 2 raters each session
Test/retest Reliability
Newcomer 19938
16
Persons with RA tested twice, 10 week
intervals; number of testers not specified
Reliability Statistic
ICC = 0.71
ICC = 0.87 rest
ICC = 0.94 warm-up
ICC=0.88
SEM=3.6
MDC90=8.4 sec
MDC95=10 sec
(calculated)
ICC = 0.88
r = 0.88
Validity:
Construct/Concurrent Validity: It is difficult to always differentiate between these 2 types of validity. Evaluating
this property requires a “gold standard” measure with which to compare the test results. Such a “gold standard” is
often not available.
Population
N=
Support for Validity
Community dwelling, age 63-9046
48
10TST correlates with Strawbridge Frailty score (0.5),
TUG (0.37), mean grip strength (r = 0.40), mean
bimanual dexterity ( 0.34); it also correlates with reported
arm weakness ( 0.45), reported leg weakness (0.34) but
not with dizziness.
Community dwelling elderly10
122
10TSTS correlates with self-reported health .(0.41) and
self-report daily function (0.49)
Males, age>50 with arthritis vs other
147
10TSTS correlates with 50’ walk (0.66), LE MMT (0.47),
chronic diseases8
Arthritis Impact Measurement Scale (AIMS) pain scale
(0.36), AIMS physical activity scale (0.33), & tender joint
count (0.33) in RA patients. 10TSTS correlates with 50’
walk (0.46), LE MMT (0.60), & AIMS composite
physical function score (0.63) control group without RA.
Healthy older Community dwellers
11men mean age 74(2.8) and 17 women
age 73.1( 5.7) years.129
Community dwelling, healthy women
with a mean age of 72.2 +/- 6.4130
28
49
No correlation between trunk flexion angle and knee
extensor (r= -.02) or trunk extensor muscle strength
(r=.02)
No correlation between max peak torque of knee
extensors (-.02) or knee extensor muscular endurance (.11) using 30 rep isokinetic testing at 180deg/ sec and 10
TSTS. There was a moderate correlation between 10
TSTS, peak VO2 (-.38), and age(.34)
Predictive Validity:
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Page 18
CHAIR STAND Tests
Population
Older females, community dwelling5
N=
34
Results
Univariate association between 10TSTS & peak power of
ankle dorsi-flexors ( 0.50) and of physical functioning on
MOS SF36 ( 0.58)
Responsiveness/Sensitivity to Change
Population Descriptor
N=
Females with postmenopausal &
idiopathic osteoporosis
50
Men with Myotonia
Congenita
6
Independent
ambulators, with selfreported disability
30
Females >
65 years
People with
Osteoarthritis (OA)
of the knee
36
71(79)yrs
67%
female
Identifying persons
with arthritis vs. other
chronic diseases
Community dwelling
individuals with end
stage renal disease
(ESRD) on
hemodialysis. Mean age
42.8 (4.4); average time
on maintenance
hemodialysis 42 (19)
months. Used standard
44-cm straight-back
chair with no arm rests.
Ends with sit.
Individuals on dialysis
at least 3 months
Age Intervention group
56(15)
Non Intervention
group 53(17). Specify
protocol used by Csuka
and McCarty 2
147
males
10
111
Reference and Intervention
131
Responsive
Yes/No
Average Change post
intervention. Group
Differences significant?
Pre-intervention time:
30.1(8.1)s; 5 wk:
22.5(6.1)s; 6 mos postintervention: 21.1(5.9)s.
Control group no
significant change
Warming up effect 56%;
effect of medication 19%
6 mos retest, weekly calls
Experimental Group=25
Self-management classes
1x/week x 5 weeks
Control Group = 25
Maintain sedentary lifestyle
4
10TSTS tested at rest, after
warm-up, with & without
medication
3
3x/week x 16 weeks
Leg presses; knee extension
High velocity resistance =15
“as fast as possible”
Low velocity resistance
Yes
YES –with
training
NO—with
type of
Exercise
10 -13% improvement
after 16 weeks both groups
11
Stationary cycling 3x/wk
x10 wks, speed variance
High intensity (n =19)
70% heart rate reserve
low-intensity (n=20)
40% heart rate reserve
8
No intervention
Yes –with
training
NO—with
intensity
No differences between
groups
Pre-intervention time:
23.3 2(9.1)s
Post-intervention time:
19.11(6.62)s.
Arthritis: 31.0 (12.9)s
Control: 24.2 (10.1)s
125
2x /wk x12 weeks
supervised resistance training.
1x /wk x12 weeks
nonsupervised with theraband.
10 TSTS completed on 4
separate occasions over 12
weeks on nondialysis days.
The first 6 weeks were a
control period. Scores
compared with predicted
normal scores.
Yes- with
resistance
exercise
training
An improvement in time to
complete the 10 TSTS
(sec) baseline for the
control period=21(2) sec
compared to end of 12
week period=18(2) sec.
good
132
Yes
Intervention group
Baseline 29.3(12.5)sec
Increased from 14% (37%)
of normal to 38% (37%) of
normal values *based on
predicted values.
NonIntervention group
Remained at 23%(66%) of
normal values
Exercise Intervention
n=111
Individualized exercise
program x8 weeks; followed
by in clinic cycling x8 weeks
NonIntervention group n=109
Yes
Yes
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Page 19
CHAIR STAND Tests
People with ESRD on
hemodialysis
Mean age 42.8(4.4);
average time on
maintenance
hemodialysis 41.6
moths. Plus –or- minus
19 months.
People with
osteoarthritis of the
knee
Community dwelling
adults on hemodialysis
Persons 2-6 months s/p
TKA
Mean age=68±8.
Community dwelling
individuals on
hemodialysis
comparing heart rate
(bpm); systolic and
diastolic blood
pressure (mmHg);
Rating of perceived
exertion.
10
125
2x/wk x12 weeks
supervised resistance-training
1x/wk x12 weeks
nonsupervised with theraband.
10 TSTS completed on 4
separate occasions over 12
weeks on nondialysis days.
The first 6 weeks were a
control period. Scores
compared with predicted
normal scores
7
50
4 and 8 week follow up
Age: 75
Experimental group n=25
(5)
Education and supervised
26% male exercise 1 day/week for 45
minutes x 4 week plus HEP
Control group n=25 diathermy
treatment 1 day /week x4
week
125
Supervised exercises done
25
3x/wk. Pre-post test design
Experimental Group = 17
18 males PRE’s
7 females Control Group = 8
Low level aerobic exercise
51
35
N=18 received functional
training alone
N=17 received functional
training and balance exercise
program
Both groups had 12 sessions
over 6 weeks
Trial 1 Trial 2 61No intervention.
N=38
N=37
10TSTS tested in 1-2week intervals
Median HR
N=31
N=29
Median SBP
Yes-with
resistance
exercise
training
N=31
N=29
Median DBP
No
N=38
N=37
Median RPE
No
N=31
N=29
Median DBP(range)
No
N=38
N=37
Rating of perceived
exertion (range)
No
Initial test 58% slower in
dialysis patients compared
with age-predicted normal
values.
At completion of 12 wks of
training the time was
36.8% slower compared to
age predicted normal
values
No
Yes
No
Mean difference between
groups at 4 weeks: -.40 s
(95%CI -14.6 to 6.61) p>
.05
Mean difference between
groups at 8 weeks: -5.5 s
(95%CI
-11.3 to 0.03) p> .05
Delta score for treatment
group -5.4 ±10.6 sec. with
decrease time 22.2%
(p<.05). Low level aerobic
exercisers time decreased
6.4% (NS)
Both groups had >20%
decrease in 5TSTS with
mean between group
change of -0.6 seconds at
6 month follow up.
Effect size= small (.035)
Yes
Delta score trial 1=11(043) trial 2=6 (-6 to 27)
p=.001
No
Delta score trial 1=2(-23 to
31); trial 2=2(-35 to
40)p=.682
Delta score trial 1=-2(-18
to 9); trial 2=0(-19 to
13)p=.194
Delta score trial 1=11(7to
13); trial 2=11 (717)p=.850
Trial 1=-2(-18 to 9)mmHg;
Trial 2=0 (-19 to13)
mmHg
Trial 1=11(7-13)
Trial 2=11(7-17)
Ceiling or floor effect: People need to be able to repeatedly rise independently from a chair for the 10 TSTS test;
thus it would not be appropriate for very low functioning and dependent individuals.
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Page 20
CHAIR STAND Tests
Interpreting results: This test has been interpreted as a measure of one aspect of balance and as a measure of
strength of knee extensor and back muscles.
Reference Data:
Subjects
Community dwelling elderly,
identifying differences by age10
N=
252
55 men
197 women
Healthy adults (subjects screened
for systemic disease; multiple
regression for age, height, weight,
sex )2
139
77 males
62 females
Community dwelling adults on
hemodialysis, recruited from 2
dialysis clinics.133
25
18 males
7 females
Results
Mean Times
Age 60 – 69: 19.4 (4.2) s
Age 70 –79: 20.1 (5.7)s
Age 80 –89: 26.3(11.1)s
Prediction Equations
Males : Time (s) = 4.9 + 0.19 x age
Females: Time(s) = 7.6 +0.17 x age
Subjects by Age
10TSTS scores (seconds)
Group
Female/Male Means
20
10.9/8.8
25
11.8/9.8
30
12.6/10.8
35
13.4/11.7
40
14.3/12.7
45
15.1/13.7
50
15.9/14.7
55
16.8/15.6
60
17.7/16.6
65
18.4/17.6
70
19.3/18.5
75
20.1/19.5
80
20.9/20.5
85
21.8/21.5
Mean time 10TSTS 22 sec
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Page 21
CHAIR STAND Tests
30 Second Chair Stand Test
Directions:. The chair-stand test was administered using a folding chair without arms, with a seat
height of17 inches (43.2 cm). The chair, with rubber tips on the legs, was placed against a wall to prevent it from
moving during the test. The test began with the participant seated in the middle of the chair, back straight, feet
approximately shoulder-width apart and placed on the floor at an angle slightly back from the knees, with one foot
slightly in front of the other to help maintain balance when standing. Arms were crossed at the wrists and held
against the chest. At the signal "go," the participant rose to a full stand (body erect and straight) and then returned
back to the initial seated position. The participants were encouraged to complete as many full stands as possible
within a 30s time limit. The participant was instructed to be fully seated between each stand. While monitoring the
participant's performance to assure proper form, the tester silently counted the completion of each correct stand.
Following a demonstration by the tester, a practice trial of one repetition was given to check proper form, followed
by the 30s test trial. The score was the total number of stands executed correctly within 30s (more than halfway up
at the end of 30s counted as a full stand). Incorrectly executed stands were not counted. 134 This format is the one
often used and quoted.
In a recent study by Kuo (2013) the standard height of the chair was 43cm. He varied the height by 80 to 120 % and
found differences from the 43cm height 135
Two versions of the chair stand test, five time sit to stand (FTSTS) and 30-second chair stand tests have been most
often used with older adults. Although the movements required by each test are identical, the two tests differ in at
least one important aspect. The 5 Times STS test measures the time required to complete five movements, whereas
the other test measures the number of movements that can be completed in 30 seconds. Based on the amount of time
needed to complete 5 successive chair stands, the 5TSTS test may be a more appropriate functional lower limb
strength, speed, and power assessment instrument for older adults who have lower physical functional abilities (e.g.,
assisted living and nursing home residents and persons with joint replacement or hip, knee, or ankle joint
involvement). In contrast, the 30-second chair STS test may be a more appropriate functional lower limb endurance
assessment instrument for older adults categorized with higher physical functional abilities (e.g., persons residing in
the community who are independent, physically active, and experiencing no hip, knee, or ankle joint involvement).
109
Reliability
Reference
N=
Sample Description
Reliability Statistic
Intrarater Reliability: same rater within one session (or day) This test has nice reliability but not a lot has been
published.
136
Gill, 2008
82
Community dwelling Australians
CI(.95)
35 THA
awaiting hip or knee replacements not
Baseline n=40
47 TKA
actively in a PT program and not having
ICC0.97(o.94-0.98)
surgery within 6 weeks.
7-wk assessment
Age 70.3 (9.8) Sex51 female (63.4%)
n=47
THR 35 (42.7 %)
ICC=0.97(0.95-0.98)
BMI 31.1 (5.6); 2 trials 30 sec CST at
15-wk assessment n=37
baseline, 7 weeks, and 15 weeks with 30- ICC=0.98(0.97-0.99)
45 min rest between
Practice effect noted at
baseline trial
109
McCarthy, 2004
47
Communitydwellers age 65 (3)
30 sec STS 14(3) reps done on the R =.93 MDC(95) 2.19 stands
same day
Interrater Reliability
136
Gill, 2008
82
Community dwelling Australians
CI(.95)
35 THA
awaiting hip or knee replacements not
Baseline n=42
47 TKA
actively in a PT program and not having
ICC=0.93(0.87-0.96)
surgery within 6 weeks.
7-wk assessment
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Page 22
CHAIR STAND Tests
Age 70.3 (9.8) Sex51 female (63.4%)
THR 35 (42.7 %)
BMI 31.1 (5.6); 2 trials 30 sec CST at
baseline, 7 weeks, and 15 weeks with 3045 min rest between
n=28
ICC=0.98(0.95-0.99)
15-wk assessment n=29
ICC=0.98(0.96-0.99)
For baseline scores:
SEM=0.70stands
CV=11%
MDC=1.64 stands
Test-retest Reliability This gives a little information that the MDC(95) is between 2 and 3 stands for the 30 second
sit to stand. In the same day testing it is 2 stands. (see above).
136
Gill, 2008
82
Community dwelling Australians
MDC(90)=1.64 stands at
35 THA
awaiting hip or knee replacements not
time one or a MDC (95)
47 TKA
actively in a PT program and not having
is 1.96 stands. These
surgery within 6 weeks.
were done in all the same
Age 70.3 (9.8) Sex51 female (63.4%)
session not a week apart.
THR 35 (42.7 %)
BMI 31.1 (5.6); 2 trials 30 sec CST at
baseline, 7 weeks, and 15 weeks with 3045 min rest between
134
Jones, 1999
76
Community dwelling elderly average age .84 for men
70.5 . Tested 2-5 days apart with seat
.92 for women
height 43.2 cm
total .89 MDC (95) = 3.11
stands
137
Alfonso-Rosa,
18
2013Older adults with type 2 NIDDM (1
week apart)
ICC > or = .92 MDC(95)
3.3
Validity
Construct/Concurrent Validity:: It is difficult to always differentiate between these 2 types of validity. Evaluating
this property requires a “gold standard” measure with which to compare the test results. Such a “gold standard” is
often not available
Population
N=
Support for Validity
Persons examined one week prior to
24
Knee swelling correlation with 30 second chair stand
TKA and at time of hospital discharge to
test (r=.08), knee extension strength correlation with 30
assess relationship of knee swelling to
second chair stand test (r=-.09).
loss of knee-extension strength and
functional ability.49 Mean age=66±7
Community dwelling elderly 134
66
Moderate correlation between chair stand and weightadjusted leg-press performance for all participants (r.77) and separate correlations for men (r=.78) and
women (r=.71)
Community dwelling age 65(3), seat
height 43 cm 109
47
Low level of relative importance in explaining STS
performance. The 30 sec test is highly correlated to the
5TSTS (.83) Regression results using all 6 lower limb
strength variables explained 48% and 35% of the
variance in 5TSTS and 30 sec chair stand scores,
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Page 23
CHAIR STAND Tests
respectively. These results suggest that variables other
than hip, knee, and ankle joint strength influence sit to
stand performance
Clients average age 76(7) 138
14
Elderly in China 139
142
1038
Subjects in Denmark tested after TKA
39
140
Predictive Validity
Population
Individuals scheduled for TKA
Age 62.7±7.5. 70% women.141
N=
82
Demonstrated average power and peak power related to
the first 20s portion of the 30s test
Correlation with LE strength in .3-.4, hip strength is
more important than knee extensor strength in the
elderly during a chair stand test. Scores decrease with
increase in participant age
30 sec chair stand was 9.6(5.2) 4 weeks after TKA and
correlated to leg press power .74 and knee extension.4
Results
Flexion strength of the surgical knee had the highest
correlation with 30 s sit to stand (.63)
Extension strength of surgical knee correlation (0.55)
with 30 s sit to stand
Flexion strength nonsurgical knee(.61)
Extension strength nonsurgical knee (.52)
Stepwise regression to predict sit to stand repetitions in
30 seconds found R2 to be .40 for flexion strength of the
surgical knee.
Subjects prior to hip replacement
{Gill 2012}142
82
PSFS .26 ; WOMAC Function -0.62
SF-36 PF 0.39 ; SF-36 PCS 0.35
SF-36 MH 0.33
Sensitivity/specificity:
Population
Brazil community
elderly143
N=
48 fallers
48 non
fallers
Cutoff Score/Description
Fallers defined by 2 or more falls
in past 6 months.
Results
No difference between the 2 groups 7.9(2.5)
fallers and 8.5(2.6) for the non-fallers.
Elderly people144
135
<14.5 to predict falls
Sensitivity 88%
Specificity 70%
Responsiveness/Sensitivity to Change
Population
N=
Intervention
Responsive
Yes/No
Av change after
intervention. Group
differences significant?
26 people with prehabilitation
28 people with usual care
before TKA Topp, 2009145
54
Prehabilitation prior to
planned TKA: resistance
training, flexibility and step
training 3x/wk
13.04(7.5) sessions.
Yes at 1
week prior
to TKA and
one month
s/p TKA
Women aged 50-65 with knee
26
Intervention group n=13,
Yes
Significant difference
within the prehab group 1
week before, 1 and 3
months after TKA to
baseline. Significant
difference within control
group at 3 months after
TKA. Effect size at one
week prior to TKA= .54,
at one month after
TKA=.31, at three months
after TKA=.39
intervention pre 15.0 (1.4)
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Page 24
CHAIR STAND Tests
OA
Neves, 2011 42
Subjects tested 1 week prior to
TKA and at hospital discharge;
mean age 66(7)Holm, 201049
24
Subjects after THA, Gill
2012142
82
Men with fibromyalgia
participating in Tai Chi, age
52(9). Carbonell-Baeza 2011
resistance training 3x/week
for 12 weeks combined
with creatine
supplementation
Control group n=13,
resistance training 3x/week
for 12 weeks 42
Examination of relationship
of knee swelling to loss of
knee extension strength and
functional ability
post 18.1 (1.8)
p=0.006
control pre 15.0 (1.8)
post 15.2(1.2)
creatinine vs placebo
P=0.004
Yes
Pre: 30 s chair stand test
10.4(2.8)
Post (POD 2) 5.4(3.0)
P =<.001
Examination of relationship
in STS in subjects who use
a gait aid (AD) or no gait
aid
Yes
Significance
(2-tailed) =
0.00
6 men
60 minutes, 3x/week for 16
weeks
Adherence 80%
No
No AD 7.3(2.8)
Gait Aid 4.5(3.3)
Mean difference (95%
CI)=2.8(1.4-4.1)
Effect size(95% CI) =
0.64(0.32 to 0.95)
Initial 9(2)
Post 10(2)
Detraining 10(2)
Persons with hip and knee OA
Shou, 2012147
Participants using Nintendo in
Denmark. Jorgensen 2013 148
34
6 weeks of programming
using GLA:D in Denmark
28 treatment x 10 weeks
30 no treatment
Yes
P<.012
Yes
P<.01
Women in Brazil, av age 63
Hallage, 2010 149
13
Step aerobics 3x/week for
30-60 min x12 weeks
Yes
F value 14,
p<0.05
Community dwelling elderly,
age 64 in Japan. Okamoto,
2007 150
45
men
155
female
42
64 step tests
yes
15 Pilates
15 Aqua-fitness
12 control
Chair stand (stands/30
seconds)
yes
146
Community dwellers in
Hungary, av age 67(5)
Plachy 2012 151
152
Blair 2013 Cancer
58
10
yes
Initial 13.8(3)
After 3 months 15.1(3)
Rx: 11.5(3.8) initial
13.3(3.2) trained
NoRx: 11.2(3.8)
12.1(3.0)
Initial 13.8(3.4)
12 week 16.9 (3.3)
1 mo post 15.3 (3.4)
18% change after 12
weeks, 10% decrease 1 mo
post training
Men increased 5.9 stands
vs controls 2.6
Women increased 4.5 over
0.1 controls
Final: Pilates 24(3)
Aqua-fitness 21(4)
Control 19(6)
Median (min,max) Initial
15.0 (12,18)
6 mo retest 17.0 (13, 22)
1 year later 17.5 (12,24)
Change 3.0 (-3.9)
Reference Data:
Subjects
Subjects tested 1 wk pre-op and
2.1+0.5 days post-op unilateral THA;
age 69(6.1) height 166.9(7.9)cm
Mass 75.9(11.8)kg
BMI 27.2(3.7)153
N=
24
20 females
Results
Score Pre-op: 9.8 (3.4)
p = .01
Score Post-op at discharge 6.3(2.8) p= .01
Change in Mean -36% from surgery
Compiled by Michele Stanley, Teresa Steffen, and numerous students. Thanks to Lina Prosser for
her help in formatting the outline. Do not copy without permission of the authors.
Page 25
CHAIR STAND Tests
Community dwelling elderly, average
age 70.5134
Criterion Reference Fitness Standards
for lower body strength154
Elderly persons in Hong Kong (HK)
ranked against United States (US)
norms
MacFarlane 2006 139
190
age
N
Chair stands
60-69
70-79
80-89
Activity Level
32
96
62
14 (2.4)
12.9(3.0)
11.9(3.6)
2140
High
Low
Age
144
46
Female
13.3(2..8)
10.8(3.6)
Male
15
15
14
13
12
11
9
17
16
15
14
13
11
9
1038
60-64
65-69
70-74
75-79
80-84
85-90
90-94
Group
HK
US
HK mean as
US %
Fe 60-64
12.3(4.2)
15
25
Fe 65-69
11.3(3.5)
14
25
US mean data and percentiles taken
Fe
70-74
10.1(3.8)
13
25
from Rikli and Jones 2001154
Fe 75-79
9.4(3.4)
12
20
Fe 80-84
9.3(3.1)
11
25
Fe 85-89
8.3(2.4)
10
25
Fe 90+
7.9(2.7)
8
50
Male 60-64
14.0(4.3)
16
25
Male 65-69
12.9(4.6)
15
30
Male 70-74
11.6(3.3)
14
25
Male 75-79
11.3(4.4)
14
25
Male 80-84
11.1(4.2)
12
35
Male 85-89
8.1(4.0)
11
25
Male 90+
5.8(2.6)
10
15
Ceiling or floor effect: People need to be able to rise from a chair repeatedly for 30 seconds independently,
therefore, this would not be an appropriate test for those needing assist to rise from a chair or without the endurance
to complete the test.
Interpreting results: This test has been interpreted as a measure for functional ability145 and as a measure of
strength of the lower extremities. This test is often combined with other measures to get a better functional outlook
on a client
Other: May be used as a functional fitness measure with children and young adults
Compiled by Michele Stanley, Teresa Steffen, and numerous students. Thanks to Lina Prosser for
her help in formatting the outline. Do not copy without permission of the authors.
Page 26
CHAIR STAND Tests
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