The composition of the samples tested using the 1-MSTST was diverse. Four samples involved groups of adults with no highlighted pathology.7 , 9 , 12 , 17 The remainder focused on patients with pathology, with lung disease being the most common.9 , 11 , 12 , 14 , 16 , 19–22 Other patient groups studied included those with renal disease,3 , 8 , 13 stroke,10 or osteoporosis,18 and those in palliative care.15 Group sample sizes ranged from 9 to 6926, but only 3 studies included >100 participants. The studies were conducted in 18 countries, and Switzerland was the most common location.
All but 1 study was conducted using a chair; the exceptional study used a height-adjustable plinth.10 In some studies, no chair specifics were provided.3 , 8 , 18 , 21 In other studies, the chair was referred to as a “standard” or “standard height” chair.7 , 15 The height of the chair was specified in 10 studies,9 , 11–14 , 16 , 17 , 19 , 20 , 22 with the height ranging from 44.5 to 48.0 cm. The chairs used in these same 10 studies were designated as armless.
A prohibition on upper limb use during the 1-MSTST was delineated in all but 4 of the studies.3 , 15 , 18 , 21 Measures taken to ensure that the upper limbs were not used included crossing the arms over the chest7 , 13 , 20 and putting hands on the hips.9 , 11 , 16 , 17 , 19 , 22 Regardless of upper limb use, instructions in most studies stipulated the objective to be the completion of as many repetitions, times, or cycles as possible3 , 8 , 10–12 , 14 , 16 , 17 , 19 , 20 or as quickly or as fast as possible.13 , 18 , 22 The criterion measure reported in all studies was the number of repetitions, but some studies were more specific. For example, Segura-Ortí and Martinez-Olmos13 addressed the issue of half-completed repetitions. Strassmann et al17 referred to fully completed cycles.
All but 1 study reported the number of STS performed by participants in 1 min.11 The mean/median number of 1-MSTST repetitions in the studies varied greatly—from 8.1 for a sample of patients with stroke10 to 50 for a population-based sample consisting of 20- to 24-y-old males.17
Test validity was addressed in 14 studies. It was supported by significant correlations between 1-MSTST performance and other measures with which such performance might be expected to be associated. These other measures included, but were not limited to, leg press7 , 20 and knee extension9 , 19 , 22 strength, 6MWT distance,9 , 20 , 22 pulmonary disease severity scores,12 , 16 laboratory measures of exercise capacity,21 and self-reported physical function.21 Validity correlation was also good for physiologic changes accompanying 1-MSTST performance; among these changes were increases in dyspnea,9 , 22 blood lactate,11 and heart rate.13 Fatigue resulting from the 1-MSTST was significantly greater than fatigue accompanying a 30-sec STS test. Notably, in comparisons with the 6MWT, the 1-MSTST evoked greater increases in blood lactate11 and comparable increases in heart rate.13 Known-groups validity of the 1-MSTST has been verified in several studies. Specifically, 1-MSTST repetitions have been shown to be greater for men than for women,7 , 16 , 17 for healthy controls than for patients with COPD,9 , 12 and for patients with COPD who survived than for patients with COPD who did not survive for 2 y after testing.16
Four studies in our review addressed test-retest reliability. Two studies did so by reporting coefficients of variation across trials (3.8% and 12.8%)3 , 21 and 3 did so by reporting intraclass correlation coefficients (0.80-0.98).7 , 13 , 21 Responsiveness of the 1-MSTST was implied by studies showing significant increases in 1-MSTST repetitions by patients participating in exercise interventions.3 , 18 , 20 Specific indicators of responsiveness have been provided by Segura-Ortí and Martinez-Olmos,13 who reported a minimal detectable change (90%) of 4 repetitions, Radtke et al,21 who reported minimal important differences of 5.4 (anchor-based) and 4.9 repetitions (distribution-based), and Vaidya et al,22 who reported minimal important differences of 1.9 and 3.1 repetitions (distribution-based) and 2.5 repetitions (anchor-based).
Only 1 study has provided normative data for the 1-MSTST. In that study, Strassmann et al17 presented summary data derived from almost 7000 Swiss adults. Summary data were presented according to 12 age strata for men and women and as reference equations accounting for explanatory variables.
Table 2 summarizes the quality ratings of the 16 articles. The total rating scores ranged from 4 to 10 out of a possible 13 points.
Exercise capacity is an important aspect of physical fitness for which practical measurement procedures are needed. Our review of the literature supports the 1-MSTST as a procedure that can be used with a wide range of adult populations and is described by investigators as inexpensive, space efficient, simple, and easy to administer.7 , 12 , 17 , 21 Investigators have also advocated the test as an alternative to the 6MWT.9 , 11 , 16
The literature provides considerable information on 1-MSTST procedures, performance, and clinimetric properties. The specificity with which procedures are described in the literature varies. However, procedures usually addressed seating, restrictions on arm use, the objective of completing as many STS actions as possible, and the counting of repetitions. Based on this review of the literature and our experience with other STS tests, we recommend the procedure outlined in Table 3. As might be expected, performance on the 1-MSTST varies with young community-dwelling males completing the highest number of repetitions17 and patients with substantial weakness10 or medical illness performing far fewer.8 , 9 , 16 , 22 Not surprisingly, the number of repetitions is related to lower limb strength.7 , 19 , 20 , 22 This is validating, but also confounding, as the intent of the 1-MSTST is typically to quantify aerobic capacity impairments accompanying pulmonary disease9 , 11 , 12 , 14 , 16 , 19–22 or debility associated with other diseases.3 , 8 , 13 , 15 The relationship between 1-MSTST repetitions and pulmonary disease severity,12 other measures of exercise capacity,9 , 20–22 and physical function21 , 22 supports the validity of the test. So does the ability of the test to predict important outcomes such as survival.16 The 1-MSTST appears to possess good test-retest reliability.3 , 7 , 13 , 21 However, as with the 6MWT,23 performance tends to increase with repeated testing. This fact needs to be taken into account by clinicians using the test to document changes in physical performance over the course of an intervention. Regarding change over time, research supporting the responsiveness of the 1-MSTST has been published,3 , 13 , 18 , 20–22 but more diagnostic-specific anchor-based minimal clinically important differences are needed. Norms derived from a large sample of community-dwelling Swiss adults are available.17 Whether they generalize to other populations (eg, Americans), however, is not known.
Our review has several limitations. First, by intention, the review was limited to adults. Thus, it provides no guidance as to the procedures, performance, and clinimetric properties as they may relate to children. Second, we used a hybrid custom scale for documenting quality. Consequently, quality comparisons vis-à-vis other reviews cannot be made. Finally, the small number and heterogeneity of the studies reviewed precluded the meta-analytic consolidation of studies included in our review.
Ease of administration, availability of needed equipment, low cost of testing equipment, and applicability of the test in small spaces point to potential clinical applications for this test. Because of these characteristics, the 1-MSTST may be used within the space of a hospital room or in a small examination room in an outpatient setting.
Possible application of the 1-MSTS submaximal field test in future research may include establishing norms for pediatric or adolescent age groups, expanding use for individuals with cardiac diagnoses, and providing an alternative submaximal exercise capacity test in the home health setting.
We have summarized the findings of 17 studies focused on the 1-MSTST. Although further research on the test is needed, extant journal publications inform as to procedures and performance on the test. The 1-MSTST appears to be a practical, reliable, valid, and responsive alternative for measuring exercise capacity, particularly where space and time are limited.
The authors thank Dr Milo Puhan for his input into this scientific review.
1. American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117.
2. Bohannon RW, Bubela DJ, Wang Y-C, Magasi SS, Gershon RC. Six-minute walk test vs three-minute step test for measuring functional endurance. J Strength Cond Res. 2015;29:3240–3244.
3. Koufaki P, Merecr TH, Naish P. Effects of exercise training on aerobic and functional capacity
of end-stage renal disease patients. Clin Physiol Funct Imaging. 2002;22:115–124.
5. Bohannon RW, Glenney SS. Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract. 2014;20:295–300.
6. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2016;23:377–381.
7. Ritchie C, Trost SG, Brown W, Armit C. Reliability and validity
of physical fitness tests for adults aged 55 to 70 years. J Sci Med Sport. 2005;8:61–70.
8. Majchrzak KM, Pupim LB, Chen K, et al Physical activity patterns in chronic hemodialysis patients: comparison of dialysis and nondialysis days. J Ren Nutr. 2005;15:217–224.
9. Ozalevli S, Ozden A, Itil O, Akkoclu A. Comparison of sit-to-stand test
with 6 min walk test in patients with chronic obstructive pulmonary disease. Respir Med. 2007;101:286–293.
10. Britton E, Harris N, Turton A. An exploratory randomized controlled trial of assisted practice for improving sit-to-stand in stroke patients in the hospital setting. Clin Rehabil. 2008;22:458–468.
11. Canuto FF, Rocco CCM, Ventura de Andrade D, et al Neurophysiological comparison between the Sit-to-Stand test
with the 6-Minute Walk test in individuals with COPD. Electromyogr Clin Neurophysiol. 2010;50:47–53.
12. Rocco CC, Sampaio LM, Stirbulov R, Corrêa JC. Neurophysiological aspects and their relationship to clinical and functional impairment in patients with chronic obstructive pulmonary disease. Clinics. 2011;66:125–129.
13. Segura-Ortí E, Martinez-Olmos FJ. Test-retest reliability and minimal detectable change scores sit-to-stand-to-sit tests, the six-minute walk test, the one-leg heel-rise test, and ongoing hemodialysis. Phys Ther. 2011;91:1244–1252.
14. van Gestel AJR, Clarenbach CF, Stöwhas AC, et al Predicting daily physical activity in patients with chronic obstructive pulmonary disease. PLoS One. 2012;7:e48081.
15. Low J, Davis S, Drake R, et al The role of acceptance in rehabilitation in life-threatening illness. J Pain Symptom Manage. 2012;43:20–28.
16. Puhan MA, Siebeling L, Zoller M, Muggensturm P, ter Riet G. Simple functional performance tests and mortality in COPD. Eur Respir Dis. 2013;52:956–963.
17. Strassmann A, Steurer-Stey C, Lana KD, et al Population-based reference values for the 1-min sit-to-stand test
. Int J Public Health. 2013;58:949–953.
18. Küçükçakır N, Altan L, Korkmaz N. Effects of Pilates exercises on pain, functional status and quality of life in women with postmenopausal osteoporosis. J Bodyw Mov Ther. 2013;17:204–211.
19. Rausch-Osthoff A-K, Kohler M, Sievi NA, Clarenbach CF, van Gestel AJR. Association between peripheral muscle strength, exercise performance, and physical activity in daily life in patients with chronic obstructive pulmonary disease. Multidiscip Respir Med. 2014;9:37.
20. Zanini A, Aiello M, Cherubino F, et al The one repetition maximum test and the sit-to-stand test
in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients. Int J Chron Obstruct Pulmon Dis. 2015;10:2423–2430.
21. Radtke T, Puhan MA, Hebestreit H, Kriemler S. The 1-min sit-to-stand test
—a simple functional capacity
test in cystic fibrosis? J Cyst Fibros. 2016;15:223–226.
22. Vaidya T, de Bisschop C, Beaumont M, et al Is the 1-minute sit-to-stand test
a good tool for the evaluation of impact of pulmonary rehabilitation? Determination of the minimal important difference in COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:2609–2616.
23. Peel C, Ballard D. Reproducibility of the 6-minute walk test in older women. J Aging Phys Activ. 2001;9:184–193.
clinimetrics; functional capacity; sit-to-stand test; validity
Supplemental Digital Content
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.