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1-Minute Sit-to-Stand Test

SYSTEMATIC REVIEW OF PROCEDURES, PERFORMANCE, AND CLINIMETRIC PROPERTIES

Bohannon, Richard W., PT, DPT, EdD; Crouch, Rebecca, PT, DPT

Journal of Cardiopulmonary Rehabilitation and Prevention: January 2019 - Volume 39 - Issue 1 - p 2–8
doi: 10.1097/HCR.0000000000000336
Scientific Review
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Purpose: Tests for quantifying exercise capacity that are applicable in diverse settings are needed. The 1-min sit-to-stand test (1-MSTST) is such a test. This systematic review summarizes the literature addressing 1-MSTST procedures, performance, and clinimetric properties.

Methods: Three online databases, hand searches, and an expert consultant were used to identify literature relevant to the aims of this review. Inclusion required that studies addressed the 1-MSTST, focused on adults, and were written in English.

Results: Seventeen articles were identified that met the inclusion criteria. The populations assessed included adults without identified pathologies and adults with lung disease, renal disease, stroke, osteoporosis, or receiving palliative care. The 1-MSTST typically involves an armless chair and the performance of as many sit-to-stand actions as possible in 1 min without using the upper limbs. The mean number of 1-MSTST repetitions reported in the literature achieved ranged from 8.1 (patients with stroke) to 50.0 (young men). Numerous studies supported the convergent and known-groups validity and the test-retest reliability of the test. The test has been shown to be responsive. Normative reference values are available.

Conclusions: The literature provides considerable support for using the 1-MSTST to quantify exercise capacity. Broader use of this test may be indicated, particularly where space and time are limited.

This systematic review focused on use of the 1-min sit-to-stand test for quantifying exercise capacity. The 16 relevant articles described application of the test in diverse groups of adults. Evidence was summarized regarding the validity, reliability, and responsiveness of the test. Normative values are available.

Department of Physical Therapy, College of Pharmacy & Health Sciences, Campbell University, Lillington, North Carolina.

Correspondence: Rebecca Crouch, PT, DPT, Doctoral Program of Physical Therapy, Department of Physical Therapy, College of Pharmacy & Health Sciences, Campbell University, Tracey F. Smith Hall, 4150 US 421 South, Lillington, NC 27546 (rcrouch@campbell.edu).

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jcrpjournal.com).

The authors declare no conflicts of interest.

Exercise capacity is a key element of physical fitness. As such, its measurement is commonplace in both healthy and diseased populations. Exercise capacity is often tested using a cycle ergometer or a treadmill; however, these devices are costly and not easily transported. Field tests not requiring such devices are available; chief among them are timed walk tests and step tests. Timed walk tests (eg, 6-min walk test [6MWT]) are supposed to be conducted on a long corridor,1 which is not available in many settings. Step tests (eg, YMCA step test) are physically demanding and cannot be completed by some older individuals with muscle weakness or joint pain.2 An alternative to the aforementioned tests that a patient could complete quickly in a small space would be advantageous. The 1-min sit-to-stand test (1-MSTST), first described by Koufaki et al3 in 2002 is such an alternative as it requires only a chair, a stopwatch, and <2 m2 of floor space. That noted, we have not seen a synopsis of information on the 1-MSTST in RehabMeasures4 or elsewhere. We, therefore, conducted a systematic review of the 1-MSTST focused on test procedures, performance, and clinimetric properties.

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METHODS

DATA SOURCES AND SEARCHES

Three bibliographic databases (PubMed, CINAHL, and Scopus) were searched on August 3, 2016. The string “sit to stand” and (1 minute or 1 min or 60 sec) was used to identify potentially relevant articles. Where possible, the search was limited to humans and adults. Thereafter, hand searches were conducted using the reference lists of relevant articles. An expert on the topic (Milo Puhan) was contacted to determine whether we had missed any pertinent articles in our search.

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SELECTION OF STUDIES

Inclusion required that studies were published in peer-reviewed journals. The studies had to provide a description of the 1-MSTST and to address 1 or more clinimetric properties of the test. Studies were excluded if a sit-to-stand (STS) test other than the 1-MSTST was described (eg, 30-sec STS test) or if they were written in a language other than English. Quality was not a factor in study selection.

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DATA EXTRACTION AND QUALITY ASSESSMENT

Two authors independently examined potentially relevant articles for inclusion and exclusion—beginning with the title and abstract and progressing to full text, if warranted. After each author compiled a list of articles to be retained for abstracting, they met to reconcile any differences. Once they agreed upon a list of articles, each author independently abstracted predetermined information from the articles. That information focused on the sample tested (composition, size, and country), procedures, findings relative to the 1-MSTST (eg, mean number of repetitions and clinimetric properties), and notable conclusions. Quality was assessed independently by the 2 authors using a custom instrument (see Supplemental Digital Content 1, available at: http://links.lww.com/JCRP/A73) adapted from similar instruments used previously by the authors.5 , 6 Ratings were compared and differences were reconciled by discussion.

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RESULTS

From a total of 95 nonduplicative articles identified by both database and hand searches and by expert advice, 17 were deemed ultimately to be appropriate for inclusion in this systematic review (Figure).3 , 7–22 The results of the studies are summarized in Table 1.

Figure

Figure

Table 1

Table 1

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.

Table 2

Table 2

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DISCUSSION

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.

Table 3

Table 3

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.

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CONCLUSION

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.

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ACKNOWLEDGMENT

The authors thank Dr Milo Puhan for his input into this scientific review.

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REFERENCES

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Keywords:

clinimetrics; functional capacity; sit-to-stand test; validity

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