There is growing literature supporting the use of functional performance measures for assessment of geriatric patients and clients and to predict future functional loss.1,2 The Five Times Sit to Stand Test (FTSST) is a simple, quick measure of function often used for this purpose. This measure has significant correlations not only with lower extremity strength,3–6 but with balance,7–10 step execution time,4,9 cognitive status,11 and vestibular function.7,12 It also predicts disability13 and falls.8,14,15 Wang and colleagues1 found that the FTSST outperformed 6 other functional measures in predicting mobility decline among community-dwelling seniors. Intrarater,3 interrater,3,8 and test-retest reliability3,8,15–17 estimates have consistently been good to excellent and are reliable even among amateur raters.3
Normative data for the FTSST have been reported in several studies.10,17,18 A recent, thorough meta-analysis by Bohannon19 yielded mean scores by age decade for community-dwelling seniors. However, community-dwelling seniors, as a group, have demonstrated very low physical activity levels.20–22 While the general population of aging adults is showing high rates of inactivity, several authors have noted a trend toward increased participation in competitive events for senior athletes.23–25 For the purpose of this article, we will define a senior athlete as an individual older than 50 years who participates in sport competition. Numbers reported by the National Senior Games Association show that while the first National Summer Senior Games event in 1987 hosted 2500 athletes, that number has grown steadily and stayed consistently over 10 000 since 2003.26 With these trends, we expect increasing demands for measures and norms that are more applicable to senior athletes. Accurate normative data for this population may provide more opportunities to identify a relative mobility decline, prevent injury or disability, and ultimately promote continued physical fitness for these active senior athletes.
The objective of this study was to (1) compare results of the FTSST in senior athletes older than 60 years to norms for community-dwelling adults of the same age, (2) determine the effect of age, gender, and sport intensity on FTSST performance in senior athletes, and (3) establish norms appropriate for this population of interest.
All participants were athletes, older than 50 years, registered in either the 2011 National Senior Summer Games or the 2011 South Dakota Senior Games. Each participant volunteered to be tested as a part of a larger 15-minute fitness screen. Testing was based on participant availability and therefore occurred before or after their sport competition or on a rest day between competitions. Participants were tested individually in a secluded area reserved for screening and were not tested at the same time, thus avoiding the possibility of competition between participants. This study was approved by the University of South Dakota Institutional Review Board, and all participants signed an informed consent to participate.
The FTSST was administered as described by Duncan and colleagues8 with participants seated in a chair 43 cm from the ground. Participants were instructed to stand and sit 5 times as quickly as possible with their arms crossed over their chests. The test was demonstrated, but no practice session was allowed. Timing began when the tester said “go” and was stopped when the participant resumed contact with the chair after the fifth stand. Time was recorded to the nearest hundredth of a second.
As a part of the larger screen subjects also self-reported their registered events and estimated time spent each week on cardiovascular and strength training activities.
The mean time to complete the FTSST and SD were calculated for age groups 50 to 59, 60 to 69, 70 to 79, 80 to 89, and 90 to 99 years. To improve the accuracy of data reports, participants were grouped into 2 categories of sport intensity based on their registered events: (1) active sports (AS) and (2) leisure sports (LS) (Table 1). AS were defined as those sports activities that provide the opportunity for strength or cardiovascular challenges such as the triathlon or basketball events. LS were those activities determined to have limited opportunity for strength or cardiovascular challenges such as shuffleboard or horseshoes. Participants grouped as LS did not report participation in any AS. The mean for decades 60+ was compared with available normative data19 using Type III sum of squares due to differences in the group size. An omnibus ANOVA was used to simultaneously test for differences by age, gender, and sport intensity (AS or LS).
All 276 participants were able to complete the FTSST. The average age was 64.9 years (SD = 15). There were 104 men and 172 women. One hundred ninety-four were between the ages of 60 and 89. The mean FTSST time and standard deviation for each age-decade are reported in Table 2. Across each age category, all FTSST mean times were significantly faster than current reported norms19 for community-dwelling adults over age 60. We also computed effect sizes (Cohen's d) for each of the tests between previously published norms and the athlete's means. Effect sizes are important for assessing clinical, as opposed to statistical significance. Generally, ds greater than 0.80 are considered large.27 All effects reported here were large, ranging from 1.00 to 2.36. This implies that senior athletes perform significantly and substantially better than their community-dwelling counterparts. We have included descriptive statistics for the 50 to 59 and 90 to 99 years age groups for clinical use, although we did not have published norms for comparative analyses.
The significant omnibus ANOVA predicting FTSST time by age group, gender, AS versus LS, and all interactions was significant and thus controls for experiment-wise error (F = 2.60, P = .0012). Experiment-wise error refers to the compounding chance for incorrectly rejecting a null hypothesis with each successive hypothesis test on a given study data set. Using an omnibus test reduced the chance that any of the analyses successively reported here were the result of alpha inflation due to multiple independent hypothesis tests.
Among the significant effects, FTSST times increased significantly for each older decade (F = 3.69, P = .0061; see Table 2). There was no difference between genders (F = 1.73, P = .19). However, there was a significant difference between the AS (mean = 7.39) and LS (mean = 9.51) groups (F = 5.88, P = .02). Not surprisingly, the difference in reported cardiovascular training times between these groups (see Table 1) did approach significance with a moderate effect size (P = .07, d = 0.49, statistical power = 0.45). Despite these differences, the LS group still performed the FTSST significantly faster than current norms, that is by 3.08 seconds on average, than previously published norms (t = 4.45, P < .001).19
There was also a significant interaction between age group and whether the subject participated in an AS or LS (F = 2.70, P = .046). Simple effects analyses revealed a significant difference in the 80 to 89 year age group between AS and LS. Specifically, subjects aged 80 to 89 years who participated in LS took significantly longer (mean = 13.71) to complete the FTSST than the AS participants in the same age group (mean = 8.70) (F = 7.22, P = .01). No other main or interaction effects were significant.
Currently available normative data for the FTSST suggest that times greater than 12 seconds19 to 15 seconds14 indicate poor performance for community-dwelling seniors. Our results suggest that the population of senior athletes is indeed in need of its own normative guidelines. On the basis of our findings, we propose that a senior athlete who performs the FTSST test with a time greater than 9 seconds, is performing more slowly than their athletically active peers. However, future studies will be necessary to empirically and more reliably make this estimate. It is also of value to note that women in this athletic population, unlike their community-dwelling counterparts,10,17 show less decline in test performance than men over time, particularly after age 80.
These findings and associated normative values should assist clinicians in more accurate assessment of senior athletes. This may include those competing in senior games events, masters-level competition, or older adults consistently involved in fitness training. Furthermore, physical therapists should take note of the very obvious impact of training and sport participation on the physical function of these seniors. As we strive to promote increased physical activity across the lifespan, the performance of these active seniors should provide clear motivation. Future research is encouraged to determine the best functional measures for use in this population as well as the appropriate interpretation of these measures.
The participants of this study were engaged in senior game competitive events near the time of testing. Thus, this environment may have fostered a more competitive attitude and motivated these participants to perform better than those who provided previous normative data. Our classification of participants into the AS and LS groups was based solely on sport registration information and may have erroneously categorized some participants. In addition, our convenience sample did not include many LS participants or participants in the oldest age categories. Ultimately, in the clinic, the decision to use these new norms on a given patient will require clinical expertise.
Senior athletes should have the opportunity to perform a physical performance measure that challenges their physical function and compares their results to other senior athletes, rather than to norms for more sedentary community-dwelling older adults. In the present article, we have tried to estimate age and activity-relevant normative statistics for such comparison and for better detection of functional decline in senior athletes.
1. Wang CY, Yeh CJ, Hu MH. Mobility-related performance tests to predict mobility disability at 2-year follow-up in community-dwelling older adults
. Arch Gerontol Geriat. 2011;52:1–4.
2. Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol Biol Sci Med Sci. 2000;55:M221–M231.
3. Mong Y, Teo TW, Ng SS. 5-Repetition sit-to-stand test in subjects with chronic stroke: reliability and validity. Arch Phys Med Rehabil. 2010;91:407–413.
4. Lord SR, Murray SM, Chapman K, Munro B, Tiedemann A. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol Biol Sci Med Sci. 2002;57(8):M539–M543.
5. Bohannon RW. Alternatives for measuring knee extension strength of the elderly at home. Clin Rehabil. 1998;12:434–440.
6. Bohannon RW, Smith J, Hull D, Palmeri D, Barnhard R. Deficits in lower extremity muscle and gait performance among renal transplant candidates. Arch Phys Med Rehabil. 1995;76:547–551.
7. Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test. Phys Ther. 2005;85:1034–1045.
8. Duncan RP, Leddy AL, Earhart GM. Five times sit-to-stand test performance in Parkinson's disease. Arch Phys Med Rehabil. 2011;92:1431–1436.
9. Goldberg A. The five-times-sit-to-stand-test (FTSST), the short version of the activities-specific balance confidence (ABC) scale, and fear of falling predict step execution time (SET) in older adults
. Arch Gerontol Geriatr. 2012;54:434–438.
10. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.
11. Annweiler C, Schott AM, Abellan van Kan G, et al. The Five-Times-Sit-to-Stand test, a marker of global cognitive functioning among community-dwelling older women. J Nutr Health Aging. 2011;15:271–276.
12. Meretta BM, Whitney SL, Marchetti GF, Sparto PJ, Muirhead RJ. The five times sit to stand test: responsiveness to change and concurrent validity in adults undergoing vestibular rehabilitation. J Vestib Res. 2006;16:233–243.
13. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 year LS as a predictor of subsequent disability. N Engl J Med. 1995;332:556–561.
14. Buatois S, Miljkovic D, Manckoundia P, et al. Five times sit to stand test is a predictor of recurrent falls in healthy community-living subjects aged 65 and older. J Am Geriatr Soc. 2008;56:1575–1577.
15. Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. 2008;37:430–435.
16. Curb JD, Ceria-Ulep CD, Rodriguez BL, et al. Performance-based measures of physical function for high-function populations. J Am Geriatr Soc. 2006; 54:737–742.
17. Butler AA, Menant JC, Tiedemann AC, Lord SR. Age and gender differences in seven tests of functional mobility. J Neuroeng Rehabil. 2009;6:31.
18. Bohannon RW. Five-repetition sit-to-stand test: usefulness for older patients in a home-care setting. Percept Mot Skills. 2011;112:803–806.
19. Bohannon RW. Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders. Percept Mot Skills. 2006; 103:215–222.
20. Harris TJ, Owen CG, Victor CR, Adams R, Cook DG. What factors are associated with physical activity in older people, assessed objectively by accelerometry? Br J Sports Med. 2009;43:442–450.
21. Evenson KR, Buchner DM, Morland KB. Objective measurement of physical activity and sedentary behavior among US adults aged 60 years or older. Prev Chronic Dis. 2012;9:E26.
22. Agency for Healthcare Research and Quality and the Centers for Disease Control. Physical Activity and Older Americans: Benefits and Strategies. http://www.ahrq.gov/ppip/activity.htm
. Published June 2002. Accessed February 24, 2012.
23. Jokl P, Sethi PM, Cooper AJ. Master's performance in the New York City Marathon 1983–1999. Br J Sports Med. 2004;38:408–412.
24. Weir P, Baker J, Horton S. The emergence of masters sport: participatory trends and historical developments. In: Baker J, Horton S, Weir P eds. The Masters Athlete: Understanding the Role of Sport and Exercise in Optimizing Aging. London: Routledge; 2009:8–10.
25. Dionigi R. Competitive sport and aging: the need for qualitative sociological research. J Aging Phys Activity. 2006;14:365–379.
26. National Senior Games
Association. History of NSGA. http://www.nsga.com/about-nsga/history-nsga
. Accessed May 1, 2012.
27. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Erlbaum; 1988:25–26.