Although there are many functional strength tests, the sit-to-stand test (chair-stand test) is probably used most often with older individuals. All sit-to-stand tests employ a chair (preferably armless) of standard height. Ideally the chair should have a hard or firm surface and be stabilized against a wall. Tested individuals stand up and sit down as quickly as they can without the use of their upper extremities; some instructions call for the arms to be folded in front of the chest (Fig 5).72 Performance is either quantified on the basis of the number of repetitions completed in a given period of time (ie, 10 or 30 seconds)73-76 or the time required to perform a given number of repetitions (usually 5 or 10).72,77-79
The sit-to-stand test has been shown to possess both convergent construct and discriminant validity. The former is supported by the correlation between sit-to-stand performance and knee extension force73,74 and leg press force.76 The latter is shown by the lower sit-to-stand performance among individuals who are older, who have lower habitual activity levels, and who report a higher need for assistance with activities of daily living.72,76,77 Reliability coefficients reported for different versions of the test vary. Measurements of the time for a single chair stand (intraclass correlation coefficient [ICC] = .25)78 lack reliability compared with measurements of the time for five or more repetitions (reliability coefficients ≥ .67).78-80 Jones et al76 reported test-retest reliability coefficients of .77 to .95 for the number of chair stands performed in 30 seconds.
Many older individuals are unable to perform one or more repetitions of the sit-to-stand maneuver. In the study by Guralnik et al,72 more than 25% of the men and 30% of the women over 80 years of age were unable to perform five chair stands. For those able to perform the requisite number of repetitions or to continue for the allotted time, however, reference values have been published. Csuka and McCarty77 published regression equations for predicting normal performance for 10 stand-ups. For women the predicted time in seconds was 7.6 + .17 · age; for men the predicted time in seconds was 4.9 + .19 · age. Guralnik et al72 reported mean and median times for five stand-ups to be 13.2 and 12.6 seconds, respectively, for males and 14.4 and 13.7 seconds, respectively, for females 71 to 79 years. For individuals age 80 years or more they documented mean and median times of 15.0 and 14.0 seconds, respectively, for males and 16.1 and 15.0 seconds, respectively, for females. Table 5 presents normative values reported by Rikli and Jones81 for the number of sit-to-stands performed in 30 seconds.
Several functional tests other than the sit-to-stand test have been described in some detail in the literature. These include other lower extremity tests such as step-ups and standing toe-raises as well as tests of upper body and trunk strength.
Amundsen and Graves described a procedure for quantifying lower extremity strength on the basis of patients' "ability to step up onto and off of platforms of progressively increasing height (10.2, 20.3, 30.5, and 40.6 cm)."82 (p25) Overall, patients' ability correlated significantly with their peak knee extension torque (normalized against body weight) of the left (r = .72) and right (r = .59). Others have described step tests, but the tests they describe have either been used with young individuals or to characterize other aspects of motor performance (eg, endurance or agility).83 Lundsford and Perry84 described a "heel-rise" test to quantify ankle plantar flexion strength. For 203 individuals age 20 to 59 years they documented the number of unilateral heel-rises performed. The average number of repetitions completed was 27.9 (range, 6 to 70). The lower limit of the 99% confidence interval was 25 repetitions.
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