As an endeavor involving the changing of basic body position, the sit-to-stand (STS) maneuver is a classical activity of mobility according to the International Classification of Functioning, Disability and Health.1 Although only one of the many activities of everyday life, it is performed often by healthy community-dwelling adults; the mean number of daily STS among such individuals may be as low as 46 or as high as 60.2,3 Regardless of the frequency with which the STS maneuver is completed, it is a prerequisite to the performance of other activities (eg, walking)4 and has implications for other outcomes.5 Sit-to-stand is a demanding activity, particularly for older adults,6 and is often compromised in patients with a variety of age-related conditions such as stroke,7,8 Parkinson's disease,9,10 hip fracture,11,12 arthritis,13 and joint arthroplasty.14 These facts render the measurement and interpretation of STS performance important to those working with older adults. The primary purpose of this review, therefore, is to summarize information relevant to the measurement of STS performance. Before addressing this purpose, however, a brief review of the mechanics of the STS maneuver will be provided.
MECHANICS OF SIT-TO-STAND
Knowledge of the mechanics of the STS maneuver provides a foundation for the measurement of the activity and factors contributing to its successful completion. Successful performance of an STS requires the shifting of weight from the buttocks and posterior thighs to the feet. This involves an anterior and then vertical movement of the body's center of mass.7,15,16 This movement is executed primarily by a flexion of the hips and anterior movement of the head-arms-trunk segment, followed by an extension of the hips, knees, and ankles.16–19 The movement has been described as having several stages. Schenkman et al17 and Ikeda et al20 noted 3 stages: (1) flexion momentum (forward flexion of trunk); (2) momentum transfer (shift of body displacement from a primarily anterior to a primarily vertical direction); and (3) extension (rising to maximum hip, knee, and ankle extension). Millington et al21 described 3 comparable phases: weight shift; transition; and lift. Several STS strategies have been described for older adults. Hughes et al22 characterized 1 strategy as relying strongly on momentum, another with a greater emphasis on stability, and a third dependent on a combination of momentum and stability. Scarborough et al23 also described 3 phases: momentum transfer; exaggerated trunk flexion; and dominant vertical rise.
Regardless of strategy, considerable range of motion is needed to egress from sitting to standing. Rising from a low chair may entail more than 100° of knee flexion, 80° of hip flexion, and 25° of ankle dorsiflexion.24 The movements contributing to STS are accomplished by the generation of torques around the hip, knee, and ankle.16,25 Greater torques are required, particularly at the knee, for rising from lower seats.24,26 Greater torques are also required at the hip when less knee flexion range is available.27 Lesser lower limb torques are used when upper limb assistance is permitted.25
Normally, each lower limb provides a comparable contribution to the STS maneuver. This follows when weightbearing is symmetrical. Such symmetry, however, is not the case when range of motion or strength differs between sides. When 1 foot is placed forward of the other before STS, the forward foot experiences less weightbearing.28 Among patients with hemiparesis accompanying stroke, it is typical for more weight to be placed through the nonparetic limb.7,29,30
MEASUREMENT OF SIT-TO-STAND PERFORMANCE
Several options have been described for measuring STS performance. Most basically, the options can be divided into those not requiring timing and those dependent on timing.
Perhaps the simplest way to characterize STS performance is to address an individual's independence in the activity. At the most basic level, a patient can be labeled as able (vs unable) to stand without assistance. Such a dichotomization is capable of denoting status and detecting change over time.31,32 For more discriminating indications of assistance required, scales such as the Functional Independence Measure provide an ordinal rating of independence that can be applied to the STS maneuver.33 On the basis of a patient's contribution to completion of the task, assistance can be graded (eg, >75% = minimal assistance).
Beyond the ability to stand up without assistance, the conditions under which an STS can be completed can also be specified. These conditions include, but are not limited to, use of hands, use of armrests, and height of seating surface. A distinction between being able to complete the maneuver without hands versus with hands is meaningful as use of the hands can substantially reduce the strength necessary to rise independently from a chair. As a percentage of body weight, the combined strength of the knee extensors required to stand without the hands is approximately 40%.34,35 The combined strength required to stand with the hands but no armrests is about 31%.34 If hands are used, it matters whether armrests or something equivalent is used. Arborelius et al25 reported that use of the hands on armrests reduced “the mean maximum hip moment by about 50%.”(p1377) Alexander et al36 reported that the percentage of older adults unable to rise from a standard-height chair with armrests decreased from 32% to 1% when hand use was allowed; the time to stand decreased from a mean 4.6 seconds to a mean 3.8 seconds. Eriksrud and Bohannon37 observed that 8 of the 26 otherwise-dependent patients were able to egress independently from sitting when they used an “Easy-up Handle,” a portable device acting much like an armrest.37 The height of a seating surface can have a profound effect on whether a patient will be able to rise successfully.36,38,39 Of the older adults observed by Weiner et al,39 about twice as many could successfully stand from a 22-in–high chair as from a 17-in–high chair. As noted previously, seat height also affects the range of motion and torques needed during STS; both increase (particularly at the knee) as seat height gets lower.26 It takes longer to stand from lower chairs.36,40
Regardless of the conditions under which an STS is completed, patients' perceived effort can be ascertained. Doing so can be as simple as asking whether they have any difficulty with the task.41,42 Corrigan and Bohannon42 did so and found that older community-dwelling women were progressively more likely to report difficulty in rising from a dining chair, toilet, easy chair, and couch. Perceived exertion can be graded more specifically by using a perceived exertion scale.25,42 Using a Borg scale of perceived exertion, subjects studied by Arborelius et al25 reported greater exertion when standing from lower heights.
When an individual is able to rise from a standard chair without assistance or use of the upper limbs, performance can be quantified while accounting for the time required to complete the task 1 or more times. This can be accomplished with a stopwatch or more sophisticated equipment.8,10,42
The time for a single STS is informative. Corrigan and Bohannon42 reported mean and median times of 1.5 and 1.4 seconds, respectively, for community-dwelling older women. Their finding of significant, albeit-only moderate, correlations (−0.32 to −0.53) between STS time and knee extension force lends some support to the validity of STS time as an indicator of lower limb strength. Known groups validity of the measure is upheld by the greater time required by patients with stroke (3.1 seconds) than for matched controls (1.9 seconds).8 Such validity has also been demonstrated for patients with Parkinson's disease whose STS times were longer when they were in their off state (1.97 seconds) than when in their on state (1.86 seconds).10 The STS times of patients during their off state were also longer than those of matched controls.
Timed STS tests usually involve more than a single repetition. Timed tests incorporating multiple repetitions require either counting the number of repetitions that can be completed in a given period of time or determining how long it takes to complete a given number of repetitions.
The most common times over which repetitions are counted are 10,43–46 30,47–49 and 6050,51 seconds. For tests documenting the number of repetitions completed in 10 seconds, criterion and/or convergent validity are demonstrated by research showing correlations between repetitions and knee extension force (0.41–0.65),43,45 comfortable and maximum walking speed (0.41 and 0.73),45 and stair-climbing performance (0.56 and 0.57).43 Known groups validity for the test is confirmed by the observation that patients on hemodialysis completed approximately 50% fewer STS repetitions in 10 seconds than matched healthy subjects.46 The test-retest reliability is supported by an intraclass correlation coefficient (ICC) of 0.84.43 Responsiveness is illustrated by research showing that patients undergoing kidney transplants performed fewer repetitions 1 month posttransplant than they did before their transplant.44
For tests noting the number of repetitions completed in 30 seconds, validity is demonstrated by correlations (>0.70) between repetitions and weight-adjusted “leg-press” strength and differences in repetitions between age and activity groups.47 Test-retest reliability across sessions is supported by research reporting an ICC of 0.84 for men and an ICC of 0.92 for women.47 Normative values have been published as well.48
For the number of repetitions completed in 60 seconds, convergent validity is supported by correlations between repetitions and 6-minute walk distance covered by patients with chronic obstructive pulmonary disease (r = 0.75) and by healthy individuals (r = 0.54).51 Known groups validity of the 60 seconds measure is evidenced by differences in the mean repetitions between a group with chronic obstructive pulmonary disease and matched healthy individuals51 and by a group of healthy subjects and a group of patients on hemodialysis whose performance was about 50% worse.50
Five-Repetition Sit-to-Stand Test
Some literature describing the timing of multiple repetitions of STS describes the use of either 252,53 or 1013,54 repetitions. However, the “Five-Repetition STS Test” (FRSTST) is by far the most widely employed STS test with older adults. It has been used in more than 50 published studies and is a component of several test batteries, including the Short Physical Performance Battery,55 Index of Mobility Limitation,56 and Physical Performance Examination of the National Health and Nutrition Examination Survey.57 Thus, the rest of this section will address only the FRSTST.
Procedures for completing the FRSTST vary somewhat.58 Although armless chairs are typically used, their heights vary slightly. Tested individuals are usually prohibited from using their upper limbs, with some protocols calling for them to be folded across the chest. While timing generally begins on the command “go,” it sometimes ends with the achievement of the fifth stand and sometimes ends with the return to the seat after the fifth stand. I recommend the following:
- Use a slightly padded armless chair with a seat height of about 17 inches.
- Stabilize the chair, preferably against a wall.
- Have the patient come forward on the chair seat until the feet are flat on the floor.
- Have the patient fold the upper limbs across the chest if possible.
- Instruct the patient to stand up all the way and sit down once without using the upper limbs.
- If the patient is able to complete the maneuver without the upper limbs or physical assistance, instruct him or her to stand up all the way and sit down landing firmly, as fast as possible, 5 times without using the arms. Guard the patient as necessary.
- Begin timing on the command “go” and cease timing on landing after the fifth stand up.
- Abort the test and start over again if the patient fails to stand up all the way or sit down firmly.
The FRSTST has been shown to have good measurement properties. These include validity, reliability, and responsiveness. There are normative values for the test.
Often considered a measure of functional strength, the criterion validity of the FRSTST is supported by correlations of FRSTST time with lower limb force or torque. Bohannon et al reported correlations of −0.48 to −0.57 between knee extension force or torque and the FRSTST times of healthy community-dwelling individuals 50 to 85 years of age.59 The correlations were slightly better when knee extension strength was normalized against body weight. Multiple regression analysis supported knee extension strength as a key determinant of FRSTST time, particularly when the curvilinear nature of the relationship was addressed. McCarthy et al,60 who measured the isokinetic strength of 6 lower limb muscle actions, found 5 to correlate significantly with FRSTST performance. Combined, the strengths explained 48% of the variance in FRSTST time. Mong et al61 also looked at the relationship between lower limb muscle strength and FRSTST performance. However, they tested patients with stroke. They found correlations of −0.01 to −0.75 on the affected side and −0.48 to −0.83 on the unaffected side. The highest correlations were with knee flexor strength of each side. Also testing patients with stroke, Ng62 reported a significant correlation (−0.58) between a muscle strength index and FRSTST results. Significant correlations between strength and FRSTST times notwithstanding, much of the variance in FRSTST performance is left unexplained by measures of muscle strength. Lord et al63 identified sensation, speed, balance, and psychological status as variables adding to the explanation of STS performance provided by knee muscle strength. They, therefore, questioned the use of the FRSTST as a “proxy measure of lower limb strength.”
Seen as a measure of balance, the criterion validity of FRSTST times is affirmed by moderate to strong correlations with other balance measures. In patients with stroke, correlations of −0.55 and −0.84 with Berg Balance Test scores have been reported.61,62 The FRSTST measures also correlate (−0.59) with scores on the Activities-Specific Balance Confidence Scale in patients with stroke.62 Among patients undergoing vestibular rehabilitation, low but significant correlations have been reported between FRSTST results and multiple balance-related measures: Activities-Specific Balance Confidence Scale (−0.32), Dizziness Handicap Inventory (0.28), and Dynamic Gait Index (−0.36).64 For a mixed sample of younger and older individuals with and without balance disorders, correlations between FRSTST time and the Activities-Specific Balance Confidence Scale (−0.58) and Dynamic Gait Index (−0.68) were higher.65
There are important variables other than strength and balance, with which performance on the FRSTST correlates. Among healthy community-dwelling people, FRSTST time has convergent validity with self-reported physical functioning (−0.47),66 Timed Up and Go test times (0.73) and gait speed (−0.82).67 A moderate correlation (0.53) has been documented between FRSTST time and Timed Up and Go performance in patients undergoing vestibular rehabilitation.64 A moderate correlation (−0.60) has also been noted between FRSTST time and the distance walked in 6 minutes by patients with hemiparesis following stroke.62
Known groups' validity is well-established for the FRSTST. Bohannon68 demonstrated a significant difference in the time for patients seen in a home care setting (15.8 seconds) and healthy matched individuals (12.1 seconds). Whitney et al65 found that the FRSTST could discriminate between individuals with and without balance or vestibular disorders. Discrimination was better for individuals younger than 60 years (15.3 seconds vs 8.2 seconds).65 Kim et al69 showed that the FRSTST distinguished between older women at low risk of frailty versus high risk of frailty. The age-adjusted odds ratio was 6.29; the area under the receiver operating characteristic curve was 0.79. These indicators of validity were slightly less than those for usual and rapid gait and the Timed Up and Go. Obese older adults have been observed to require significantly longer (nonsarcopenic 10.6 seconds and sarcopenic 10.7 seconds) than nonobese older adults (nonsarcopenic 11.3 seconds and sarcopenic 12.3 seconds) to complete the FRSTST.70 Curb et al71 reported the FRSTST to be good at discriminating between individuals functioning at different levels. The FRSTST was comparable with the 10-repetition STS test in this regard. For patients with peripheral arterial disease, Atkins et al72 found those with low ankle-brachial indexes to require significantly more time to complete the FRSTST than those with moderate ankle-brachial indexes (mean, 15.9 seconds vs 13.5 seconds).
Several studies have examined the predictive validity of the FRSTST. Both Tiedemann et al73 and Buatois et al74 focused on the prediction of falls in their studies. Tiedemann et al73 investigated the ability of 8 mobility tests to predict multiple falls over a subsequent year. The time required to complete the FRSTST was significantly less in nonmultiple fallers (mean, 12.5 seconds) than in multiple fallers (mean, 14.8 seconds). For the prediction of falls, an FRSTST time of 12.0 seconds was associated with a relative risk of 2.0 and a likelihood ratio of 1.47. Buatois et al74 looked at the value of 3 tests to predict recurrent falls over a period 18 to 36 months. Only the FRSTST was independently associated with risk of such falls after adjustment for relevant covariates. Using a criterion of 15 seconds, a risk ratio of 1.74 was calculated. Wang et al75 examined the usefulness of 7 performance measures for predicting mobility disability 2 years later. After adjusting for age and gender, the FRSTST was the only measure identified as a significant predictor of future mobility disability.
The test-retest reliability of the FRSTST has been studied widely. Bohannon76 recently summarized the findings of 10 studies reporting reliability coefficients for measurements obtained across sessions. The coefficients ranged from 0.64 to 0.96. The adjusted mean for the reported coefficients was 0.81.
There is very little literature that specifically addresses the responsiveness of the FRSTST. Schaubert and Bohannon77 reported technical errors of measurement for repeated measures obtained from community-dwelling older adults over 6- and 12-week intervals. The values ranged from 1.6 to 2.8 seconds. Follow-up measurements of FRSTST time would have to change more than these amounts to conclude that a real change had taken place. For a sample of individuals, including, but not limited, to older adults, Bohannon et al78 calculated a method error of 0.5 seconds for FRSTST measurements obtained 4 to 10 days apart. A difference between sessions greater than this value would be required to conclude that a real change had occurred. The responsiveness of the FRSTST is illustrated by its ability to detect declines in lower limb function accompanying aging. Forrest et al79 noted that FRSTST time of older women increased by 22% over a 10-year period. This exceeded the 17% decline in gait speed over the same period. Meretta et al64 addressed the responsiveness of the FRSTST among patients undergoing vestibular rehabilitation. The patients demonstrated a 2.7-second reduction in FRSTST time. The standardized response mean associated with the change was 0.58 (moderate). A change of at least 2.3 seconds was determined to be clinically meaningful.
Numerous studies have provided data for FRSTST performance that can be used for normative purposes. Bohannon58 has summarized the information from 14 such studies in a descriptive meta-analysis. He calculated mean values for use as standards for older adults aged 60 to 69 years (11.4 seconds), 70 to 79 years (12.6 seconds), and 80 to 89 years (12.7 seconds).
The STS maneuver is important to everyday functioning. It can be quite demanding, particularly for older adults with pathologies resulting in impaired strength, balance, and range of motion. While there are several options for measuring STS performance, the FRSTST is probably the most widely employed. The simplicity of the test along with its sound-measurement properties and the availability of normative values for comparison are a compelling reason to utilize the test to describe mobility among older adults.
1. World Health Organization. International Classification of Functioning, Disability and Health (Short Version). Geneva, Switzerland: World Health Organization; 2001.
2. Bohannon RW, Barraca SR, Shove ME, Lambert C, Masters LM, Sigouin CS. Documentation of daily sit-to-stands performed by community-dwelling adults. Physiother Theory Pract. 2008;24:437–442.
3. Dall PM, Kerr A. Frequency of the sit to stand task: an observational study of free-living adults. Appl Ergonom. 2010;41:58–61.
4. Kerr A, Durward B, Kerr KM. Defining phases for the sit-to-walk movement. Clin Biomech. 2004;19:385–390.
5. Penninx BWJH, Ferrucci L, Leveille SG, Rantanen T, Pahor M, Guralnik JM. Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. J Gerontol. 2000;55A:M691–M697.
6. Hortobágyi T, Mizelle C, Beam S, DeVita P. Old adults perform activities of daily living near their maximal capabilities. J Gerontol. 2003;58A:M453–M460.
7. Hesse S, Schauer M, Malžicˇ M, Jahnke M, Mauritz K-H. Quantitative analysis of rising from a chair in healthy and hemiparetic subjects. Scand J Rehab Med. 1994;26:161–166.
8. Cameron DM, Bohannon RW, Garrett GE, Owen SV, Cameron DA. Physical impairments related to kinetic energy during sit-to-stand and curb-climbing following stroke. Clin Biomech. 2003;16:332–340.
9. Pääsuke M, Ereline J, Gapeyeva H, Joost K, Mõttus K, Taba P. Leg-extension strength and chair-rise performance in elderly women with Parkinson's disease. J Aging Phys Act. 2004;12:511–524.
10. Inkster LM, Eng JJ, MacIntyre DL, Stoessl AJ. Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair. Mov Disord. 2003;18:157–162.
11. Fox KM, Felsenthal G, Hebel R, Zimmerman SI, Magaziner J. A portable neuromuscular function assessment for studying recovery from hip fracture. Arch Phys Med Rehabil. 1996;77:171–176.
12. Zimmerman S, Hawkes WG, Hebel JR, Fox KM, Lydick E, Magaziner J. The lower extremity gain scale: a performance based measure to assess recovery after hip fracture. Arch Phys Med Rehabil. 2006;87:430–436.
13. Newcomer KL, Krug HE, Mahowald ML. Validity and reliability of the timed-stands test for patients with rheumatoid arthritis and other chronic diseases. J Rheumatol. 1993;20:21–27.
14. Unver B, Karatosun V, Bakirhan S. Ability to rise independently from a chair during 6-month follow-up after unilateral and bilateral total knee replacement. J Rehabil Med. 2005;37:385–387.
15. Pai Y-C, Naughton BJ, Chang RW, Rogers MW. Control of body centre of mass momentum during sit-to-stand among young and elderly adults. Gait Posture. 1994;2:109–116.
16. Roebroeck ME, Doorenbosch CAM, Harlaar J, Jacobs R, Lankhorst GJ. Biomechanics and muscular activity during sit-to-stand transfer. Clin Biomech. 1994;9:235–244.
17. Schenkman M, Berger RA, Riley PO, Mann RW, Hodge WA. Whole-body movements during rising to standing from sitting. Phys Ther. 1990;70:638–651.
18. Vander Linden DW, Brunt D, McCulloch MU. Variant and invariant characteristics of the sit-to-stand task in healthy elderly adults. Arch Phys Med Rehabil. 1994;75:653–660.
19. Papa E, Cappozzo A. Sit-to-stand motor strategies investigated in able-bodied young and elderly subjects. J Biomech. 2000;33:1113–1122.
20. Ikeda ER, Schenkman ML, Riley PO. Influence of age on dynamics of rising from a chair. Phys Ther. 1991;71:473–481.
21. Millington PJ, Myklebust BM, Shambes GM. Biomechanical analysis of the sit-to-stand motion in elderly persons. Arch Phys Med Rehabil. 1992;73:609–617.
22. Hughes MA, Weiner DK, Schenkman ML, Long RM, Studenski SA. Chair rise strategies in the elderly. Clin Biomech. 1994;9:187–192.
23. Scarborough DM, McGibbon CA, Krebs DE. Chair rise strategies in older adults with functional limitations. J Rehab Res Dev. 2007;44:33–42.
24. Rodosky MW, Andriacchi TP, Andersson GBJ. The influence of chair height on lower limb mechanics during rising. J Orthop Res. 1989;7:266–271.
25. Arborelius UP, Wretenberg P, Lindberg F. The effects of armrests and high seat heights on lower-limb joint load and muscular activity during sitting and rising. Ergonomics. 1992;35:1377–1391.
26. Crosbie J, Herbert RD, Bridson JT. Intersegmental dynamics of standing from sitting. Clin Biomech. 1997;12:227–235.
27. Fleckenstein SJ, Kirby RL, MacLeod DA. Effect of limited knee-flexion range on peak hip moments of force while transferring from sitting to standing. J Biomech. 1988;21:915–918.
28. Shepherd RB, Koh HP. Some biomechanical consequences of varying foot placement in sit-to-stand in young women. Scand J Rehab Med. 1996;28:79–88.
29. Brière A, Lauzière S, Gravel D, Nadeau S. Perception of weight-bearing distribution during sit-to-stand tasks in hemiparetic and healthy individuals. Stroke. 2010;41:1704–1708.
30. Lomaglio MJ, Eng JJ. Muscle strength and weight-bearing symmetry relate to sit-to-stand performance in individuals with stroke. Gait Posture. 2005;22:126–131.
31. Janssen W, Bussmann J, Selles R, Koudstaal P, Ribbers G, Stam H. Recovery of sit-to-stand movement after stroke: a longitudinal cohort study. Neurorehab Neural Repair. 2010;24:763–769.
32. Barreca SR, Sigouin CS, Lambert C, Ansley B. Effects of extra training on the ability of stroke survivors to perform an independent sit-to-stand: a randomized controlled trial. J Geriatr Phys Ther. 2004;27:59–64.
33. Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level Functional Independence Measure (FIM). Scand J Rehab Med. 1994;26:115–119.
34. Eriksrud O, Bohannon RW. Relationship of knee extension force to independence in sit-to-stand performance in patients receiving acute rehabilitation. Phys Ther. 2003;83:544–551.
35. Bohannon RW. Body weight-normalized knee extension strength explains sit-to-stand independence: a validation study. J Strength Cond Res. 2009;23:309–311.
36. Alexander NB, Galecki AT, Nyquist LV, et al. Chair and bed rise performance in ADL-impaired congregate housing residents. J Am Geriatr Soc. 2000;48:526–533.
37. Eriksrud O, Bohannon RW. Effectiveness of Easy-Up Handle in acute rehabilitation. Clin Rehabil. 2005;19:381–386.
38. Mazza C, Benvenuti F, Bimbi C, Stanhope SJ. Association between subject functional status, seat height, and movement strategy in sit-to-stand performance. J Am Geriatr Soc. 2004;52:1750–1754.
39. Weiner DK, Long R, Hughes MA, Chandler J, Studenski S. When older adults face the chair-rise challenge. A study of chair height availability and height-modified chair-rise performance in the elderly. J Am Geriatr Soc. 1993;41:6–10.
40. Hughes MA, Schenkman ML. Chair rise strategy in functionally impaired elderly. J Rehabil Res Dev. 1996;33:409–412.
41. Daltroy LH, Logigian M, Iversen MD, Liang MH. Does musculoskeletal function deteriorate in a predictable sequence in the elderly? Arthritis Care Res. 1992;5:146–150.
42. Corrigan D, Bohannon RW. Relationship between knee extension force and stand-up performance in community-dwelling elderly women. Arch Phys Med Rehabil. 2001;82:1666–1672.
43. 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.
44. Bohannon RW, Smith J, Hull D, Palmeri D, Barnhard R. Strength, balance and gait before and after kidney transplantation. Int J Rehab Res. 1997;20:199–203.
45. Bohannon RW. Alternatives for measuring knee extension strength of the elderly at home. Clin Rehabil. 1998;12:434–440.
46. Sterky E, Stegmayr BG. Elderly patients on haemodialysis have 50% less functional capacity than gender- and age-matched healthy subjects. Scand J Urol Nephrol. 2005;39:423–430.
47. Jones CJ, Rikli RE, Beam WC. A 30-s Chair-Stand Test to measure lower body strength in community-residing older adults. Res Quart Exer Sport. 1999;70:113–119.
48. Rikli RE, Jones CJ. Functional fitness normative scores for community-residing older adults, ages 60–94. J Aging Phys Activ. 1999;7:162–181.
49. Agarwal S, Kiely PDW. Two simple, reliable and valid tests of proximal muscle function, and their application to the management of idiopathic inflammatory myositis. Rheumatology. 2006;45:874–879.
50. McIntyre CW, Selby NM, Sigrist M, Pearce LE, Mercer TH, Naish PF. Patients receiving maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease. Nephrol Dial Transplant. 2006;21:2210–2216.
51. 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.
52. Simmonds MJ. Physical function in patients with cancer: psychometric characteristics and clinical usefulness of a physical performance test battery. J Pain Symptom Manage. 2002;24:404–414.
53. Shelton ML, Lee JQ, Morris GS, et al. A randomized control trial of a supervised versus a self-directed exercise program for allogeneic stem cell transplant patients. Psycho-Oncol. 2009;18:353–359.
54. Csuka M, McCarty DJ. Simple method for measurement of lower extremity muscle strength. Am J Med. 1985;78:77–81.
55. 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–M94.
56. Lan T-Y, Deeg DJH, Guralnik JM, Melzer D. Responsiveness of the index of mobility limitation: comparison with gait speed alone in the longitudinal aging study Amsterdam. J Gerontol: Med Sci. 2003;58A:721–727.
57. Ostchega Y, Harris TB, Hirsch R, Parsons VL, Kington R, Katzoff M. Reliability and prevalence of physical performance examination assessing mobility and balance in older persons in the US: data from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc. 2000;48:1136–1141.
58. Bohannon RW. Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders. Percept Motor Skills. 2006;103:215–222.
59. Bohannon RW, Bubela DJ, Magasi SR, Wang Y-C, Gershon RC. Sit-to-stand test: performance and determinants across the age span. Isokinet Exerc Sci. 2010;18:235–240.
60. McCarthy EK, Horvat MA, Holtsberg PA, Wisenbaker JM. Repeated chair stands as a measure of lower limb strength in sexagenarian women. J Gerontol. 2004;59A:1207–1212.
61. 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.
62. Ng S. Balance ability, not muscle strength and exercise endurance, determines the performance of hemiparetic subjects on timed-sit-to-stand test. Am J Phys Med Rehabil. 2010;89:497–504.
63. 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: Med Sci. 2002;57A:M539–M543.
64. Meretta BM, Whitney SL, Marchetti GF, Sparto PJ, Muirhead RJ. The five times sit to stand test: validity in adults undergoing vestibular rehabilitation. J Vestibular Res. 2006;16:233–243.
65. 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.
66. Bohannon RW, Shove ME, Barreca SR, Masters LM, Sigouin CS. Five-repetition sit-to-stand test performance by community-dwelling adults: a preliminary investigation of times, determinants, and relationship with self-reported physical performance. Isokinet Exerc Sci. 2007;15:77–81.
67. Schaubert KL, Bohannon RW. Reliability and validity of three strength measures obtained from community-dwelling elderly persons. J Strength Cond Res. 2005;19:717–720.
68. Bohannon RW. Five repetition sit-to-stand test: usefulness among older adults in a home-care setting. Percep Motor Skills. 2011; in press.
69. Kim M-J, Yabushita N, Kim M-K, Nemoto M, Seino S, Tanaka K. Mobility performance tests for discriminating high risk of frailty in community-dwelling older women. Arch Gerontol Geriatr. 2010;51:192–198.
70. Bouchard DR, Dionne IJ, Brochu M. Sarcopenic/obesity and physical capacity in older men and women: data from the nutrition as a determinant of successful aging (NuAge)—the Quebec Longitudinal Study. Obesity. 2009;17:2082–2088.
71. 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.
72. Atkins LM, Gardner AW. The relationship between lower extremity functional strength and severity of peripheral arterial disease. Angiology. 2004;55:347–355.
73. 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.
74. Buatois S, Manckoundia P, Vançon G, Perrin P, Benetos A. 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.
75. Wang C-Y, Yeh C-J, Hu M-H. Mobility-related performance tests to predict mobility disability at 2-year follow-up in community-dwelling older adults. Arch Gerontol Geriatr. 2011;52:1–4.
76. Bohannon RW. Test-retest reliability of the five-repetition sit-to-stand test: a systematic review of literature involving adults. J Strength Cond Res. 2011;25:3205–3207.
77. Schaubert K, Bohannon RW. Reliability of sit-to-stand test over dispersed test sessions. Isokinet Exerc Sci. 2005;13:119–122.
78. Bohannon RW, Bubela DJ, Magasi SR, Gershon RC. Relative reliability of three objective tests of limb muscle strength. Isokinet Exerc Sci. 2011;19:77–81.
79. Forrest KYZ, Zmuda JM, Cauley JA. Correlates of decline in lower extremity performance in older women: a 10-year follow-up study. J Gerontol: Med Sci. 2006;61A:1194–1200.