sit-to-stand test

The sit-to-stand test (STS) is a functional assessment tool primarily used to evaluate lower extremity strength, balance, and fall risk, particularly in older adults. The sit-to-stand test (STS) is a simple, reliable, and widely used assessment tool in clinical and community settings to evaluate lower limb strength, functional mobility, balance, and neuromuscular control, particularly in older adults and individuals with mobility limitations. It is considered a key indicator of general health and physical functioning, with strong predictive value for fall risk, frailty, and even overall mortality.

Main Types of Sit-to-Stand Tests

Several variations of the STS test exist, each with specific protocols and clinical uses:

30-Second Sit-to-Stand Test (30CST)

• Purpose: Assesses leg strength and endurance.
• Protocol: The participant sits in the middle of a standard chair, crosses their arms over their chest, and stands up and sits down as many times as possible within 30 seconds.
• Scoring: The total number of full stands completed in 30 seconds is recorded. Higher numbers indicate better lower limb strength and endurance.
• Population: Commonly used for older adults but applicable in various populations.

Five Times Sit-to-Stand Test (5xSTS or 5XSST)

• Purpose: Evaluates functional lower limb strength, dynamic balance, and fall risk.
• Protocol: The participant sits with arms folded across the chest and stands up and sits down five times as quickly as possible. The time taken to complete all five repetitions is measured.
• Scoring: Lower times indicate better performance. Age-matched normative values are available (e.g., 11.4 seconds for ages 60–69; 12.6 seconds for 70–79; 14.8 seconds for 80–89).
• Clinical Relevance: Times ≥12 seconds in older adults may indicate increased fall risk.

One-Minute Sit-to-Stand Test (1-MSTST)

• Purpose: Measures exercise capacity and endurance, often used in respiratory or cardiac rehabilitation.
• Protocol: The participant completes as many sit-to-stand repetitions as possible in one minute

Below are key details about its clinical use and variations:

Standard Sit-to-Stand Test

Purpose: Assesses functional strength, balance, and fall risk in older adults or individuals with mobility impairments.

Procedure:

• Use a standard chair (17–18 inches high) without armrests.
• The patient sits with arms crossed over the chest and feet flat on the floor.
• On command, they stand up fully and sit back down five times as quickly as possible.
• Time is recorded from the first movement to the completion of the fifth stand.

Interpretation:

Lower times indicate better strength and balance (e.g., <12 seconds for adults aged 60–69).

Fall risk: Scores >15 seconds suggest increased fall risk in older adults or those with vestibular disorders.

Age-matched norms:

60–69 years: 11.4 seconds

70–79 years: 12.6 seconds

80–89 years: 14.8 seconds.

Clinical Applications

Geriatrics:

• Predicts fall risk and mortality.
• Minimal Detectable Change (MDC): 3.6–4.2 seconds (indicates meaningful improvement).
• Minimal Clinically Important Difference (MCID): 2.3 seconds.

Neurological Conditions:

• Used in Parkinson’s disease (>16 seconds = high fall risk).
• Assesses stroke recovery and vestibular disorders.

Musculoskeletal Health:

• While not specific to groin injuries, it evaluates functional strength relevant to pelvic stability.
• Poor performance may indicate hip weakness or core instability, which can contribute to groin injury risk.

Resisted Cross-Body Sit-Up Test (For Groin Pain)

A distinct test used to diagnose core muscle injuries (e.g., sports hernias) in athletes with groin pain:

• Procedure: Patient lies supine in a figure-4 position; examiner resists a cross-body sit-up to elicit pain.
• Purpose: Identifies pubic-related groin pain (e.g., athletic pubalgia).
• Limitations: High sensitivity (100%) but low specificity (3%), necessitating use in a test cluster.
• Key Considerations
• Equipment: Standard chair and stopwatch.
• Modifications: Inability to complete five stands without arm support indicates functional impairment.
• Limitations: Less specific for groin injuries; prefer adductor squeeze tests or Doha agreement protocols for groin-specific assessments.

For groin injury evaluation, clinicians typically prioritise  hip adductor resistance tests, palpation, and sport-specific movement analysis over the STS

How does the sit-to-stand test compare to other functional mobility tests

The sit-to-stand (STS) test is a widely used functional mobility assessment with distinct advantages and limitations compared to other tests. Below is a comparison with key alternatives:

1. Sit-to-Stand vs. Timed Up and Go (TUG)

STS:

• Focus: Lower limb strength, balance, and endurance.
• Metrics: Time (5STS/30STS) or repetitions (30STS/60STS).
• Population: Older adults, post-stroke, Parkinson’s disease (PD).
• Advantages: Low cost, no specialized equipment (standard chair only).

TUG:

• Focus: Dynamic balance, gait speed, and fall risk.
• Metrics: Time to stand, walk 3 meters, turn, and sit.
• Population: Older adults, neurological conditions.
• Advantages: Incorporates walking and turning, better for assessing multitasking mobility.
• Key Difference: TUG includes walking and turning, making it more comprehensive for daily mobility, while STS isolates lower limb strength.

2. Sit-to-Stand vs. 6-Minute Walk Test (6MWT)

STS:

• Focus: Muscle strength and functional capacity.
• Correlation: Moderately linked to 6MWT distance (r = 0.4–0.6).
• Use Case: Quick screening in clinics or home settings.

6MWT:

• Focus: Cardiorespiratory endurance and walking capacity.
• Metrics: Distance walked in 6 minutes.
• Use Case: Chronic conditions (COPD, heart failure).
• Key Difference: 6MWT assesses aerobic endurance, while STS targets muscular strength and balance.

3. Sit-to-Stand Variants

5-Repetition STS (5STS):

• Metrics: Time to complete 5 stands.
• Strengths: Reliable for lower limb strength and fall risk.
• Limitations: Less sensitive to mild impairments.

30-Second STS (30STS):

• Metrics: Repetitions in 30 seconds.
• Strengths: Better for endurance and frailty screening.
• Limitations: Less precise for asymmetric weaknesses.

60-Second STS (60STS):

• Metrics: Repetitions in 60 seconds.
• Strengths: Most sensitive to age-related functional decline.
• Key Insight: Longer-duration STS tests (60s) better differentiate functional capacity across age groups.

4. Advanced STS with Technology

Force Plate-Assisted STS:

• Metrics: Force asymmetry, power, and rate of force development.
• Advantages: Detects subtle imbalances (e.g., post-injury).
• Use Case: Precision rehab and elite sports.

Functional STS (FSTS):

• Focus: Movement quality (e.g., trunk control, asymmetry).
• Advantages: Identifies compensatory patterns missed by timed tests.
• Key Advantage: Technology-enhanced STS provides actionable biomechanical data for personalized rehab.

5. STS vs. Squat Tests

STS:

• Advantages: Safer for frail individuals, standardised chair height.
• Limitations: Less challenging for athletic populations.

Squat Tests:

• Metrics: Depth, form, and load capacity.
• Advantages: Better for assessing sport-specific strength.
• Limitations: Requires supervision to avoid injury.
• Key Difference: STS is more accessible for clinical populations, while squats are used in fitness settings.

General Clinical Applications

• STS: Best for geriatric fall risk, post-stroke rehab, and PD.
• TUG: Preferred for assessing multitasking mobility.
• 6MWT: Gold standard for cardiorespiratory and functional endurance.
• Force Plate STS: Ideal for precision rehab and asymmetry detection.