Sit down ... and get up again

​Thanks to recent publicity, courtesy of the delightful Angela Rippon and Dr. Chris Van Tulleken, the sit to rise test has caused quite a stir in my classes. The idea behind the test is to use how easily you can sit on the floor and return to a standing position as a predictor of mortality risk.

The scoring is based on five points for sitting and five for rising. Sitting without using the aid of support (such as a hand or knee), and without losing balance scores five points, and five points is scored for returning to standing without needing support. One point is lost for each point of support used, and 0.5 points are deducted for a loss of balance. The sitting and rising scores are added together to give a score out of ten (the “SRT score”). Crossing legs is permitted, but it isn’t required. The test can be repeated and an assessor can give advice on how to improve the score. The final score is independent of the number of attempts and the best sitting score is combined with the best rising score to give a score out of ten.

As a theory, it’s easy to see how this could measure the characteristics associated with good health. To score a perfect ten requires a combination of power, balance, flexibility, coordination and leg and core strength. Excessive obesity would also make this a harder task. But what does the science say?

The test was originally proposed in the late 1990s as an evaluation method in sports and exercise medicine (Araújo, 1999). More recently, a study to assess its effectiveness as a predictor of mortality was conducted, using over 2000 volunteers aged between 51 and 80 years (Brito et al., 2012). The subjects were followed up later, by which time there had been 159 deaths in the group. The results showed that lower SRT scores were strongly associated with higher mortality1. Each increase of one point in the SRT score was associated with a 21 percent improvement in survival. The findings held even when controlling for gender, age and body mass index (BMI). Those with a score of one had a 5-6 times higher risk of death than those with a score of eight to ten. This difference suggests that the sitting score is good predictor of all-cause mortality.

There are some limitations to the research, which the authors note. These include the possibility that some subjects had sub-clinical injuries or degenerative injuries that affected their score. They also did not control for physical activity patterns, which would likely have influenced the score, but not necessarily in a way that invalidates the conclusions. Excluded from the study were those a) regularly competing in sports events; (b) presenting any relevant musculoskeletal limitations that could affect SRT; and (c) refusing to perform the SRT. This would naturally exclude the high performing outliers and also those who were too nervous to try the test - perhaps they are at high risk of falls, or have osteoporosis? The ‘musculoskeletal limitations’ were not specified, but I would hazard a guess that it would include problematic knees and hips, including replacements. Indeed, I would not recommend that this test is done by people with joint problems or osteoporosis, or if you have any concerns about falling, except under the advice and supervision of a suitably qualified professional.

The sample was mainly of Caucasian individuals of high socio-economic status in Brazil, so it is unclear how applicable the study is globally. I note that in many countries, the flat footed squat is a common resting position - so I would be interested to see the test repeated across continents. Additionally, the subjects were aged between 51 and 80 years old at the start of the study. It doesn’t necessarily follow that the test will give the same results for people outside this age range. The follow up time was on average (median) 6.3 years later, but with a range of 0.1-13.9 years! It was not explained why this range was so high, but is presumably a consequence of administering a large study of volunteers.

The authors noted:
“We considered participants who achieved [SRT scores of 8–10] to have preserved functional independence regardless of age. The ability to achieve a high SRT score could reflect the capacity to successfully perform a wide range of activities of daily living, such as bending over to pick up a newspaper or a pair of glasses lying under the bed or table. Moreover, a high SRT score likely indicates a reduced risk of falls. It is also noteworthy that during the application of SRT in our centre over a 14-year period, there have been no adverse events, reflecting a high level of safety associated with this simple assessment tool.”

If you can do the sit to rise test with a score of eight to ten, then this is a positive indicator for your wellbeing. If you struggle to get up and down, then work on your general fitness and revisit the test later. There are some minor issues with the methodology of the test, but nothing that makes it invalid for the general older population. 

Watch me demonstrating high and low scores for the test below.

1 P<0.001 Mathematicians refer to this as ‘highly statistically significant’, which means that the probability that the results are a fluke are less than one in one thousand.

Araújo, C. G. S. (1999). Teste de sentar-levantar: apresentação de um procedimento para avaliação em Medicina do Exercício e do Esporte. Revista Brasileira De Medicina Do Esporte 5(5), 179-182. URL: http://www.clinimex.com.br/artigoscientificos/rbme_set-out99_teste%20sentar-levantar_procedimento%20para%20avalia%C3%A7%C3%A3o%20em%20med%20exerc%C3%ADcio.pdf

Brito, L.B.B., Ricardo, D.R., de Araújo, D.S.M.S., Ramos, P.S., Myers, J. and de Araújo, C.G.S., 2012. Ability to sit and rise from the floor as a predictor of all-cause mortality. European journal of preventive cardiology 21(7):892-898. URL:  http://geriatrictoolkit.missouri.edu/srff/deBrito-Floor-Rise-Mortality-2012..pdf