The Sitting-Rising Test: what’s your score?

~ Carolyn Thomas

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by Carolyn Thomas  ♥  @HeartSisters

Back when I was a run leader at the Y Marathon Running Clinic, we’d have an overflow crop of eager new participants at our first Sunday morning run of each New Year. Some even told me that this was finally going to be the year in which they quit smoking, lost 30 pounds, and ran a marathon! “Pick one!” was my pragmatic response to such announcements . . .    

By mid-March, our overflow January crowd had inevitably dwindled in size (thanks to the sad reality of most New Year’s resolutions like the triple threat mentioned above) down to a manageable group of those who actually made it all the way through summer training to reach our annual marathon/half-marathon events in the fall.

I wish I’d known back then this deceptively simple test that not only assesses your level of fitness, but just might help predict your longevity. 

I’d like to thank Brazilian physician Dr. Claudio Gil Araújo MD PhD  for letting me know about this test when he contacted me in response to my earlier post called “Failure to refer: why are doctors ignoring cardiac rehab?”.

He wanted to tell me about his Programa de Exercício Supervisionado at Clinimex Exercise Medicine Clinic in Rio de Janeiro. By the way, he also pointed out that – unlike our pathetically low North American cardiac rehabilitation attendance averages – 35-40% of the heart patients in his supervised Clinimex cardiac rehabilitation programs are female.  See also: Why aren’t women heart attack survivors showing up for cardiac rehab?

As well, Dr. Araújo shared his research with me about a simple test called the Sitting-Rising Test (SRT).  In a study published in the European Journal of Preventive Cardiology, he and his research team followed over 2,000 patients ages 51 to 80, all part of an exercise program at Clinimex who had taken the SRT.

Even after the SRT results were controlled for age, gender and body mass index, results suggest that the sitting-rising test score is a significant predictor of all-cause mortality.  The two basic movements in the Sitting-Rising Test – lowering to the floor and then standing back up – are each scored on a 1-to-5 scale, with one point subtracted from 5 each time a body part is used for support and 0.5 points subtracted for loss of balance; this two-part total yields a single 10-point scale.  You can watch Dr. Araújo’s patients doing the test here (narrated in Portugese with English subtitles). 

Dr. Araújo’s team found that those who required more than one hand or knee support to sit and rise from the floor in a stable way were twice as likely to die within the next six years compared with those who scored higher. Those who scored three or fewer points were five times more likely to die within the same period compared with those who scored more than eight points. The study’s surprising conclusion:

“Musculoskeletal fitness, as assessed by the Sitting-Rising Test, was a significant predictor of mortality in 51 to 80-year-old subjects.”

In an interview with the European Society of Cardiology, Dr. Araújo explained:

“It is well-known that aerobic fitness is strongly related to survival, but our study also shows that maintaining high levels of body flexibility, muscle strength, power-to-body weight ratio and co-ordination are not only good for performing daily activities but have a favourable influence on life expectancy.

“When compared to other approaches to functional testing, the Sitting-Rising Test does not require specific equipment and is safe, easy to apply in a short time period (less than two minutes), and reliably scored.

“In our clinical practice, the test has been shown over the past 10 years to be useful and practical for application to a large spectrum of populations, ranging from paediatric to geriatric.”

While the study found a strong association between the ability to rise from the floor and mortality risk, it did not prove a cause-and-effect relationship. This is good news for those of you living with debilitating joint, back or leg limitations that would make such sitting/standing painful, if not downright impossible.

But maybe we shouldn’t be surprised at all by the good outcomes linked with being able to get up and down from the floor easily. I’ve often written here on Heart Sisters about the known cardioprotective benefits of regular physical activity.

Let’s face it: for those of us diagnosed with coronary artery disease, the entire medical care model is built entirely around opening blockages in patients with late-stage disease, which can relieve symptoms but does not prevent heart attack. But regular physical activity helps every cell in the body – including those in our hearts.

Want to see how you’d make out on the Sitting-Rising Test? Follow the instructions in the image above (via Roen Kelly at Discover) and try to carefully lower yourself onto the floor from a standing position and then back up again without using hands, forearms, knees or the sides of your legs to help you.  

* IMPORTANT NOTE: You know your own body! Do not attempt this test alone if you have reason to suspect you will keel over and bonk your head on something sharp and pointy while attempting it.

It’s surprisingly difficult! So far, I still cannot do this test with an assistance-free 10-point score.  I’m blaming my wonky right knee and resulting reduced flexibility for this. But when my daughter-in-law Paula tried this test the other night after dinner, she effortlessly sat down on the living room floor, and then just as easily stood back up – with not a single assist from hand or knee. She credits her years of yoga practice for this.

Yoga incorporates a move that in itself may help us to improve that SRT score: sitting on the floor more often, which naturally involves getting down and getting up more often as well. Compared to our common practice of sitting on chairs, sitting on the floor is healthier.  When we sit on a chair, we often slouch, or use the back of the chair to support us, thus robbing the back muscles of a chance to do the work of staying strong. Sitting on a chair also means we tend to keep our legs together, which in turn means that our hip sockets start to shrink-wrap to this reduced range of motion. We start losing our natural flexibility in the hips as well as the spine.

As Berkeley yoga instructor Nina Zolotow recalls, her childhood spent in India involved “sitting on the floor for all kinds of activities, including eating, writing, reading and playing indoor games.”

So because I believe I’m never too old to do something good for myself, my New Year’s resolution this year is a simple one: sit on the floor more often (which will give me more opportunities to practice this Sitting-Rising Test as well!)

Aging is precisely why this SRT may be so important, according to Dr. Araújo.

He knew that many of his patients, particularly older people, had trouble with ordinary motions such as simply bending down to pick up something off the floor – a common difficulty that indicates a loss of flexibility. And he knew that as people age, reduced muscle power and loss of balance can greatly increase the risk of dangerous falls.

To live a longer and healthy life, he maintains, we must get moving and keep moving to maintain both muscle and balance.

(And by the way, speaking of living a longer and healthy life, Feliz Aniversário Dr. Araújo!)

Back in 2004, Dr. Rainer Hambrecht of Bremen, Germany published a landmark study in the journal Circulation comparing two groups of patients diagnosed with coronary artery disease:

  • one group was treated with angioplasty/stents
  • the other group did regular exercise – in this case, cycling

Both groups were also prescribed medications as recommended by cardiac treatment guidelines.

But what Dr. Hambrecht’s team found out was pretty amazing stuff: he observed that nearly 90% of heart patients who rode bikes regularly were free of heart problems one year after they started their exercise regimen.

But among patients who had an angioplasty instead, only 70% were problem-free after a year.

And five years later, Dr. Hambrecht presented new findings from his follow-up research to the 2009 European Congress of Cardiology meetings in Barcelona, confirming his earlier 2004 results that regular exercise training is superior to angioplasty at preventing subsequent cardiovascular events.  He said:

“It’s difficult to convince people to exercise instead of having an angioplasty, but it works.”

I believe that exercise does indeed work – but not just for those of us who have been diagnosed with heart disease.

Or, as I like to quote here, in the words of the eminently quotable Kentucky cardiologist Dr. John Mandrola:

“You only have to exercise on the days you plan to eat!”

See also:

Were you “born to walk”?

Heart disease is a sitting disease

The surprising reasons heart patients don’t go to cardiac rehab

Failure to refer: why are doctors ignoring cardiac rehab?

Do we need to change the name of cardiac rehab?

Physical exercise vs. the ‘plumber’s pipe’ theory of heart disease treatment

We know we should do ____, but instead we do ____

Why your heart needs work – not rest! – after a heart attack

What prevents heart disease “better than any drug”?

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Q:  How did you do on the Sitting-Rising Test?

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Published by Carolyn Thomas

29 thoughts on “The Sitting-Rising Test: what’s your score?”

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  8. Much to my surprise, I was successful in sitting down and rising up without problem. At the senior center in some of the exercise classes we are urged to stand up from a chair without using our hands. I think doing that has helped.

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  9. Thank you for your continued help in the fight against heart disease! I wish everyone I know would read and heed your suggestions — I should start with myself!

    I score a 0 on this test, but I knew I would. I do get on the floor and play with my grandchidren (65), and while I literally use a wheelchair outside since I can’t walk far due to my heart disease– I slide out and crawl around my garden to weed, transplant, etc!

    Getting back up is a different thing! LOL I can do it fine, if I grunt and groan while I use my wheelchair or a heavy piece of furniture to hold on to! LOL I have been “kicked out of” cardiac rehab 3 times because they say I am exercise intolerant — mildest form causes angina with my stage 4 coronary artery disease. I was also told at Duke, almost 16 years ago now, that I could only live five to eight more years at the most! Halleluia!

    I try to enjoy every day, every moment, every adventure! So far it seems to help…cognition…positive thinking…lots of medicine! I am going to try to build in some exercise though, I know I need to! I can surely do a minute or two, or stretch ten times an hour! We must move! Thanks for the encouragement.
    H.

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    1. I can just picture you sliding out of that wheelchair to crawl around your garden to weed and transplant, Helen! And good for you for making those “experts” at Duke so wrong about your prognosis. Somehow, I think your attitude has a lot to do with that.

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  10. Wonderful test. At this time I score a 6, points lost trying to get back up.

    I am at baseline after the last run in with statins and am restarting my Yoga Practice. Not a resolution, just life alignment at the right time.

    Thanks Carolyn!

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    2. This test is an impossibility for me as I have osteoarthritis in both knees; however, I can rise from a low sofa or chair without using my arms & keeping my back fairly straight. One of my regular exercises involves sitting straight down and getting straight up. Sometimes I hover in the about-to-sit position for a few seconds before sitting. I was taught this exercise in a balance class for seniors.

      Keeping my flexibility is very important to me. Thanks for this article.

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      1. Great example of a simple and effective chair exercise, Linda. I heard recently of a local seniors’ exercise class (oldest participant is 81) that teaches timed reps of ‘chair squats’ which sound just like your standing/sitting routine. “Moving is medicine!” as the Arthritis Foundation reminds us. Any physical activity that increases our flexibility is a major non-drug way to reduce symptoms like pain or loss of function.

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  13. Here is an interesting way to remain flexible: Bring a small puppy into your home and spend the next 6 months training it (and yourself). You would be surprised how many times you have to get down on the floor!

    Marilyn Edmonds

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  14. As a physical therapist, of course I find this sort of thing fascinating. In my job as a homecare PT, I use a lot of standardized and evidence-based mobility tests like this one, either to compare a patient’s performance to healthy people of her/his own age, or to determine the patient’s risk for falling — another determiner related to mortality, especially if a fall results in a fracture.

    One simple item I use to test balance is simply to have someone try to stand on one leg without holding on. When I worked in outpatient rehab, I used to use this little tool a lot. A reasonably fit person should be able to do this for at least 10 seconds (wobbly is okay as long as you remain upright without holding something). It’s amazing how many people — including those who, say, work out on a standard Cybex circuit 3-4x/wk, cannot stand on one leg for even a second or two.

    A simple exercise to improve this is to practice rising up on the balls of your feet, holding a counter as needed. Once you can do this about 20x without holding onto something, you’re well on your way to having better balance & are much less likely to fall, and consequently have a better chance of living longer.

    Useful fitness is, indeed, a combination of many factors. I’ve often told patients that, in many ways, it’s more important to stretch as we get older than anything else. Yoga may not be advisable for everyone, but any basic, regular stretching program, taught by a PT, can make a tremendous difference, relieve pain & prevent injury.

    Another great post, Carolyn.

    🙂
    Kathi

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    1. Thanks so much for this, Kathi. I’m glad you mentioned the importance of balance, and your ‘standing on one leg’ test. Balance can be improved through practice, as you suggest. I’ve observed my own remarkable improvement simply through balance exercises I learned at a weight-training class I take every Friday. And I think you’re so right about stretching, especially as we age.

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  15. An easy test for me. No problems to do it without any help of hands or knees. Nevertheless I had a heart attack about three weeks ago. Got 7. stent in one of my bypasses. I feel fine again. 32. year with three bypasses has begun.

    Re yoga: I would like to tell you about my brother-in-law who is a very sportif man with his 76 years, looking 10 years younger. He has been practising yoga for 8 years, shoulder stands, headstands etc. He had a stroke 4 weeks ago. The day before he had done a headstand, too. Two vertebral arteries were almost totally calcified. He got two stents in them and is ok again. The only symptom was: One morning he could not speak for a while.

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    1. First, I’d like to say that I’m so sorry to hear of your recent heart attack, Mirjami! You have certainly had more than your fair share of cardiac crises over the past few decades. Your brother-in-law’s stroke experience reminds us that there are always exceptions within all healthy lifestyle routines – there is no guarantee that, as in my case, a distance runner would not have a heart attack, for example. My cardiologist told me that my 19 years of running, however, likely postponed my heart attack by a decade. Meanwhile, we just continue to do the best we can, right?

      Please take care of yourself as you recuperate.

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      1. Oh, you are right. A good condition helps to survive heart attacks and other bad things. My heart attack came from emotional stress. I had to call the ambulance in the night, because I thought my husband had a heart attack.

        As soon as the ambulance was gone with him, I got terrible heart pain. I was alone and knew this is a heart attack. I took all the pills I could, till I had the feeling to lose consciousness. So I had to call 112 (911). My husband did not have a heart attack, which I did not know at the moment.

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