Sit-to-stand exercise programs improve sit-to-stand performance in people with physical impairments due to health conditions: a systematic review and meta-analysis

Which Sit-to-Stand Test Best Differentiates Functional Capacity in Older People?

ABSTRACT

The sit-to-stand test provides insight into age-related functional capacity; however, there are various variants of sit-to-stand, and we do not know which of these better discriminates against age-related functional capacity. Our study aimed to compare the age-related functional capacity in older people by evaluating sit-to-stand power variants, using young individuals as a reference. A cross-sectional study was conducted in 102 adults (57 women) aged 60-80 and 105 adults (54 women) aged 20-30. Participants performed five times sit-to-stand (5 sit-to-stand), 30-second sit-to-stand, and 1-min sit-to-stand. Z scores were obtained for each sit-to-stand variant using power (W), relative (W/kg), and allometric (W/m 2 ) normalization methods. A mixed repeated-measures analysis of variance assessed the interactions among the sit-to-stand variants, normalization methods, sex, physical activity, and tobacco history. A significant interaction between sit-to-stand variants, normalization methods, and sex ( P = 0.002) was found. The mean effect of sit-to-stand variants revealed that the 1-min sit-to-stand had the lowest Z score ( P < 0.05). Significant variations were observed between sit-to-stand variants in all normalization methods for women ( P < 0.001). However, in men, only the difference between 5 sit-to-stand and 1-min sit-to-stand remained consistent across normalization methods ( P < 0.05). Our findings highlight the efficacy of 1-min sit-to-stand in distinguishing age-related functional capacity over the other sit-to-stand tests, especially in women.

Sit-to-stand performance in children with cerebral palsy: a population-based cross-sectional study

BACKGROUND

Sit-to-stand (STS) is one of the most commonly performed functional movements in a child's daily life that enables the child to perform functional activities such as independent transfer and to initiate walking and self-care. Children with cerebral palsy (CP) often have reduced STS ability. The aim of this study was to describe STS performance in a national based total population of children with CP and its association with age, sex, Gross Motor Function Classification System (GMFCS) level, and CP subtype.

METHODS

This cross-sectional study included 4,250 children (2,503 boys, 1,747 girls) aged 1-18 years from the Swedish Cerebral Palsy Follow-Up Program (CPUP). STS performance was classified depending on the independence or need for support into "without support," "with support," or "unable." "With support" included external support from, e.g., walls and furniture. Physical assistance from another person was classified as "unable" (dependent). Ordinal and binary logistic regression analyses were used to identify associations between STS and age, GMFCS level, and CP subtype.

RESULTS

60% of the children performed STS without support, 14% performed STS with support, and 26% were unable or needed assistance from another person. STS performance was strongly associated with GMFCS level and differed with age and subtype (p < 0.001). For all GMFCS levels, STS performance was lowest at age 1-3 years. Most children with GMFCS level I (99%) or II (88%) performed STS without support at the age of 4-6 years. In children with GMFCS level III or IV, the prevalence of independent STS performance improved throughout childhood. CP subtype was not associated with STS performance across all GMFCS levels when adjusted for age.

CONCLUSIONS

Independent STS performance in children with CP is associated with GMFCS level and age. Children with CP acquire STS ability later than their peers normally do. The proportion of children with independent STS performance increased throughout childhood, also for children with GMFCS level III or IV. These findings suggest the importance of maintaining a focus on STS performance within physiotherapy strategies and interventions for children with CP, including those with higher GMFCS level.

Home hazard modification programs for reducing falls in older adults: a systematic review and meta-analysis

Objective

This study aims to assess the effect of home modification in preventing falls in older adults.

Methods

A systematic review and meta-analysis of randomized studies were performed. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. Five electronic databases were systematically searched for related articles. The titles and abstracts of the articles found using the key search phrases-home modification and falling-were screened using inclusion and exclusion criteria. The Cochrane risk of bias tool was used to evaluate the studies' methodology.

Results

A total of 12 trials were included. A meta-analysis was conducted using 10 studies with n = 1, 960 participants showing a clinically meaningful 7% reduction in falls (risk ratio = 0.93; 0.87-1).

Conclusions

Falls can be significantly reduced with the use of home modification interventions that are thorough, well-focused, have an environmental-fit perspective, and have adequate follow-up.

Effect of sit-to-stand-based training on muscle quality in sedentary adults: a randomized controlled trial

The aim of this study was to compare the effects of sit-to-stand (STS) training programs with 5 vs. 10 repetitions on muscle architecture and muscle function in sedentary adults. Sixty participants were randomly assigned into three groups: five-repetition STS (5STS), 10-repetition STS (10STS), or a control group (CG). Participants performed three sets of five or 10 repetitions of the STS exercise three times per week for 8 weeks. Before and after 8 weeks, all groups performed ultrasound measures to evaluate muscle thickness (MT), pennation angle (PA), and fascicle length (FL), and the five-repetition STS test to estimate the relative STS power and muscle quality index (MQI). After 8 weeks, both experimental groups improved MQI (40-45%), relative STS power (29-38%), and MT (8-9%) (all p < 0.001; no differences between the 5STS vs. 10STS groups). These improvements in both groups resulted in differences regarding the CG, which did not present any change. In addition, only the 5STS group improved PA (15%; p = 0.008) without differences to the 10STS and CG.This suggests that STS training is time-effective and low-cost for improving muscle function and generating adaptations in muscle architecture.

Effects of Motor-Cognitive Dual-Task Standing Balance Exergaming Training on Healthy Older Adults' Standing Balance and Walking Performance

Objective: This study examined the effects of motor-cognitive dual-task exergaming standing balance training on healthy older adults' static, dynamic, and walking balance. Methods: Twenty-four adults older than 70 years (control group: n = 9, males = 6, balance training group: n = 15, males = 8) completed the experiment. Dual-tasking standing balance training comprised the accurate control of a ping-pong ball on a tray held with both hands, while standing on one leg (analog training) and three modules of Wii Fit™ exergaming (digital training). The duration of balance training was ∼15 minutes per day, 2 days per week for 8 weeks, in total 16 sessions. We measured one-leg standing time, functional reach distance, walking balance evaluated by the distance walked on a narrow beam (4-cm long, 4-cm wide, and 2-cm high) with single and dual tasking, habitual and maximal walking speed, and muscle strength of the hip extensor, hip abductor, hip adductor, knee extensor, and plantarflexor muscle groups in the right leg at baseline and after 8 weeks. Results: Control group decreased, but balance training group increased one-leg standing time. Only the balance training group improved functional reach distance and hip and knee extensor strength. There was no change in walking speed and walking balance in either group. In the balance training group, changes in maximal speed correlated with changes in dual-tasking walking balance and changes in one-leg standing time correlated with changes in single-tasking walking balance. Conclusion: These results suggest that 16 sessions of motor-cognitive dual-task standing exergaming balance training substantially improved healthy older adults' static and dynamic balance and leg muscle strength but failed to improve walking speed and walking balance. Balance exercises specific to walking balance need to be included in balance training to improve walking balance.

Circumstances of Falls During Sit-to-Stand Transfers in Older People: A Cohort Study of Video-Captured Falls in Long-Term Care

OBJECTIVE

To characterize the circumstances of falls during sit-to-stand transfers in long-term care (LTC), including the frequency, direction, stepping and grasping responses, and injury risk, based on video analysis of real-life falls.

DESIGN

Cohort study.

SETTING

LTC.

PARTICIPANTS

We analyzed video footage of 306 real-life falls by 183 LTC residents that occurred during sit-to-stand transfers, collected from 2007 to 2020. The mean age was 83.7 years (SD=9.0 years), and 93 were female (50.8%).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

We used Generalized Estimating Equations to test for differences in the odds that a resident would fall at least once during the rising vs stabilization phases of sit-to-stand and to test the association between the phase of the transfer when the fall occurred (rising vs stabilization) and the following outcomes: (1) the initial fall direction; (2) the occurrence, number, and direction of stepping responses; (3) grasping of environmental supports; and (4) documented injury.

RESULTS

Falls occurred twice as often in the rising phase than in the stabilization phase of the transfer (64.0% and 36.0%, respectively). Falls during rising were more often directed backward, while falls during stabilization were more likely to be sideways (odds ratio [OR]=1.95; 95% confidence interval [CI]=1.07-3.55). Falls during rising were more often accompanied by grasping responses, while falls during stabilization were more likely to elicit stepping responses (grasping: OR=0.30; 95% CI=0.14-0.64; stepping: OR=8.29; 95% CI=4.54-15.11). Injuries were more likely for falls during the stabilization phase than the rising phase of the transfer (OR=1.73; 95% CI=1.04-2.87).

CONCLUSION

Most falls during sit-to-stand transfers occurred from imbalance during the rising phase of the transfer. However, falls during the subsequent stabilization phase were more likely to cause injury.

Caregivers' Perceptions of a High Repetition Sit-To-Stand Exercise Program for Children with Cerebral Palsy Who Have Mobility Limitations

AIMS

To explore caregiver perceptions about the outcomes and feasibility of a high repetition sit-to-stand home-based exercise program on themselves and their children with cerebral palsy who have mobility limitations.

METHODS

Face-to-face semi-structured interviews were conducted with 19 caregivers (17 women, mean age 39 y 6 mo (SD 8 y 4 mo) of 19 children with cerebral palsy (10 males, mean age 7 y 2 mo (SD 2 y 1 mo) classified as level III (n = 8) or IV (n = 11) on the Gross Motor Function Classification System. The children had completed a 6-week task-specific sit-to-stand exercise program. Each week a physical therapist and caregivers supervised the program: twice by the physical therapist and three times by the caregivers. Interviews were completed immediately after program completion, and transcripts were analyzed using a process of inductive thematic analysis within an interpretive description framework.

RESULTS

Themes were: (1) caregivers saw positive changes in their children from completing the program, (2) seeing positive changes gave caregivers hope that their child could develop with further training, and (3) the program was feasible to complete.

CONCLUSIONS

Caregivers perceived positive changes in their children and expressed increased hope for their child's future after a high repetition sit-to-stand exercise program, suggesting the program is feasible with caregiver supervision.

Sit-to-stand training for self-care and mobility in children with cerebral palsy: a randomized controlled trial

AIM

To investigate if a sit-to-stand exercise programme for children with cerebral palsy (CP) would improve self-care and mobility.

METHOD

Thirty-eight children with CP (19 males, 19 females; mean age 8y 0mo, SD 2y 4mo, age range 4y 0mo-12y 4mo) classified in Gross Motor Function Classification System (GMFCS) levels III and IV and their caregivers were randomly allocated to sit-to-stand training plus routine physiotherapy (balance and gait training) or routine physiotherapy only (controls). Task-specific sit-to-stand training was completed five times a week for 6 weeks under physiotherapist (twice weekly) and caregiver (three times weekly) supervision. Blinded outcome assessments at week 7 were the self-care and mobility domains of the Functional Independence Measure for Children, Five Times Sit-to-Stand Test (FTSST), and Modified Caregiver Strain Index (MCSI).

RESULTS

The sit-to-stand group self-care increased by 2.2 units (95% confidence interval [CI] 1.3-3.1) and mobility increased by 2.2 units (95% CI 1.4-3.0) compared to the control group. In the sit-to-stand group, the FTSST was reduced by 4.0 seconds (95% CI -4.7 to -3.2) and the MCSI was reduced by 0.8 units (95% CI -1.2 to -0.4) compared to the control group.

INTERPRETATION

A sit-to-stand exercise programme for children with CP classified in GMFCS levels III and IV improved sit-to-stand performance and resulted in small improvements in self-care and mobility, while reducing caregiver strain. What this paper adds Sit-to-stand training improved independence in self-care and mobility for children with cerebral palsy (CP). Home-based sit-to-stand training programmes for children with CP can reduce the burden on supervising caregivers.