Validity of a Novel, Clinically Relevant Measure to Differentiate Functional Power and Movement Velocity and Discriminate Fall History Among Older Adults: A Pilot Investigation

Assessing muscular power in older adults: evaluating the predictive capacity of the 30-second chair rise test

Background: Timed chair rise tests are frequently used as a substitute for assessing leg muscle strength or power. To determine if timed chair rise tests are an indicator of lower extremity muscle power, we examined the relationship between the repetitions completed in a 30-s chair rise test and the power generated during the test. Methods: Seventy-five individuals participated in this study (n = 30 < 65 years and 45 ≥ 65 years). Participants underwent a 30-s chair rise test while instrumented with a power analyzer. Handgrip strength was also evaluated. Results: The relationship between chair rise repetitions and average chair rise power was R 2 = 0.32 (p < 0.001). Chair rise repetitions when regressed on a total (i.e., summed) chair rise power, it yielded R 2 = 0.70 with data from all participants combined (p < 0.001). A mediation analysis indicated that anthropometrics partially mediates the relationship between chair rise repetitions and total chair rise power accounting for 2.8%-6.9% of the variance. Conclusion: Our findings indicate that in older adults, the overall performance of chair rises offers limited information about the average power per rise but is more indicative of the cumulative power exerted. Thus, the total number of chair rises in a 30-s test is likely a more comprehensive metric of overall muscular power, reflecting endurance aspects as well. Additionally, we found that personal physical attributes, such as height and weight, partially influence the link between chair rise count and total power, highlighting the importance of factoring in individual body metrics in assessments of muscular performance.

Temporal, Kinematic and Kinetic Variables Derived from a Wearable 3D Inertial Sensor to Estimate Muscle Power during the 5 Sit to Stand Test in Older Individuals: A Validation Study

The 5-Sit-to-stand test (5STS) is widely used to estimate lower limb muscle power (MP). An Inertial Measurement Unit (IMU) could be used to obtain objective, accurate and automatic measures of lower limb MP. In 62 older adults (30 F, 66 ± 6 years) we compared (paired t-test, Pearson's correlation coefficient, and Bland-Altman analysis) IMU-based estimates of total trial time (totT), mean concentric time (McT), velocity (McV), force (McF), and MP against laboratory equipment (Lab). While significantly different, Lab vs. IMU measures of totT (8.97 ± 2.44 vs. 8.86 ± 2.45 s, p = 0.003), McV (0.35 ± 0.09 vs. 0.27 ± 0.10 m∙s^-1, p < 0.001), McF (673.13 ± 146.43 vs. 653.41 ± 144.58 N, p < 0.001) and MP (233.00 ± 70.83 vs. 174.84 ± 71.16 W, p < 0.001) had a very large to extremely large correlation (r = 0.99, r = 0.93, and r = 0.97 r = 0.76 and r = 0.79, respectively, for totT, McT, McF, McV and MP). Bland-Altman analysis showed a small, significant bias and good precision for all the variables, but McT. A sensor-based 5STS evaluation appears to be a promising objective and digitalized measure of MP. This approach could offer a practical alternative to the gold standard methods used to measure MP.

Sit-to-Stand Power Across the Lifespan: A Cross-Sectional Analysis

Lower-body power measured by a linear position transducer during the sit-to-stand (STS) movement declines with age and may be a predictor of physical disability in older adults. The purpose of this study was to establish normative data for STS power across the lifespan and to determine if differences exist between age cohorts, sexes, and age cohort-sex subgroups. Adults (N = 557) aged 18-89 were divided into five age cohorts and performed the STS connected to a linear position transducer, which calculated power and velocity during the movement. Significantly lower (p < .01) velocity was observed in a younger age cohort in females than males, whereas males saw a significant average power decrement (p < .01) in a younger age cohort than females. STS power norms give clinicians a metric predicting physical disability and may be of particular interest to males as their power production begins to decline at an earlier age.

Cognitive decline negatively impacts physical function

Many older adults report difficulty performing one or more activities of daily living. These difficulties may be attributed to cognitive decline and as a result, measuring cognitive status among aging adults may help provide an understanding of current functional status. The purpose of the present investigation was to determine the association between cognitive status and measures of physical functioning. Seventy-six older adults participated in this study; 41 were categorized as normal memory function (NM) and 35 were poor memory function (PM). NM participants had significantly higher physical function as measured by Short Physical Performance Battery (SPPB; 9.4 ± 2.2 vs. 8.4 ± 2.0; p = .03) and peak velocity (0.67 ± 0.16 vs. 0.56 ± 0.19; p = .04) during a quick sit-to-stand task. Dual-task walking velocities were 22% and 126% slower between cognitive groups for the fast and habitual trials, respectively when compared to the single-task walking condition. Significant correlations existed between measures of memory and physical function. The largest correlations with memory were for peak (r = 0.42) and average (r = 0.38) velocity. The results suggest a positive relationship between physical function and cognitive status. However, further research is needed to determine the mechanism of the underlying relationships between physical and cognitive function.

Validity, reliability, and measurement error of a sit-to-stand power test in older adults: A pre-registered study

OBJECTIVES

Lower body power declines with age and is associated with decreased physical function in older adults. However, the majority of the tools available to measure power are expensive and require considerable space and expertise to operate. The purpose of this study was to assess the validity, reliability, and measurement error of a sit-to-stand power test (STSp) to assess lower body power.

METHODS

51 community-dwelling adults, 65 years or older, completed a power test using a pneumatic leg press (LP), the Short Physical Performance Battery (SPPB) that includes a test of balance, usual walking speed, and chair stand tests; Timed Up and Go (TUG) test at both usual and fast paces, and Patient-Reported Outcome Measures (PROMs). A two-week test-retest assessed the reliability in 36 participants. The study hypotheses and analysis were pre-registered prior to data collection and statistical analyses were blinded.

RESULTS

The mean age was 71.3 years, with 63% females, and an average SPPB score of 10.6 (median = 12). STSp peak power was strongly correlated with LP (r = 0.90, 95% CI (0.82, 0.94). As hypothesized, the STSp peak power showed similar or higher correlations with physical function tests relative to LP peak power: SPPB (0.41 vs. 0.29), chair stand test (-0.44 vs. -0.35), TUG test at usual pace (-0.37 vs. -0.29) and fast pace (-0.41 vs. -0.34) and balance (0.33 vs. 0.22), but not for mobility (0.34 vs. 0.38) and function (0.41 vs. 0.48) questionnaire. For discriminant validity, as hypothesized, males showed higher STSp peak power compared to females (Δ = 492 W, p < .001, Cohen's d = 2.0). Test-retest assessment yielded an intraclass correlation coefficient of 0.96 and a standard error of measurement of 70.4 W. No adverse events were reported or observed for both tests.

CONCLUSION

The STSp showed adequate validity and reliability in measuring lower body power in community-dwelling older adults. The test is quick, relatively inexpensive, safe, and portable and thus should be considered for use in aging research.

Comparison of handrail reaction forces between two different handrails during sit-to-stand movement in the elderly

BACKGROUND

The handrail is an effective means of assisting sit-to-stand movements. As some elderly people need force to support their body during sit-to-stand movements because of instability and weakness; however, few handrails are specifically shaped to generate more force and support the body. This study aimed to investigate the effect of a newly designed curved-angled handrail on the reaction force during sit-to-stand movements in the elderly.

METHODS

Twenty-one elderly subjects (age range, 72-84 years) participated in the study. They performed sit-to-stand movements using a conventional vertical handrail and then the curved-angled handrail five times each. For each subject, body coordinate data were acquired and the handrail reaction force was measured using motion analysis and load sensors on the handrail.

FINDINGS

The reaction forces generated in the anterior-posterior and upward-downward directions during sit-to-stand movements using the curved-angled handrail were significantly greater than those generated using the conventional vertical handrail (p < .001).

INTERPRETATION

Compared with using the conventional vertical handrail, using the curved-angled handrail enhances the generated force during sit-to-stand movements.

Instrumented Analysis of the Sit-to-Stand Movement for Geriatric Screening: A Systematic Review

The Sit-to-Stand (STS) is a widely used test of physical function to screen older people at risk of falls and frailty and is also one of the most important components of standard screening for sarcopenia. There have been many recent studies in which instrumented versions of the STS (iSTS) have been developed to provide additional parameters that could improve the accuracy of the STS test. This systematic review aimed to identify whether an iSTS is a viable alternative to a standard STS to identify older people at risk of falling, frailty, and sarcopenia. A total of 856 articles were found using the search strategy developed, with 12 articles retained in the review after screening based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six studies evaluated the iSTS in fallers, five studies in frailty and only one study in both fallers and frailty. The results showed that power and velocity parameters extracted from an iSTS have the potential to improve the accuracy of screening when compared to a standard STS. Future work should focus on standardizing the segmentation of the STS into phases to enable comparison between studies and to develop devices integrated into the chair used for the test to improve usability.

Sit-to-Stand Kinetics and Correlates of Performance in Young and Older Males

PURPOSE

To compare sit-to-stand (STS) kinetics in young (YM) and older (OM) males and determine correlates of STS performance.

METHODS

YM (n = 15, age = 20.7 ± 2.2 yrs) and OM (n = 15, age = 71.6 ± 3.9 yrs) performed a single STS task as quickly as possible on a force plate and the vertical ground reaction force (VGRF) signal was analyzed. Peak VGRF, as well as peak (100 ms rolling average), early (minimum VGRF to 50% peak VGRF), late (50% peak VGRF to peak VGRF), and overall (minimum VGRF to peak VGRF) rate of force development (RFD) were calculated. Power (absolute and relative) and velocity parameters as well as rate of electromyography rise (RER) were also obtained.

RESULTS

STS time, average power, early RFD, and lower limb lean mass were similar between groups (p > 0.05). All other power, velocity, RFD, and RER measures were lower in OM (p < 0.05; d = 0.41-2.19). Peak VGRF and all RFD measures, except late RFD, were strongly correlated with STS performance in OM, while peak VGRF and peak RFD were only moderately correlated with performance in YM.

CONCLUSIONS

Most kinetic variables, except absolute average power, were diminished in OM, and there was a preferential decrease in late RFD compared to early RFD. Peak VGRF and RFD exhibited stronger correlations with STS time and power in OM compared to YM, and early RFD appears to be more influential for STS performance than late RFD. These findings may be useful for practitioners/clinicians involved in designing interventions aimed at optimizing STS performance in older adults.