The first episode of the BBC series, How To Stay Young broadcast earlier this month, introduced the television audience in the UK to the Sitting-Rising Test. See the video at the foot of the page showing the relevant section from the programme.
Background to the Sitting-Rising Test
This Sitting-Rising Test was developed as part of a research study carried out in Brazil by Dr Claudio Gil Soares de Araújo and his team, the findings of which were published in 2012.
While research findings consistently show that cardiorespiratory fitness is strongly related to survival, limited data exists regarding musculoskeletal fitness indicators. The aim of Dr Claudio Gil Soares de Araújo’s research was to evaluate the association between the ability to sit and rise from the floor and all-cause mortality. 2002 adults aged 51–80 years (68% of which were men) were asked to perform a Sitting-Rising Test (SRT) to and from the floor.
The pictogram below explains the SRT. Click on the image to view it in more detail…
The sample of 2002 adults was followed up on average 6.3 years later. 159 of those people had died (7.9% of the total). The findings showed that lower Sitting-Rising Test scores were associated with higher mortality rates. People who scored low on the test were twice as likely to die within the next six years compared with those who scored higher. Those with the lowest scores were more than five times as likely to die within the same period. These findings led the researchers to conclude that musculoskeletal fitness, i.e. strength and flexibility, as assessed by SRT, was a significant predictor of mortality in the 51–80-year-old subjects.
Is the Sitting-Rising Test Valid and Safe?
The findings of the research look convincing, don’t they. However, the Sitting-Rising Test isn’t now systematically used by the medical profession to predict patient mortality risk, which is arguably a key indicator of whether or not it is considered a sound diagnostic tool. Although the Sitting-Rising Test is used to some degree – mostly for people recovering from a stroke – it is not used as an assessment of mortality.
An article on the SRT by Stephen Propatier at Skeptoid, takes a closer a look at the findings and points out various structural flaws in the research study. Here are the main points from Propatier’s critical analysis…
- the scoring system adopted by researchers was extremely subjective, e.g. the researchers decided if a hand was used and by how much and graded participants accordingly. This lacks the kind of clinical detachment normally required in such studies.
- the study had a small sample size with too many confounding variables, i.e. the sample had a big age range and didn’t separate the sexes.
From my reading of the research, other health issues, which may have affected the rate of mortality didn’t appear to be factored into the study. Neither did matters such as the physiology of the participants; a short and stocky person, for example is arguably much more predisposed to performing the Sitting-Rising Test well than someone who is tall and gangly.
My personal view is that the Sitting-Rising Test may be a useful predictor of general fitness. I also believe that performing the test may do more harm than good. The force on the leg joints at such an acute angle as you lower yourself to the floor then try to rise, could cause a painful injury, particularly if the person performing the manoeuvre is overweight, has osteoporosis, or has had problems in their knee, hip or ankle joint in the past. The potential for falling over and hurting yourself while trying to execute the test is also quite high.
UPDATE: The BBC has now included the following disclaimer for the episode on iPlayer of How To Stay Young that features the Sitting-Rising Test: The sit to rise test should only be done in a controlled environment and if you are in any doubt consult medical advice.
I rest my case!
Pilates as a more valid test of musculoskeletal fitness
A safer, more thorough and arguably more valid indicator of your musculoskeletal strength and flexibility would be your ability to perform well a small number of key Pilates exercises…under the supervision of a fully qualified and experienced Pilates teacher, of course. These are as follows:
- kneeling spine stretch
- thread the needle
- sitting curl back
- diamond press
- abdominal curl
- squats against the wall
To learn how to execute the above Pilates exercises well (in addition to many other valuable exercises) and to have the chance to practise them regularly as a means of improving your musculoskeletal health, why not join one of the many Pilates classes I run in Clevedon and Bristol.
Thanks for providing your opinion regarding the SRT (our citation alert system picked up your comment). I appreciated your description of the SRT and for one of our research studies that was published in the European Journal of Preventive Cardiology online in Dec 13, 2012. You may find interesting to know that the SRT was developed in late 90’s and included in the routine of our evaluation in Exercise Medicine since them at CLINIMEX, Rio de Janeiro, Brazil. A total of over 6,000 subjects aging from 6-98 years old have performed the SRT in our Clinic without any accident or injury, suggesting its safety when performed seriously and correctly. In addition, differently from your comment, it was not proposed to be used for patients that have had a stroke. Additionally, several other research studies have been already published using the SRT , as this one that have appeared in the American Journal of Physical Medicine (http://www.ncbi.nlm.nih.gov/pubmed/23128326 ) . For those interested in learn more about the SRT a comprehensive and original 4-min long video produced in our Clinic is available: youtube https://www.youtube.com/watch?v=MCQ2WA2T2oA . It is also likely adequate to update your information by telling you that BBC has likely been alerted about SRT thru a story featured in Daily Mail some years ago http://www.dailymail.co.uk/sciencetech/article-2858804/Can-exercise-test-predict-DEATH-People-struggle-sitting-rising-test-five-times-likely-die.html or maybe by the nice story published in Discovery magazine in Nov 2014 http://discovermagazine.com/2013/nov/05-sit-down. The pictogram that you have used was originally published by Singapore TImes, after a lecture and an interview with me in Changi hospital, Singapore last year. Another point, it is appropriate to point out that although I have been contacted by e-mail and phone by BBC TV professionals last year, I was not directly involved (not even cited) in the production of the interesting episode that was aired a couple of weeks ago. Finally, I appreciate Pilates and have many of my patients involved in this type of activities. SRT is an assessment tool and not a training method, so that, I can not see or understand why you have compared SRT and Pilates as if they have identical purposes. All the best. Claudio Gil Araújo, MD/PhD – Rio de Janeiro, RJ, Brazil
Thank you for responding to the news item I wrote expressing my personal opinion on the Sitting-Rising Test, and for providing links to other articles which interested parties visiting this blog might like to read.
I’m pleased but not surprised to hear that the 6,000+ subjects who performed the test in your clinic did so without injury or accident. They would have been properly taught and supervised by your research team, and would have carried out the test in a controlled, fit-for-purpose environment. My concern is for the millions of people around the world seeing the test on popular TV programmes, or reading about it in the mass media, who then get up from their desk/armchairs and try to perform the test without thinking too much about the technique, or the furniture that may be in the way, or the type of floor they may land heavily on etc. The potential for accident and injury in this scenario is arguably much greater. I believe this is the reality of how people are actually performing the test out in the world, i.e. they are not doing the test in a carefully supervised, clinical environment.
The SRT may not have been proposed by you for use by stroke victims, but the article I linked to in the news item suggests that a sit-to-stand test has been utilised, rightly or wrongly, by researchers in Hong Kong to assess foot placement and arm position in individuals with chronic stroke.
I think it was valid for me to point out to readers that the SRT is not being systematically used by the medical profession, following the publication of your findings, as a means of predicting patient mortality risk. If it was globally accepted as key indicator of mortality, I propose that doctors would now be using it routinely alongside other recognised tests found to accurately predict a person’s mortality risk, e.g. cholesterol, blood pressure, BMI.
Again, as I mentioned in the news item, I believe that the SRT, if carried out carefully in a controlled environment, is a potentially useful predictor of musculoskeletal fitness. However, I believe that an individual’s ability to perform well under professional supervision, the seven Pilates exercises I proposed in my article, would be a more comprehensive indicator of their musculoskeletal strength and flexibility. To clarify so you understand me completely, I am proposing these seven exercises be used, to use your terminology, as an assessment tool, as a potentially more thorough and meaningful test of a person’s physical strength and flexibility. I freely admit that I don’t have the extensive quantitative data you have to back up this proposition. However, I do have over 11 years of experience as a Pilates instructor, working with thousands of clients aged from 16-87 to help them improve their physical health and wellbeing.
Thank you once more for taking the time to comment on my news item. Best wishes. Melissa Mann.