Can The "Sitting-Rising" Test Predict All-Cause Mortality In Older Adults?

Robert C. Fisher

The challenge seems simple: sit cross-legged on the floor and rise to a standing position without supporting yourself with your hands or knees. However, it's not as easy as you might think in practice.

This is known as the “sitting-rising” test or SRT. It was created by Brazilian Sports Medicine doctor and researcher Dr. Claudio Gil Araújo and his team.

In 2012, the European Journal of Cardiovascular Prevention released it to the public. The test predicts "all-cause" mortality in middle-aged and older adults. It comes back around, causing people of all ages to panic if they have difficulty getting up from sitting on the ground.

This article can help you determine if this panic is warranted.

How Does it Work?

In this simple test, you must lower yourself to the ground in a crisscross sitting position without supporting yourself with your arm, hand, side of the leg, or knee.

You get 5 points for sitting and 5 for standing back up. Therefore, if you can sit and rise without assistance, you get 10 points. Every time you use forbidden body parts to support yourself, one point is subtracted.

Dr. Claudio Gil Araújo and his research team in Brazil tested 2,002 adults between the ages of 51 and 80 and followed them until they either passed away or the study ended (October 2011), which was about 6.3 years. 

During this time, 159 participants passed away - only 2 had a final score of 10 on the test. The participants with the lowest SRT score, 0 to 3 points, were 5 to 6 times more likely to die than those with an SRT score between 8 to 10 points.

We know that aerobic and musculoskeletal fitness is related to life expectancy. However, this sit-to-stand test also indicates that there are other factors involved in life expectancy, including:

  • Flexibility

  • Coordination

  • Power-to-bodyweight ratio

  • Muscle strength

This test measures core strength, leg strength, and balance. 

According to the Centers for Disease Control and Prevention, or CDC, falling due to loss of balance is the leading cause of injury-related deaths for adults 65 and older. Adults with a higher final score on the “sitting-rising” test are less likely to fall because they have strength and flexibility.

However, what if you can’t sit and get up without support? Does this mean that you're doomed to die early and must get your affairs in order? Not necessarily. 

Your clothes may affect your ability to complete this sit-to-stand test, and you are more likely to struggle if you're not wearing comfortable clothes.

Several other variables determine your overall health and life expectancy than this test focuses on.

Also, it’s important to note that the results of this study are most applicable to individuals between the ages of 51 and 80 - a fact that is often forgotten. Most subjects that scored lower were on the older end of the spectrum (76 to 80), and this group typically experiences an overall reduction in coordination and mobility.

Another factor that isn't discussed is the cause of death in the 159 participants who passed away. We are not sure if their deaths were due to complications from falling or if other factors were involved, such as cancer, cardiovascular disease, or something else.

It's not wrong.

According to Greg Hartley, assistant professor at the University of Miami Miller School of Medicine and the president of the Academy of Geriatric Physical Therapy, this test does screen for sarcopenia, which is loss of muscle due to aging. This decline causes other mobility issues, reducing the overall quality of life.

Physical performance, frailty, muscle mass, and strength are correlated to mortality. That being said, it's important to remember that correlation is not the same as causation.

For example, if someone has bad knees, they are not likely to be able to do the test. This doesn't indicate that they may die soon; they have bad knees.

Getting up off the floor is great, but it can be hard for anyone to do without using their hands. You may fail this test because of where you carry your weight. Getting up off the floor without support can be extremely challenging for individuals with a thicker midsection.

However, unless you have other health complications, such as obesity, you're not likely to die from it.

A high score on the "sit-rise" test indicates that you're in decent physical strength at that time. Also, it's genetic - some people are stronger and more coordinated than others. However, it isn't necessarily a predictor of life expectancy.

If you are sitting on the floor panicking because you can’t stand up without support, as long as you don’t have issues such as inner ear problems or arthritis, it is something you can work on and improve.

Take time to practice every day. Resilience is another factor - will you try to fix it, or will you give up? 

3 Other Screening Tests that Indicate Life Expectancy

According to the experts, there are several other screening tests that medical providers can use to indicate life expectancy.

1. Push-Up Capacity

In February 2019, the Journal of the American Medical Association Network Open published a 10-year study involving 1,104 middle-aged, active male firefighters.

This Harvard study looked at the health data and push-up capacity of the participants. Those who completed 40 push-ups during this time were 96% less likely to develop cardiovascular disease than those who did less than 10.

2. Walking Speed

Another factor that gives us some insight into life expectancy is walking speed.

In 2011, the Journal of the American Medical Association published a study indicating that individuals age 65+ who could walk 1 meter in a second or less lived longer than those who could not.

Another study published by the British Journal of Sports Medicine revealed that walking at a faster pace reduced mortality risk due to cardiovascular disease in 53% of participants 60+.

These results indicate that walking speed is closely tied to mortality. If you can walk 2 miles in an hour or less, your risk of dying within the next 10 years is greatly reduced.

3. Grip Strength

Finally, medical providers can learn much about life expectancy by using a hand dynamometer to test grip strength.

Another Harvard study indicated for each 11-pound decrease in grip strength an individual has, their risk of death from cardiovascular causes is 16% higher.

Grip strength is an indicator of frailty, and your fitness level as a young adult and into middle adulthood has the greatest impact on your grip strength. Therefore, there is a preventative.

How To Improve Life Expectancy by Staying Active

While the sit-to-stand test does help in some ways to predict mortality risk, it’s more of an indicator of cardiovascular health. Just because you have to use other body parts to help you lower to a sitting position or rise to a standing position does not mean that your risk of death is increased substantially.

If you struggle with this sit-rise test, once you get up, you can use your defeat to encourage you to improve your fitness and strength.

According to the U.S. Department of Health and Human Services, adults 65 and older should get 150 to 300 minutes of exercise per week. This should be broken down into short bursts focusing on improving muscle strength, balance, and aerobic activity. After all, it's never too late to improve your physical fitness.

Ideally, you should find something you enjoy doing, so it's not a chore. If not, at least find purpose in what you're doing.

Medical experts agree that telling patients exercise will improve their cardiovascular health doesn't give them motivation. However, telling them that improving their health as they age will allow them to be active in their grandchildren’s lives does.