How Fit Are You?
How fit are you? Fitness is not always best measured by parameters like your weight, your ability to run a 5K, or whether you can do ten push-ups. Instead, one test of fitness is how well you can stand from a seated position.
Let’s try it:
Rise from the floor without using your hands
Keep in mind that this test is not for everyone. For instance, someone with a sore knee, arthritis, poor balance, or another kind of limitation would have difficulty doing the test with little or no assistance.
Sit on the floor with your legs crossed or straight out. Now stand up again. For safety, do this with someone next to you.)
How did you do? Did you need to use your hands or knees? Could you not get up at all?
Now, do the test again. Only this time, grade your effort. Beginning with a score of 10, subtract one point if you do any of the following for support when you both sit and stand:
Use your hand
Use your knee
Use your forearm
Use one hand on the knee or thigh
Use the side of your leg
Lose your balance at any time.
For example, if you sat with no problem, but had to use either a hand or a knee to get up, take off one point. If you had to use both your hands and knees, deduct four points (two points each).
If you can sit and stand with no assistance, you scored a perfect 10. If you could not get up at all, your score is zero. Ideally, you want a score of eight or higher.
What does the no-hands test tell us about fitness?
It can reveal much about your current strength, flexibility, and overall wellness. Performing the sit-and-rise test [SRT] requires leg and core strength, balance and coordination, and flexibility. But if you struggle, that does not necessarily mean you are out of shape. It is an opportunity to focus on areas of your physical health you should address. Even if you currently do reasonably well on the test, practicing can find weak spots before they become worse.
Three exercises that can specifically help improve your score — and ultimately, your fitness. Add them to your regular workout routine. If you are just starting, perform them twice a week and build from there.
Lunges.: help with both leg strength and balance. Stand with your feet shoulder-width apart. While keeping your abdomen tight and your back in an upright position, step forward with one leg until your knee aligns over the front of your foot. The trailing knee should drop toward the floor. Hold for a few seconds and return both legs to the starting position. Repeat with the opposite leg. Do five to 10 repetitions with each leg to make a set. Do two to three sets.
Modification: Stand next to a wall for hand support if needed. For an extra challenge, hold small hand weights during the movements.
Hamstring stretch. Tight hamstrings are a significant contributor to poor flexibility among older adults. Lie on your back and place a strap, belt, or towel around one foot. Holding the strap, gently pull the leg back until you feel a stretch in the back of the leg. Hold the stretch for 30 seconds and then release. Switch to the other leg and repeat.
Plank: helps strengthen a weak core. Lie face down with your forearms resting on the floor. Raise your body, so it forms a straight line from your head and neck to your feet. Tighten your abs and try to hold this position for 10 seconds. Rest and then repeat. Do two to three planks in total. Work up to holding each plank for 30 seconds or longer.
Modification: To make the exercise easier, do it while leaning against a counter or table at a 45-degree angle. You can also hold the plank from a full push-up position.
Research evidence indicates that musculoskeletal fitness (as assessed by SRT) is linked to cardiorespiratory fitness and longevity. Researchers have been investigating ways to evaluate physical fitness, quality of life, and life expectancy in a more straightforward approach. In the late 1990’s Claudio Gil Soares de Araûjo, a professor at Gama Filho University in Rio de Janeiro, developed the SRT to help evaluate physical fitness simply and directly. Professor Araûjo published a study in 2012 that showed a clear correlation between the SRT score and how long people will live. He studied people 51-80 years old. The results may be surprising. People scoring in the lowest range (scores 0 - 3) had a 5 ~ 6 times higher chance of dying in the period of the study than those scoring in the highest range (scores 8 - 10). 40% of those in the lowest range (red line) had died within 11 years of the study, while only 6% of those in the highest range (black line) passed away. These mortalities were from all causes.
Aerobic fitness is unequivocally related to survival. This study reveals that maintaining high levels of body flexibility, muscle strength, power-to-body weight ratio, and coordination are not only useful for performing daily activities but have a favorable influence on life expectancy. The ability to achieve a high SRT score could reflect the capacity to complete a wide range of activities of daily living, such as bending over to pick up a newspaper or a pair of glasses lying under the bed or table. Moreover, a high SRT score likely indicates a reduced risk of falls. The SRT can be considered a simple screening procedure in which a low score primarily reflects the degree of impairment in the components of musculoskeletal fitness – mainly those indicating a reduction in muscle strength and joint flexibility. SRT is a good measure of leg and core strength, as well as balance. Older adults who have such muscular strength and flexibility are less likely to fall. And falls are the leading cause of unintentional-injury-related deaths for people ages 65 and older, according to the Centers for Disease Control and Prevention.
SRT serves as one method of screening an individual’s loss of muscle in the aging process, known as sarcopenia. That decline leads to other mobility problems, which decreases the quality of life. Frailty, strength, muscle mass, physical performance — those things are all correlated to mortality. A word of caution: correlation doesn’t mean causation. If somebody had a terrible knee and there’s no way they could do the test, just because that person has a terrible knee doesn’t mean they’re going to die soon. The ability to get off the floor is a useful screening tool, but it can be difficult for anyone. If you have a thicker midsection, getting off the floor might be challenging. But unless body composition is a sign of other health problems, such as obesity, you’re probably not going to die of it.
A high score is a sign that now, you’re in pretty good physical condition in terms of muscle strength. One shouldn’t forget the genetic component. Some people are just healthier physiologically and more coordinated than others. If you’re sitting on the floor worried because you can’t get up, the good news is that barring complications such as arthritis or inner ear problems, you can work on it, and you’ll likely improve over time.
Physicians have many other screening tools to measure health and longevity. A study published in the February 2019 Journal of the American Medical Association Network Open, measured the health data and push-up capacity of 1,104 middle-aged, active male firefighters for ten years. The men who could complete 40 push-ups during the ten years had a 96 percent lower risk of cardiovascular disease than those who could do fewer than ten push-ups.
Walking speed can also provide insight to life span. One 2011 study published in the Journal of the American Medical Association concluded that people ages 65 and older who could walk one meter per second or faster lived longer than those who couldn’t. Another study published in the British Journal of Sports Medicine concluded that walking at a faster than average pace reduced the risk of death from cardiovascular disease by 53 percent for all people 60 and older. If you can walk at your natural pace at two miles per hour or faster, you’re a lot less likely to die in the next ten years. Walking speed is highly correlated to mortality.
Occasionally a hand dynamometer to assess grip strength can help one determine the risk of death. One study showed that each 11-pound decrease in grip strength leads to a 16 percent higher risk of dying from any cause, including heart disease, stroke, and heart attack. How hard you can squeeze the dynamometer is another marker of frailty. The most definite impact on grip strength has to do with how fit you were in young adult and middle adult life.
TAKEAWAYS
Get moving.
The U.S. Department of Health and Human Services recently released new guidelines for physical activity, suggesting that adults 65 and older break their 150 to 300 minutes of exercise each week into short bouts of activities that focus on balance, aerobic exercise, and muscle strengthening.
The key is to find forms of exercise you enjoy — or find purpose in doing what you may not like to do. If I tell a patient to exercise because it’s going to improve cardiovascular health, it may not motivate them as much. What motivates them is the ability to go to a grandchild’s kindergarten graduation. Think, what do you care about? What do you want to be able to do?
It’s never too early or too late in life to start or increase physical activity — it’s beneficial and increases life expectancy no matter when you do it. Aim for 30 minutes of moderate exercise a day.
Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone rebalancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP, for their excellence and contributions made to both medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients
