Friday, May 11, 2012

Predicting Future Disability

I cringe every time I see a senior on a scooter (such as the one above).  Some seniors are disabled to the point where a motor scooter, walker, or other travel aid is necessary, but these tools are all merely palliative; they deal with the symptoms of the problem, but they don't solve the actual problem.  Decreasing movement will not help solve the difficulties one has with moving.  While fixing the movement difficulties is a great topic in itself, let's think one step ahead: what if we could predict future disability, therefore allowing us to take preventative actions?

The Chair Stand Test

The Chair Stand Test (CST) is a simple test primarily focusing on the major muscles of the lower body: the quadriceps, hamstrings, and gluteus maximus.  It is performed by seeing how many times an individual can stand from a standard chair (perhaps the chair at your dinner table) in 30 seconds, without the use of an aid or the arms (arms should be crossed).  The muscles used in performing this test are the essentially the same muscles and muscle groups that we use to run, walk up stairs, and perform many other activities of daily living.  While this test may sound easy to you, over 20% of 1,122 seniors in their 70s were unable to stand five times [1]!

The CST is a useful because it is effective in determining risk of future disability.  One study assessed seniors four years after completing a CST [1].  When the CSTs were conducted, all subjects were free of disability.  The subjects were then broken up into four groups based on test score, with Group 1 having the poorest scores while Group 4 had the most stands.  After four years, 79% of Group 4 were disability free, as compared to 67 and 60% in groups 2 and 1.  Group 1 also had about twice the amount of mobility disorders that group 4 did.  CST scores also predicted the risk of falling in two studies [2, 3].

Use of the CST and Scores

I urge you to give the CST a try, especially if you fit into one of the age brackets below.  The test only requires effort, 30 seconds, and a chair similar to that generally found at dining room tables.  Remember to keep your arms crossed during the test, ensuring valid results.

According to the Senior Fitness Test Manual by Roberta Rikli and Jessie Jones, here are the minimum desired stands during a 30-second test (obviously you should strive to go well beyond the minimum):

60-64 years: 12 (women), 14 (men)
65-69: 11, 12
70-74: 10, 12
75-79: 10, 11
80-84: 9, 10
85-89: 8, 8
90-100: 4, 7 

Keep in mind that the CST test is an indication of risk based on associations.  The associations could be explained by those who score better having better exercise habits at the start and through the duration of the study.  Regardless, if you score poorly on the CST,  look at it as added motivation to to improve lifestyle habits, specifically through a strength training program.

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