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Does Flexibility Influence the Ability to Sit and Rise from the Floor?
Abstract
Objective:
The purpose of this study was to establish whether flexibility influences the ability to sit and rise from the floor.
Design:
Subjects aged 6-92 yrs (n = 3927 [2645 men]) performed the Sitting-Rising Test (SRT) and the Flexitest on the same laboratory visit. The SRT evaluates components of musculoskeletal function by assessing the subject's ability to sit and rise from the floor, which was scored from 0 to 5, with 1 point being subtracted from 5 for each support used (hand/knee). The subject's final SRT score, varying from 0 to 10, was obtained by adding the sitting and rising scores. The Flexitest evaluates the maximum passive range of motion of 20 body joint movements. For each one of the movements, there are five possible scores, 0-4, in a crescent mobility order. Adding the results of the 20 movements provides an overall flexibility score called the Flexindex (FLX).
Results:
The SRT score differed when the Flexindex results were stratified into quartiles: 6-26, 27-35, 36-44, and 45-77 (P < 0.001). The SRT and Flexindex scores were moderately and positively associated (r = 0.296; P < 0.001). In addition, the subjects with an SRT score of 0 are less flexible for all 20 Flexitest movements than those scoring 10 are.
Conclusions:
Although seemingly simple tasks, the actions of sitting and rising from the floor are also partially dependent on flexibility in male and female subjects of a wide age range. Future studies should explore the potential benefit of regular flexibility exercises for these actions.
... Similar to previous reports (Araújo, 2008b;Medeiros et al., 2013;Quatman et , the results of the GIJM showed that wo had higher joint mobility and ROM than men. We also assessed the profile of ROM for the individual movements of the Flexitest battery as recommended (Brito et al., 2013). Regarding the IMVI, most proportion of the Physical Education students were categorized as normal, albeit 23% of the men participants showed atypical low values. ...
... Finally, although several other tests to evaluate flexibility/joint mobility exist, it is noteworthy to mention that the Flexitest has shown easiness of application, reliability (intra-and inter-observer), and no need of equipment or large space to perform it (Araújo, 2008b;Medeiros et al., 2013). In addition, there are no ceiling nor floor effects that are often seen with other joint mobility tests (e.g., the Beighton-Horan joint laxity test) (Brito et al., 2013). ...
... On the other hand, most of the population that participated in this study was categorized as high and medium-high in terms of joint mobility. Although it has been reported that having high joint mobility can provide the ability to sit and rise properly (Brito et al., 2013), readers should be concerned about the lack of data to link the identified cluster-based phenotypes with physical fitness, quality of life (including ADL) and/or academic success. The relative absence of students' homogeneity per major programs does not allow to extend generalizability to other undergraduate populations. ...
Abstract
Introduction: Joint mobility has been considered an important component of the physical fitness. Objective: This STROBE-based study aimed to evaluate the joint mobility in undergraduate students of Physical Education. Materials and methods: Data measurements were obtained for 239 students attending from 4th to 9th academic semester of a physical education major (200 men: 22±4.3 years, 1.72±0.05 m, 67±8.5 kg; and 39 women: 21±3.4 years, 1.61±0.07 m, 57±6.4 kg). Flexibility expressed as a General/global Index of Joint Mobility (GIJM) was measured through the Flexitest method, which assesses the maximum passive range of motion (ROM) of 20 body joint movements. We also reported the profile of ROM for the individual movements of the Flexitest battery. Results: The differences found between sexes, highlight index of general articular mobility (GIJM) and ROM (p< .05). This aspect is also observed when comparing standardized joint limitations (p< .01 ankle, knee, hip, trunk, elbow and shoulders). However, the homogeneity profile range of movement in the intermovement variability index, the interjoint variability index and the flexion-extension variability index indices don´t reflect gender differences (p> .05), contrary to found in the between segment variability index and distal-proximal variability index (p< .01). Conclusions: The hierarchical clustering algorithm subdivided the study participants into groups according to GIJM. We identified two significantly different phenotypes representing younger, lighter, and with higher joint mobility (Cluster 1) versus older, heavier, and with lower joint mobility students (Cluster 2). More research is needed to evaluate associations with body composition, physical performance, quality of life and academic success.
... The Sitting-Rising Test (SRT) is a scale that evaluates musculoskeletal fitness 65 and ability to sit and rise from the floor. It is conducted on a flat nonslippery surface. ...
... Prior to the test, the assessor gives the following instruction: 'Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed'. 65 The 2 items are assessed on a 6 level (0-5 points) rating scale. The score ranges from a minimum of 0 (worst performance) to a maximum of 10 (best performance). ...
... Crossing the legs during the test is allowed, but the participants were told not to use the side of the feet for support. 65,66 SRT scores demonstrated good to excellent inter-rater and test-retest reliability in the Shamay 67 evaluation (see Table 2). In this validation study, SRT rising scores correlated significantly with some clinical tests (Table 2), but not with many important outcome measures. ...
Introduction:
Stroke may result in decreased trunk muscle strength and limited trunk coordination, frequently determining loss of autonomy due to the trunk impairment. Furthermore, sitting balance has been repeatedly identified as an important predictor of motor and functional recovery after stroke. Given the importance of trunk it is therefore mandatory that validated tools be available to assess its performance. To perform a systematic review of clinical measurement tools to assess trunk performance after stroke.
Evidence acquisition:
We searched the PubMed database from January 2006 to April 2017 to select articles which reported or included a clinical measure of trunk performance used in an adult stroke population. The data collected were integrated with the results of a previous review published in 2006. A total of 302 articles were identified, of which 19 were eligible for inclusion.
Evidence synthesis:
Numerous clinical tools have been validated to assess trunk performance after stroke, including: the Trunk Control Test (TCT), Trunk Impairment Scale (TIS), Postural Assessment Scale for Stroke (PASS), Ottawa Sitting Scale (OSS), Modified Functional Reach Test (MFRT), Function In Sitting Test (FIST), Physical Ability Scale (PAS), Trunk Recovery Scale (TRS), Balance Assessment in Sitting and Standing Positions (BASSP) and Sitting-Rising Test (SRT).
Conclusions:
Several scales and tests have been demonstrated to be valid for assessing trunk performance in stroke. Some of these have already been refined by Rasch analysis to increase their psychometric characteristics. Further psychometric analysis of these tools in large and different samples is, however, still needed.
... Common components of exercise include stretching [7], and flexibility is generally considered a necessary component of sports and fitness [8]. Lower extremity flexibility, especially, is important for successful performance of sports movements [9] and activities of daily living [10,11], and is essential for reducing the risk of injury [12,13]. Hamstring muscle shortening is a major risk factor for knee joint stiffness due to increased patella and femur compression, muscle dysfunction, and cartilage decline [14]. ...
This study investigated the effect of digital therapeutics on ROM, flexibility, dynamic balance, satisfaction, and adherence. A sample of 34 volunteers was randomly assigned into a Digital Therapeutic Group (DTG) (n = 17) and a Non-Digital Therapeutic Group (NDG) (n = 17). The groups performed four calf muscle stretches and two hamstring stretches for 4 weeks. Flexibility and balance were evaluated to assess the effectiveness of the exercise program. A survey was conducted to assess subjects’ satisfaction, and exercise performance record papers and video records were assessed for exercise adherence. The paired t-test was used to compare the two populations before and after the program. The independent t-test was used to compare the change scores between groups. In the pre- and post-comparison within each group, the DTG group showed significant differences in all items except the dorsiflexion range of motion (ROM) (p < 0.05). The left straight leg raise (SLR) was significantly different (p < 0.05), and there was a significant difference in exercise satisfaction and participation between the two groups (p < 0.05). DTG showed improved flexibility, dynamic balance, and higher exercise satisfaction and adherence than NDG. The application, providing lower extremity stretching, can improve dorsiflexion ROM, flexibility of the lower extremity, dynamic balance, exercise satisfaction, and exercise adherence.
... Up to 70% of patients with a history of severe ankle sprains will eventually develop chronic ankle instability (CAI) [1][2][3]. Joint flexibility, especially in the lower 2 of 12 extremities, not only increases performance in both sports and daily living activities, but is also an essential factor in injury prevention [4][5][6][7][8][9]. ...
This study was conducted to measured talar displacement using ultrasound during an anterior drawer test (ADT) with a Telos device. Five adults (3 men and 2 women; 8 ankles; mean age: 23.2 y) with a history of ankle sprain and eight adults (5 men and 3 women; 16 ankles; mean age: 22.1 y) without a history of ankle sprain were recruited into a history of ankle sprain (HAS) and a control group, respectively. Talar displacement was observed in response to load forces applied by a Telos device during the ultrasound stress imaging test. The ultrasound probe was placed 5 mm inside from the center of the Achilles tendon on the posterior ankle along the direction of the major axis. The inter-rater reliability for the present method was classified as good and excellent (ICC(2,2) = 0.858 and 0.957 at 120 N and 150 N, respectively) in the control group and excellent (ICC(2,2) = 0.940 and 0.905 at 120 N and 150 N, respectively) in the HAS group, according to specific intraclass correlation coefficient values. We found that talar displacement during the ADT was lower in the HAS group than in the control group. Analysis of the receiver operating characteristic curve revealed that the quantitative ultrasound-based ADT using a Telos device was superior to the X-ray-based test in detecting reduced ankle joint mobility during the ADT (area under the curve of 0.905 and 0.726 at a force of 150 N using ultrasound-based and X-ray-based tests, respectively). Further investigation is needed; nevertheless, this preliminary study suggests that the ultrasound-based quantitative ADT using a Telos device might detect talar displacement more sensitively than the conventional stress X-ray.
... Up to 70% of patients with a history of severe ankle sprains will eventually develop chronic ankle instability (CAI) [1][2][3]. Joint flexibility, especially in the lower 2 of 12 extremities, not only increases performance in both sports and daily living activities, but is also an essential factor in injury prevention [4][5][6][7][8][9]. ...
... Hip extension, dorsiflexion, and plantar ankle flexion range of motion are known to be important factors that influence physical function in community-dwelling older women [94]. In addition, it has been found that ADLs that require sitting and standing movements are partially dependent on flexibility [95]. This study indicates that the range of motion of the lower limbs is a predictor of disability in older adults [96]. ...
Disability is negatively associated with the health of older adults, and it can be mediated by healthy lifestyles and behaviors throughout one’s life. In this context, understanding the interrelationships between sedentary behavior, physical activity and functionality may assist in the implementation of effective public health actions. Thus, the aim of the present study was to investigate the relationships between both physical activity and sedentary behavior and functionality in older adults and the possible mediators. The variables analyzed were selected according to the content analysis of International Classification of Functioning, Disability and Health model, and included activity, participation, health conditions, body functions and structures, environmental factors and personal factors. 419 individuals participated in the study. Physical activity was directly associated with disability in instrumental activities of daily living (IADL), and the association was mediated by self-esteem, aerobic endurance, and agility/balance. Sedentary behavior was indirectly associated with IADL disability, and the association was mediated by aerobic resistance, nutritional status, and agility/balance. Regarding the basic activities of daily living (BADL), physical activity showed an indirect association mediated by aerobic resistance and IADL. The association of sedentary behavior with BADL was mediated by aerobic resistance and lower limb flexibility. These results reinforce the idea that functionality is multidimensional, and the mediating factors must be considered when strategies for promoting physical activity and reducing sedentary behavior are designed.
... Bu test kişinin ayakta durur pozisyonda ve ayakları birbiri ile çapraz şekilde herhangi bir uzvundan destek almadan yere oturma (zemine alçalma) ve tekrar başlangıç pozisyonuna dönme (zeminden yükselme) şeklinde ölçülmektedir. SRT zemine alçalmada 5 puan ve zeminden yükselmede 5 puan olmak üzere toplam 10 puandan oluşmaktadır (Brito, de Araújo ve de Araújo, 2013). SRT'deki her bir puan artışının ölüm riskini %21 azalttığı belirtilmiştir. ...
Günümüzde kişilerin fiziksel uygunluk düzeylerini belirlemek ve sağlık
durumları ilgili bilgi almak için farklı ölçüm yöntemleri kullanılmasına
karşın, yerli literatürde bu parametreleri sitting-rising testi (SRT) ile
belirleyen bir çalışma bulunmamaktadır. Yapılan çalışmanın [1] amacı
kadınlarda SRT ile fiziksel aktivite düzeyi (FAD), bazı motorik ve
antropometrik özellikler arasındaki ilişkinin incelenmesi, [2] amacı SRT
kategorilerine göre FAD, bazı motorik ve antropometrik özellikler
arasındaki farkın belirlenmesidir. Çalışmaya 35-55 yaş arası sağlıklı
sedanter 200 kadın gönüllü olarak katılmıştır. Değişkenler arasındaki
ilişkiyi belirlemede Pearson korelasyon analizi, SRT kategorileri arasındaki
farkı belirlemede One Way Anova testi kullanılmıştır. Elde edilen veriler
sonucunda, kadınların SRT puanı ile antropometrik özellikler arasında
negatif yönlü; SRT puanı ile FAD ve motorik özellikler arasında pozitif
yönlü anlamlı bir ilişki olduğu tespit edilmiştir (p<0,05). Sonuç olarak, SRT
puanın hem antropometrik hem de motorik özellikler ile ilişkili olduğu, bu
özelliklerin FAD’ni artırarak geliştirilebileceği söylenebilir.
... In correlational studies, greater flexibility usually correlates with better ability to perform ADLs (r = 0.20-0.50) [88,89,[91][92][93], but so does muscle strength [88,89,92,93]. This relationship between muscle strength and ADLs has been observed numerous times in older adults [90,[94][95][96][97][98][99][100][101] and results from longitudinal studies indicate muscle strength at middle or older age predicts ADL performance later in life [94,[97][98][99]. ...
Flexibility refers to the intrinsic properties of body tissues that determine maximal joint range of motion without causing injury. For many years, flexibility has been classified by the American College of Sports Medicine as a major component of physical fitness. The notion flexibility is important for fitness has also led to the idea static stretching should be prescribed to improve flexibility. The current paper proposes flexibility be retired as a major component of physical fitness, and consequently, stretching be de-emphasized as a standard component of exercise prescriptions for most populations. First, I show flexibility has little predictive or concurrent validity with health and performance outcomes (e.g., mortality, falls, occupational performance) in apparently healthy individuals, particularly when viewed in light of the other major components of fitness (i.e., body composition, cardiovascular endurance, muscle endurance, muscle strength). Second, I explain that if flexibility requires improvement, this does not necessitate a prescription of stretching in most populations. Flexibility can be maintained or improved by exercise modalities that cause more robust health benefits than stretching (e.g., resistance training). Retirement of flexibility as a major component of physical fitness will simplify fitness batteries; save time and resources dedicated to flexibility instruction, measurement, and evaluation; and prevent erroneous conclusions about fitness status when interpreting flexibility scores. De-emphasis of stretching in exercise prescriptions will ensure stretching does not negatively impact other exercise and does not take away from time that could be allocated to training activities that have more robust health and performance benefits.
... As a consequence, the assessment of supine to standing is becoming more popular as a screening tool related to functional performance [2,3]. The supine-to-stand (STS) test is conceptualised as a combined assessment of flexibility [4], strength [5], locomotion and balance [2], and overall motor competence (MC) [3]. Due to its potential importance as a measure for assessing physical function and in informing strength and conditioning and rehabilitation programs across the lifespan [1,6], an examination of how STS relates to other aspects of MC and fitness is a needed step in establishing the utility of this test as a measure of functional MC. ...
This study examined how supine-to-stand (STS) performance is related to process and product assessment of motor competence (MC) in children. Ninety-one children aged 5–9 years were assessed for process and product MC (10 m running speed and standing long jump) as well as process and product measures of STS. Tertiles were created for STS process and STS product scores to create 3 groups reflecting low, medium, and high STS competency. ANCOVA analysis, controlling for age, for process STS, indicated that process MC was significantly higher in children, classified as medium STS (p = 0.048) and high STS (p = 0.011) competence, and that 10 m run speed was slower for low STS compared to medium (p = 0.019) and high STS (p = 0.004). For product STS tertiles, process MC was significantly higher for children in the lowest (fastest) STS tertile compared to those in the medium highest (slowest) tertile (p = 0.01).
... Valores muitos elevados, expressos por uma hipermobilidade, podem estar associados a uma maior predisposição a lesões musculares, tendíneas e articulares e a algumas outras doenças específicas do tecido conjuntivo ou a determinadas enfermidades clínicas 29 . Por outro lado, quando presente em valores reduzidos pode representar um risco maior de quedas nos idosos 14 , diminuindo assim a qualidade de vida dos mesmos e prejudicando a execução de atividades rotineiras, tal como sentar e levantar do solo 30 . Dessa forma, os resultados deste estudo sugerem que, em relação à flexibilidade corporal de adultos, parece ser conveniente a inclusão desse tipo de exercício nos programas de exercício físico para que possa ser otimizado esse componente não-aeróbico da aptidão física, aparentemente, independente do histórico de sua prática na juventude. ...
Introdução:
A flexibilidade corporal é um dos componentes da aptidão física relacionada com a saúde e desempenho físico. Esse componente tende a diminuir com o envelhecimento, sendo passível de modificação por treinamento específico; por outro lado, essas adaptações favoráveis tendem a desaparecer com destreinamento.
Objetivo:
Avaliar a influência do histórico de exercício físico e/ou participação desportiva competitiva na juventude sobre a flexibilidade corporal em adultos que foram pouco ativos ou sedentários nos últimos cinco anos.
Métodos:
Análise retrospectiva de 1.388 indivíduos avaliados entre 2012 e 2015. Após aplicação de critérios de exclusão, a amostra final incluiu 533 adultos (63,6% homens; 20-94 anos de idade) pouco ativos ou sedentários nos últimos cinco anos. Em uma breve entrevista foram obtidos os perfis de exercício físico na infância/adolescência (PEFIA) e nos últimos cinco anos de vida. Esses perfis foram agrupados em três categorias, em função da quantidade mínima de exercício recomendado para cada idade, como: abaixo, adequado ou acima. A flexibilidade foi avaliada pelo Flexiteste e o flexíndice (FLX) foi calculado - somatório dos resultados da mobilidade passiva de cada um dos 20 movimentos articulares medidos (escala de 0 a 4) -, que foi posteriormente ajustado por idade e sexo por percentis (P-FLX) (Araújo, 2008).
Resultados:
Homens e mulheres adultos fisicamente inativos nos últimos cinco anos tiveram P-FLX medianos, respectivamente, de 25 e 35. Quando classificados pelo PEFIA, não foram observadas diferenças entre homens (P=0,23) e mulheres (P=0,10) no P-FLX.
Conclusão:
A flexibilidade de adultos pouco ativos ou sedentários nos últimos cinco anos, quando avaliada pelo FLX, é inferior à prevista para a idade e não é influenciada pelo PEFIA, indicando que o sedentarismo recente é prejudicial à flexibilidade global e que um histórico de mais exercício e/ou esporte na juventude não parece prevenir essa deficiência.
... Predominant use of this sequence presents a shift from the symmetrical pattern typically used by healthy younger adults ( Ulbrich et al., 2000;VanSant, 1988). Potential reasons for this selection may be related to musculoskeletal weakness or inflexibility ( Brito et al., 2013). It is also plausible that subjects may have felt more vulnerable when attempting to position the lower extremities without the assistance from the upper extremities or nearby furniture. ...
While considerable research has targeted physical performance in older adults, less is known about the ability to rise from the floor among community-dwelling elders. The purposes of the study were to 1) Examine physical performance correlates of timed supine to stand performance and 2) Identify the predominant motor pattern used to complete floor rise. Fifty-three community-dwelling elders over the age of 60 [x=78.5+/-8.5; 36(68%) females] performed a timed supine to stand test and physical performance assessments. Forty-eight subjects (90.6%) demonstrated an initial roll with asymmetrical squat sequence when rising to stand. Supine to stand performance time was significantly correlated with all physical performance tests, including gait speed(r= -.61; p<0.001), grip strength (r= -.30; p<0.05), and Timed Up and Go (TUG) performance (r= .71; p<0.001). Forty-eight percent of the variance in rise time (p<.001) was attributed to TUG velocity. Findings serve to enhance both functional performance assessment and floor rise interventions.
... Previous studies have shown that SRT scoring is highly reliable 18 and has been applied in a variety of research contexts. [19][20][21][22] Age (5-95 years) and sex-specific norms for SRT scoring -both partial and total scoresare available from the senior author. ...
Background:
While cardiorespiratory fitness is strongly related to survival, there are limited data regarding musculoskeletal fitness indicators. Our aim was to evaluate the association between the ability to sit and rise from the floor and all-cause mortality.
Design:
Retrospective cohort.
Methods:
2002 adults aged 51-80 years (68% men) performed a sitting-rising test (SRT) to and from the floor, which was scored from 0 to 5, with one point being subtracted from 5 for each support used (hand/knee). Final SRT score, varying from 0 to 10, was obtained by adding sitting and rising scores and stratified in four categories for analysis: 0-3; 3.5-5.5, 6-7.5, and 8-10.
Results:
Median follow up was 6.3 years and there were 159 deaths (7.9%). Lower SRT scores were associated with higher mortality (p < 0.001). A continuous trend for longer survival was reflected by multivariate-adjusted (age, sex, body mass index) hazard ratios of 5.44 (95% CI 3.1-9.5), 3.44 (95% CI 2.0-5.9), and 1.84 (95% CI 1.1-3.0) (p < 0.001) from lower to higher SRT scores. Each unit increase in SRT score conferred a 21% improvement in survival.
Conclusions:
Musculoskeletal fitness, as assessed by SRT, was a significant predictor of mortality in 51-80-year-old subjects. Application of a simple and safe assessment tool such as SRT, which is influenced by muscular strength and flexibility, in general health examinations could add relevant information regarding functional capabilities and outcomes in non-hospitalized adults.
Background
The enormous effect of lifestyle-related disorders on health of the global population warrants the development of preventive interventions. Focusing on musculoskeletal health and physical activity may be a way to encourage necessary lifestyle changes by making them more concrete and understandable. The aims of the current study were to develop a function-based preventive intervention aimed at lifestyle-related disorders in physically inactive 40-year-old people and to investigate the feasibility of the intervention. The feasibility study aimed to solve practical and logistical challenges and to develop the intervention based on the experiences of participants and involved clinical personnel according to defined criteria.
Methods
Development of the standardised functional examination was based on literature-validated tests and clinical reasoning. Development of a risk profile was based on the functional examination and similar profiles which have already proved feasible. The feasibility of the functional examination and risk profile, together with function-based lifestyle counselling was tested on 27 participants in a pilot study with two physiotherapist examinations over a four-month period. Practical results and feedback from participants and collaborating personnel were examined.
Results
The functional examination consists of 20 established tests not requiring specialised equipment or training which were deemed relevant for a middle-aged population and a sub-maximal ergometer test. The risk profile consists of seven functional dimensions: cardiovascular fitness, strength in upper extremity, lower extremity and trunk, mobility, balance and posture, and three non-functional dimensions: weight, self-assessed physical activity and pain. Each dimension contains at least two measures. The participants appreciated the intervention and found it motivating for making lifestyle changes. They found the tests and risk profile understandable and could see them as tools to help achieve concrete goals. The examination required 60–75 min for one physiotherapist. The recruitment rate was low and recruited participants were highly motivated to making lifestyle changes.
Conclusion
This project developed a functional test battery and risk profile aimed at inactive 40-year-olds which fulfilled our feasibility criteria. Functional screening and lifestyle counselling were found to be of value to a sub-group of inactive 40-year-olds who were already motivated to improve their health situations.
Trial registration
ClinicalTrials.gov: NCT05535296 first posted on 10/09/2022.
Objective
Music-related physical and mental health conditions are common among post-secondary music students, with many studies reporting a prevalence greater than 70%. However, there is currently no consensus on appropriate, validated assessments for this population. The aim of this pilot study was to test the feasibility of an assessment protocol developed for a German longitudinal study with Canadian post-secondary music students, and to compare the health of music students to non-music students. Using a cross-sectional design, first-semester music and non-music control students were recruited at two campuses at the same university. Both groups completed questionnaires and physical testing, including range of motion, core strength, and pressure pain threshold. Nineteen music students and 50 non-music student controls participated in this study.
Results
The German protocol is feasible in a Canadian post-secondary setting. Canadian music students demonstrated similar health outcomes to those in the parent study. All participants demonstrated poorer mental and physical quality of life than the Canadian norms, though this was not statistically significant. The results of this study should be confirmed in a larger study. Future studies with larger sample sizes can provide further insight into the health of Canadian music students, providing a basis for prevention and intervention.
Frailty is one of the leading causes of morbidity and premature mortality in older people. It is a multidimensional syndrome characterized by a reduced ability to deal with acute, physical, mental, socio-economic and spiritual stressors, and/or to perform daily living activities. Physical frailty is a complex condition deriving from multiple causes and contributors. It is characterized by the decline of physiological systems, leading to a loss of strength and endurance, and reduced physical ability. Frailty presents an increased risk of vulnerability to disease, dependency and/or death. Frail individuals are also prone to falls and are at greater risk of hospitalization and admission to long-term care. Consequently, there is a need for an effective tool or tools that can easily identify frail community-living individuals at an early stage of physical decline. Screening tools can be performance-based tests, questionnaires or a combination of both. The aim of the present narrative literature review is to describe the existing simple performance-based frailty screening tools.
Objectives
To assess the construct validity and responsiveness of floor sitting-rising test (SRT) in individuals with total knee arthroplasty (TKA).
Design
Cohort study with 6-month follow-up. Secondary analysis using data from a randomized controlled trial.
Setting
Outpatient rehabilitation research center.
Participants
All 240 participants enrolled in the parent study who had unilateral primary TKA.
Intervention
Participants in parent study underwent 12 weeks of exercise programs.
Main outcomes
Validity analysis correlated baseline data of participants who completed the SRT and measures of knee motion, muscle strength, performance-based tests, and patient-reported outcomes (PROs) of physical and psychosocial function. Responsiveness analysis used the 3- and 6-month follow-up data. Effect sizes were calculated using changes from baseline. Areas under the receiving operating characteristics curve (AUC) were calculated using a global rating of change as the external anchor.
Results
Of the 240 participants (148 female, age 70±7SD years), 180 (75%) were able to perform the SRT at baseline. Performers scored significantly better in all physical function tests (P<.0001) than non-performers. SRT scores generally converged with measures of knee impairment and performance-based tests (associations ranged from small [r=0.15; p=0.0516] to moderate [r=0.52; p<0.0001]). SRT scores associated with self-efficacy for function (r=0.34; p=<0.0001) and fear of falls (r=-0.25; p=0.001). At 3 (n =174) and 6 months (n=160), SRT effect sizes were 0.38 (95% CI 0.25-0.52) and 0.42 (95% CI 0.25 - 0.60), and AUCs were 0.59 (95%CI: 0.49, 0.69) and 0.62 (95% CI: 0.52, 0.73), respectively.
Conclusion(s)
The results add evidence to the validity of the SRT in patients post-TKA. The strength of the associations suggests that the SRT measures a physical function construct not captured by the other tests. The magnitude of indices of responsiveness for the SRT were similar to other performance-based tests, indicating comparable responsiveness to more widespread tests of functional performance.
Purpose:
To investigate feasibility and reliability of functional mobility measures in children with Cri du Chat syndrome (CdCS).
Methods:
Nine children with CdCS and 9 children with typical development (TD) completed the Timed Up and Go, 5 times sit-to-stand test, Timed Floor to Stand, and 4 Square Step Test. Feasibility was determined using testing time and need for modifications. Intraclass correlation coefficients were calculated for intrarater and interrater reliability.
Results:
Children with CdCS required modifications to complete all tests. One child with CdCS completed the 4 Square Step Test. Good reliability was found for both groups.
Conclusions:
The Timed Up and Go, 5 times sit-to-stand test, and Timed Floor to Stand are feasible and reliable tools for children with TD between ages of 5 and 15 years; however, may require modifications to the protocols to be feasible in children with CdCS. The 4 Square Step Test is not a feasible tool for children with CdCS.
Context:
Falls and loss of autonomy are often attributed in large part to musculoskeletal impairments in later adulthood. Age-related declines in flexibility contribute to late adulthood musculoskeletal impairment. The novel sitting-rising test has been proposed to be a quick, effective screening of musculoskeletal fitness, fall risk, and all-cause mortality in older adults. The timed up and go and 5 times sit-to-stand tests are two of the 3 most evidence-supported performance measures to assess fall risk.
Objective:
This study aimed to determine if 5 weeks of flexibility training could increase sitting-rising test, timed up and go, and 5 times sit-to-stand scores in community-dwelling older adults.
Participants:
Forty-seven adults aged 60 years and older (mean age = 66.7 y, SD = 4.1) participated in this study. Participants completed a static stretching protocol consisting of 3 weekly 1-hour stretching sessions.
Results:
The protocol improved flexibility as seen in sit-and-reach scores and improved scores on all outcome variables. Specifically, there was a significant increase in sitting-rising test scores from preintervention (M = 7.45, SD = 1.45) to postintervention (M = 8.04, SD = 1.36), t(42) = -5.21, P < .001. Timed up and go scores demonstrated a significant decrease from preintervention (M = 8.85, SD = 1.32) to postintervention (M = 8.20, SD = 1.35), t(46) = 5.10, P < .001. Five times sit-to-stand scores demonstrated a significant decrease from preintervention (M = 12.57, SD = 2.68) to postintervention (M = 10.46, SD = 2.06), t(46) = 6.62, P < .001. Finally, significant increases in sit-and-reach scores were associated with improved functional performance (r = -.308, P = .03).
Conclusion:
Findings suggest that flexibility training can be an effective mode of low-level exercise to improve functional outcomes. Static stretching may help to improve musculoskeletal health, promote autonomy, and decrease mortality in community-dwelling older adults.
RELATIONSHIP BETWEEN FEAR OF FALLING & ABILITY
TO SIT ON & RISE FROM THE FLOOR IN ELDERLY
This brief research letter presents sex- and age-reference data for the sitting-rising test (SRT), a good predictor of survival in middle-aged and older subjects, derived from 6141 adult men and women (16 to 98 years of age).
Results are presented in several charts
For free download go to journal's DOI link
https://doi.org/10.1177/2047487319847004
Bu çalışmanın amacı, Y Denge Test (YBT) uzanma mesafeleri ve hamstring esnekliği arasındaki ilişkiliyi incelemektir. Çalışmaya, rekreasyonel olarak aktif olan, sağlıklı 25 kadın (yaş, 34,5 ± 7,82) ve 7 erkek (yaş, 37,3 ± 6,13) dahil edildi. Her katılımcının yaş, boy, kilo ve bacak uzunlukları ölçümleri alındı. Hamstring esnekliği otur-uzan testi ile ölçüldü. Y BalanceTest platformu kullanılarak katılımcıların, anterior (ANT), posteromedial (PM) ve posteriolateral (PM) olmak üzere 3 yönde uzanma mesafeleri ölçüldü. Elde edilen ortalama puanların her yönün için (ANT, PM ve PL) bacak uzunluk değerlerine göre normalize değerlerine ulaşıldı ve ANT, PM ve PL puanların ortalaması alınarak toplam puan (TOP) hesaplandı. Pearson korelasyon analizi, Y Denge test normalize uzanma puanları ile hamstring esnekliği arasındaki ilişkiyi incelemek için kullanıldı. Sonuç olarak, YBT’nin uzanma mesafeleri ile katılımcıların hamstring esnek değerleri arasında anlamlı bir ilişkiye rastlanılmadı.
BACKGROUND: Range ofMotion (ROM) and passive torque have been widely used to evaluate flexibility stretching protocols, but little attention has been given to the reliability of these measurements. OBJECTIVE: To verify the interday reliability of isokinetic dynamometer for assessing ROM measures based on discomfort perception (initial and maximum), static and dynamic measures of passive torque during a leg extension movement on a young adult sample. METHODS: Twenty students (13 men; 7 women) aged between 18 and 30 years attended the laboratory to perform the test and retest with 2-7 days interval. The evaluations included: Initial Discomfort Angle (IDA), Passive dynamic torque (Stiffness), Passive static torque (Viscoelastic Stress Relaxation-VSR) and Maximal Discomfort Angle (MDA). Reliability was tested by the Intraclass Correlation Coefficient (ICC), one-sample t-test and Bland-Altman charts. RESULTS: Stiffness (ICC = 0.93), IDA (ICC = 0.90) and MDA (ICC = 0.87) showed excellent reliability values, while VSR had moderate ones (ICC = 0.59). Bland-Altman plots indicated bias close or equal to zero. The one-sample t-test for all measures reinforced the absence of a systematic error. CONCLUSIONS: Dynamic and static stiffness measures and ROM based on the subject's discomfort perception may be applied to relevant clinical issues.
[Purpose] To investigate the inter-rater and test-retest reliability of the sitting-rising test (SRT), the correlations of sitting-rising test scores with measures of strength, balance, community integration and quality of life, as well as the cut-off score which best discriminates people with chronic stroke from healthy older adults were investigated. [Subjects and Methods] Subjects with chronic stroke (n=30) and healthy older adults (n=30) were recruited. The study had a cross-sectional design, and was carried out in a university rehabilitation laboratory. Sitting-rising test performance was scored on two occasions. Other measurements included ankle dorsiflexor and plantarflexor strength, the Fugl-Meyer assessment, the Berg Balance Scale, the timed up and go test, the five times sit-to-stand test, the limits of stability test, and measures of quality of health and community integration. [Results] Sitting-rising test scores demonstrated good to excellent inter-rater and test-retest reliabilities (ICC=0.679 to 0.967). Sitting-rising test scores correlated significantly with ankle strength, but not with other test results. The sitting-rising test showed good sensitivity and specificity. A cut-off score of 7.8 best distinguished healthy older adults from stroke subjects. [Conclusions] The sitting-rising test is a reliable and sensitive test for assessing the quality of sitting and rising movements. Further studies with a larger sample are required to investigate the test’s validity.
The study investigated age-related difference for three range of motion assessments in younger (Mage [#x0003D] 21.2 years, SD [#x0003D] 2.5) and older (Mage [#x0003D] 71.0 years, SD [#x0003D] 5.6) adults, before and after an acute exercise bout. Forty-three volunteer participants, 16 males and 27 females from a younger and older age cohort, completed a sit-and-reach, sit-and-rise, and trunk rotation test, before and after an exercise session. Three 2(age) [#x000D7] 2 (gender) [#x000D7] 2 (pre-post exercise) repeated measures ANOVA revealed statistically significant age-related differences for all range of motion assessments. The repeated measures factor, exercise, reached significance for the sit-and-reach test and the trunk rotation test, but not the sit-and-rise test. While age-related deterioration regarding flexibility appears inevitable, acute exercise responses, as demonstrated in their effect on range of motion, should not be underestimated. In fact, they may even be considered plausible means in motivating long-term exercise adherence.
Flexibility training responses to distinct stretching techniques are not well defined, especially in the elderly. This study compared the flexibility of elderly individuals before and after having practiced hatha yoga and calisthenics for 1 year (52 weeks), at least 3 times/week. Sixty-six subjects (12 men) measured and assigned to 3 groups: control (n = 24, age = 67.7±6.9 years), hatha yoga (n = 22, age = 61.2±4.8 years), and calisthenics (n = 20, age = 69.0±5.8 years). The maximal range of passive motion of 13 movements in 7 joints was assessed by the Flexitest, comparing the range obtained with standard charts representing each arc of movement on a discontinuous and non-dimensional scale from 0 to 4. Results of individual movements were summed to define 4 indexes (ankle+knee, hip+trunk, wrist+elbow, and shoulder) and total flexibility (Flexindex). Results showed significant increases of total flexibility in the hatha yoga group (by 22.5 points) and the calisthenics group (by 5.8 points) (p < 0.01 for each) and a decrease in the control group (by 2.1 points) (p < 0.01) after one year of intervention. Between-group comparison showed that increases in the hatha yoga group were greater than in the calisthenics group for most flexibility indexes, particularly the overall flexibility (p <0.05). In conclusion, the practice of hatha yoga (i.e., slow/passive movements) was more effective in improving flexibility compared to calisthenics (i.e., fast/dynamic movements), but calisthenics was able to prevent flexibility losses observed in sedentary elderly subjects.
Joint flexibility, bilateral asymmetries in flexibility, and bilateral asymmetries in performance of the Y-Balance Test have all been associated with injuries. However, relationships amongst these attributes are unclear. The goal of this investigation was to examine how flexibility and flexibility asymmetries relate to the Y-Balance Test. Twenty (9 men, 11 women) healthy, active young adults (mean ± SD: age=21.9 ± 2.6 years; height=171 ± 8.8 cm; mass=67.2 ± 1.9 kg) performed nine different lower extremity active range of motion (AROM) tests and the Y-Balance Test in a single visit. Significant correlations (p<0.05) existed between bilateral average AROM measures and bilateral average Y-Balance Test scores at the ankle and hip. Specifically, Ankle Dorsiflexion AROM at 0° knee flexion significantly correlated with Anterior, Posterolateral, and Composite directional scores of the Y-Balance test (r=0.497-0.736). Significant correlations in Ankle Dorsiflexion AROM at 90° knee flexion also existed with Anterior, Posterolateral, Posteromedial, and Composite directional scores (r=0.472-0.795). Hip Flexion AROM was significantly correlated with Posterolateral, Posteromedial, and Composite directional scores (r=0.457-0.583). Significant correlations between asymmetries in AROM and asymmetries in the Y-Balance Test existed only in Ankle Plantarflexion with Anterior, Posterolateral, and Composite directional scores of the Y-Balance Test (r=0.520-0.636). Results suggest that when used with recreationally active healthy adults the Y-Balance Test may help identify lower extremity flexibility deficits and flexibility asymmetries in the ankle and hip regions, but may need to be used in conjunction with additional tests to understand a broader picture of functional movement and injury risk.
Although aging is commonly linked to a reduction in joint range of motion, it is unclear if all body joints behave similarly. To address this issue, the main purpose of this study was to compare age-related loss of mobility of seven body joints. A total of 6,000 participants (3,835 men and 2,165 women) aged 5 to 92 years took part in this study. The maximal passive range of motion of 20 movements was evaluated by Flexitest, and each movement was scored from 0 to 4. Composite scores were obtained for each of seven joints and for overall flexibility (Flexindex (FLX)) by adding individual movement scores. Confirming previous findings, FLX systematically decreased with aging (p < .001), with female participants being more flexible for all ages (p < 0.001) and having a more gradual, 0.6 % vs. 0.8 %/year, age reduction (p < .001). Starting at 30 and 40 years, respectively, for male and female participants, the relative contribution of each composite joint score to FLX dramatically changed. Shoulder contribution to FLX male's score went from 13.9 % at 28 years of age to only 5.2 % at 85 years of age. In general, proportionally, shoulder and trunk became less flexible, while elbow and knee mobility was preserved to a greater extent. Our findings indicated that age-related loss of mobility is rather joint-specific, which could be related to distinct routine usage patterns of the major body joints along life.
In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary recommendation:
To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]
Adequate levels of muscle strength and flexibility allow for efficient movements, improving sports performance and providing a better quality of life. However, the potential mutual interference between strength and joint motion is unknown. The purpose of the study was to investigate the relationship between global and regional muscle strength and flexibility in young adults. Fifty (30 men, 20 women, age 22 ± 4 years) healthy subjects were submitted to an evaluation consisting of kineanthropometry (body weight, height, limb girths, skinfolds), measurement of the maximal passive range of joint motion (flexitest method which compares the joint range achieved to reference maps) and of the peak skeletal muscle strength [one-repetition maximum (1-MR) test of hand-grip, legpress and bench press]. The results of muscle strength were corrected by the corresponding muscular girth, calculated by subtracting the limb girth from the skinfold times the π value. The global flexibility (the sum of the result of all 20 joint movements) was higher in women [(median and range) = 52 (38-69)] compared to men [46 (37-57); p = 0.004] due to a higher regional flexibility (the sum of related movements) of the hip (p = 0.004), spine (p = 0.006) and lower limbs (p = 0.011), whereas the strength of each movement was higher in men (p = 0.001). There was no correlation between flexibility and muscle strength either for men or women, when all data points were pooled (women: r = 0.149; p = 0.531; men: r = 0.092; p = 0.628) or separated by body regions (p > 0.05). The authors concluded that, considering the age range studied, women presented higher flexibility than men, particularly for the movements of the spine, hip and lower limbs, while men present higher global and regional muscle strength, even when corrected for the difference in muscle mass. Results suggest that there was no relationship between muscle strength and flexibility in healthy young adults.
In the present study 10 healthy subjects were measured, performing sit-to-stand transfers in a natural way. Starting position and speed of movement were standardized. Sagittal kinematics, the ground reaction force, and muscle activity of nine leg muscles were recorded. During sit-to-stand transfer the mass centre of the body was moved forward and upward. Based on the velocity of the mass centre of the body three phases were distinguished. In horizontal direction forward rotation of the upper body contributed to the velocity of the mass centre of the body, whereas extension of the legs contributed considerably in vertical direction. After seat-off most muscles were concentrically active, whereas the shortening velocity of the rectus femoris was very low. Thus hip and knee joints were extended and a relatively high knee moment was delivered to control the ground reaction force in a slightly backward direction. Co-contraction of hamstrings and rectus femoris in sit-to-stand transfer was judged to be efficient.
Sitting-rising test: introduction of a new procedure for eval- uation in exercise and sports medicine Regular physical activity is linked with longer life expect- ancy and better quality of life. It is already known that well- ness is related to health-related quality of life and personal autonomy. There is a consensus that a good physical fitness depends not only on adequate levels of maximal aerobic pow- er, but also on appropriate levels of muscle power and strength, flexibility, and postural stability. Thus, it is convenient that, in the public health and clinical perspectives, there should be simple and highly sensitive screening tools that makes evalu- ation of these variables in office possible. The purpose of this article is to introduce the Sitting-rising test (SRT). The SRT basically consists in the quantification of the number of sup- port (hands and/or knees, or hands or forearms on knees) one utilizes in order to sit and to rise from the floor. Independent grades are provided to each of the two actions - sitting and rising. The maximal grade is 5 for each one of the actions, losing one point for each support and additional half point for any detectable unbalance. The SRT allows, in very short time and practically in any place, the evaluation of many items - flexibility of lower limb joints, balance, motor coordination, and muscle power/body weight relationship - at the same time, which could be perhaps characterized as minimum functional muscular fitness. Based on the SRT results, health profession- als are likely to have better means of stimulating the adoption of more active lifestyles and to advising physical activity pro- grams in a more scientific way.
ABSTRACT The aim of this study was to relate flexibility improvements,from a supervised,exercise program,(SEP) attendance, to possible improvements in the execution of daily actions by adults. The sample consisted of 20 subjects, the majority of them cardiac patients, with an average age of 58 ± 9 years, actively participating in an SEP, selected intentionally. The Flexitest, was used to determine flexibility . In addition, the subjects answered an 11-question questionnaire, aiming to assess relative difficulty in daily actions. The questionnaire was completed,between,three and 18 months after beginning,the program,and assessed,the subjects’ opinion on their improvements in daily actions since starting on the SEP. After the SEP, improvements were observed in
Physical inactivity is common in overweight individuals. The objective of this study was to identify the acute effect of body weight increase on the performance of sitting and rising actions from the ground, and to verify the influence of some morphologic and functional variables on these movements. Initially (E1), 33 soldiers, aged 20 ± 1.4 years (mean ± sd) and with similar values of BMI (22 ± 1.0 kg/m2) and BF% (5.3 ± 2.3), were randomly divided into three groups of 11 subjects. The Sitting-Rising Test (SRT) was applied in a latin square order without artificial increment in the weight (A0), and with 10% (A10), and 20% of increment (A20), simulated by the use of sand vests placed in the trunk. In the second study (E2), 24 pubescent and post-pubescent soccer players (15.4 ± 1.1 years), randomly divided into four groups of six and with similar general flexibility, measured by the Flexitest, were submitted to SRT as in E1, but also in the condition of 30% increment in body weight (A30). Between individuals who maintained the maximal score in each action with the increase in weight and the others, general and specific movement flexibilities were compared in E1, and BMI, S 7 skinfolds, BF%, waist-hip and waist-thigh and superior to inferior skinfolds ratios, Heath-Carter somatotype, leg muscle power (vertical jump), and 50 m sprint time, in E2. In sitting, Friedman test did not identify differences among the conditions in both E1 (p = .21) and E2 (p = .07). But for rising they occurred in both studies (p
Mitral valve prolapse (MVP) is common in women. Other clinical features such as flexibility and hyperlaxity are often associated with MVP, as there is a common biochemical and histological basis for collagen tissue characteristics, range of joint motion, and mitral leaflet excursion.
To confirm whether adult women with MVP are more flexible and hypermobile than those without.
Data from 125 women (mean age 50 years), 31 of them with MVP, were retrospectively analysed with regard to clinical and kinanthropometric aspects. Passive joint motion was evaluated in 20 body movements using Flexitest and three laxity tests. Flexitest individual movements (0 to 4) and overall Flexindex scores were obtained in all subjects by the same investigator.
Women with MVP were lighter, less endomorphic and mesomorphic, and more linear. The Flexindex was significantly higher in the women with MVP, both absolute (48 (1.6) v 41 (1.3); p<0.01) and centile for age (67 v 42; p<0.01) values. In 13 out of 20 movements, the Flexitest scores were significantly higher for the women with MVP. Signs of hyperlaxity were about five times more common in these women: 74% v 16% (p<0.01). Scores of 0 and 1 in elbow extension, absence of hyperlaxity, and a Flexindex centile below 65 were almost never found in women with MVP.
Flexitest, alone or combined with hyperlaxity tests, may be useful in the assessment of adult women with MVP.
The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.
The aim of this study was to relate flexibility improvements from a supervised exercise program (SEP) attendance, to possible improvements in the execution of daily actions by adults. The sample consisted of 20 subjects, the majority of them cardiac patients, with an average age of 58 ± 9 years, actively participating in an SEP, selected intentionally. The Flexitest, was used to determine flexibility. In addition, the subjects answered an 11-question questionnaire, aiming to assess relative difficulty in daily actions. The questionnaire was completed between three and 18 months after beginning the program and assessed the subjects' opinion on their improvements in daily actions since starting on the SEP. After the SEP, improvements were observed in the execution of 11 daily actions, global flexibility, and six individual movements on the Flexitest (p<.05). There was a correlation between differences in answers given to the questionnaire and changes in global flexibility (r=.45; p<.04). There was an inverse relationship between body weight and flexibility changes for the group as a whole (r=-.66; p<.05). It was concluded that ease of execution of daily actions after a period of SEP is related to improvements in global flexibility. Improvements in global flexibility are also related to reductions in body weight. These results may have implications for the personalization of flexibility training, in the context of a health-oriented exercise program.
FUNDAMENTAÇÃO: Algumas variáveis da aptidão física são marcadamente influenciadas pelas fases do ciclo menstrual (CM); contudo, há pouca informação sobre eventuais modificações na flexibilidade. OBJETIVO: Analisar o comportamento da flexibilidade corporal - global, por articulação e por movimento - em mulheres adultas jovens nas diferentes fases do CM. MÉTODOS: Estudou-se uma amostra de 15 mulheres. O grupo experimental (GE) foi constituído de alunas eumenorréicas, enquanto o grupo controle (GC) incluía alunas em uso regular havia pelo menos um mês de anticoncepcional oral (AO). Dados referentes ao período menstrual e ao uso de AO foram obtidos através da aplicação de um questionário. A flexibilidade foi avaliada pelo Flexiteste, permitindo uma análise da flexibilidade global (Flexíndice), por articulação, por movimento e em sua variabilidade. Os Flexíndices foram ainda comparados com os correspondentes percentis para gênero e idade. Para a análise estatística das três medidas do GE - fases folicular, ovulatória e lútea - e das duas do GC entre dias cinco e 26 do ciclo, utilizou-se ANOVA ou teste t conforme apropriado. RESULTADOS: Não houve diferenças na flexibilidade, movimento a movimento ou Flexíndice nas diferentes fases do CM no GE e nas duas medidas do GC (p > 0,05). O percentil do Flexíndice para o GC variou de 14 a 35 e no GE, de 14 a 80. Analisando as articulações e os índices de variabilidade, não foram encontradas diferenças significativas com as fases do CM (p > 0,05), com a exceção do índice de variabilidade distal-proximal entre as fases ovulatória e folicular no GE. CONCLUSÃO: Os dados obtidos não corroboram a impressão empírica de que a flexibilidade varia durante as fases do CM. Não se pode, contudo, afastar a hipótese de que a ausência de variações tenha ocorrido devido a alguma característica da amostra ou por limitações do Flexiteste em identificar mínimas variações, sendo necessária a realização de outros estudos.
Background sit-to-stand (STS) failure is a transient loss of balance that can engender falls among elders. The purpose of this paper is to describe the mechanisms whereby failed STS differs from successful STS. The authors compared successful STS from 11 normal elders to 20 "sitback" and 20 "step" type failed STS's in 13 subjects. Kinematic and kinetic data were incorporated into our 11-segment whole body model to estimate the net joint forces and torques and body segment momenta. Significant between group differences in the magnitude and timing of momentum generation and dissipation, knee extensor torques and the magnitude of the vertical ground reaction force were identified. Both types of failed sit-to-stand maneuvers are less energetic than successful rises. STS failures might result from either weakness or balance control and coordination impairment, or both, resulting in an insufficiently energetic effort. Further research is required to differentiate between these two possible sources of impairment. Determining the root cause of functional limitations is necessary to develop effective interventions.
Sit-to-stand (STS) performance is often used as a measure of lower-limb strength in older people and those with significant weakness. However, the findings of recent studies suggest that performance in this test is also influenced by factors associated with balance and mobility. We conducted a study to determine whether sensorimotor, balance, and psychological factors in addition to lower-limb strength predict sit-to-stand performance in older people.
Six hundred and sixty nine community-dwelling men and women aged 75-93 years (mean age 78.9, SD = 4.1) underwent quantitative tests of strength, vision, peripheral sensation, reaction time, balance, health status, and sit-to-stand performance.
Many physiological and psychological factors were significantly associated with sit-to-stand times in univariate analyses. Multiple regression analysis revealed that visual contrast sensitivity, lower limb proprioception, peripheral tactile sensitivity, reaction time involving a foot-press response, sway with eyes open on a foam rubber mat, body weight, and scores on the Short-Form 12 Health Status Questionnaire pain, anxiety, and vitality scales in addition to knee extension, knee flexion, and ankle dorsiflexion strength were significant and independent predictors of STS performance. Of these measures, quadriceps strength had the highest beta weight, indicating it was the most important variable in explaining the variance in STS times. However, the remaining measures accounted for more than half the explained variance in STS times. The final regression model explained 34.9% of the variance in STS times (multiple R =.59).
The findings indicate that, in community-dwelling older people, STS performance is influenced by multiple physiological and psychological processes and represents a particular transfer skill, rather than a proxy measure of lower limb strength.
The decline of physical function of older adults, associated with loss of independent living status, is a major public health concern. The purpose of this study was to examine the relationship of physical impairment and disability to performance of activities of daily living (ADL) among community-dwelling older adults.
Eighty-three community-dwelling older men who were referred to a comprehensive outpatient geriatric evaluation program (mean age=75.5 years, SD=7.0, range=64-97) were examined. Measurements of physical impairment (muscle force production, flexibility, and fitness) and physical disability (gait speed, stride length, risk for recurrent falls, and physical function) were recorded.
A stepwise linear regression was used to determine the relationship of physical impairments and disability measures with ADL. The results indicated that walking speed, fall risk, and muscle force contributed independently to the characterization of the activities of daily living of the community-dwelling older men studied (adjusted R2=.68; F=56.81; df=3,80; P<.001). Using a principal components factor analysis, 4 domains were identified that explained 68.2% of the variance in performance of ADL: (1) mobility/fall risk=26.5%, (2) coordination=15%, (3) fitness=14.7%, and (4) flexibility=12.0%.
The identification of domains of physical function may be useful to physical therapists in the development of interventions targeted for physical impairments and disabilities that contribute to deficits in performance of ADL. Targeting interventions for physical impairments and disabilities related to function may improve the effectiveness of physical therapist interventions and reduce the loss of independence among community-dwelling older people.
The sit-to-stand (STS) movement is a skill that helps determine the functional level of a person. Assessment of the STS movement has been done using quantitative and semiquantitative techniques. The purposes of this study were to identify the determinants of the STS movement and to describe their influence on the performance of the STS movement.
A search was made using MEDLINE (1980-2001) and the Science Citation Index Expanded of the Institute for Scientific Information (1988-2001) using the key words "chair," "mobility," "rising," "sit-to-stand," and "standing." Relevant references such as textbooks, presentations, and reports also were included. Of the 160 identified studies, only those in which the determinants of STS movement performance were examined using an experimental setup (n=39) were included in this review.
The literature indicates that chair seat height, use of armrests, and foot position have a major influence on the ability to do an STS movement. Using a higher chair seat resulted in lower moments at knee level (up to 60%) and hip level (up to 50%); lowering the chair seat increased the need for momentum generation or repositioning of the feet to lower the needed moments. Using the armrests lowered the moments needed at the hip by 50%, probably without influencing the range of motion of the joints. Repositioning of feet influenced the strategy of the STS movement, enabling lower maximum mean extension moments at the hip (148.8 N m versus 32.7 N m when the foot position changed from anterior to posterior).
The ability to do an STS movement, according to the research reviewed, is strongly influenced by the height of the chair seat, use of armrests, and foot position. More study of the interaction among the different determinants is needed. Failing to account for these variables may lead to erroneous measurements of changes in STS performance.
It is well-established that at old age there is a significant decline in muscle strength. Reference values for muscle strength might be useful for assessment of muscle impairment and of physiological adaptations. However, it is still unclear whether gender affects the rate of decline. Therefore, the aim of this study is to investigate the effect of gender and age on handgrip strength and to establish reference values for this variable. Reviewing medical charts collected from 1994 to 2005, a convenience sample of 2,648 subjects (1,787 men and 861 women), aged between 18 and 90 years, was obtained. Our results show higher handgrip strength for men compared with women (36.8 +/- 0.20 vs. 21.0 +/- 0.18 kg; p < 0.001). The regression analysis with a quadratic model shows that aging accounts for 30% of the variance in handgrip strength (r(2) = 0.30; p < 0.001) in men and 28% (r(2) = 0.28; p < 0.001) in women. In addition, the bent linear regression with multiple regressors show that a faster decline in handgrip strength occurs at the age of 30 years for men and 50 years for women. We conclude that handgrip strength decline with age differs between genders, making useful the existence of distinct male and female normative age group data.
Physical exercise plays a role in health-promotion policies and its prescription should be scientifically based. Flexibility is one of the major components of health-related and performance-related physical fitness, and is defined as the maximum physiological passive range of motion of a given joint movement. According to its specificity, the assessment of flexibility should, ideally, incorporate multiple movements. Introduced in 1980 and with redesigned evaluation maps published in 1986, Flexitest consists of the assessment of mobility with the use of a scale from 0 to 4. By adding the individual results of the 20 joint movements assessed, it is possible to obtain a global score called Flexindex.
To present Flexitest updated normative values.
Data were obtained from 4711 non-athlete subjects (2943 men and 1768 women) with age ranging from 5 to 91 years, and were collected by experienced raters. Approximately 70% of the data were collected by the author of the method himself.
Considering the data heteroscedasticity and non-parametric distribution, we chose to use age and gender-percentile tables. Flexindex decreases with age and the median results for females are higher than for males of the same age since childhood. This trend becomes stronger with physical development and, later, with the aging process.
these normative data contribute to a better knowledge of the flexibility behavior with age and gender and will be useful for professionals who assess flexibility in their professional practice.
OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management. Language: en
With a clinical goniometer, we measured the arcs of active motion of the shoulder, elbow, forearm, wrist, hip, knee, ankle, and foot in 109 normal male subjects ranging in age from eighteen months to fifty-four years old. The normal limits were determined for subjects who were one to nineteen years old and for those who were twenty to fifty-four years old. Significant differences were found between the two age groups for most motions. The data were compared with estimations in the handbook of The American Academy of Orthopaedic Surgeons as the standard reference. The data constitute a more detailed set of measurements, based on a sample described according to height and age, than has been available hitherto.
The purpose of this study was to determine the relationships between possible predictive measures of a 50 m front crawl swimming and a 22.86 m flutter kicking speed. Ten women who were National Collegiate Athletic Association Division I collegiate swimmers and 10 women who were recreational swimmers (mean +/- SD = 20.6 +/- 1.6 years; 66.7 +/- 10.3 kg; 166.7 +/- 8.8 cm) volunteered for the study. Anthropometric measures were obtained including height, leg length, lower leg length, and foot length. Ankle flexibility was assessed by measuring ankle plantar flexion and ankle inversion. Lower body power was measured using a vertical jump. Swimming and kicking speed were measured as the time to complete a 50 m front crawl and a 22.86 m flutter kick, respectively. Significant moderate correlations were demonstrated between ankle plantar flexion and flutter kicking speed (r = 0.509); age and 22.86 m kick time (r = 0.608); age and 50 m swim time (r = 0.476); and 50 m swim time and 22.86 m kick time (r = 0.790). No significant correlations were observed between any of the anthropometric measurements or vertical jump power with either kicking or swimming speed. As anecdotally noted by swim coaches over the years, this study provides some actual data showing that ankle flexibility significantly influences flutter kick capability. Surprisingly, vertical jump power and body size were not strong predictors of kicking or swimming speed in this group of subjects. Strength and conditioning coaches, swim coaches, and athletes should evaluate and carefully develop ankle flexibility to positively contribute to kicking capabilities.
With a clinical goniometer, we measured the arcs of active motion of the shoulder, elbow, forearm, wrist, hip, knee, ankle, and foot in 109 normal male subjects ranging in age from eighteen months to fifty-four years old. The normal limits were determined for subjects who were one to nineteen years old and for those who were twenty to fifty-four years old. Significant differences were found between the two age groups for most motions. The data were compared with estimations in the handbook of The American Academy of Orthopaedic Surgeons as the standard reference. The data constitute a more detailed set of measurements, based on a sample described according to height and age, than has been available hitherto.
An age associated decline in joint mobility during the early and middle adult years is well documented, however, little information exists on the progress of this aspect of joint function during old age. Active and passive ranges of 10 lower limb joint motions were measured in 80 healthy, active men and women aged from 70 years, to examine the relationship between the capacity for joint movement and age, gender, and type of motion. Joint mobility declined consistently as age increased, with women generally having greater movement capability than their male peers. The predominant trend was for a more rapid reduction in mobility during the ninth decade. Passive ranges were larger than those produced actively, and the pattern of change in both measurement modes was parallel over the age range. It is hypothesized that the consistent decline in mobility indicates the importance of biological aging of articular structures as a primary cause of increasing resistance to movement, while environmental causes, such as changing activity status, are suggested by the variation in the magnitude and patterns of change over the age range.
Joint mobility was measured in 1,081 members of a Tswana community in the Western Transvaal, as part of an epidemiological survey of bone and joint conditions. The method, using an assessment of the range of movements of a predetermined set of joints, was easy to carry out and gave reproducible results. Joint mobility diminished with ageing, falling rapidly as childhood progressed, and more slowly throughout adult life. Marked differences were present between the sexes, females having a greater degree of joint laxity than males of the same age. A positive correlation existed between the mobility score and the degree of passive hyperextension which could be achieved by the fifth finger. The range of movements of the fifth finger was greater on the nondominant side in both left and right handed individuals. Arthralgic complaints were positively related to joint laxity in both sexes. Physique, as expressed by ponderal index and metacarpal length, was not found to bear any relation to joint mobility.
Develop and test a self-administered questionnaire that measures perceived and actual functional limitations in rising and sitting down.
Private practices for physical therapy and outpatient clinics of hospitals and rehabilitation centers.
345 outpatients (43% male, aged 14 to 92 years) with different grades of functional limitations and different types of lower extremity orthopedic or rheumatologic disorders.
The Questionnaire Rising and Sitting Down (QR&S) was developed on the basis of a literature review and careful operationalization of functional limitations. Five dimensions concerning different objects (high chair, low chair, toilet, bed, and car) and one global dimension were postulated to be contained in the instrument. Mokken scale analysis was used to test the postulated dimensions (scalability coefficient H). Furthermore, robustness with respect to patient characteristics was determined, as well as intratest reliability (reliability coefficient Rho), test-retest reliability (intraclass correlation coefficient [ICC]), content validity (coverage of operationalized aspects), and construct validity (testing of seven hypotheses).
Mokken scale analysis confirmed the existence of 5 object dimensions (H = .53-.59). However, two global dimensions were found (H = .50-.54). The resulting hierarchical scales, consisting of subsets of the 32 final QR&S items, are robust and measure functional limitations in a reliable (Rho .77-.91; ICC .72-.90) and valid (3 out of 4 aspects covered, 2 hypotheses rejected for 3 out of 7 scales) manner.
The QR&S is a reliable and valid self-administered questionnaire. It consists of hierarchical scales and measures perceived and actual functional limitations in rising and sitting down.
Being able to sit-to-stand (STS) effectively is an important functional skill, but there is little information available on the changes that occur with growth and maturity. This study aimed to investigate the inter-segmental co-ordination of STS in three different age groups (12-18 months, 4-5 years and 9-10 years).
The children studied wore reflective markers and were videotaped as they stood up from a height-adjustable seat that straddled a forceplate. Segmental kinematics and vertical ground reaction force were determined from the co-ordinate and forceplate data.
Even at the earliest developmental stage the children had mastered the basic inter-segmental pattern observed in adults. The youngest children, however, were not able to end the movement in quiet standing; rather they raised up on their toes or took a step forward. Performance varied both within and between subjects. Although there was a similarity in the motor pattern used by the younger subjects to that of the older subjects, developmental trends were evident on the videotapes and on examination of the kinematic and kinetic variables. Movement time, amplitude and peak angular velocity of trunk flexion increased with age. Whereas the children in the older age groups displayed a pattern of vertical ground reaction force similar to that reported for adults, the youngest children tended to reach peak force gradually, often with fluctuations. Although there were characteristic trajectories in the phase-plane plots for each group, the overall trend was for the percentage of smooth plots representing a co-ordinated movement, to increase with age.
Differences in inter-segmental co-ordination between the ages studied may relate to the child's ability to control horizontal momentum and to balance.
Treatment of joint disease that results in limited flexion is often rejected by patients in non-Western cultures whose activities of daily living require a higher range of motion at the hip, knee, or ankle. However, limited information is available about the joint kinematics required for high range of motion activities, such as squatting, kneeling, and sitting cross-legged, making it difficult to design prosthetic implants that will meet the needs of these populations. Therefore, the objective of this work was to generate three-dimensional kinematics at the hip, knee, and ankle joints of Indian subjects while performing activities of daily living. Thirty healthy Indian subjects (average age: 48.2 +/- 7.6 years) were asked to perform six trials of the following activities: squatting, kneeling, and sitting cross-legged. Floating axis angles were calculated at the joints using the kinematic data collected by an electromagnetic motion tracking device with receivers located on the subject's foot, shank, thigh, and sacrum. A mean maximum flexion of 157 degrees +/- 6 degrees at the knee joint was required for squatting with heels up. Mean maximum hip flexion angles reached up to 95 degrees +/- 27 degrees for squatting with heels flat. The high standard deviation associated with this activity underscored the large range in maximum hip flexion angles required by different subjects. Mean ankle range of flexion reached 58 degrees +/- 14 degrees for the sitting cross-legged activity. The ranges of motion required to perform the activities studied are greater than that provided by most currently available joint prostheses, demonstrating the need for high range of motion implant design.
To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.
A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.
The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature.
After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.
The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.
In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. PRIMARY RECOMMENDATION: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)].
Teste de sentar-levantar: Apresentac ¸a ˜o de um procedimento para avaliac ¸a ˜o em Medicina do Exercı ´cio e do Esporte
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Autopercepc ¸a ˜o das var-ia ´veis da aptida ˜o fı ´sica
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Lack of flexibility variation during menstrual cycle in university stu-dents
- Cp Chaves
- R Sima
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Chaves CP, Sima ˜o R, Arau ´jo CGS: Lack of flexibility variation during menstrual cycle in university stu-dents. Rev Bras Med Esporte 2002;8:212Y1
American College of Sports Medicine position stand Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise
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Garber CE, Blissmer B, Deschenes MR, et al: American College of Sports Medicine position stand.
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Factors affecting flutter kicking speed in women who are FIGURE 4 Distribution of the SRT scores according to the FLX quartiles
- As Mccullough
- Wj Kraemer
- Js Volek
McCullough AS, Kraemer WJ, Volek JS, et al: Factors
affecting flutter kicking speed in women who are
FIGURE 4 Distribution of the SRT scores according to the FLX quartiles.
Unauthorized reproduction of this article is prohibited. competitive and recreational swimmers
- © Copyright
- Lippincott Williams
- Wilkins
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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www.ajpmr.com
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Araú jo CGS: Flexibility assessment: normative values for flexitest from 5 to 91 years of age
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