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ESCOLA

SUPERIOR
DE SAÚDE
POLITÉCNICO
DO PORTO

L
LICENCIATURA
EM FISIOTERAPIA

Influence of age, gender, body mass


index and physical exercise practice on
1-Minute Sit-to-Stand Test performance
on a Portuguese population
Beatriz Raposo Viveiros
Inês Filipa Ferreira Pinheiro

2020/2021
Influence of age, gender, body mass index and physical exercise
practice on 1-Minute Sit-to-Stand Test performance on a Portuguese
population

Beatriz Raposo Viveiros1,2, Inês Filipa Ferreira Pinheiro1,2, António Mesquita Montes2,
Cristina Argel de Melo2, Pedro Matos2, Rui Vilarinho2

1
ESS-P. Porto – Escola Superior de Saúde, Politécnico do Porto
2
ATCFT – Área Técnico-Científica da Fisioterapia

Resumo
Introdução: O sentar e levantar representa uma atividade essencial da vida diária, conferindo
independência e autonomia, que pode ser avaliada através dos Sit-to-Stand Tests (STST). O 1-Minute STST
(1-M STST) é amplamente utilizado para avaliar a capacidade funcional. Vários fatores podem influenciar
o desempenho do 1-M STST, nomeadamente, a idade, sexo, IMC (Índice de Massa Corporal) e a prática
de exercício físico.
Objetivo: Analisar a influência da idade, sexo, IMC e prática de exercício físico no desempenho do 1-M
STST, em adultos portugueses sem incapacidade.
Métodos: A amostra foi constituída por 261 sujeitos que completaram questões sobre idade, sexo, IMC e
prática de exercício físico. Os que cumpriram os critérios de seleção elegidos realizaram o 1-M STST três
vezes com um tempo de descanso igual ao tempo de teste. A principal variável recolhida no 1-MSTST foi
o número de repetições. Foram utilizados os testes Kolmogorov–Smirnov, Mann-Whitney e Kruskal-Wallis
(Pairwise analyses).
Resultados: Observou-se que os grupos mais jovens tiveram um resultado final no 1-M STST
significativamente superior que os grupos mais velhos (p<0.05).
Conclusão: A performance do 1-M STST está significativamente influenciada pela idade na população
portuguesa em estudo.

Palavras-chave: 1-Minute Sit-to-Stand Test, Idade, Género, Índice de Massa Corporal, Exercício Físico

Abstract
Background: Sit-to-Stand represents an essential activity of daily living that confers independence and
autonomy, and this can be assessed through the Sit-to-Stand Tests (STST). The 1-Minute STST (1-M
STST) is widely used to assess functional capacity. Several factors can influence the performance of the 1-
M STST, including age, gender, BMI (Body Mass Index) and physical exercise.
Aim: To analyze the influence of age, gender, BMI and practice of physical exercise on the performance
of the 1-M STST in Portuguese adults without disabilities.

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Methods: The sample consisted of 261 subjects who completed questions about age, gender, BMI and
physical exercise. Those who met the selected selection criteria performed the 1-M STST three times with
a rest time equal to the test time. The main variable collected in 1-MSTST was the number of repetitions.
The Kolmogorov–Smirnov, Mann-Whitney and Kruskal-Wallis (Pairwise analyses) tests were used.
Results: It was observed that the younger groups had a significantly higher 1-M STST final result than the
older groups (p<0.05).
Conclusion: The performance of the 1-M STST is significantly influenced by age in the Portuguese
population under study.

Keywords: 1-Minute Sit-to-Stand Test, Age, Gender, Body Mass Index, Physical Exercise

1. Introduction
Sit-to-Stand Tests (STST) are based on a simple movement of standing up from a chair,
which in its turn represents an essential activity of daily living that confers independence
and autonomy to the person in the community and demonstrates his functional capacity
(Ozalevli et al., 2007). This activity requires competencies like lower limbs’ strength,
power, endurance, balance, mobility, and postural control. Muscular strength and
endurance are important indicators of current health and among the strongest predictors
of mortality in both healthy individuals and patients with chronic diseases (Strassmann,
et al., 2013; Ozalevli et al., 2007; Zanini et al., 2019). Therefore, STST can be used as a
functional capacity assessment tool, addressed to disabled people, providing useful
information on their independence/disability in daily life. It is also considered a simple,
safe, well-tolerated and more economical, in terms of time and equipment, option.
(Vaidya, Chambellan, & Bisschop, 2017; Zanini et al., 2019).
The task of sitting up is an essential daily life activity, being performed an average
of 60 times a day by healthy adults. It is a task that, compared to walking or climbing
stairs, is more demanding, requires greater muscle strength and produces greater joint
strength. Unlike other dynamic movements, STS is an activity that is performed with
bilateral support of both feet in contact with the ground. The STS movement is initiated
by trunk flexion to provide horizontal thrust and shift the center of gravity forward, which
is the main kinematic strategy to improve the performance of this task. One of the factors
identified as most important in the ability to stand up from a chair is the strength of the
knee extensor (quadriceps femoris). A deficit in the strength of the quadriceps femoris
may limit the ability to perform this task (Abujaber, Marmon, Pozzi, Rubano, & Zeni Jr.,

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2016; Steingrebe, Stein, Bös, & Hoffmann, 2018; Ploutz-Snyder, Manini, Ploutz-Snyder,
& Wolf, 2002; Kim & Ju, 2021).
There are different types of STST, depending on the functional component to
evaluate and objective (Vaidya, Chambellan, & Bisschop, 2017; Zanini et al., 2019). The
1-Minute STST (1-M STST), the Five Times STST (5T STST), the Ten Times STST
(10T STSTS), the 30 Seconds STST (30S STST) and the 3-Minutes STST (3-M STST).
The 5T STST is used for identifying fall risk and measuring lower body muscular
strength. Although the 10T STSTS and 30S STST evaluate these same components, these
tests are more likely to reflect endurance than the 5T STST. The 3-M STST, as the 1-M
STST, evaluates functional capacity (Vaidya, Chambellan, & Bisschop, 2017; Yanagawa,
Shimomitsu, Kawanishi, Fukunaga, & Kanehisa, 2017; Bohannon, Bubela, Magasi,
Wang, & Gershon, 2010).
1-M STST is a widely used measure of muscular endurance and functional
capacity thus constituting a health predictor of mortality. This test consists of performing
the sit-to-stand activity for 1 minute, in which the number of repetitions the subject can
do is counted. (Strassmann, et al., 2013; Ozalevli et al., 2007; Zanini et al., 2019).
Nowadays, most post-covid symptoms are related to persistent fatigue, dyspnea,
sleep disturbance, depression and anxiety. These symptoms have implications for
physical activity, so it is recommended the use of the 1-M STST in order to provide
valuable clinical information regarding exercise limitation, as it correlates with other tests
of functional capacity, including the Incremental Shuttle Walk Test and the Six-Minute
Walk Test (Venturelli, et al., 2021; D’Cruz, et al., 2020). Nevertheless, it is fundamental
to know what factors affect the test’s performance on a specific healthy population, in
order to elaborate an adequate intervention based on the characteristics of each individual.
Therefore, the aim of this study is to assess the influence of age, gender, BMI and
physical exercise practice in the performance of the 1-M STST, among Portuguese adults
without disabilities.

2. Methods
2.1. Study Design
The study design was a cross-sectional study.

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2.2. Participants
The studied population consisted of Portuguese adults aged between 18 and 90 years
recruited voluntarily and for convenience. The participants were eligible if (1) they were
aged between 18 and 90 years, (2) they had cognitive and comprehension skills to perform
the tests, and (3) they volunteered to participate in the study. Individuals who (1)
presented serious pathologies such as (chronic cardiac, respiratory and neurological
diseases), (2) had uncontrolled high blood pressure and diabetes, (3) had undergone
surgery on the lower limbs, spine and thoracoabdominal region in the last 6 months, (4)
reported disabling pain in the lower limbs, spine and thoracoabdominal region, (5) had a
BMI (Body Mass Index) greater than or equal to 30 kg/m2, or (6) were infected with
COVID-19 were excluded from the study.
Of the individuals who accepted to participate in the study, those who meet the
established eligibility criteria were selected, by completing a questionnaire in digital
format made on the Google Forms platform. The final sample was then composed of all
volunteers who meet the criteria for participation, and who, subsequently, perform the 1-
M STST. Ultimately, the final sample consisted of 261 participants.

2.3. Ethical considerations


Each participant signed a written informed consent, according to the Declaration of
Helsinki. The anonymity of participants and the confidentiality of data were guaranteed.
Each participant was assigned a random code and their data was placed in a database,
protected by a password, to which only researchers had access. The opportunity to clarify
doubts was given to every participant. The Ethics Committee of the School of Health -
Polytechnic of Porto approved this study (CE0013B 24/02/2021). Data was collected in
the Rehabilitation Research Centre (CIR).

2.4. Instruments
In this study, a questionnaire (Annex 1) was used to characterize the sample according to
its sociodemographic and clinical data, carried out through the Google Forms platform,
to assist in the selection and characterization of the sample in question. Its main objective
was to collect the participants’ sociodemographic and anthropometric data and determine
inclusion and exclusion criteria.
A chronometer was used, which was important for measuring and/or timing 1
minute in the 1-M STST while the participant performed as many repetitions as possible.

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Ultimately, a chair was used with a standard height (46 cm), without arms for the
standardization of the results obtained. The study on 1-M STST by Vaidya, Chambellan,
& Bisschop (2017) found a minimal important difference of 1.9 (standard error of
measurement method) or 3.1 (standard deviation method). As regards a deeper aspect of
the efficiency of the test, they found a very excellent test-retest reliability with ICC at
0.99 (95% CI 0.97-1), findings strongly suggesting that the test is capable of giving
reliable results when performed only once.

2.5. Procedures
2.5.1. Pilot study
A pilot study was carried out on a small sample (n = 7) with similar characteristics to the
study population. This allowed to practice the instruments and procedures of the study,
as well as standardize the explanation and verbal commands to be used by the researchers
during the application of the tests.
To ensure that all participants in the study hear the same explanation of the tests
by the various researchers, an explanatory video was produced.

2.5.2. Sample selection and characterization


Individuals who agreed to participate in the study signed an informed consent and
completed a digital format questionnaire. By completing the questionnaire, the
individuals who satisfy the eligibility criteria were selected to perform the 1-M STST.
The sample characterization was obtained by completing the questionnaire.

2.5.3. Data collection


After being selected to perform the 1-M STST by completing the questionnaire,
participants watch a video with an explanation of how to perform each test and their
objectives. All questions from the participant about performing the test are answered.
The test was performed 3 times with a rest time equal to the time of the test.
To perform the tests, the participant was instructed to sit on the chair near to a
wall, in a comfortable position for him/her with the spine away from the chair’s backrest.
The feet could not be moved during the test. If during the tests the participant felt any
pain, or any other symptom that prevented him from continuing, the test was stopped. All
participants wore a mask during the test, complying with the measures imposed because
of the pandemic.

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The 1-M STST consisted of getting up and sitting on a chair as many times as
possible during 1 minute. The test started when the investigator said "now" and ended
when he said "stop". At the last 15 seconds, the researcher warned the participant "15
seconds left". The number of repetitions was counted and registered by the investigator.
All 1-min STS tests were performed according to a standardized protocol
established by Crook, et al. (2017): “We used a standard chair (height 46 cm) with a flat
seat and no armrests, stabilized against a wall. Patients were asked to sit with their legs
hip-width apart and flexed to 90°, with their hands stationary on the hips without using
the hands or arms to assist movement. They were instructed to stand completely straight
and touch the chair with their bottom when sitting, but that they need not sit fully back
on the chair. Patients were asked to perform as many repetitions as possible in 1 minute,
and after 45 seconds were told “you have 15 seconds left until the test is over”.”

2.6. Statistical analyses


The study population was divided into five different age groups: 18–29 years, 30–41
years, 42–53, 54-65 years and more than 65 years. IBM SPSS Statistics software version
27.0 (Statistical Package for the Social Sciences®, IBM New York) was used for
descriptive and inferential data analysis, with a significance level of 0,05. Descriptive
data were reported as mean ± standard deviation (SD). The normality of the distribution
was verified by the Kolmogorov–Smirnov test. The Mann-Whitney test was used to
verify differences between two groups, and the Kruskal-Wallis test (Pairwise analyses)
for more than two groups.

2.7. Results
Of the 359 participants that answered the questionnaire, we excluded 23 because they
presented serious pathologies, 2 had undergone surgery on the lower limbs, spine or
thoracoabdominal region in the last 6 months, 6 reported disabling pain, 22 presented a
BMI greater than or equal to 30 kg/m2 and 41 were infected with COVID-19. 4 of the 265
participants did not complete the test due to pain or another impeding symptom, leaving
a final number of 261 (Figure 1).

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Figure 1 – Flow diagram of participants

The study population was divided into five different age groups: 18–29 years, 30–
41 years, 42–53, 54-65 years and more than 65 years. The age group with more
participants was the one from 18-29 years old and with more women. The group 54-65
years old showed a higher BMI, on average, and was the group with a higher percentage
of sedentary participants. The age group 18-29 years old showed a higher percentage of
participants that accomplished the ACSM (American College of Sports Medicine)
recommendations of physical activity minutes per week. The age group that showed
better scores of 1-M STST was the 18-29 years old, and the group +65 years old was the
age group that performed the lower scores, on average (Table 1).

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Table 1 – Participants’ characteristics

When analyzing 1-M STST performance differences between age groups it was
found an overall difference between age groups, mainly in the younger groups when
compared with the older groups (p<0.05). There was found no significant difference
between 18-29 and 30-41 years old and these two groups between 42-53 years old. The
older two groups showed no significant difference in the 1-M STST performance too
(p>0.05) (Table 2).
Table 2 – Comparison of 1-M STST between age groups

Men in the 1-MSTST total score were, on average, 1 repetition more than women,
but there were no significant differences in the number of repetitions in 1-M STST
between genders (p>0.05) (Table 3).

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Table 3 – Comparison of 1-M STST between gender

To analyze the influence of BMI on 1-M STST performance, it was decided to


divide the sample into two groups. Those with a BMI less than 25 were considered to be
normal weight and those with a BMI between 25 and 29.9 overweight. Even the normal
weight group 1-M STST total score was higher, on average, than the overweighted, there
were no significant differences (Table 4).
Table 4 – Comparison of 1-M STST between BMI classifications

When analyzing the influence of the physical exercise performance by week, it


was observed that those who performed more than 150 min/week presented higher 1M-
STST repetitions than the other groups. Nevertheless, no significant differences were
found between the 3 groups (p>0.05). Figure 2 confirms that, despite the number of
repetitions increasing slightly with increasing physical exercise practice, these
differences were not significant.

Figure 2 – Comparison of 1-MSTST between physical exercise groups

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When analyzing the influence of gender, BMI and physical exercise in each age
group, there were no significant differences in the total 1-M STST score (p>0.05).

3. Discussion
The study’s aim was to analyze the influence of age, gender, BMI and physical exercise
on the 1-M STST total score. The age significantly influenced the number of 1-M STST
repetitions, with young participants performing significantly more repetitions than the
older groups. In fact, 1-M STST is a widely implementable measure of muscular
endurance and functional capacity, and it is known that with aging these are decreased.
Older people are less physically active, which has an impact on muscle-strength loss and
in the decline in functional capacity. Furthermore, in aging occur changes that modify the
delivery of oxygen to exercising muscles and the ability of muscles to utilize oxygen
(Milanovic, et al., 2013; Fleg, et al., 2005; Wilson & Tanaka, 2000; Goldspink, et al.,
2009; Fleg, et al., 1995). Furthermore, with increasing age, there is a change in the center
of gravity, affecting balance. In addition to this, the aging process is usually accompanied
by a decrease in metabolism and energy expenditure, since more sedentary habits are
adopted (Aslan, Sertel, Sahan, & Kurtoglu, 2017). Therefore, the less number for 1-M
STST in the older groups was expectable as the age-associated decline in functional
capacity increases progressively with each decade of life (e.g., 3–6% in the third and
fourth decades and 20% per decade after age 70) (Wilson and Tanaka, 2000; (Strassmann,
et al., 2013; Ozalevli, Ozden, Itil, & Akkoclu, 2007).
The results of the influence of BMI on the total 1-M STST were unexpected.
Despite those with normal weight made three more repetitions, on average, than the
overweight group, this difference was not significant. In fact, individuals with higher BMI
have more intermuscular fat as individuals lower BMI, resulting in a slower contraction
speed and reduced energy production, thus having a lower knee extensor force needed to
perform the STS task (Kim & Ju, 2021). According to Kim and Ju (2021), individuals
with normal BMI start the STS movement by flexing the trunk forward and keeping the
feet in the initial position, the same does not happen to individuals with abnormal weight,
they limit trunk flexion and move the feet behind the starting position, thus decreasing its
performance in carrying out this task. A possible reason for these study results was the
fact that body volume thought to be the main factor to changed trunk kinematics during
STS had no influence on the population (Rodosky, Andriacchi, & Andersson, 1989;

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Demura & Yamada, 2007; Hurley, Rutherford and Hubley-Kozey, 2016; Kim & Ju,
2021).
When analyzing the influence of gender on the 1-M STST total score males
performed, on average, 1 more repetition than females, being an unexpected result too,
as in the study of Strassmann, et al., (2013) the mean difference was higher (3 more
repetitions) (Strassmann, et al., 2013). As it would be expected, the fact that functional
capacity is different between genders, especially with regard to muscle performance due
to anatomical and physiological characteristics, would influence the results. Men's
muscles are generally larger, having a higher proportion of fibers of type II, therefore men
have greater strength, contraction speed and resistance to fatigue (Hunter, 2015). Since
STST 1-M has a small contribution from the anaerobic metabolic pathway, more type II
fibers are recruited, so there will naturally be a gender difference in physical performance
(Vaidya, Chambellan & Bisschop, 2017). The lack of significant differences between
gender could be explained by the fact that males were, on average, taller, and a standard
height chair of 46cm was used. This fact influences the kinematics of STS, influencing
the peak torque on the quadriceps, decreasing the 1-M STSTs total number of repetitions
in men (Rosário, et al., 2018; Strassmann, et al., 2013; Hunter, 2015; Vaidya, Chambellan
& Bisschop, 2017; Vaidya, et al., 2016; Radtke, Puhan, Hebestreit, & Kriemler, 2016;
Rodosky, Andriacchi, & Andersson, 1989; Demura & Yamada, 2007; Hurley,
Rutherford, & Hubley-Kozey, 2016).
The more active participants presented a higher number of repetitions in 1-M
STST, but unexpectedly with no significant differences, perhaps due to the higher
standard deviations presents in each group, reflecting the variance in each group. In fact,
the American College of Sports Medicine (ACSM) recommends that healthy adults
between the ages of 18 and 65 should undertake a total of 150 minutes per week
(American College of Sports Medicine, 2018).
The limitations of the present study are related to the fact that it was conducted
during the COVID-19 pandemic, which limited the number of participants in each age
group. In addition to this, due to the pandemic context, some of the anthropometric data,
such as weight and height, were self-reported by the participants.

4. Conclusion
The 1-M STST performance was influenced by age in this Portuguese adults population.

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Acknowledgements
We kindly thank our professors for their orientation and advice in the elaboration of this
study. We also thank all the participants that accepted to participate in this study.

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17
Annex 1 - Questionnaire

Este questionário é crucial para o estudo “Valores normativos para a população


portuguesa dos testes 5 repetições Sit-to-Stand e 1 minuto Sit-to-Stand” que abrange
estudantes de Mestrado e Licenciatura em Fisioterapia da Escola Superior de Saúde do
Politécnico do Porto (ESS-IPP). O seu objetivo é recolher os dados sociodemográficos
dos participantes e apurar critérios de inclusão e exclusão no estudo.
Os dados pessoais fornecidos são anónimos e serão utilizados só para fins científicos.
A duração do questionário é de, aproximadamente, 1 minuto.

A sua contribuição é crucial e agradecemos desde já a sua disponibilidade!

Nome em siglas:

1- Sexo:
• Feminino ____
• Masculino ____

2- Idade: ____

3. Peso: ____

4. Altura: ____

5. Fuma?
• Sim ____
• Não ____
Se sim,
• há quantos anos? ____
• quantos cigarros fuma por dia? ____

6. Fez alguma cirurgia nos últimos 6 meses?


• Sim ____
• Não ____
Se sim, a quê e aonde? ____________________________________

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7. Tem alguma dor neste momento?
• Sim ____
• Não ____
Se sim, onde? _________________

8. Assinale qual/quais doenças tem diagnosticadas.


• Problemas de coração ____
o Se sim, qual? ____
• Problemas respiratórios ____
o Se sim, qual? ____
• Hipertensão arterial ____
o Se sim, qual a última medição? ____
• Diabetes ____
• Problemas de tiroide ____
• Outra(s) _________________
• Não tenho nenhuma doença ____

9. Teve alguma infeção respiratória nos últimos 6 meses?


• Sim ____
• Não____
Se sim, qual? ____________________________________

10. Já teve COVID-19?


• Sim
• Não
Se sim, há quanto tempo? ________________

16- Realiza exercício físico regularmente?


• Sim ____
• Não____
Se sim,
• quantas vezes por semana ________
• quanto tempo por dia? ________

19
Obrigado pela sua participação!

O questionário e o tratamento dos seus dados constituem uma manifestação de vontade, livre, específica,
informada e explícita, pela qual o titular dos dados aceita, mediante declaração, que os dados pessoais e
de saúde, que lhe dizem respeito sejam objeto de tratamento nos moldes legalmente admissíveis.

20
ESCOLA
DE SAÚDE
POLITÉCNIC
O DO PORTO

LICENCIATURA
L EM
FISIOTERAPIA

Influence of age, gender, body


mass index and physical
exercise practice on 1-Minute
Sit-to-Stand Test performance
on a Portuguese population

21
Beatriz Raposo Viveiros
Inês Filipa Ferreira Pinheiro

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