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R. McGrath


Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA; Fargo VA Healthcare System, Fargo, ND, USA

Corresponding Author: Ryan McGrath, Department of Health, Nutrition and Exercise Sciences, North Dakota State University, NDSU Dept. 2620, PO Box 6050, Fargo, ND 58108, Phone: 701-231-7474, Fax: 701-231-8872, Email: ryan.mcgrath@ndsu.edu

J Frailty Aging 2021;in press
Published online October 6, 2021, http://dx.doi.org/10.14283/jfa.2021.41


Dear Editor,

Screening for age-related disease and disability is critical for proper diagnosis and management of a condition (1). The disabling process, for example, often consists of successive deficits in 1) muscle function, 2) physical performance, and 3) physical functioning during aging. Muscle function is generally characterized by strength, endurance, and power. Objectively measured whole body tasks related to mobility such as gait speed and the short physical performance battery are used to examine physical performance. Persons with poor physical functioning often have problems completing basic self-care tasks and are also at an elevated risk for age-related morbidities such as sarcopenia (2). Given that muscle dysfunction represents the onset and potential progression of the disabling process (2, 3), routinely examining muscle function in clinical settings will allow for the early intervention of age-related disease and disability, which in turn, may increase intervention efficacy and more quickly decelerate disablement.
Strength, endurance, and power have been constantly identified as hallmark characteristics of musculoskeletal fitness that have widespread health benefits across the lifespan (4). Handgrip strength is a well utilized assessment of muscle function in clinical settings, but handgrip strength measurements are inconsistently included in routine geriatric clinical practice and have known limitations (5). For example, the generalizability of handgrip strength alone for being representative of overall muscle function is lacking because handgrip strength does not directly account for lower extremity functioning. Moreover, only strength capacity is being evaluated during handgrip strength assessments, and other aspects of muscle function such as endurance and power are not ascertained (5). However, alternative muscle function assessments that account for both lower extremity function and additional muscle function aspects are not feasible. Procedures for examining muscle endurance with handgrip dynamometry are not yet well established (5). Further, knee extension power measurements require expensive equipment and complex protocols that are mostly invasive for older adults (2). Therefore, continuing to examine how we can feasibly and accurately assess muscle function in clinical practice is crucial for precision in geriatric screenings and appropriate referrals.
The 30-second chair stand test is a measure of lower extremity power and endurance (2). Similar to the gait speed test, the chair stand test can be both conducted as a stand-alone assessment or as part of the short physical performance battery (2). Equipment for conducting the chair stand test as a stand-alone assessment requires a straight back chair without arm rests and a stopwatch, and the number of total sit-stand-sit cycles are counted over 30-seconds (2). The 30-second chair stand protocol differs from that used in the short physical performance battery, such that the time to complete five sit-stand-sit cycles is instead recorded (2). Additional evaluations such as coronal plane angle can also be adopted in chair stand tests (6). Although gait speed is a commonly used physical performance assessment (2), chair stands as an individual assessment are likewise predictive of adverse health outcomes (7-9).
Indeed, standing-and-sitting from a chair includes mobility-related characteristics, and the 30-second chair stand test is accordingly considered a physical performance assessment. However, the test could be more suitable for assessing muscle function because the movements involved in the test are repetitive and fixed. The 30-second chair stand test, as a muscle function assessment, presents a feasible protocol for older adult patients and healthcare providers, and does not require expensive equipment. Moreover, the European Working Group on Sarcopenia in Older People classifies the chair stand test at the assessment category alongside handgrip strength, not in the physical performance category which is instead used to evaluate sarcopenia severity (10). Both power and endurance are also evaluated in the 30-second chair stand test, and these muscle function characteristics are absent when handgrip strength alone is used as an overall assessment of muscle function. As such, the 30-second chair stand test fulfills the limitations of only examining handgrip strength, and should be considered a muscle function assessment.
Given that the 30-second chair stand test could be considered an assessment of muscle function, the timed-up-and-go test should be emphasized as a replacement to chair stands for evaluating physical performance. Similar to chair stands, the timed-up-and-go test not only includes sitting-and-standing as part of the exam, but better encompasses mobility because walking is also involved. Figure 1 proposes a conceptual model of clinical assessments for examining each stage of the disabling cascade (2, 5). Additional handgrip strength measurements are included as an assessment of muscle function (5), but are in need of more research before being recommended in routine geriatric health assessments. Nevertheless, utilizing the 30-second chair stand test as a muscle function assessment, instead of a physical performance assessment, will improve how the disabling process is evaluated in clinical and translational research settings.

Figure 1. Conceptual Model of Clinical Assessments for Examining Each Stage of the Disabling Process

*May include the following handgrip assessments: rate of force development, asymmetry, bilateral strength, force steadiness, fatigability, and task-specific tremoring.


Conflicts of Interest: None declared.

Funding Sources: None declared.



1. Crosignani S, Sedini C, Calvani R, Marzetti E, Cesari M. Sarcopenia in Primary Care: Screening, Diagnosis, Management. J Frailty Aging. 2021;10(3):226-232. doi:10.14283/jfa.2020.63.
2. Beaudart C, Rolland Y, Cruz-Jentoft AJ, et al. Assessment of Muscle Function and Physical Performance in Daily Clinical Practice : A position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Calcif Tissue Int. 2019;105(1):1-14. doi:10.1007/s00223-019-00545-w.
3. McGrath R, Erlandson KM, Vincent BM, Hackney KJ, Herrmann SD, Clark BC. Decreased Handgrip Strength is Associated With Impairments in Each Autonomous Living Task for Aging Adults in the United States. J Frailty Aging. 2019;8(3):141-145. doi:10.14283/jfa.2018.47.
4. Fraser BJ, Rollo S, Sampson M, et al. Health-Related Criterion-Referenced Cut-Points for Musculoskeletal Fitness Among Youth: A Systematic Review [published online ahead of print, 2021 Aug 2]. Sports Med. 2021;10.1007/s40279-021-01524-8. doi:10.1007/s40279-021-01524-8.
5. McGrath R, Tomkinson GR, Clark BC, et al. Assessing Additional Characteristics of Muscle Function With Digital Handgrip Dynamometry and Accelerometry: Framework for a Novel Handgrip Strength Protocol [published online ahead of print, 2021 Jun 21]. J Am Med Dir Assoc. 2021;S1525-8610(21)00517-X. doi:10.1016/j.jamda.2021.05.033.
6. Takeshima N, Kohama T, Kusunoki M, et al. Development of Simple, Objective Chair-Standing Assessment of Physical Function in Older Individuals Using a KinectTM Sensor. J Frailty Aging. 2019;8(4):186-191. doi:10.14283/jfa.2019.23.
7. Bahat G, Kilic C, Eris S, Karan MA. Power Versus Sarcopenia: Associations with Functionality and Physical Performance Measures. J Nutr Health Aging. 2021;25(1):13-17. doi:10.1007/s12603-020-1544-8.
8. Looijaard SMLM, Oudbier SJ, Reijnierse EM, Blauw GJ, Meskers CGM, Maier AB. Single Physical Performance Measures Cannot Identify Geriatric Outpatients with Sarcopenia. J Frailty Aging. 2018;7(4):262-267. doi:10.14283/jfa.2018.19.
9. Patrizio E, Calvani R, Marzetti E, Cesari M. Physical Functional Assessment in Older Adults. J Frailty Aging. 2021;10(2):141-149. doi:10.14283/jfa.2020.61.
10. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019 Jul 1;48(4):601]. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169.