Does the Sitting-Rising Test Predict Your Risk for Dying?

According to a 2012 study published in the European Journal of Cardiology, the ability to stand up from the floor is a good predictor of five-year mortality. I see this research commonly used as a medical foundation for the reported life-prolonging benefits of many strength and flexibility programs—yoga, pilates, and balance exercises like Zumba. The buzz surrounding this test was based on the study, conducted on 2,002 adults in Brazil. The adults were ages 51 to 80 and were part of an exercise program at Clinimex Exercise Medicine Clinic in Rio de Janeiro. People who scored low on the test were twice as likely to die within the next six years compared with those who scored higher. Those with the lowest scores were more than five times as likely to die within the same period. Those numbers sound pretty compelling. However, although it has been tested repeatedly since its development in the 1990s, the strength and standing test isn’t used much used to predict a patient’s mortality risk. Why? As you well know, Skeptoid likes to take a close look pop culture claims, so let’s take a closer look at this one.

A diagram showing the steps of the sitting-rising test. Via the Daily Mail.

A diagram showing the steps of the sitting-rising test. Via the Daily Mail.

What is this test exactly, and what is testing for specifically? Let’s take a look at the researchers’ description of the test. The YouTube video below was published by the medical center of Dr. Claudio Gil Araujo, MD, PhD, who developed the test. It is in Portuguese with English subtitles.

On the surface it seems pretty convincing as a scientific evaluation. The research numbers do show a firm correlation between lower scores and short-term mortality. Does this mean that everyone with a higher score is safe and everyone with a lower score is staring death in the face?

The short answer is no: it is not a test everyone should undergo, and it probably says little about your mortality and more about your strength. It has several structural flaws that limit generalization and, as we all know, correlation is not causation. Let me explain.

The structural flaws of the 2012 study are numerous and not really surprising for an index study.

First, it needed better blinding. The scores done by researchers were extremely subjective; the researchers decided if a hand was used and by how much and graded participants accordingly. That lacks the kind of clinical detachment we tend to like in such studies. The participants should have been numbered, videotaped, and graded by one person, with different cameras breaking up the field of vision so that the grades are not colored by the whole perception of the subject’s ability. This is one way the researchers could have provided a more detached grading system.

The study also had a small sample size with too many confounding variables. In other words, that small sample size had a big age range and didn’t separate the sexes. That’s not a terrible problem for an index study, but it’s also not OK as a medical tool. The sample size means you can’t draw the kinds of conclusions that have been promulgated by news reports about this research.

Finally, and more suspiciously, it has not been reproduced, which is the key indicator of solid diagnostic tool. Although it is used in a variety of studies, mostly for people recovering from a stroke, it is not used as a mortality assessment.

In my opinion, it isn’t remarkable or surprising that a complicated physical maneuver is more easily done by people in good physical condition, and that being in good physical condition is associated with decreased mortality risk. You may find vastly different results if you limited this test to a group aged 18 to 40. Younger males might have higher scores and paradoxically have higher mortality because of the risk-taking behavior of that cohort. Or, one could suppose that, given the small sample size, for younger females the risks of childbirth could disproportionately outweigh the significance of their test results.

So what does this test really say about the risk of mortality from all causes? Realistically nothing. It may be a predictor of overall fitness, but even that is not a great predictor of five-year mortality rates at all ages.

The pop culture idea that one thing defines our risk for death is in itself a myth. You can do a lot of things that increase your risk for dying, and yet people survive. Your personal risk for death is just that personal, and no single test can give accurately predict your risk of death. That’s why a physical exam looks at many factors, not just one test.

My opinion for this test specifically is that is of little use. I would grudging agree that it should be a part of current examination, if further research supported the initial hypothesis. Given the current science I cannot agree that it is useful as a predictor. And, as poor as this research is, it’s not half as bad as the wild extrapolations made from it, suggesting that this test supports the idea that flexibility and strengthening exercise is superior to cardiovascular fitness. In the majority of research, cardiovascular aerobic exercise is a clear and strong indicator of lower mortality.

Individually, we are each a much more complicated puzzle than can be summed up in one physical test. I’m not even convinced I would want a test that predicts accurately my five-year survival rate. I am sure that theoretical physicist Stephen Hawking (who has been unable to rise from the floor since 1963), would not be concerned about this research one bit.

 

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About Stephen Propatier

Stephen Propatier is a board certified acute care nurse practitioner specializing in spine and sports medicine. He is a member of the Society for Science Based Medicine.
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19 Responses to Does the Sitting-Rising Test Predict Your Risk for Dying?

  1. Lazer says:

    I really don’t think it’s ever been possible for me to do this maneuver. I’m 65, now, and have dieted and exercised, almost daily, since I was 14. I’d hate to think that I will die soon because of this silly test. The center of gravity of most objects, including humans, differs wildly, and I am sure that the CG will be an important factor in this exercise as it has much to do with strength, weight, moment arm, torque, etc.

    • I’m 75 & I don’t think I’ve ever been able to do it either.I also have a long history of exercizing

    • TO be honest I never tried the test. After reading your comments I tried it. I had difficulty with it. I commonly cycle 100-150 miles a week and believe myself to be in fairly good condition for a guy my age. Still I don’t think I need to purchase extra life insurance just yet. For whatever that anecdote is worth;)

  2. Marvin says:

    I just did this with ease, going down and backup, no hands. I’m 64, 7 mts old.

  3. This doesn’t even need double blinding, it is ridiculous on its surface. As we age our ability to easily make these maeuvers declines. As we age we also come closer and closer to our mortality. Even younger people who are in poor health would be less likely to be able to make these maneuvers and would probably die sooner than their healthier co-horts. This is a fraudulent exercise–just the kind of thing the media loves to jump on because the average person never looks beneath the surface of any claim and it seems to be saying something when it is not. This is like saying that a person in his 80s is more likely to die in the next five years than a person in his 20s and 30s. Well, duh!

  4. John E says:

    I can’t get up without using a hand on the floor, but at least my BS detector still works.

  5. ausGeoff says:

    I can get up okay without either hand on the floor, but I do need to swing my leg over and get one knee on the floor to overcome my body’s inertia. Like most commenters though, I think the whole hypothesis smells of BS.

  6. louise says:

    I have an arthritic hip and knee but am otherwise in good health. I can’t get up or down as described because my left leg will not support me. I am sure many people gave a similar condition. So this “test” means nothing.

  7. Greg says:

    Sadly, the “miracle” that this test predicts mortality has just been broadcast on BBC Radio 4 (the highbrow BBC radio channel) Woman’s Hour programme. My immediate thought, as a fairly fit (cyclist) but not very flexible 48-year-old male was “sounds interesting”. Once I had half-listened to the piece, then checked out some of the claims on the internet, I was puzzled by how such a study could have been designed in order to draw the claimed findings. Thanks for you article putting this one to bed. I am a researcher in the field of autism, and have spent the last 15 years or so waiting for the myth of MMR as a cause of autism to go away….

  8. Paula Sharratt says:

    Excellent: I love this. We’re all being socialized into becoming exactly the same through ‘strengthening’ exercise.
    While developing strength is good, surely it’s more about confidence and
    happiness?

  9. William Gillespie says:

    (NOTE TO MODERATOR – please use this post instead of my previous one. It had a typo in it. And then please remove the bracketed font, thank you) How happy and/or confident will you be when you can’t get up off the floor? While there maybe some valid criticism, the fact of it is not whether or not you can get up without using your hands as many have said, but rather how easily you are able to get up from the ground. Lack of mobility and fear of falling for the inability to get up from the ground are legitimate clinical concerns. Low cardiorespiratory fitness (CRF) is a much better predictor of all-cause mortality however poor mobility and excess weight which would likely be a significant factor in individuals scoring low (not perfect, but low 0-3) are much more likely to be sedentary and therefore have much lower CRF which will kill you before obesity, high cholesterol and diabetes combined.

  10. Mike Falconer says:

    I have been working out on average 6 hrs per week for many years, rowing machine, stepping, cross trainer, weight training, heaps of leg work and told by my gp i am super fit, i am nearly 64, however even in my 20s i could not do this test and cannot do it now,its all about how your built and center of gravity, its shear nonsense!

  11. kijana says:

    I think you may be overlooking the fact that the srt test as described in the cardiology journal does not test for overall mortality but of heart health specifically. Looking at it in that light makes your point about the increase mortality of younger people due to their increased risk taking moot i think.

  12. Logan says:

    I think it’s funny how just about everyone here denigrates the test as useless when they can’t do it, rather then practicing the movement the little bit it would take to actually perform the test.

    To say that you lose mobility as you get older is the whole point of this test. Use it or lose it. Work on your mobility and you’ll get better, and thus live longer. Obviously, it is not the end-all, be-all of fitness or health, but it has it’s uses.

    • Alexandria Nick says:

      “rather then practicing the movement the little bit it would take to actually perform the test”

      No amount of practice will get me to do it. Old skiing injury has reduced the flexibility of my right knee.

      I’m skeptical that a slightly wonky knee is going to have a large impact on my mortality. The fried chicken is taking care of that, I’m sure.

  13. Jonathan Lyle says:

    I have read about this test many times lately, but never once have I read: 1) the logic of the test (i.e. why less mobile people will die earlier) or 2) what exactly one can do to improve one’s “score”. Like several other commenters, i have been an avid exerciser for many years, yet have “never” been able to do this test at all!

    • It is an excellent question. A better question is… if you get good at it are you suddenly in much better health?

      • Jane says:

        And how many injuries might occur trying to get good at it?

        • Bill Gillespie says:

          It is a reasonable question and consistent with many people’s thinking when presented with new or physically challenging. The key is more so identification that a substantial deficiency exists and that you use a thorough and appropriate progressively challenging series of drills to lessen that discrepancy. This discussion started about the cross legged test which as you can see there are plenty of skeptics however the evidence based support for single leg strength and its link to early death and poor quality of life is well documented.

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