Does the Sitting-Rising Test Predict Your Risk for Dying?
July 8, 2015
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.According to a 2012 study
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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