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SKEPTOID BLOG:

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

by Stephen Propatier

July 8, 2015

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Donate According to a 2012studypublished 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 researchcommonly used as a medical foundation for the reported life-prolonging benefits of manystrength and flexibility programs"yoga, pilates, and balance exercises like Zumba. The buzz surrounding this testwas based on thestudy, conducted on2,002 adults in Brazil.The adults were ages 51 to 80 andwerepart of an exercise program at Clinimex Exercise Medicine Clinic in Rio de Janeiro. People who scored lowon the test were twice as likely to die within the next six years compared with those who scored higher. Those with the lowest scoreswere 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 muchused to predict a patient's mortality risk. Why? As you well know, Skeptoid likes to take a close look pop culture claims, solet's take a closer look at this one.

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 ofDr. Claudio Gil Araujo, MD, PhD, who developed the test. Itis in Portuguese with English subtitles.

[embed]https://youtu.be/MCQ2WA2T2oA?t=23[/embed]

On the surface it seems pretty convincing as a scientific evaluation. The research numbers do show a firm correlation between lower scores andshort-term mortality. Does this mean that everyone with a higher score is safe and everyone with a lower score is staring deathin 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, itneeded better blinding. The scores done by researchers were extremely subjective; the researchers decided if ahand was used and by how much and graded participantsaccordingly. 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 provideda more detached grading system.

The studyalso had a smallsample size with too many confounding variables. In other words, that small sample size hadabig age range anddidn't separate the sexes. That's not a terrible problem for an index study, but it's also not OKas a medical tool.The sample size means you can't drawthe kinds ofconclusions that have been promulgated by news reportsabout 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 astroke,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 18to40. Younger males mighthavehigher scores and paradoxically havehigher 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 thingsthat increase your risk for dying, and yet people survive. Your personal risk for death is just that personal, and no singletest can give accurately predictyour 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 littleuse. 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 supportsthe 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 morecomplicated puzzlethan 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.

I'll be inTAM in Las Vegas, July 16 " 19. Please feel free to say hello if you see me!

Take a minute and support Skeptoid. The money doesn’t go to me, but instead goes to keep Skeptoid running as a resource of science and skepticism. Remember: all donations and gifts to Skeptoid Media, Inc. are tax deductible under section 501(c)(3) of the Internal Revenue Code (sections 170, 2055, 2106, 2522).

You can follow me at Twitter @steveproacnpfor a daily dose of skeptical nursing. Please check out the completion of the seriesOcc: The Skeptical Caveman,which I helped produce withthe guys at The Skeptics Guide To the Universe.

Disclaimer: This post is my personal opinion, it is not a substitute for medical care. It is for informational purposes only. The information on Skeptoid blogis not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. This postdoes not reflect the opinion of my partners, professional affiliates, or academic affiliations. I have no financial conflicts of interest to disclose.

by Stephen Propatier

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