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30 Second Sit to Stand Test

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Purpose

The 30CST is a measurement that assesses functional lower extremity strength in older adults. It is part of the Fullerton Functional Fitness Test Battery. This test was developed to overcome the floor effect of the 5 or 10 repetition sit to stand test in older adults. 

Acronym 30CST

Area of Assessment

Functional Mobility
Strength

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions

Populations

Osteoarthritis
Older Adults and Geriatric Care
Mixed Populations

Key Descriptions

  • The 30-Second Chair Test is administered using a folding chair without arms, with seat height of 17 inches (43.2 cm). The chair, with rubber tips on the legs, is placed against a wall to prevent it from moving.
  • The participant is seated in the middle of the chair, back straight; feet approximately shoulder width apart and placed on the floor at an angle slightly back from the knees, with one foot slightly in front of the other to help maintain balance. Arms are crossed at the wrists and held against the chest.
  • Demonstrate the task both slowly and quickly.
  • Have the patient practice a repetition or 2 before completing the test.
  • If a patient must use their arms to complete the test they are scored 0.
  • The participant is encouraged to complete as many full stands as possible within 30 seconds. The participant is instructed to fully sit between each stand.
  • While monitoring the participant’s performance to ensure proper form, the tester silently counts the completion of each correct stand.? The score is the total number of stands within 30 seconds (more than halfway up at the end of 30 seconds counts as a full stand). Incorrectly executed stands are not counted.
  • The 30-second chair stand involves recording the number of stands a person can complete in 30 seconds rather then the amount of time it takes to complete a pre-determined number of repetitions. That way, it is possible to assess a wide variety of ability levels with scores ranging from 0 for those who can not complete 1 stand to greater than 20 for more fit individuals.

Number of Items

1

Equipment Required

  • 43.2 cm (17in) folding chair with back
  • Stopwatch
  • Wall Space

Time to Administer

30 seconds

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Alicia Esposito, PT, DPT, NCS & the PD Edge Task Force of the Neurology Section of the APTA;Updated by Diane Wrisley, PT, PhD, NCS and Elizabeth Dannenbaum MScPT, for the Vestibular EDGE taskforce of the Neurology section of the APTA.

Body Part

Lower Extremity

ICF Domain

Body Function
Activity

Measurement Domain

Motor

Considerations

Variations in sit to stand tests are available. Examples include:

  • 5x sit to stand
  • 10x sit to stand
  • 10 second sit to stand

Measurements of time are more precise (5x sit to stand; 10x sit to stand) than counting of repetitions within a particular time frame (30 second sit to stand; 10 second sit to stand). Individuals who are weak however may not be able to complete the requisite number of repetitions and consequently counting the number of repetitions in a pre-set amount of time may be preferable for certain patient populations.

Although chair heights vary depending on literature ensure consistency of chair height when performing serial assessment.

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Older Adults and Geriatric Care

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Cut-Off Scores

Moderately Active Older Adults:

Normative data published in Rikli and Jones 1999b

(Rikli and Jones, 2013; n = 2140 moderately active older adults)

Criterion fitness standards to maintain physical independence

Age

60-64

65-69

70-74

75-79

80-84

85-89

90-94

Women

15

15

14

13

12

11

9

Men

17

16

15

14

13

11

9

 

Normative Data

Community Dwelling Elderly

(Jones et al, 1999)

Characteristics

Men (n = 34)

 

Women (n = 42)

 

 

Mean

Standard Deviation

Mean

Standard Deviation

Age (years)

72.6

6.6

69.1

5.1

Height (cm)

177

7.4

163.1

5.8

Weight (kg)

83.1

16.6

71.2

14.3

Chair stand

13.7

3.2

12.7

3.6

Leg press (resistance in pounds/body weight in pounds)

3.2

1.8

2.4

0.1

  • Scores ranged from 2-21 correct stands within 30 seconds 

 

Community Dwelling Elderly

(Jones et al, 1999; as an adjunct to the main part of the study, chair stand scores of 190 male and female residents from a nearby retirement housing complex (mean age = 76.2(6.7) years were analyzed to determine the test’s ability to detect age differences over 3 age groups (60’s, 70’s, 80’s) as well as differences in people with high and low levels of fitness (high level of fitness = individuals who participated in moderate physical activity at least 3 days a week, that is activity strenuous enough to cause a noticeable increase in breathing, heart rate and perspiration; low level of fitness = those who either did not participate in moderate exercise or who participated less then 3 times/week)

 

N

Mean

SD

Age groups

   

60-69 years

32

14

2.4

70-79 years

96

12.9

3.0

80-89 years

62

11.9

3.6

 

Activity Group

   

High activity

144

13.3

2.8

Low activity

46

10.8

3.6

 

Community Dwelling Sexagenarian Women

(McCarthy, et al, 2006)

  • Mean number of stands: 13.97(3.07)

 

Hong Kong Community Dwelling Elderly

(MacFarlane, et al, 2006)

30 CST across age span (years)

Mean # of stands

Female 60-64

12.3(4.2)

Female 65-69

11.3(3.5)

Female 70-74

10.1(3.8)

Female 75-79

9.4(3.4)

Female 80-84

9.3(3.1)

Female 85-89

8.3(2.4)

Female 90+

7.9(2.7)

Male 60-64

14(4.3)

Male 65-69

12.9(4.6)

Male 70-74

11.6(3.3)

Male 75-79

11.3(4.4)

Male 80-84

11.1(4.2)

Male 85-89

8.1(4.0)

Male 90+

5.8(2.6)

Moderately Active Older Adults:

(Rikli and Jones, 1999; n = 7183 community residing subjects aged 60-94)

Range of scores between 25-75 percentiles

Age

Number of Stands- Women

Number of Stands- Men

60-64

12-17

14-19

64-69

11-16

12-18

70-74

10-15

12-17

75-79

10-15

11-17

80-84

9-14

10-15

85-89

8-13

8-14

90-94

4-11

7-12

 

Test/Retest Reliability

Community Dwelling Elderly

(Jones et al, 1999)

Participants

Test 1

 

Test 2

 

R

95% CI

 

Mean

SD

Mean

SD

 

 

# of Chair Stands

 

 

 

 

 

 

Total (n = 76)

13.1

3.4

13.4

4.0

0.89

0.79-0.93

Men (n = 34)

13.7

3.2

13.8

3.8

0.84

0.77-0.90

Women (n = 42)

12.7

3.5

13.0

4.2

0.92

0.87-0.95

 

  • Excellent test-retest reliability total number of participants: r = 0.89 (95% Confidence interval 0.79-0.93)
  • Excellent test-retest reliability total number of male participants: r = 0.84
  • Excellent test-retest reliability total number of female participants: r = 0.9
    2

Interrater/Intrarater Reliability

Community Dwelling Elderly

(Jones et al, 1999 a pilot study using a subsample of 15 participants)

  • Excellent interrater reliability: r = 0.95 (95% CI = 0.84-0.97)

Criterion Validity (Predictive/Concurrent)

Community Dwelling Elderly

(Jones et al, 1999)

  • Excellent criterion validity of the chair stand compared to weight adjusted leg press performance for all participants: r = 0.77, 95% CI = 0.64-0.85
  • Excellent criterion validity of the chair stand compared to weight adjusted leg press performance of men: r = 0.78, 95% CI = 0.63-0.88
  • Excellent criterion validity of the chair stand compared to weight adjusted leg performance of women: r = 0.71, 95% CI = 0.53-0.84

 

Community Dwelling Sexagenarian Women

(McCarthy, et al, 2006)

  • Adequate validity when compared to hip extensor isokinetic strength: r = 0.33
  • Adequate validity when compared to hip flexor isokinetic strength: r = 0.47
  • Adequate validity when compared to knee extensor isokinetic strength: r = 0.44
  • Adequate validity when compared to knee flexor isokinetic strength: r = 0.33
  • Adequate validity when compared to ankle plantar flexor isokinetic strength: r = 0.52
  • Poor validity when compared to ankle dorsiflexion isokinetic strength: r = 0.21
  • Excellent validity when compared to 5x sit to stand test: r = 0.83

 

Hong Kong Chinese Community Dwelling Elderly

(MacFarlane et al, 2006)

  • Adequate criterion validity compared to isometric hip flexion (HF) using Nicholas Manual Muscle Tester: r = 0.42 (95% CI = 0.27-0.54)
  • Poor criterion validity compared to isometric knee extension (KE) using Nicholas Manual Muscle Tester: r = 0.29 (95% CI = 0.14-0.44)
  • Adequate criterion validity compared to HF/kg: r = 0.33 (95% CI = 0.17-0.47)
  • Poor criterion validity compared to KE/kg: r = 0.24 (95% CI = 0.08-0.39)

Floor/Ceiling Effects

Community Dwelling Elderly

(Jones et al, 1999)

  • 0% floor effects

Responsiveness

Community Dwelling Elderly

(Jones et al, 1999)

  • Effect sizes for high vs. low activity level means = 0.83; p < 0.0001
  • Effect sizes for the 60’s to 70’s age group comparisons = 0.38
  • Effect sizes for the 70’s to 80’s age group comparisons = 0.30

Osteoarthritis

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Standard Error of Measurement (SEM)

Hip OA

(Wright et al, 2011)

  • SEM = 1.27

Minimally Clinically Important Difference (MCID)

Hip OA

(Wright et al, 2011)

External criterion standard: Participants graded their perceived level of change on the Global Rating of Change Score (GCRS) which is a 15 point scale from -7 to +7. A score of at least +5 is considered major improvement and a score of +4 or less is considered an unimportant change

Measure/Method

MCII (Minimally Clinical Important Improvement)

30 s chair stand

 

Method 1 (the sensitivity and specificity based approach)

2.0

Within patients score change approach

2.6

Between patients score change approach

2.1 (p = 0.06)

Normative Data

Hip OA

(Wright et al, 2011)

External criterion standard: Participants graded their perceived level of change on the Global Rating of Change score (GCRS) which is a 15 point scale from -7 to +7. A score of at least +5 is considered major improvement and a score of +4 or less is considered an unimportant change

30 s chair stand; n repetitions

Overall (n = 65)

Major improvement (n = 9)

Unimportant change (n = 56)

Baseline scores

10.1(4.4)

8.4(4.2)

10.3(4.4)

9 wk. scores

10.9(5.5)

11.0(3.8)

10.8(5.7)

Change scores

0.8(3.0)

2.6(2.2)

0.5(3.1)

 

Individuals with OA awaiting joint replacement of the hip or knee

(Gill et al, 2012)

  • Mean number of stands for individuals who do not walk with gait aid = 7.3(2.8) (n = 50)
  • Mean number of stands for individuals who walk with a gait aid = 4.5(3.3) (n = 32)

Test/Retest Reliability

Hip and Knee Osteoarthritis:

(Gill et al, 2008)

  • Established test-retest reliability between 2 administrations of the test on the same day by the same rater at 3 time points over 15 weeks in 40 patients awaiting total hip or knee replacement.  ICC (1,1) values ranged from 0.97 (95% CI 0.94-0.98) to 0.98 (95% CI 0.97-0.99).

Interrater/Intrarater Reliability

Hip and Knee Osteoarthritis:

(Gill et al, 2008)

  • Established inter-rater reliability between 2 administrations of the same test by 2 different raters on the same day.  Reliability was assessed at 3 time points over 15 weeks in 42 patients awaiting total hip or knee replacement.  ICC (1,1) ranged from 0.93 (95% CI 0.87-0.96) to 0.98 (95% CI 0.96-0.99).

Construct Validity

Individuals With OA Awaiting Joint Replacement of the Hip or Knee

(Gill et al, 2012)

  • Excellent correlation to the 50 ft. walk test: ICC = -0.64(95% CI = -0.75 to -0.49)
  • Poor correlation to the Patient Specific Function Scale (PSFS): ICC = 0.26 (95% CI 0.04-0.45)
  • Adequate correlation to the SF-36 Physical Function (SF-36 PF): ICC = 0.39 (95% CI 0.19-0.56)
  • Adequate correlation to the SF-36 Physical Component Summary (SF-36 PCS): ICC = 0.35 (0.14-0.53)
  • Excellent correlation to the Western Ontario and McMaster Universities Arthritis Index (WOMAC): ICC = -0.62 (95% CI -0.74 to -0.47)
  • Adequate correlation to the SF-36 Mental Health (SF-36 MH): ICC = 0.33 (95% CI 0.12-0.51)

Responsiveness

Individuals with OA awaiting joint replacement of the hip or knee

(Gill et al, 2012)

  • Significantly higher scores for individuals who did not ambulate with gait aide compared to individuals who did ambulate with gait aid: p = 0.00, Effect size = 0.64 (95% CI 0.32-0.95)
  • Responsiveness:
    • Standardized Response Mean (SRM) = 0.84 (95% CI 0.61-1.07)
    • Guyatt’s Responsiveness Index (GRI) = 0.98 (95% CI 0.73-1.22)

Mixed Populations

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Normative Data

Mixed Populations: (McKay et al., 2017; n = 988; mean (SD) = 21.7 (6.8))

Reference values for the 30-Second Chair Stand Test by age group and sex (number)

Age Group (years)

Male (mean (SD), n)

Female (mean (SD), n)

3-9

23.1 (6.6), 65

23.4 (6.1), 63

10-19

25.5 (5.7), 80

24.3 (5.9), 80

20-59

24.2 (6.3)a, 200

22.6 (6.2), 200

60+

18.3 (6.0)b, 150

15.9 (5.1), 150

aSignificant sex differences, p < 0.05

bSignificant sex differences, p < 0.01

Bibliography

Gill, S. and McBurney, H. (2008). "Reliability of performance‐based measures in people awaiting joint replacement surgery of the hip or knee." Physiotherapy Research International 13(3): 141-152.

Gill, S. D., de Morton, N. A., et al. (2012). "An investigation of the validity of six measures of physical function in people awaiting joint replacement surgery of the hip or knee." Clin Rehabil 26(10): 945-951.

Jones, C., Rikli, R., et al. (1999). "A 30-s chair-stand test as a measure of lower body strength in community-residing older adults." Research Quarterly for Exercise and Sport 70(2): 113.

Macfarlane, D. J., Chou, K. L., et al. (2006). "Validity and normative data for thirty-second chair stand test in elderly community-dwelling Hong Kong Chinese." Am J Hum Biol 18(3): 418-421.

McCarthy, E. K., Horvat, M. A., et al. (2004). "Repeated chair stands as a measure of lower limb strength in sexagenarian women." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 59(11): 1207-1212.

McKay, M.J., Baldwin, J.N., et al. (2017). Reference values for developing responsive functional outcome measures across the lifespan. Neurology, 88, 1512-1519.

Rikli, R. E. and Jones, C. J. (1999). "Development and validation of a functional fitness test for community-residing older adults." Journal of aging and physical activity 7: 129-161.

Rikli, R. E. and Jones, C. J. (1999). "Functional fitness normative scores for community-residing older adults, ages 60-94." Journal of Aging and Physical Activity 7: 162-181.

Rikli, R. E. and Jones, C. J. (2013). "Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years." The Gerontologist 53(2): 255-267.

Wright, A. A., Cook, C. E., et al. (2011). "A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis." J Orthop Sports Phys Ther 41(5): 319-327.

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