6-meter mark, with 2 meters remaining to allow for deceleration. To obtain the gait speed, the distance (i.e., 4 meters) is divided by the time in seconds that it took to complete the test. Two trials should be completed and the average of the two trials taken to ensure the most reliability. A minimal clinically important How to measure changes after resistance exercise In a gym or a research setting, progression with resistive exercise has traditionally been documented using a one-repetition max test or a dynamometer. A one-repetition max test is a measure of the maximum amount of weight that can be moved one time through a full range of motion with good form. Hand-held or computerized dynamometers have been used in research settings to assess maximal isokinetic and isometric strength; however, few practitioners have this equipment. Additionally, the time and equipment necessary for a one-repetition max test may not be available in all settings. Use of the timed chair rise, grip strength, and Short Physical Performance Battery (SPPB) tests will allow for measurement of both lower and upper extremity strength and will also allow for documenting progression with resistive exercise in almost all settings with only minimal equipment needed. 30-second chair stand The 30-second chair stand (30CST) is a simple test to assess lower extremity strength that can be used in almost any setting with a minimal amount of equipment (Cobo et al., 2020). It can also be self-administered by a patient at home without supervision (Cobo et al., 2020). This test has been used to measure strength in a variety of older adult populations, including healthy older adults, as well as older adults with cardiovascular disease, osteoarthritis, and dementia (Shirley Ryan Ability Lab, 2022). For this test, the number of times a participant moves from sitting to standing in 30 seconds is counted (Shirley Ryan Ability Lab, 2022). Timed chair rise is a good functional measure of lower extremity extensor strength for older adults and is used in combination with other medical exams to assess functional status in older adults (Cobo et al., 2020). The patient should start the test seated in a chair, and the same chair should be used every time testing is performed (i.e., pre- and postexercise testing). The patient should cross their arms over the chest to minimize arm use during this task. The patient should practice one or two chair stands to ensure that they can do it safely without the use of their arms. Patients who are unable to perform even one stand without the use of their arms should be allowed to use their arms to assist in pushing up, but this information should be documented for future reference. Once the participant is ready, they assume a seated position. At the word “Go,” the participant stands up and sits back down as many times as possible in 30 seconds. Only full chair stands are counted, but if the individual goes more than halfway on the last repetition, it should be counted. Any adaptations a person may have needed for chair height, the use of arms, or required assistance to complete a chair stand must be described. The range of normal values for the 30-second chair stand test for both males and females can be found by referring back to Table 11. These normal values apply only when the test is not modified. Grip strength Grip strength is a significant check-in with a client, as it tells how their strength functionally impacts ADL skills (Caughlin et al., 2022). This skill is used to generally characterize upper extremity strength and is predictive of functional abilities in older adults (Eckstrom et al., 2020). A hand-held dynamometer is a device used to measure grip that is available in most clinical settings and easily transported for use outside of the clinic (Shirley Ryan Ability Lab, 2022). Older adults with poor grip strength generally have poor overall function and are at risk for future declines and increased risk of mortality compared to older adults with good grip strength, which possibly explains the good responsiveness relating the test to upper arm pain (Eckstrom, 2020; Shirley Ryan Ability Lab, 2022).
difference for gait speed depends on the specific population measured, but generally is 0.1 meter per second for community- dwelling older adults (Middleton et al., 2015). Normal values for self-selected gait speed broken down by age and gender can be found in Table 11. To test grip strength, the patient should be seated with feet flat on the floor. The forearm should rest on an armrest with the elbow flexed 90 degrees and the forearm in a neutral position with thumb facing upward. The patient should be instructed to squeeze the dynamometer as hard as possible until told to stop. Once the patient starts squeezing, verbal encouragement can be given until the needle of the dynamometer stops rising, which indicates that their maximum force has been reached. Three trials on each arm, alternating sides between tests, should be completed, and the single highest grip score from all six trials should be used as the patient’s grip strength score (Shirley Ryan Ability Lab, 2022). The normal values for grip strength for both the left and right hands for males and females can be found in Table 11. Short physical performance battery (SPPB) The SPPB combines the results of three simple functional tasks into a single functional battery with a maximal combined score of 12. The advantage of the SPPB is that it is a simple test of lower extremity function that mimics everyday activities and can be done in a small space (such as an exam room or a patient’s living room) with minimal equipment (Treacy & Hasset, 2017). A large diversity of research devoted to the SPPB finds that it is a valid and reliable test that can be used across a large variety of populations and settings, including in older adults with pulmonary, cardiovascular, or neurologic disease in both community and hospital settings (Shirley Ryan Ability Lab, 2022). It should be noted, however, that high-functioning older adults will generally score at or near the maximum for the SPPB (2022). The SPPB is responsive to improvements in mobility and can be used to document improvements following an exercise intervention (Treacy & Hassett, 2017). The three tasks used in the SPPB are a simple balance measure (the ability to stand with feet together, in a semitandem stance, and in a tandem stance for 10 seconds each); the time it takes to complete five repeated chair stands; and self-selected gait speed (Treacy & Hassett, 2017). Each task is scored from 0 to 4 for a possible combined maximum score of 12 and minimum score of 0 (Shirley Ryan Ability Lab, 2022). Details for scoring each of the three subsections can be found in Table 12. For all balance tasks, individuals are allowed assistance to move into the position. For example, they may use the wall or the therapist’s hands for balance assistance to get into a semitandem stance. Once in this position, they are asked to balance without assistance. They are allowed to bend their legs and move their arms and trunk as necessary to hold the position. Time ends after 10 seconds for each position or if their feet move. Self-selected gait speed is determined as detailed above. While being timed for the five chair stands, participants are asked to keep their arms crossed over their chest and to perform a full stand without the assistance of their arms. Timing starts when they begin to stand up and ends when they reach full standing position for the fifth repetition. If they are unable to stand without using their upper extremities for assistance, it is scored a 0. Generally, a combined score of less than 10 indicates some level of disability (Puthoff, 2008) and is a strong predictor of future disability, risk of falling, risk for rehospitalization, and death in older adults (Pavasini et al., 2016; Shirley Ryan Ability Lab, 2022; Treacy & Hassett, 2017). The minimal clinically important difference is 1 point on the overall score. A change of 0.5 point on the SPPB is considered to be a small meaningful change (Treacy & Hassett 2017). Table 12. Scoring the Subsections of the Short Physical Performance Battery
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