overall health in older adults and an easy, short, and simple test to administer, it should be included in all fitness assessments and is an appropriate test for almost all settings. Self-selected gait speed can be assessed over any distance, but a distance of 4 meters is most commonly used. Ideally, 2 meters should be allowed for acceleration and deceleration on either side of the test. This means that if gait speed is tested over 4 meters, an 8-meter course should be used to allow for 2 meters for acceleration, 4 meters for testing, and 2 meters for deceleration. When testing self-selected gait speed, patients should be instructed to start walking at their normal speed. Timing begins once they cross the 2-meter mark and ends when they cross the 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 difference for gait speed depends on the specific population measured, but generally is 0.1 meters per second for community-dwelling older adults (Middleton et al., 2015; Perera et al., 2006). Normal values for self-selected gait speed broken down by age and gender can be found in Table 3.
be used to indicate progress. The use of fingertips to balance initially and progressing to not needing any upper extremity support would also be significant. Self-selected gait speed Self-selected gait speed is increasingly recognized as an important measure of overall health in older individuals (Studenski et al., 2011). It can be used in a variety of settings and with a wide range of diagnoses, making it an ideal measure for many therapists (Middleton, Fritz, & Lusardi, 2015). Slow gait speed is a predictor of functional decline, disability, falls, and mortality in older adults (Guralnik et al., 2000; Hardy, Perera, Roumani, Chandler, & Studenski, 2007; Studenski et al., 2011). Improvements in gait speed are associated with decreases in mortality (Hardy et al., 2007), and physical therapy interventions can result in improved gait speed (Barthuly, Bohannon, & Gorack, 2012; Braden, Hilgenberg, Bohannon, Ko, & Hasson, 2012; Middleton et al., 2015). Gait speeds of less than 1 meter per second identify older adults at high risk of negative health- related outcomes and increased mortality (Cesari et al., 2005). Self-selected gait speed is not a traditional measure of aerobic fitness. However, because gait speed is both a measure of Table 3: Normal Values for Aerobic and Resistance Measures Age 2-Minute Step Test (#) 6-Minute Walk (m)
Grip Strength (lbs) Left Right
Gait Speed (m/sec)
30-Second Chair Stand (#)
Men
60 to 69 70 to 79 80 to 89 60 to 69 70 to 79 80 to 89
572 527 417 538 471 392
86 to 116 73 to 110 59 to 103 73 to 107 68 to 101 55 to 91
1.34 1.26 0.97 1.24 1.13 0.94
12 to 19 11 to 17 8 to 15 11 to 17 10 to 15 8 to 14
85.4 68.5 59.6 50.6 42.5 37.6
92.0 72.7 66.4 57.1 47.6
Women
38.2 Note . Adapted from (Bohannon & Andrews, 2011; Bohannon, Peolsson, Massy-Westropp, Desrosiers, & Bear-Lehman, 2006; Casanova et al., 2011; Jones & Rikli, 2002). How to measure changes after resistance exercise
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 post-exercise testing). The patient should cross his or her arms over the chest to minimize the use of the arms for this task. The patient should practice one or two chair stands to ensure that he or she can do it safely without the use of the 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, he or she assumes a seated position; at the word “Go,” the participant stands up as many times as possible in 30 seconds. Only full chair stands are counted, but if the individual has gone more than halfway on the last repetition it should be counted. Any adaptations that 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 3. These normal values apply only when the test is not modified. Grip strength Grip strength is measured with a hand-held dynamometer, a device that is available in most clinical settings and easily transported for use outside of the clinic. Grip strength can be used to generally characterize upper extremity strength and is predictive of functional abilities in older adults (Bohannon, 2009; Stevens et al., 2012). 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 (Cooper et al., 2010; Stevens et al., 2012). To test grip strength, the patient should be seated
In a gym or a research setting, progression with resistive exercise has traditionally been documented using a 1-repetition max test or a dynamometer. A 1-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, a minority of PTs and PTAs has access to this equipment. Additionally, the time and equipment that are necessary for a 1-repetition max test may not be available in all settings. Use of the timed chair rise, grip strength, and the Short Physical Performance Battery (SPPB) tests will allow for measurement of both lower and upper extremities 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 is a simple test to assess lower extremity strength that can be used in almost any setting with a minimum amount of equipment. This test has been used to measure strength in a variety of older adult populations, including healthy older adults, older adults with cardiovascular disease, and older patients with dementia (Jones, Rikli, & Beam, 1999; Liu et al., 2010; Santana-Sosa, Barriopedro, Lopez- Mojares, Perez, & Lucia, 2008). For this test, the number of times a participant moves from sitting to standing in 30 seconds is counted. The number of chair stands performed in 30 seconds was found to have a high correlation with maximum leg-press performance in older adults with COPD (Benton & Alexander, 2009). In other words, timed chair rise is a good functional measure of lower extremity extensor strength for older adults.
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