EQOL Journal (2023) 15(1): 5-9

ORIGINAL ARTICLE

Inability to perform the five-chair stand test predicts increased risk of

sarcopenia in nursing home residents

Martin Šporin

✉ • Dorjana Zerbo Šporin

Received: 15

May, 2023 DOI: 10.31382/eqol.230601

Accepted: 31

May, 2023

Abstract

The proportion of elderly and sarcopenia cases is

expected to increase in the coming decades. Early

diagnosis of sarcopenia using muscle strength as a

criterion is important to prevent adverse health

effects. The repetitive chair stand test is an effective

tool for assessing muscle strength. Poor test

performance may indicate an individual with

potential sarcopenia. The aim of this study was to

investigate the effect of the ability to perform the

five-repetition chair stand test on the prevalence of

sarcopenia in residents of western Slovenian nursing

homes. 83 candidates (age 83.8±7.6 years, 69% of

whom were women) we included in the study. The

prevalence of sarcopenia was determined according

to European Working Group for Sarcopenia

guidelines and the five-repetition chair stand test

was used to assess physical performance. Relative

risk with a 95% confidence interval was calculated

to assess the difference in risk for sarcopenia

between the complete rises and the incomplete rises

group. 37% of participants were diagnosed as

sarcopenic, of whom approximately half were

unable to complete the 5-chair stand test. The risk of

sarcopenia was twice as high in participants who

were unable to complete the test (RR = 2.05 (CI

1.21-3.49); p=0.0077). The inability to complete the

repeated chair stand test in older adults from nursing

homes significantly increases the risk of sarcopenia.

Therefore, this test could be useful in identifying

individuals at high risk.

Keywords sarcopenia • aged • nursing homes •

physical fitness.

Introduction

The proportion of older people in the total

population is expected to increase significantly in

the coming decades. By 2100, the over-65s will

account for 31.3% of the EU's population

(Population structure and aging, 2023). As

sarcopenia is directly related to the aging process,

it is an issue of growing importance (Boshnjaku,

2022). Sarcopenia is a disorder characterized by

loss of skeletal muscle mass and function, often

occurring in old age and long-term illness (Sayer

& Cruz-Jentoft, 2022). Sarcopenia affects 8% to

36% of older people over 60 years of age

(Petermann-Rocha et al., 2021) and is associated

with several harmful outcomes, including higher

mortality (Beaudart et al., 2017; Xu et al., 2021),

falls, functional decline and increased risk of

hospitalization (Beaudart et al., 2017). Early

diagnosis of sarcopenia is crucial to prevent these

adverse outcomes. Focusing on early diagnosis

and interventions will reduce the costs associated

with sarcopenia (Filippin et al., 2014). Greater

muscle strength and physical performance have

been associated with less disability (Zanker et al.,

2022). The chair stand test has been reported to be

an effective tool for assessing muscle strength or

physical performance (Cruz-Jentoft, et al., 2019)

and shows the predictive ability for sarcopenia

(Pinheiro et al., 2016). The use of the chair stand

test as a criterion for muscle strength rather than

✉

dorjana.zerbosporin@fvz.upr.si

Zgornje Škofije 52 c 6281 Škofije, Slovenia

University of Primorska, Faculty of Health

Science, Polje 42 6310 Izola, Slovenia

EQOL Journal (2023) 15(1): 5-9

grip strength more than doubled the probable

prevalence of sarcopenia in all age groups

(Johansson, Strand, Morseth, Arnesdatter Hopstock,

and Grimsgaad, 2020). Poor performance on the five-

repetition chair stand test, especially test

incompleteness, may indicate individuals with

potentially severe sarcopenia (Dodds et al., 2021).

The aim of this study was to investigate the effect

of the ability to perform the five-repetition chair stand

test on the prevalence of sarcopenia in residents of

western Slovenian nursing homes. We were also

interested in whether sarcopenic and nonsarcopenic

residents differed in the average time it took them to

perform the five-repetition chair stand test.

Method

Participants

During the period from June to October 2019, older

adults from six western Slovenia nursing homes were

invited to participate in the study of physical fitness

and the prevalence of sarcopenia. In order for

candidates to participate in the study, they had to meet

the following criteria: (1) age of 65 years or older, (2)

ability to stand and walk (walking aids permitted), (3)

Mini-Mental State Examination score above 18. We

enrolled 83 candidates (age 83.8±7.6 years, 69% of

whom were women). The study was conducted in

accordance with the Declaration of Helsinki and was

part of a larger research project approved in advance

by the National Medical Ethics Committee of the

Republic of Slovenia no. 0120-321/2017-4. Each

participant voluntarily provided written informed

consent before participating.

Study protocol

In this cross-sectional study, the prevalence of

sarcopenia was determined according to the European

Working Group on Sarcopenia in Older People

(EWGSOP2) guidelines (Cruz-Jentoft et al., 2019).

To test the ability to stand up from a chair, 5-chair

stand test was used. Participants were asked to cross

their arms across the chest and stand up from the chair

once. If the result was positive, they were asked to

stand up and sit down again five times as quickly as

possible. The time from the first sitting down to the

fifth standing up was measured in seconds (s) and the

test was recorded as a 5-chair stand test complete. The

test was terminated and noted as 5-chair stand test

incomplete: (1) when the participant began to use his

or her arms, (2) after 1 min if the participant had not

completed 5 stand-ups, and if the participant's safety

was compromised (Guralnik, et al., 1994). All

measurements were performed in nursing homes by

trained personnel.

Data analysis

Microsoft Office Excel (MS for Windows 365 MSO,

2017) was used for data collection. Statistical analysis

was performed in IBM SPSS 29.0. Data were

presented descriptively by median values and ranges.

The Independent-Samples Mann-Whitney U test was

used to assess differences in the time required to

perform the 5-chair stand test between sarcopenic and

nonsarcopenic participants. We also calculated the

relative risk (RR) with 95% confidence intervals (CI)

to assess the difference in risk for sarcopenia between

the complete rises and incomplete rises groups.

Results

Sarcopenia diagnosis and performance tests were

conducted on 83 participants living in nursing homes

in western Slovenia who participated in the cross-

sectional study. According to EWGSOP2 guidelines

(Cruz-Jentoft et al., 2019), 31 (37%) of them were

diagnosed as sarcopenic, of which 16, or about half

(51% (95% CI 33%-69%)), were able to complete the

5-chair stand test. In the nonsarcopenic group, 41 of

52 participants (79% (95% CI 65% - 89%))

successfully completed all five stands (Table 1,

Figure 1).

Table 1. Statistics for the results of 5-chair stand test in sarcopenic and nonsarcopenic nursing home residents

Variable

Sarcopenic residents

(n=31)

Nonsarcopenic

residents

(n=52)

Total residents

(n=83)

Median time need for complete the test (s)

18.08

16.75

16.93

Min-Max time need for complete the test (s)

(10.07-30.88)

(7.35-35.95)

(7.35-35-95)

Note: Min – minimal value, Max – maximal value

Among those able to complete the 5-chair stand

test, the median time required to repeat five stands

was higher in the sarcopenic group than in the

nonsarcopenic group: 18.08 s and 16.75 s,

EQOL Journal (2023) 15(1): 5-9

respectively (Table 1). However, the difference

between the groups was not statistically significant

(U=292.00; p=0.523).

The effect of the ability to perform the 5-chair

stand test on the prevalence of sarcopenia was

assessed by relative risk. The risk of sarcopenia was

twice as high in participants who were unable to

complete the test (RR = 2.05 (CI 1.21-3.49);

p=0.0077) (Figure 1).

Figure 1. Percentage of sarcopenic and nonsarcopenic

nursing home residents who completed the 5-chair stand

test

Discussion

In this study, we demonstrated that inability to

perform the five-chair stand test predicts an increased

risk of sarcopenia in nursing home residents.

The prevalence of sarcopenia depends particularly

on the diagnostic criteria applied (Bijlsma et al.,

2012). For this reason, data on prevalence in

residential facilities vary widely, ranging from 17.7%

to 73.3% in long-term care homes (Rodriguez-Rejon

et al., 2019). In our study, we found a prevalence rate

of 37% for sarcopenia in Slovenian nursing home

residents, which is consistent with 38.7% in a similar

sample (Urzi, Šimunič, and Buzan, 2017).

Poor performance in the 5-chair stand test

indicates decreased lower limb muscle strength.

Performance in this test worsened with an increasing

SARC-F score for sarcopenia. A SARC-F score of 4

or higher (a cutoff for detecting sarcopenia) was

associated with a mean time of 22s required to repeat

the five stands (Dodds et al., 2021). In our study,

poorer performance and a longer median time to test

completion were observed in sarcopenic nursing

home residents compared with nonsarcopenic

residents (18.08 s and 16.75 s, respectively), but there

was no statistical difference (Table 1). These results

are consistent with those of previous studies in which

the time required for the test was positively associated

with sarcopenia. For each second increase in test

performance, the probability of sarcopenia increases

by 8% in older women (Pinheiro, et al., 2016). Cesari

et al. (2009) suggest a cut-off value of 17.1 s to

identify a high-risk group.

With increasing age, the proportion of individuals

unable to complete the 5-chair stand test increases

strongly. Inability to complete the test leads to the

worst outcome on the SARC-F questionnaire (Dodds

et al., 2021), an increased risk of injury-related falls

(Shea et al., 2018), subsequent falls, and disability in

the elderly (Zhang et al., 2013). We found that the risk

of sarcopenia was twice as high in nursing home

residents who were unable to perform the 5-stand

chair test (Figure 1). Similarly, the findings of Doods

et al. (2021) suggest that identifying those in whom

the 5-chair stand test was not performed and the

reasons why are important in studies of sarcopenia.

The five-repetition sit-to-stand test is a useful

screening tool for sarcopenia even in older people

with heart disease (Shikenbaru et al., 2019).

Assessment of chair stand performance in the elderly

may be a new strategy for predicting parameters

useful for the diagnosis of sarcopenia (Yoshico et al.,

2022).

In conclusion, the inability to perform the repeated

chair stand test in older adults from nursing homes

greatly increases the risk of sarcopenia. Thus, this test

could be useful in identifying those at high risk and

implementing interventions. Resistance training is the

first-line treatment for sarcopenia in older adults

(Hurst et al., 2022) and has the greatest effect on their

quality of life (Shen et al., 2023).

Study limitations

This study has potential limitations. The results

obtained may not reflect physical performance and

sarcopenia prevalence among all Slovenian nursing

home residents. In addition, we included only

participants who met specific inclusion criteria.

EQOL Journal (2023) 15(1): 5-9

Acknowledgments

The study was carried out at the Faculty of Health

Sciences, University of Primorska, and was not

funded. The authors would like to thank all the

subjects participating in the study as well as all the

students who participated in the measurements.

Conflict of interest

The authors declare no conflicts of interest.

References

Beaudart, C., Zaaria, M., Pasleau, F., Reginster, J-Y. &

Bruyère, O. (2017). Health Outcomes of Sarcopenia: A

Systematic Review and MetaAnalysis. PLoS ONE,

12(1), e0169548.

Bijlsma, A.Y., Meskers, C.G., Ling, C.H., Narici, M.,

Kurrle, S.E., Cameron, I.D., …Maier, A.B. (2013).

Defining sarcopenia: the impact of different diagnostic

criteria on the prevalence of sarcopenia in a large

middle aged cohort. Age, 35(3), 871-881.

Boshnjaku, A. (2022). Is age-related sarcopenia a real

concern for my developing country? Journal of

Cachexia, Sarcopenia and Muscle, 13, 2589–2592.

Cesari, M., Kritchevsky, S.B., Newman, A.B., Simonsick,

E.M., Harris, T.B., Penninx, B.W., … Pahor, M.

(2009). Health, Aging and Body Composition Study.

Added value of physical performance measures in

predicting adverse health-related events: results from

the Health, Aging and Body Composition Study.

Journal of the American Geriatric Society, 57(2), 251-

259.

Cruz-Jentoft, A.J., Bahat, G., Bauer, J., Boirie, Y., Bruyère,

O., Cederholm, T., … Writing Group for the European

Working Group on Sarcopenia in Older People 2

(EWGSOP2), and the Extended Group for EWGSOP2.

(2019). Sarcopenia: revised European consensus on

definition and diagnosis, Age and Ageing, 48(1), 16–

31.

Dodds, R.M., Murray, J.C., Granic, A., Hurst, C.,

Uwimpuhwe. G., Richardson, S., …Sayer, A.A.

(2021). Prevalence and factors associated with poor

performance in the 5-chair stand test: findings from the

Cognitive Function and Ageing Study II and proposed

Newcastle protocol for use in the assessment of

sarcopenia. Journal of Cachexia, Sarcopenia and

Muscle, 12(2), 308-318.

Filippin, L.I., Teixeira, V.N., da Silva, M.P., Miraglia, F.

& da Silva. F.S. (2015). Sarcopenia: a predictor of

mortality and the need for early diagnosis and

intervention. Aging Clinical and Experimental

Research, 27(3), 249-254.

Guralnik, J.M., Simonsick, E.M., Ferrucci, L., Glynn, R.

J., Berkmal, L.F., Blazer, D.G., … Wallace, R.B.

(1994). A Short Physical Performance Battery

Assessing Lower Extremity Function: Association with

Self-Reported Disability and Prediction of Mortality

and Nursing Home Admission. Journal of

Gerontology, 49, 85-94.

Hurst, C., Robinson, S.M., Witham, M.D., Dodds, R.M.,

Granic, A., Buckland, C., …Sayer, A.A. (2022).

Resistance exercise as a treatment for sarcopenia:

prescription and delivery. Age and Ageing, 51(2),

afac003.

Johansson,