Simple chair-rise test may reveal risk of falls, injury or even death in older adults

Analysis of 1,876 older adults from the Toledo Study for Healthy Aging has suggested that low muscle power, estimated through a 30-second sit-to-stand test, may provide a practical marker of frailty, functional decline and mortality risk

A simple 30-second chair-rise test may help to identify older adults at increased risk of falls, hospitalisation and death, according to an analysis of data from the Toledo Study for Healthy Aging conducted in Toledo, Spain.

The study has highlighted the importance of muscle power as a marker of healthy ageing. While longer life expectancy has been one of the major public health achievements of recent decades, researchers have warned that additional years of life do not necessarily mean additional years of independence. In older age, the ability to stand, walk, climb stairs and respond quickly to physical challenges can determine whether a person remains functionally independent or develops frailty, disability and other geriatric syndromes.

The musculoskeletal system is among the body systems most affected by ageing. From the third decade of life, muscle function begins to decline gradually, with the process to accelerate substantially after the age of 60. Several biological changes contribute to this deterioration. Fast-twitch muscle fibres, which help to produce rapid and powerful movements, decrease in number and size. At the same time, the nervous system becomes less efficient at activating muscle fibres, while fat and connective tissue accumulate within muscle. Together, these changes reduce the capacity to generate force and move efficiently.

Muscle power has emerged as a particularly important component of this process. Unlike muscle strength, which refers mainly to the ability to produce force, muscle power combines force with speed. It therefore reflects the ability to produce force quickly, a capacity that is essential for everyday movements such as rising from a chair, walking at pace, climbing stairs or recovering balance after a stumble.

Previous studies have suggested that muscle power declines earlier and faster than muscle strength or muscle mass. Reported annual losses have been about two to three per cent for muscle power, compared with about one to 1.5 per cent for muscle strength and about 0.5 to one per cent for muscle mass. This faster decline may explain why muscle power can provide an especially sensitive indication of early functional deterioration.

Traditionally, the assessment of muscle power has required specialist and expensive equipment, which has limited its use in routine clinical practice. However, a research team led by Dr. Julian Alcazar, assistant professor at the University of Castilla-La Mancha, Spain, developed a validated equation based on the 30-second sit-to-stand test. In this test, a person is asked to stand up from, and then sit down onto a chair, as many times as possible within 30 seconds, with their arms crossed over their chest. The result can then be combined with body mass, height and the number of repetitions completed to estimate sit-to-stand muscle power. The calculation can also be made through the POWERFRAIL app. When the result is normalised to body mass, it provides a measure of relative sit-to-stand power.

To investigate the clinical relevance of this measure, researchers analysed data from 1,876 adults aged 65 years and older who had taken part in the Toledo Study for Healthy Aging, a large population-based cohort study. The study was made available online in the Journal of Sport and Health Science on 13 August 2025.

Using the 30-second sit-to-stand test and Alcazar’s equation, the researchers estimated each participant’s relative sit-to-stand power. They classified low relative sit-to-stand power as values below 2.53 watts per kilogram in men and below 2.01 watts per kilogram in women, in line with previous research.

When the researchers examined participants’ recent health history, they found clear differences between those with normal relative sit-to-stand power and those with low relative sit-to-stand power. Among men, low relative sit-to-stand power was associated with a higher likelihood of previous fractures of all types and previous falls. Among women, low relative sit-to-stand power was associated with a higher likelihood of previous hip fracture. Women with low relative sit-to-stand power also showed a trend towards a higher likelihood of previous falls and fractures of all types.

The findings also linked low relative sit-to-stand power with poorer longer-term outcomes. During a six-year follow-up period, women with low relative sit-to-stand power had a 29 per cent higher risk of hospitalisation than women with normal relative sit-to-stand power. They also tended to spend more days in hospital.

The strongest associations were seen for mortality during nine years of follow-up. Men with low relative sit-to-stand power had a 57 per cent higher risk of death from any cause than men with normal relative sit-to-stand power. Among women, the association was stronger still, with low relative sit-to-stand power linked to a more than doubled risk of death, equivalent to a 104 per cent higher risk.

The findings suggest that a simple functional test could provide clinically useful information about older adults’ health status and future risk. In only 30 seconds, the ability to rise repeatedly from a chair may reflect not only lower-limb function but also broader physiological reserve, mobility, frailty and resilience.

The study adds to evidence that muscle power should be considered a central marker of healthy ageing. Unlike muscle mass alone, muscle power captures the capacity to act quickly and effectively which is crucial for independence and safety in later life. The authors suggested that assessment of relative sit-to-stand power could therefore offer a practical way to identify older adults who may benefit from targeted interventions, including resistance and power-based exercise programmes.

The results also reinforce the need to preserve physical function before substantial decline has occurred. Because muscle power appears to deteriorate earlier and faster than strength or mass, routine assessment may help clinicians and public health teams to detect risk at a stage when preventive action is still possible.

A simple chair-rise test cannot replace full clinical assessment but the findings suggest that it could provide a low-cost and accessible tool for use in community, research and healthcare settings. Its value lies in its simplicity: the movement is familiar, the equipment requirement is minimal and the result may reveal important information about the biological ageing process.

For further reading please visit: 10.1016/j.jshs.2025.101080