It seems a simple enough challenge: Sit down on the floor and get back up without the help of your hands or knees. Try it, though, and you might discover it’s not as easy as it sounds.
This “sitting-rising” exercise was designed to predict mortality in middle-aged and older people. The test was devised by a team led by Claudio Gil Araújo, a Brazilian physician and researcher in exercise and sports medicine, and published in the European Journal of Cardiovascular Prevention in 2012. It resurfaces periodically in media outlets or online, causing widespread alarm regarding mortality among the many people (of all ages) who can’t seem to get themselves off the ground. We decided to find out whether that worry is warranted.
The test requires you to lower yourself to the floor, crisscross style, without bracing yourself with your hands, knees, arms, or sides of your legs. If you can stand back up, again without the aid of those body parts, you’ve scored a perfect 10 (five points for sitting, five points for standing). You lose a point every time you support yourself with a forbidden joint or appendage.
The researchers tested 2,002 adults 51 to 80 years old, and then followed them until a participant died or until the study concluded, which was a median of 6.3 years. In that time, 159 people died — only two of whom had scored a perfect 10. Those who had the lowest score of zero to three points had a risk of death that was five to six times higher than those who scored eight to 10 points.
“It is well known that aerobic fitness is strongly related to survival, but our study also shows that maintaining high levels of body flexibility, muscle strength, power-to-body weight ratio and co-ordination are not only good for performing daily activities, but have a favorable influence on life expectancy,” Araújo said in a 2012 news release.
Sure, the test is a good measure of leg and core strength, as well as balance. Older adults who have such muscular strength and flexibility are less likely to fall. And falls are the leading cause of unintentional-injury-related deaths for people ages 65 and older, according to the Centers for Disease Control and Prevention.
But what if you can’t do it? Are you doomed? Should you plan for an early demise? If so, a test of about a dozen 35 to 40-something friends at a recent dinner party revealed that more than half of us should probably get our affairs in order, pronto.
Luckily, a few more variables apply to our health (and our longevity) than those this particular test focuses on. It’s important to remember that the study results are most relevant to those the same age as the subjects in the testing group, who were ages 51 and up — a point often lost in discussion. Most of the people who scored the lowest on the test were in the 76-to-80 age range, a group that generally experiences decreased mobility and coordination. The research also didn’t reveal the causes of the 159 deaths during the follow-up period. Should we assume they all died of complications from falling, instead of cardiovascular disease or cancer? We don’t know.
The exercise serves as one method of screening an individual’s loss of muscle in the aging process, known as sarcopenia, said Greg Hartley, president of the Academy of Geriatric Physical Therapy and assistant professor at the University of Miami Miller School of Medicine. That decline leads to other mobility problems, which decreases quality of life, he said.
“Frailty, strength, muscle mass, physical performance — those things are all correlated to mortality, but I would caution everybody that correlation doesn’t mean causation,” Hartley said. “For example, if somebody had a really bad knee and there’s no way they could do the test, just because that person has a really bad knee doesn’t mean they’re going to die soon.”
Barbara Resnick, professor and chair of gerontology at the University of Maryland, said the ability to get off the floor is valuable but “it’s really pretty hard for anybody” if you’re not using your hands. Failure may be because of something as simple as where you carry your weight, she said. If you have a thicker midsection, getting off the floor might be challenging. But unless body composition is a sign of other health problems, such as obesity, you’re probably not going to die of it.
“[A high score] is a sign that at that point in time, you’re in pretty good physical condition in terms of muscle strength, but I do not believe it’s a predictor of longevity,” Resnick said. “There’s a genetic component. Some people are just stronger physiologically and more coordinated than others.”
If you’re sitting on the floor worried because you can’t get up, the good news is that barring complications such as arthritis or vestibular (inner ear) problems, you can work on it, and you’ll likely improve over time.
“You can practice every day — teaching to the test, in other words,” Resnick said. “Resilience is also part of it. Are you going to keep trying or are you going to just going say, ‘The heck with it’?”
Physicians have many other screening tools at their disposal to measure health and longevity, Hartley said.
For example, a study published in the February 2019 Journal of the American Medical Association Network Open, measured the health data and push-up capacity of 1,104 middle-aged, active male firefighters over the span of 10 years. The men who could complete 40 push-ups during the 10 years had a 96 percent lower risk of cardiovascular disease than those who could do fewer than 10 push-ups.
Walking speed also has been shown to provide insight to life span. One 2011 study published in the Journal of the American Medical Association concluded that people ages 65 and older who could walk one meter per second or faster lived longer than those who couldn’t. Another study that appeared in the British Journal of Sports Medicine concluded that walking at a faster than average pace reduced risk of death from cardiovascular disease by 53 percent for all people 60 and older.
“If you can walk at your natural pace at two miles per hour or faster, you’re a lot less likely to die in the next 10 years,” Hartley said. “Walking speed is highly correlated to mortality.”
Doctors also sometimes use a hand dynamometer to assess grip strength and can learn a lot about our death risk from it. One study showed that each 11-pound decrease in grip strength is linked to a 16 percent higher risk of dying from any cause, including heart disease, stroke and heart attack.
“It’s how hard you can squeeze the dynamometer,” Hartley said. “It’s another marker of frailty. The biggest impact on grip strength has to do with how fit you were in young adult and middle-adult life. So, there’s a preventive aspect to this.”
Once you’ve peeled yourself off the ground following the sit-rise test, use your newfound sense of defeat to get stronger and improve your fitness. The U.S. Department of Health and Human Services recently released new guidelines for physical activity, suggesting that adults 65 and older break their 150 to 300 minutes of exercise each week into short bouts of activities that focus on balance, aerobic exercise and muscle strengthening.
The key is to find forms of exercise you enjoy — or find purpose in doing what you may not like to do.
“If I tell a patient to exercise because it’s going to improve cardiovascular health, it doesn’t motivate them,” Hartley said. “What motivates them is the ability to go to a grandchild’s kindergarten graduation. What do you really care about? What do you want to be able to do?”
It’s also never too early or too late in life to start or increase physical activity — it’s beneficial and increases life expectancy no matter when you do it. Aim for 30 minutes of moderate exercise a day, Resnick said.
“I always say my patients walk to heaven — that’s my goal,” she said.
Erin Strout is a freelance journalist and digital editor of Women’s Running. Her work also appears in Runner’s World and Outside. Follower her on twitter: @erinstrout.