10 Chapter 10: Older adult fitness testing

Melissa Markofski

Background

Older adult fitness testing

Physical ability testing of older adults is done for several reasons. It can be done for the same reasons as testing younger adults—to evaluate an exercise training program—or for other reasons. These other reasons include evaluating disease risk or diagnosis, pre- and post-surgery testing, or evaluating frailty and/or the ability to live independently. For example, testing walking speed will assist with a sarcopenia or frailty diagnosis.

In older adults, we frequently refer to fitness tests as “functional tests” or “functional assessments”. There is a strong relationship between doing well on these short tests and being able to live independently and care for oneself. Although these tests may seem “easier” than a 1RM, in an older adult or other special population we can infer a lot of information from the relatively simple tests. Most of these tests require little (if any) specialized equipment and can be conducted in a clinician’s office.

Many of these tests are also commonly used in special populations. For example, the six minute walk test (6MWT) is validated in patients with pulmonary disease and is also commonly used in research in cancer patients and survivors.

Most of these tests should be easy for healthy, young adults. To help us understand challenges faced by older adults, there are suggested modifications. For at least two of these tests, add a modified technique (half weighted vest, straw and nose clip, spin, and/or heel lift). Some modifications work better with some tests than others. See the specific activities for suggestions for which modification works best for which test.

 

Class activity

Activity 1: 30 second chair stand test

Equipment: chair without arms, stopwatch

Participant: everyone who is able to do the movement without limitation or restriction

 

  1. Place a chair against the wall.
  2. The participant starts in a sitting position in the chair.
  3. Instruct the participant to start the test, and at the same time start the stopwatch.
  4. For 30 seconds, the participant comes to a full stand and sits back down. Count the number of times the person stands. At the end of 30 seconds, if the person is at least halfway to a stand count it as a stand.
  5. Use table 6.16 (in Blackboard folder) to compare yourself to 60-64 year old.
Suggested modification: spinning around to simulate medication side effects

 

Video: 30 Second Chair Stand Test

Virtual Lab Activity 1
Perform a Chair Stand test:
1. Watch the video above.
2. Follow the instructions and perform the chair stand test. If it is safe to do so, perform it with the suggested modification.
3. Use table 6.16 (in Blackboard folder)to compare yourself to a 60-64 year old.
Practice table interpretation:
1. A 62 year old Female performed 18 complete repetitions on the 30-second chair stand test. What was her percentile ranking?

 

Activity 2: Timed up and go (8’ version)

Equipment: chair without arms, stopwatch, tape measure

Participant: everyone who is able to do the movement without limitation or restriction

 

  1. The participant starts seated on a chair
  2. The participant stands up, walks around a cone placed 8’ away, and returns to a seated position.
  3. Start the stopwatch as soon as the person attempts to stand, and stop it as soon as they sit.
  4. Look up your results in Table 12.3 (in Blackboard folder).
Suggested modification: spinning around to simulate medication side effects

Video: Timed Up and Go (TUG) Test

Virtual Lab Activity 2:
Perform the Timed Up and Go (TUG) test:
1. Watch the video above.
2. Follow the instructions and perform the Timed Up and Go (TUG) test.
3. Look up your results in Table 12.3 (in Blackboard folder).
Practice table interpretation:
1. A 76 year old male performed the TUG test in 5.2 seconds. What was his percentile ranking?

 

Activity 3: 10M walk with and without carry

Equipment: stopwatch, tape measure, various small hand weights

Participant: everyone who is able to do the movement without limitation or restriction

There are three options for this test, and we are going to do all three. Usually the test is conducted at a “comfortable” pace and either a “comfortable” pace with a weight or an accelerated pace. Mark out a 10M course, plus 2M on either side for acceleration and deceleration. Have the subject do all three conditions one time each:

1) Comfortable pace: Instruct the subject to walk at a comfortable walking pace. Give the command that they have somewhere to be, but are not in a hurry.

2) Accelerated pace: Instruct the subject to walk at an accelerated pace. Give the command that they have a bus to catch and cannot be late, but do not want to run to the bus stop.

3) Walk with carry: Instruct the subject to repeat the comfortable walking pace, but this time they are carrying 10% of their body weight.

Use the Bohannon 1997 (25’ test) table (in the Blackboard folder) to interpret your results.

Suggested modification: breathing through a straw (while using a nose clip) to empathize with people with COPD

 

Virtual Lab Activity 3
Perform the 10m walk with & without carry:
(if you have the necessary equipment available)
1. Follow the instructions above to complete the 10m walk one time for each of the three different conditions.
2. Use the Bohannon 1997 (25′ test) table (in the Blackboard folder) to interpret your results.
Practice table interpretation:
1. A 65 year old woman completes this test 3 times. Her times were: comfortable pace=1.28m/s, accelerated pace=1.33m/s, and walk with carry=1.26m/s. Do her results fall within the normative data ranges?

 

Activity 4: Handgrip strength

Equipment: handgrip dynamometer

Participant: everyone who is able to do the movement without limitation or restriction

  1. Adjust the dynamometer so that it is comfortable for the participant. Make sure the dial marker is set to “0.”
  2. One at a time, test both hands of the participant. While standing, keep your arm at your side with the shoulder slightly abducted**.
  3. Squeeze the dynamometer as hard as the participant is able to squeeze it. After the participant releases the dynamometer, read the dial marker.
  4. Administer the test three times with a one minute rest in between attempts. Record the highest attempt and compare to table 6.2.

 

**When testing older adults, the test is typically conducted with the elbow at a 90° angle. However, the norms Table 6.2 relates to measurements with the elbow extended so that is the method we will use in this lab.

Video: NIH Handgrip Test

Virtual Lab Activity 4:
Understand how to measure and interpret the handgrip test:
1. Watch the video above.
Practice table interpretation:
1. You administered the handgrip test on a 55 year old male. His results for each trial were: Trial 1: R: 40kg and L: 41kg, Trial 2: R: 40kg and L: 42kg, and Trial 3: R: 41kg and L: 43kg. What category does he fall under on the strength norms table 6.2?

 

Activity 5: Arm curl test

Equipment: 5lb and 8lb hand weights, stopwatch, chair without arms

Participant: everyone who is able to do the movement without limitation or restriction

 

  1. Subject sits in a chair, with a 5 lb (women) or 8 lb (men) weight in their dominant hand in a neural grip. Their feet are on the floor, and the upper arm must remain in contact with the upper body
  2. Count how many complete repetitions the subject can perform in 30 sec
  3. Compare your results to Table 6.15 (in Blackboard folder)

Video: Arm Curl Test

Virtual Lab Activity 5
Perform the Arm Curl Test:
(if you have the necessary equipment available)
1. Watch the video above.
2. Perform the arm curl test and compare your results to an older adult’s in table 6.15 (in Blackboard folder).
Practice table interpretation:
1. A 67 year old male performed 19 arm curl repetitions in 30 seconds. What was his percentile rank?

 

Activity 6: Six minute walk test (6MWT)

Equipment: cones, tape measure, stopwatch

Participant: everyone who is able to do the movement without limitation or restriction

Set-up: Ideally, a 25 by 5 yard rectangle course or a 20-30 yard straight path (like in a hallway, if that is all that is available) with marks every 5 yards is set up for this test.

  1. The subject walks around the course for six minutes, and the number of yards competed to the nearest 5 yards is recorded. The test should be done individually and not walked with another person. Instruct the person that this is a walking (not running) test, they should walk at a comfortable pace, that they can walk for six minutes, breaks are permitted, and notify them each time one minute has passed (“There are five minutes remaining in this test” etc.) as well as a fifteen second warning prior to the end of the test (“in 15 seconds I will tell you to stop, and please stay where you are until I come to you.”)

 

Additional notes for testing older adults: No warm-ups prior to starting the test. If the person usually walks with a cane or walker, they will use it for this test. Breaks are permitted, but the clock keeps running. If the person is unsteady, walk behind them and try to not influence their pace.

Suggested modification: breathing through a straw (while using a nose clip) to empathize with people with COPD, half-weighted vest, heel lift


Video: 6-Minute Walk Test (6MWT)

Virtual Lab Activity 6
Perform the 6MWT:
(If you have the necessary space available)
1. Watch the video above.
2. Perform the 6MWT. Record total distance walked.