Sit-to-Stand Tests

Our walk tests — the 6MWT, ISWT and ESWT — all need a measured corridor. The sit-to-stand family needs a chair, which is why it is the most useful field test in home visits, small consulting rooms and community settings.¹

The three variants

The 1MSTS is the one most closely studied in chronic respiratory disease and is the variant we default to when the question is exercise capacity. The 5STS is quicker and sits well alongside gait speed as a frailty measure.

How it is done

A standard chair without armrests, seat height about 46 cm, placed against a wall. The patient sits with arms folded across the chest — using the arms invalidates the comparison — and stands fully upright then returns to sitting, as many times as possible. Standardised encouragement only. Record heart rate, SpO₂ and Borg breathlessness and fatigue scores before and after; a fall in SpO₂ during the test is a meaningful finding.^1,2

⚠ Standardise the chair. Seat height materially changes the result, and a different chair between tests is a common reason an apparent change is not real.

Interpretation

• Compare against published reference values for age and sex; performance below the lower limit of normal indicates impairment.
• 1MSTS minimal important difference is around 3 repetitions in chronic respiratory disease.²
• A 5STS time exceeding about 12 seconds is a widely used frailty threshold in older adults, and ≥15 seconds indicates marked impairment.³
• Correlation with 6MWD is moderate — the tests are related but not interchangeable, and a change in one does not license reporting a change in the other.
• 1MSTS performance is prognostic in COPD and predicts exacerbation-related outcomes.⁴

Prescribing exercise from the result

Sit-to-stand testing translates directly into training because the test is the exercise. See prescribing exercise from test results for the full method; in brief:

• Use repetitions achieved to set a starting volume — typically sets at 60–80% of the one-minute count, repeated with rest, progressing by repetitions before progressing by sets.
• Where desaturation occurs during the test, expect it during training and plan oxygen or interval work accordingly.
• The 5STS time identifies patients whose limitation is strength rather than endurance, which redirects the programme toward resistance work.

Cautions

Unstable cardiac disease, acute musculoskeletal problems affecting the knees or hips, and significant balance impairment or falls risk — stand beside the patient, and consider a chair behind at all times. Stop for chest pain, severe breathlessness, dizziness or a critical fall in SpO₂. The test is maximal in effort terms despite its brevity, and should be treated as such.

References & evidence base

1. Bohannon RW, Crouch R. 1-minute sit-to-stand test: systematic review of procedures, performance, and clinimetric properties. J Cardiopulm Rehabil Prev 2019;39(1):2–8.
2. Crook S, Büsching G, Schultz K, et al. A multicentre validation of the 1-min sit-to-stand test in patients with COPD. Eur Respir J 2017;49(3):1601871.
3. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function. J Gerontol 1994;49(2):M85–M94.
4. Vaidya T, de Bisschop C, Beaumont M, et al. Is the 1-minute sit-to-stand test a good tool for the evaluation of the impact of pulmonary rehabilitation? Int J Chron Obstruct Pulmon Dis 2016;11:2609–2616.
5. Jones SE, Kon SS, Canavan JL, et al. The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax 2013;68(11):1015–1020.
6. Holland AE, Spruit MA, Troosters T, et al. An official ERS/ATS technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44(6):1428–1446.

References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.