Middle-aged chair stands predict mortality risk

Nicolle A Mode, Alan B Zonderman and Michele K Evans

PLOS Aging and Health, 2026, vol. 1, issue 2, 1-10

Abstract: The five chair stand test (CST-5) has been used for decades in the elderly to assess physical performance and predict future fall and mortality risk, but its use is less common for middle-aged adults. We examined longitudinal measures of the CST-5, a 60-second assessment of leg strength, endurance, and balance by five repeated stands from a seated position, in a cohort of middle-aged adults and their relation to mortality risk. This longitudinal prospective cohort study examined CST-5 at four visits and mortality over 18 years (2004−2022). Cox regression was used with time-varying covariates to analyze data for 2943 socioeconomically diverse adults aged 30−64 enrolled in Baltimore, Maryland, US. Participants had a mean of 2.5 visits and a mean age of 48.7 years at enrollment and 59.7 years at visit 4. Inability to complete the CST-5 varied from 19% at visit 1 to 31% at visit 4. Half of those unable to complete the CST-5 at visit 1 reported no difficulties getting out of a chair. CST-5 was a significant risk for mortality and inability to complete the test corresponded to more than double (HR: 2.19, 95%CI: 1.65, 2.92) the mortality risk compared with those who completed the test in less than 13.7 seconds. There was no significant difference in mortality risk among those who could complete the exam (slower versus faster HR:1.24, 95%CI: 0.95, 1.62). Inclusion of additional risk factors for mortality did not change the main findings. This longitudinal study demonstrated that the CST-5 is a significant mortality risk in middle-aged adults and that inability to complete the test should be assessed. The CST-5 may provide important clinical information for middle-aged adults in an easy-to-administer test.Author summary: The chair stand test, a simple test employing a chair and a timer, has been used for decades to assess physical performance in the elderly (>65 years) and has been shown to predict future risk of death. It has been less frequently used to assess middle-aged adults (30–64 years). Here, we used repeated measurements from a longitudinal study to test if the chair stand test was significantly related to mortality risk in middle-aged adults. Considering the prevalence of participants unable to complete the test in our socioeconomically diverse cohort, we also assessed if this information was predictive of mortality. We found that adults unable to complete the chair stand test, compared with fast completers, had more than double the risk of mortality. Also, half of those unable to complete the test at the first visit had reported no difficulties getting out of a chair. The chair stand test, and inability to perform it, may serve as an inexpensive and easy-to-administer exam for middle-aged patients that provides important clinical risk assessment.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:page00:0000026

DOI: 10.1371/journal.page.0000026

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