Sitting–rising test scores predict natural and cardiovascular causes of deaths in middle-aged and older men and women

Abstract

In a previous study, the ability to sit and rise from the floor was associated with all-cause mortality. Now, we aim to assess whether sitting–rising test (SRT) scores also predict premature natural and cardiovascular (CV) deaths. This is a prospective cohort design study.A total of 4282 adults aged 46–75 years (68% men) performed sitting and rising from the floor, which was scored from 0 to 5, with one point being subtracted from 5 for each support used (hand/knee) and 0.5 for an unsteadiness execution. The final SRT score was obtained by adding sitting and rising scores and stratified in five groups for analysis: 0–4, 4.5–7.5, 8, 8.5–9.5, and 10. During a median follow-up of 12.3 (interquartile range = 7.6–18.0) years, there were 665 deaths (15.5%). There was a continuous trend for higher mortality with low SRT scores (P < 0.001), with death rates of 3.7, 7.0, 11.1, 20.4, and 42.1%, respectively, for Groups 5 to 1 of SRT scores. The Cox multivariate-adjusted (age, sex, body mass index, and clinical variables) hazard ratios of 3.84 [95% confidence interval (CI) 2.25–6.97] and 6.05 (95% CI 2.29–20.94) (P < 0.001) were observed, respectively, for natural and CV mortality, when comparing the highest and lowest SRT score groups.Non-aerobic physical fitness, as assessed by SRT, was a significant predictor of natural and CV mortality in 46–75-year-old participants. Application of the SRT, a simple assessment tool that is influenced by muscular strength/power, flexibility, balance, and body composition, could add relevant clinical and prognostic information to routine examinations of healthy and unhealthy individuals.From 1998 to 2023, 4282 individuals (46–75-year-old; 68% men) voluntarily participated in a medical evaluation focusing on physical fitness and health. None of them presented relevant physical or clinical limitations for fitness testing. All performed the sitting–rising test (SRT), aimed to safely evaluate, simultaneously, in the absence of equipment, the main components of non-aerobic physical fitness—muscle strength/power, flexibility, balance, and body composition. On the SRT, scores from 0 to 10 were attributed to the ability to sit and rise from the floor.This study expanded the findings of a previous study on the association of SRT scores and survival. Over a median follow-up of 12 years, 665 deaths (15.5% of the participants) due to natural causes (after excluding COVID-19 and external causes) occurred. Death rates were 3.7% for those having an SRT score of 10, tripled for 11.1% with an SRT score of 8 and dramatically increased by 42.1% in the 10% of participants with the lowest SRT score (0–4). After controlling for several covariates, we found a 3.8- and 6.0-fold higher risk for mortality, respectively, for natural and cardiovascular causes among those scoring 0–4 on the SRT when compared with those scoring a perfect 10, i.e. those able to sit and rise from the floor without using supports or exhibiting an unstable execution.Health professionals assessing non-aerobic fitness through SRT may have relevant subsides for a more individualized exercise prescription and to obtain clinically important prognostic information on survival for middle-aged and older healthy and unhealthy individuals.