Functional Fitness Assessments

Functional fitness assessments measure an individual's ability to perform activities relevant to daily life. For older adults, these assessments help identify strengths, weaknesses, and areas of concern while providing baseline data for program design and progress tracking. This lesson covers evidence-based assessment protocols specifically designed for the senior population.

Principles of Senior Fitness Assessment

Assessment Goals

When assessing older adults, your goals should be to:

1. Establish baseline function for program design
2. Identify fall risk factors that need addressing
3. Detect limitations that require program modification
4. Monitor progress over time
5. Motivate clients by demonstrating improvement

Safety Considerations

Before conducting any assessment:

• Review health history for contraindications
• Ensure appropriate environment (non-slip surfaces, adequate space)
• Have a chair nearby for seated rest
• Stop if client reports pain, dizziness, or excessive fatigue
• Never push clients beyond their comfort level
• Spot appropriately during balance and mobility tests

General Guidelines

• Demonstrate each test before the client attempts it
• Allow practice trials when appropriate
• Use standardized protocols for valid comparisons
• Consider time of day and medication effects
• Test in comfortable, non-intimidating environment
• Celebrate effort regardless of outcome

The Senior Fitness Test Battery

Developed by Rikli and Jones, the Senior Fitness Test (SFT) is the most widely used and validated assessment battery for older adults. It measures the physiological parameters that support physical functioning.

1. Chair Stand Test (Lower Body Strength)

Purpose: Assesses lower body strength needed for activities like climbing stairs, getting out of chairs, and walking.

Equipment: Straight-back chair (seat height approximately 17 inches), stopwatch

Protocol:

1. Client sits in middle of chair, feet flat on floor, arms crossed at wrists against chest
2. On "Go," client rises to full stand and returns to seated position
3. Count the number of complete stands in 30 seconds
4. One trial only

Scoring:

• Count only full stands (full extension of hips and knees)
• Below average scores indicate increased fall risk

Normal ranges (ages 65-94):

2. Arm Curl Test (Upper Body Strength)

Purpose: Assesses upper body strength needed for lifting and carrying.

Equipment: Straight-back chair, stopwatch, dumbbell (5 lbs for women, 8 lbs for men)

Protocol:

1. Client sits in chair, dominant arm at side, weight in hand, palm facing inward
2. On "Go," client curls weight through full range of motion (palm rotates up during curl)
3. Count complete curls in 30 seconds
4. Weight must be fully lowered between repetitions

Scoring:

• Count only full curls (complete flexion and extension)
• Anchoring elbow against body is acceptable

Normal ranges (ages 65-94):

3. 2-Minute Step Test (Aerobic Endurance)

Purpose: Alternative to 6-minute walk test; assesses aerobic endurance.

Equipment: Stopwatch, tape or measuring tape to mark knee height

Protocol:

1. Determine minimum knee height (midway between patella and iliac crest)
2. Mark this height on a wall or use a taut string
3. Client marches in place for 2 minutes, raising knees to minimum height
4. Count the number of times the right knee reaches the required height

Scoring:

• Count only steps reaching minimum height
• Allow slowing but not sitting
• Stop if client cannot continue safely

Normal ranges (ages 65-94):

4. Chair Sit-and-Reach Test (Lower Body Flexibility)

Purpose: Assesses hamstring flexibility, important for mobility and fall prevention.

Equipment: Straight-back chair, 18-inch ruler

Protocol:

1. Client sits on front edge of chair, one leg extended with heel on floor, ankle at 90°
2. Other leg bent with foot flat on floor
3. With hands overlapping, client slowly reaches toward toes of extended leg
4. Hold furthest point for 2 seconds
5. Measure distance from fingertips to toe (negative if short, positive if past toe)

Scoring:

• Record to nearest half-inch
• Test both legs and record the better score
• Two trials per leg

Normal ranges (ages 65-94):

5. Back Scratch Test (Upper Body Flexibility)

Purpose: Assesses shoulder flexibility, important for dressing and reaching.

Equipment: 18-inch ruler

Protocol:

1. Client stands and places one hand over the same shoulder, palm down, reaching down back
2. Other hand reaches behind back, palm up, reaching up
3. Measure overlap (positive) or gap (negative) between middle fingers
4. Test both sides, record better score

Scoring:

• Positive score: fingers overlap
• Negative score: fingers don't touch
• Zero: fingers just touch

Normal ranges (ages 65-94):

6. 8-Foot Up-and-Go Test (Agility/Dynamic Balance)

Purpose: Assesses agility and dynamic balance needed for quick maneuvering.

Equipment: Straight-back chair, cone, stopwatch, measuring tape

Protocol:

1. Client sits in chair, hands on thighs, feet flat on floor
2. On "Go," client stands, walks as quickly as possible around cone 8 feet away, and returns to seated position
3. Time from "Go" until client is seated
4. Two trials, record best time

Scoring:

• Time to nearest 0.1 second
• Client may use walking aid if normally used
• Higher times indicate increased fall risk

Normal ranges (ages 65-94):

Additional Balance Assessments

Single Leg Stance Test

Purpose: Simple static balance assessment

Protocol:

1. Client stands on one leg, other foot lifted slightly off floor
2. Arms can be free or on hips (standardize for repeat testing)
3. Time how long position is held (up to 30 seconds)
4. Stop if support foot moves or other foot touches down

Interpretation:

• Less than 5 seconds: High fall risk
• 5-20 seconds: Moderate fall risk
• Greater than 20 seconds: Lower fall risk

Tandem Stance

Purpose: Challenging static balance position

Protocol:

1. Client stands with one foot directly in front of the other (heel to toe)
2. Time how long position is held (up to 30 seconds)
3. Test both configurations (each foot forward)

Four-Stage Balance Test

Purpose: Progressive balance challenge from CDC STEADI initiative

Positions held for 10 seconds each:

1. Side-by-side stance
2. Semi-tandem stance (heel of one foot beside big toe of other)
3. Tandem stance (heel to toe)
4. Single leg stance

Interpretation: Inability to hold semi-tandem or tandem for 10 seconds indicates increased fall risk.

Gait Assessment

Usual Gait Speed

Purpose: Powerful predictor of function, fall risk, and mortality

Protocol:

1. Mark a walking course (typically 4-6 meters with 2-meter acceleration zone)
2. Client walks at usual pace
3. Time the middle distance (excluding acceleration/deceleration zones)

Interpretation:

• Greater than 1.0 m/s: Generally good function
• 0.8-1.0 m/s: Moderate function
• Less than 0.8 m/s: Poor function, increased fall risk
• Less than 0.6 m/s: Severe limitation

Timed Up and Go (TUG)

Purpose: Similar to 8-foot up-and-go but with longer distance (3 meters)

Interpretation:

• Less than 10 seconds: Normal mobility
• 10-20 seconds: Mostly independent
• Greater than 20 seconds: Variable mobility, may need assistance
• Greater than 30 seconds: Impaired mobility, needs assistance

Grip Strength

Purpose: Global indicator of muscle strength and predictor of many health outcomes

Equipment: Handheld dynamometer

Protocol:

1. Client seated, elbow at 90°, wrist neutral
2. Squeeze dynamometer maximally for 3-5 seconds
3. Three trials per hand, record best

Cut-points indicating weakness:

• Men: Less than 27 kg
• Women: Less than 16 kg

Putting It All Together

Assessment Selection

Not all clients need all tests. Select based on:

• Client's functional level
• Specific concerns identified in health history
• Time available
• Equipment available
• Client comfort and safety

Interpretation Guidelines

Consider results in context of:

• Age-appropriate norms
• Client's personal goals
• Previous assessment results
• Health conditions and medications
• Typical daily activities

Using Results for Program Design

Assessment findings inform:

• Exercise selection
• Starting intensity levels
• Areas requiring emphasis
• Safety precautions needed
• Realistic goal setting

Key Takeaways

1. Functional assessments provide practical information for program design
2. The Senior Fitness Test is a validated, comprehensive battery for older adults
3. Balance assessments are critical for fall risk identification
4. Gait speed is a powerful predictor of health outcomes
5. Grip strength provides a global indicator of muscle function
6. Safety first—never push clients beyond safe limits during testing
7. Use results to motivate—celebrate improvement and effort
8. Reassess periodically to track progress and adjust programs