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Thursday
May012014

Health Equals Fitness, Fitness Equals Health (Part 1)

Guest blog Dr. Ben Fung, Physical Therapist, Doctor of Physical Therapy

We all know that to be healthy, we must be fit. 

Conventional wisdom suggests that a balanced lifestyle, a smart diet, and regular exercise are the keys to health. However, recent research in the last decade has suggested a concerted focus on musculoskeletal fitness. Three tasks measuring physical ability and fitness have been identified to be more accurate in predicting one’s health, likelihood of hospitalization, morbidity, mortality, well-being, and overall quality of life than age, gender, the presence of chronic diseases, blood pressure, body-mass index (BMI), and prior hospitalization combined1, 2, 3

Such data certainly demands our attention. What are these physical performance measures that quantify fitness and discern our status of health? The three fitness measures I would like to suggest careful attention to are:

  1. Gait velocity
  2. Speed of sit-to-stand (Squatting)
  3. And, the ability to rise from the floor (fall/floor recovery) 

1. Gait Velocity

Gait velocity has been identified as perhaps one of the most significant predictors of health in the last decade of medical research. This has been a most interesting development as musculoskeletal health has traditionally not been a major focus of general health; in contrast, internal, neurological, and cardiovascular health have been the long standing areas of focus when it came to considerations for disease prevention and overall well-being. 

However, gait has been demonstrated to predict outcomes with such precision that it has even been coined the “Sixth Vital Sign.2” Measurement of gait holds information which can predict likelihood of fall risk, hospitalization, discharge disposition, need for assistive devices, and even survivability1, 2, 3. It is also extremely easy to measure as objective data, and, is quite reliable not to mention reproducible in testing. 

When it comes to expanding perspectives, it certainly makes sense that the musculoskeletal system, the engine of human locomotion, controls the body’s ability to exercise – stimulating the cardiovascular system by which oxygen and precious nutrients are delivered to all the various “important” organs of interest such as the brain, heart, and lungs. 

Even from a psychological standpoint, the ability to walk is truly a central element of the human experience; from the moments of infancy to our twilight hours, are we not all considerably focused our ability to stand up and walk? 

2. Speed of Sit-To-Stand

To speak of the devil: the ability to achieve stance and sitting postures. Musculoskeletal health experts measure this ability on a daily basis. Perhaps most commonly analyzed by physiotherapists (physical therapists), the performance measure of stance-transfer is crucial to independent function in life. Recently, a test called the Short Physical Performance Battery4 has gained popularity when considering the health of the aging population. Within this physical performance battery is the “five-repetition sit-to-stand test” also referred to as the “five times sit-to-stand test (FTSTS Test)”5

When we think of how this relates to fitness, every mind should be thinking “squats!” The ability to control the rising and resting, to and from surfaces of various heights is a normal feat of fitness for the healthy individuals. We do this on every chair we sit upon, as we find rest in our beds, when we take place in automobiles/locomotives, and of course, when nature calls. 

Normative values for stance capabilities have been documented, suggesting one’s overall health, risk of falls, and inherent ability to achieve safe independence at home. Many times, we don’t think about the ability to sit and stand as a major factor of health until we find ourselves with difficulty performing the tasks of which fitness is certainly required. 

3. The Ability to Rise From The Floor

In a recent study published in European Journal of Preventive Cardiology, the ability to rise from the ground, from a sitting position into a standing position was highly predictive of morality6. The Sitting-Rise Test (SRT) was utilized to measure this ability, by which the authors made clear mention, “is influenced by muscular strength and flexibility” – fitness6

And, of course, their conclusions are only logical. If one can recover from the floor, then one could recover from a fall. If one could recover from the floor, one could physically get out of bed and participate in activities of daily living. If one can recover from the floor, then the many musculoskeletal and neuromuscular requirements to do so safely would assuredly be in good shape – a condition by which most would describe individuals to be capable, healthy, and fit. 

A Quick Note:

It should be noted that some of these tests did make special considerations for those with special needs, or needing to exercise within their abilities, as well as orthopaedic and neurologic limitations; and, as with almost every test we have in healthcare, no single test is valid for offering sweeping generalizations. Quite the opposite, in fact, most tests are best used in conjunction with other clusters of tests to cross-validate results. Most importantly, the tests should be highly considerate of each individual's unique situation and specific needs.

To Be Continued… “Health Equals Fitness, Fitness Equals Health (Part 2)”

So with these three fitness measures identified as critical elements of health, we must consider specific groups of exercises by which these feats of physical performance can be strengthened, optimized, and maintained for healthy living. Please join in next time on “Health Equals Fitness, Fitness Equals Health (Part 2)” for recommended exercises for optimal gait, sit-to-stand, and floor recovery.

 

Guest blog via Dr Ben FungReferences: 

1. Kuys SS et al. Gait speed in ambulant older people in long term care: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014 Mar;15(3):194-200.
2. Fritz and Lusardi. White Paper: "Walking Speed: the Sixth Vital Sign." Journal of Geriatric Physical Therapy: 2009 - Volume 32 - Issue 2 - p 2–5
3. Studenski S et al. Gait speed and survival in older adults. JAMA. 2011 Jan 5;305(1):50-8.
4. Fischer et al. Short Physical Performance Battery in hospitalized older adults. Aging Clin Exp Res. 2009 Dec;21(6):445-52.
5. Bohannon RW. Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders. Percept Mot Skills. 2006 Aug;103(1):215-22.
6. de Brito LB et al. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2012 Dec 13. [Epub ahead of print]

Blog moderated by Ann Gates, Founder and Director of Exercise Works!

 

 

 

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