Next Article in Journal
Sustainable Healthy Working Life for All Ages—Work Environment, Age Management and Employability
Next Article in Special Issue
Drop Jump Performance Improves One Year Following Anterior Cruciate Ligament Reconstruction in Sportsmen Irrespectively of Psychological Patient Reported Outcomes
Previous Article in Journal
Microbial Air Contamination in a Dental Setting Environment and Ultrasonic Scaling in Periodontally Healthy Subjects: An Observational Study
Previous Article in Special Issue
Repeatability of Brain Activity as Measured by a 32-Channel EEG System during Resistance Exercise in Healthy Young Adults
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 20
Issue 3
10.3390/ijerph20032711
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Symptoms of Sarcopenia and Physical Fitness through the Senior Fitness Test

by
Alex Barreto de Lima
1,2,*,
Fátima Baptista
1,
Duarte Henrinques-Neto
3,4,
André de Araújo Pinto
5 and
Elvio Rúbio Gouveia
6,7
1
CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal
2
Course of Physical Education, Universidade do Estado do Amazonas, Manaus 69065-001, AM, Brazil
3
Research Center in Sports Sciences, Health Sciences and Human Development, Maia University, 4475-690 Maia, Portugal
4
School of Higher Education, Polytechnic Institute of Porto, 4200-465 Porto, Portugal
5
Department of Physical Education, Universidade Estadual de Roraima, UERR, Boa Vista 69306-530, RR, Brazil
6
Department of Physical Education and Sport, University of Madeira, 9000-072 Funchal, Portugal
7
LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(3), 2711; https://doi.org/10.3390/ijerph20032711
Submission received: 16 November 2022 / Revised: 30 January 2023 / Accepted: 1 February 2023 / Published: 3 February 2023
(This article belongs to the Special Issue Advances in Physical Activity, Physical Fitness, and Sports Injury)
Browse Figures
Versions Notes

Abstract

:
Introduction: Physical fitness concerns a set of attributes related to the ability to perform physical activity that may justify the symptoms reported by the elderly in the context of sarcopenia. Objective: This study aimed to investigate the relationship between the perception (symptomatology) of physical functioning (what the person thinks they are capable of) and the capacity itself for physical functioning in elderly people in northern Brazil. Methods: Cross-sectional study that analyzed 312 elderly people (72.6 ± 7.8 years) from the city of Novo Aripuanã, Amazonas, Brazil. Sarcopenia symptomatology was assessed using the SARC-F, a 5-item questionnaire designed for screening sarcopenia in older individuals in five domains: strength, walking aids, difficulty getting up from a chair, difficulty climbing stairs, and falls. Physical fitness was assessed by the Senior Fitness Test (SFT) battery including balance evaluated with the short version of the Fullerton Advanced Balance scale (FAB). Results: ROC curve analysis revealed that the tests with the greatest ability to discriminate participants with significant symptoms for sarcopenia (≥4 points on SARC-F) were arm curl and 6 min walk: the probability of suspected sarcopenia increased exponentially with an arm curl < 11.5 reps for men (se = 71%; sp = 69%; AUC = 0.706, 95% CI: 0.612–0.788; p = 0.013) and women (se = 81%; sp = 51%; AUC = 0.671, 95% CI: 0.601–0.735; p ≤ 0.001) or with a 6-min walk <408.5 m for men (se = 71%; sp = 63%; AUC = 0.720, 95% CI: 0.628–0.690; p = 0.001) and <366.0 m for women (se = 69%; sp = 58%; AUC = 0.692, 95% CI: 0.623–0.755; p = 0.0001). Conclusions: Physical fitness assessed through the senior fitness test, particularly the 30-s-arm curl test and the 6-min walk test, can discriminate for suspected symptoms of sarcopenia.

1. Introduction

Sarcopenia has been defined as a generalized disease characterized by decreased muscle mass and muscle function [1,2]. As in other diseases, the prevalence of sarcopenia increases with the aging of the population, constituting a public health problem of great priority in the elderly [3]. Although sarcopenia is identified in young people with particular clinical conditions [4] and healthy young people [5], it is in the elderly that sarcopenia has mostly been investigated [6]. The disease varies in severity and can limit the individual’s daily living activities (ADLs) and increase the risk of frailty, hospitalization, functional dependence, and mortality [7]. Most cases of sarcopenia are attributed to physical inactivity and inadequate protein/energy intake [8], although other causes may also contribute [7,8,9,10].
A wide variety of tools are available for screening, evaluating, and monitoring sarcopenia, but population differences in body composition, physical capacity, and perceptions of physical functioning as well as diverse research scenarios have hampered the systematic implementation of these tools [6]. In this context, the vast majority of cases of sarcopenia are not diagnosed [7]. A case-finding approach is recommended practice [2] and the screening of sarcopenia with user-friendly, simple tools is necessary [10]. This approach involves investigating sarcopenia when relevant symptoms are reported [11]. The symptoms/signs that have been most associated with sarcopenia include a history of falls and difficulties in lifting and carrying a shopping bag-like load (4.5 kg), moving around a room, getting up from a chair/bed, or going up a flight of stairs [11]. The SARC-F is the most widely used questionnaire for the rapid screening of sarcopenia [12]. For this purpose, the SARC-F consists of five questions referring to difficulties or events (falls) resulting from muscle weakness [13]. The sensitivity of SARC-F for screening positive cases has, however, been shown to be low in contrast to the specificity, which is high [3,14,15], meaning that SARC-F better signals people who do not have sarcopenia than people who have [2,16]. For this reason, several changes have been investigated including the addition of information to the original SARC-F [3,14]. However, attention is drawn to the fact that most of the answers to the SARC-F questions are due to musculoskeletal fitness and multisensory integration (balance) at the level of the lower limbs to ensure mobility for carrying out activities of daily living (ADLs) [17], while the identification of sarcopenia is assessed using a maximal handgrip strength test (upper limbs) [2]. As people get older, their level of physical fitness decreases [18], compromising, in the first instance, their health and, in the second instance, intrinsic capacity [19].
The Senior Fitness Test (SFT) is a battery widely used to assess the physical fitness of older people in a community context [20]. The SFT is composed of several tests that aim to inform about aerobic, musculoskeletal, and neuro-motor fitness [21], and ultimately about health and intrinsic capacity [22,23,24]. Bearing in mind that the symptoms of sarcopenia are expressed by difficulties in performing activities of daily living due to insufficient physical fitness and a previous history of falls, it was intended to analyze associations between the perception of symptoms as a whole and individually and physical fitness assessed by the Senior Fitness Test. Since this battery of simple and inexpensive tests is widely used in community exercise programs, the question arises as to its relevance for a more objective screening (suspect) of sarcopenia. The purpose of this investigation was to analyze the relationships between the perception of physical functioning (what the person thinks they are capable of) and the capacity itself for physical functioning in elderly people in northern Brazil.

2. Methods

2.1. Sample and Study Design

The sample included 312 older adults from the community of Novo Aripuanã (Amazonas, Brazil). Of the 942 older adults who met the search criteria, 630 were excluded (215 not meeting the inclusion criteria and 415 declined to participate). Participants were recruited in basic health units, parks, squares, churches, and other public places in the city’s urban area, in addition to invitations broadcast on local radio stations. Participants living in rural areas were excluded from the study due to difficulties in accessing the evaluation site (distance and means of transportation needed). After explanations about the procedures and risks of the study, all participants signed the informed consent form. All assessments were performed at UEA. The following criteria were considered for participant inclusion: (1) older aged 60 and over residing in the community; (2) be independent in carrying out activities of daily living; (3) moderate or high level of cognitive functioning; (4) no contraindications for physical exertion (stroke, neurological diseases, unstable chronic conditions); and (5) without chest pain, and/or angina pectoris and limiting joint pain [25]. The cognitive level was evaluated with the Mini-Mental State Examination (MMSE) [26]. MMSE ≤ 15/30 points were used to exclude the participants of the study.
This cross-sectional study was approved by the Ethics Committee of the Declaration of Helsinki and Resolution 466/12 of the National Health Council, making part of the research project: “Sarcopenic Syndrome—Physical Function, Phenotype and Quality of Life in Elderly with and without Sedentary Lifestyle” (CAAE 74055517.9.0000.5016/Referee 2.281.400).

2.2. Instruments

2.2.1. Anthropometric Measurements

Body mass was measured using a calibrated mechanical anthropometric scale (110 CH, Welmy, São Paulo City, Brazil), with participants barefoot and wearing light clothes. Body height was measured using the anthropometric scale metal stadiometer, with participants in an upright position, arms hanging at their sides, heels together, and occipital and gluteal regions touching the upright ruler of the scale. Body mass index (BMI) was calculated by the ratio between body mass and height (meters) squared (body mass/height2).

2.2.2. Symptomatology of Sarcopenia

The SARC-F is a 5-item questionnaire designed for screening sarcopenia in older individuals and addresses five domains: strength, walking aids, difficulty getting up from a chair, difficulty climbing stairs, and falls [13]. Each domain has a question, and the answer is scored from 0 to 2 points for each item [13]. The total score ranges from 0 to 10, with ≥4 points indicating a risk of sarcopenia [13]. The (Brazilian) Portuguese-translated version [27] of the SARC-F questionnaire was applied.

2.2.3. Senior Fitness Test (SFT)

According to Rikli and Jones [28], the Senior Fitness Test (SFT) was developed for adults over 60 years of age. It is primarily used to evaluate physical function in healthy elderly people but is also used for people with dementia [29]. The SFT includes six tests: the 30-s Chair Stand Test (CST), the 30-s arm curl test (ACT), the chair sit and reach test, the back-scratch test (BST), the 8-foot up-and-go test (FUG), and the 6-min walk test (6MWT).

2.2.4. Body Balance

Balance was assessed using the short version of the Fullerton Advanced Balance scale (FAB) [30]. The FAB is an assessment tool used to measure the multiple dimensions of balance in older adults. The short version is composed of four tests, each test is scored using a 4-point ordinal scale (0–4), resulting in a maximum score of 16 possible points, representing the optimal balance performance. The cutoff point is 9 out of 16 points, concluding that an elderly person with a score < 9 on the FAB short version scale will be considered at a higher risk of falling [31].

2.3. Statistics

Statistical analyses were performed using SPSS (v26.0, Chicago, IL, USA). Descriptive statistics were calculated for all outcome measurements. Comparisons between sex were made by using the Student’s t-test. When the assumptions of the parametric tests were not verified, the Mann–Whitney test was used. Given the existence of an interaction effect for sex (p < 0.01), logistic regression analysis was used to examine the associations, for each sex, between the physical fitness tests and the risk of sarcopenia assessed by the SARC-F. The odds ratio of the physical fitness tests for predicting the sarcopenia symptoms was also estimated, according to sex, using the logistic regression. Significance was set at p < 0.05.

3. Results

Table 1 presents the sample characteristics for the total sample and by sex. Men were taller and heavier than women (p ≤ 0.001) but there were no differences in the BMI. Regarding the physical fitness tests, males showed better scores on the ACT, FUG, and 6MWT tests compared to females (p < 0.05). Conversely, females showed higher scores on BST and FAB. Despite a tendency of women to present a higher prevalence of significant symptoms (≥4 pts), no differences were observed between men and women in terms of total symptomatology.
Table 2 presents the prevalence of each symptom of sarcopenia separately. Symptom 1 relates to strength, symptom 2 to assistance in walking, symptom 3 to rise from a chair, symptom 4 to climbing stairs, and symptom 5 to the occurrence of falls. Difficulty climbing stairs and assistance in walking were the most and least prevalent symptoms, respectively, in both men and women. Table 2 shows a trend toward a higher prevalence of total symptomatology, but not individual symptoms, suggestive of sarcopenia in women compared to men.
Table 3 presents the results of the logistic regression to predict the likelihood of the occurrence of significant symptoms of sarcopenia (≥4 points) according to several attributes of physical fitness evaluated through the SFT. In women (back stretch, up-and-go, balance), in men (chair stand, sit and reach), or in both sexes (arm curl, 6 min walk), all tests showed the ability to discriminate participants with and without significant symptoms for sarcopenia.
Logistic regression analysis and the ROC curve indicated that the likelihood of suspected sarcopenia (associated with SARC-F ≥ 4 points) increased exponentially with an arm curl test < 11.5 reps for men (sensitivity = 71.43%; specificity = 69.39%; AUC = 0.706, 95% CI: 0.612–0.788; p = 0.013) and women (sensitivity = 80.95%; specificity = 50.63%; AUC = 0.671, 95% CI: 0.601–0.735; p = 0.0001) or with a 6-min walk test <408.5 m for men (sensitivity = 71.43%; specificity = 63.27%; AUC = 0.720, 95% CI: 0.628–0.690; p = 0.001 and <366 m for women (sensitivity = 69.05%; specificity = 58.23%; AUC = 0.692, 95% CI: 0.623–0.755; p = 0.0001), respectively (Figure 1). The odds ratio of having a SARC-F ≥4 pts decreased by 21.2% in men and 17.1% in women for each repetition (Table 3). Regarding the 6-min walk, the odds ratio of having a SARC-F ≥ 4 pts decreased by 0.7% in men and 0.8% in women per meter walked (or 7–8% per 10 m).
Table 4 shows the same type of analysis as Table 3, but individually considering each of the symptoms included in the SARC-F questionnaire. In women, a predictive capacity of the shoulder flexibility for the ability to lift and carry a load of 4.5 kg, the strength of arms to get up from a chair, and the balance for the occurrence of falls were observed. In men, no predictive ability of physical fitness was observed for individual symptoms.

4. Discussion

This study with elderly people in northern Brazil aimed to analyze associations between symptoms of sarcopenia resulting from physical fitness and reported through the SARC-F questionnaire, and physical fitness itself assessed through the SFT. Specifically, it was intended with this work to know (a) which components of physical fitness assessed through the SFT could screen the symptoms associated with sarcopenia and (b) which values of these components should be considered sufficient, that is, indicators of the absence of significant symptoms of sarcopenia when evaluated by SARC-F. The results revealed a trend toward a higher prevalence of total symptomatology, but not of individual symptoms, suggestive of sarcopenia in women compared to men. Individually, difficulty climbing stairs was the most reported symptom by both men (43.7%) and women (42.5%), while gait difficulty was the least reported symptom by both men (17%) and women (22%); that is, greater symptomatology in line with the physical demands of the activity. In men, falls were the second most reported symptom/event (34.8%), followed by strength to carry a load (29.5%) and to get up from a chair (25%). In women, strength to carry a load (33.5%) and to get up from a chair (29%) were the second and third most reported symptoms, followed by a history of falls (25%).
All physical fitness assessment tests were able to discriminate sarcopenia symptoms, although some tests were able to predict the presence of significant symptoms only in men and others in women. showed the ability to discriminate for the symptomatology of sarcopenia, although some tests were more predictive in men and others in women. The 30-s arm curl and the 6-min walk are noteworthy as they are tests with the greatest ability (acceptable discrimination) to suspect sarcopenia in both sexes. The increase of 1 repetition in the 30-s arm curl test corresponded to a decrease in the odds ratio of suspicion of sarcopenia of 22% in men and 17% in women. With the increase in the distance covered in the 6-min walk test, a decrease in the odds ratio of sarcopenia suspicion was also observed in both sexes: the decrease was 7–8% for every 10 m of distance covered.
Interestingly, the cutoff values of these tests for suspected sarcopenia coincided with the cutoff values proposed by Rikli and Jones [32] to distinguish between maintenance and the risk of loss of functional independence in older adults (11 reps in arm curl and 366 m in 6 min walk). This means that the SFT, usually implemented in community programs to assess physical fitness and identify the risk of loss of functional independence, also seems to show capacity for screening (suspect) sarcopenia. Additionally, this study also showed that the reference values for screening for sarcopenia appear to be similar to the screening values for the risk of loss of functional independence, at least concerning the 30-s arm curl test and the 6-min walk test. If the most prevalent sarcopenia symptoms are related to difficulty climbing stairs and carrying loads, it is likely that the physical fitness components that most discriminated sarcopenia symptoms in our sample were the 6-min walk test (the SFT does not assess stair climbing) and the 30-s arm curl test. Physical fitness is the ability to perform daily tasks with vigor and safety [28] and with sufficient energy reserves to meet emergencies and/or enjoy leisure or personal development activities [33]. High levels of physical fitness are associated with better physical and cognitive functioning, a better quality of life, and lower health costs [34,35,36].
Sarcopenia has only recently been classified as a medical condition [37], and therefore its importance is still poorly recognized, and diagnosis is scarce in clinical practice. The SARC-F is a simple and easy-to-use screening tool for sarcopenia that would be of great use for identifying sarcopenia in clinical practice. As the pioneer of screening tools for sarcopenia, SARC-F has been widely used in the field of sarcopenia research. The SARC-F has been validated in different ethnic populations [38,39,40,41,42] since it was developed in 2013 [13].
Previous studies have revealed SARC-F to be a valuable tool to predict clinically significant outcomes such as functional impairment, hospitalization [15,16,43,44], poor quality of life, and mortality. Several works that tested SARC-F as a screening tool for sarcopenia consensually reported moderate to high specificity (sp: ~70–90%), that is, the ability to identify elderly people who were not suspected of having sarcopenia and who therefore should not proceed with the diagnostic evaluation [13,45,46,47].
The main limitation of the present study is related to the selection of the reference instrument for the assessment of suspected sarcopenia—the SARC-F—since several screening approaches [48] have been proposed. However, the different sarcopenia screening approaches present validation limitations related to the determination of muscle mass by dual-energy x-ray absorptiometry [49]. Another limitation is that the diagnosis of sarcopenia was not carried out, but only its suspicion through the symptomatology and the analysis of its relationship with physical fitness assessed by the SFT. As strengths of this work, we highlight the recruitment, characterization, and investigation with a peculiar and rarely studied sample, whose participants live in poor and difficult-to-access cities in Brazil where screening is even more important for health promotion and the facilitation of clinical practice.

5. Conclusions

The 30-s arm curl test (<11.5 reps) and the 6-min walk test (<408.5 for men and <366.0 m for women) of the SFT showed the ability to discriminate between elderly people from Novo Aripuanã with and without suspicious symptoms of sarcopenia.

Author Contributions

Conceptualization, A.B.d.L. and F.B.; Methodology, A.B.d.L., E.R.G. and D.H.-N.; Software, D.H.-N. and A.d.A.P.; Validation, E.R.G. and F.B.; Formal analysis, D.H.-N. and A.d.A.P.; Investigation, A.B.d.L., F.B. and E.R.G.; Resources, A.B.d.L. and F.B.; Data curation, F.B. and E.R.G.; Writing—original draft preparation, A.B.d.L. and D.H.-N.; Writing—review and editing, F.B., E.R.G. and A.d.A.P.; Visualization, F.B. and E.R.G.; Supervision, F.B. and E.R.G.; Project administration, A.B.d.L., F.B. and E.R.G.; Funding acquisition, A.B.d.L. and F.B. All authors have read and agreed to the published version of the manuscript.

Funding

F.B. was partly supported by the Fundação para a Ciência e Tecnologia, under grant UIDB/00447/2020 to CIPER—Centro Interdisciplinar para o Estudo da Performance Humana (unit 447). E.R.G. acknowledges support from LARSyS—Fundação para a Ciência e Tecnologia (FCT) pluriannual funding 2020–2023 (Reference: UIDB/50009/2020).

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Universidade do Estado do Amazonas (UEA) (CAAE: 74055517.9.0000.5016; Number: 2.281.400; Brazil Platform).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available as they belong to a database of a Ph.D. thesis in progress.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Cruz-Jentoft, A.J.; Baeyens, J.P.; Bauer, J.M.; Boirie, Y.; Cederholm, T.; Landi, F.; Martin, F.C.; Michel, J.-P.; Rolland, Y.; Schneider, S.M. Sarcopenia: European consensus on definition and diagnosisReport of the European Working Group on Sarcopenia in Older People. Age Ageing 2010, 39, 412–423. [Google Scholar] [CrossRef] [PubMed]
  2. Cruz-Jentoft, A.J.; Bahat, G.; Bauer, J.; Boirie, Y.; Bruyère, O.; Cederholm, T.; Cooper, C.; Landi, F.; Rolland, Y.; Sayer, A.A. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing 2019, 48, 16–31. [Google Scholar] [CrossRef] [PubMed]
  3. Bahat, G.; Yilmaz, O.; Kiliç, C.; Oren, M.; Karan, M. Performance of SARC-F in regard to sarcopenia definitions, muscle mass and functional measures. J. Nutr. Health Aging 2018, 22, 898–903. [Google Scholar] [CrossRef] [PubMed]
  4. Orsso, C.E.; Tibaes, J.R.; Oliveira, C.L.; Rubin, D.A.; Field, C.J.; Heymsfield, S.B.; Prado, C.M.; Haqq, A.M. Low muscle mass and strength in pediatrics patients: Why should we care? Clin. Nutr. 2019, 38, 2002–2015. [Google Scholar] [CrossRef]
  5. Baptista, F.; Zymbal, V.; Janz, K.F. Predictive validity of handgrip strength, vertical jump power, and plank time in the identification of pediatric sarcopenia. Meas. Phys. Educ. Exerc. Sci. 2021, 26, 361–370. [Google Scholar] [CrossRef]
  6. Ackermans, L.L.; Rabou, J.; Basrai, M.; Schweinlin, A.; Bischoff, S.; Cussenot, O.; Cancel-Tassin, G.; Renken, R.; Gómez, E.; Sánchez-González, P. Screening, Diagnosis and Monitoring of Sarcopenia: When to use which tool? Clin. Nutr. ESPEN 2022, 48, 36–44. [Google Scholar] [CrossRef]
  7. Dent, E.; Morley, J.; Cruz-Jentoft, A.; Arai, H.; Kritchevsky, S.; Guralnik, J.; Bauer, J.; Pahor, M.; Clark, B.; Cesari, M. International clinical practice guidelines for sarcopenia (ICFSR): Screening, diagnosis and management. J. Nutr. Health Aging 2018, 22, 1148–1161. [Google Scholar] [CrossRef]
  8. Liu, X.; Hao, Q.; Yue, J.; Hou, L.; Xia, X.; Zhao, W.; Zhang, Y.; Ge, M.; Ge, N.; Dong, B. Sarcopenia, obesity and sarcopenia obesity in comparison: Prevalence, metabolic profile, and key differences: Results from WCHAT study. J. Nutr. Health Aging 2020, 24, 429–437. [Google Scholar] [CrossRef]
  9. Dent, E.; Woo, J.; Scott, D.; Hoogendijk, E.O. Toward the recognition and management of sarcopenia in routine clinical care. Nat. Aging 2021, 1, 982–990. [Google Scholar] [CrossRef]
  10. Bahat, G.; Yilmaz, O.; Oren, M.M.; Karan, M.A.; Reginster, J.Y.; Bruyère, O.; Beaudart, C. Cross-cultural adaptation and validation of the SARC-F to assess sarcopenia: Methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group. Eur. Geriatr. Med. 2018, 9, 23–28. [Google Scholar] [CrossRef]
  11. Cruz-Jentoft, A.J.; Sayer, A.A. Sarcopenia. Lancet 2019, 393, 2636–2646. [Google Scholar] [CrossRef]
  12. Malmstrom, T.; Morley, J. Sarcopenia: The target population. J. Frailty Aging 2013, 2, 55–56. [Google Scholar] [CrossRef]
  13. Malmstrom, T.K.; Morley, J.E. SARC-F: A simple questionnaire to rapidly diagnose sarcopenia. J. Am. Med. Dir. Assoc. 2013, 14, 531–532. [Google Scholar] [CrossRef]
  14. Yang, M.; Hu, X.; Xie, L.; Zhang, L.; Zhou, J.; Lin, J.; Wang, Y.; Li, Y.; Han, Z.; Zhang, D. SARC-F for sarcopenia screening in community-dwelling older adults: Are 3 items enough? Medicine 2018, 97, e11726. [Google Scholar] [CrossRef]
  15. Woo, J.; Leung, J.; Morley, J.E. Validating the SARC-F: A suitable community screening tool for sarcopenia? J. Am. Med. Dir. Assoc. 2014, 15, 630–634. [Google Scholar] [CrossRef]
  16. Ida, S.; Murata, K.; Nakadachi, D.; Ishihara, Y.; Imataka, K.; Uchida, A.; Monguchi, K.; Kaneko, R.; Fujiwara, R.; Takahashi, H. Development of a Japanese version of the SARC-F for diabetic patients: An examination of reliability and validity. Aging Clin. Exp. Res. 2017, 29, 935–942. [Google Scholar] [CrossRef]
  17. Yee, X.S.; Ng, Y.S.; Allen, J.C.; Latib, A.; Tay, E.L.; Abu Bakar, H.M.; Ho, C.Y.J.; Koh, W.C.C.; Kwek, H.H.T.; Tay, L. Performance on sit-to-stand tests in relation to measures of functional fitness and sarcopenia diagnosis in community-dwelling older adults. Eur. Rev. Aging Phys. Act. 2021, 18, 1. [Google Scholar] [CrossRef]
  18. Rodrigues, F.; Domingos, C.; Monteiro, D.; Morouco, P. A Review on Aging, Sarcopenia, Falls, and Resistance Training in Community-Dwelling Older Adults. Int. J. Environ. Res. Public Health 2022, 19, 874. [Google Scholar] [CrossRef]
  19. Patrizio, E.; Calvani, R.; Marzetti, E.; Cesari, M. Physical Functional Assessment in Older Adults. J. Frailty Aging 2021, 10, 141–149. [Google Scholar] [CrossRef]
  20. Todde, F.; Melis, F.; Mura, R.; Pau, M.; Fois, F.; Magnani, S.; Ibba, G.; Crisafulli, A.; Tocco, F. A 12-week vigorous exercise protocol in a healthy group of persons over 65: Study of physical function by means of the Senior Fitness Test. BioMed Res. Int. 2016, 2016, 7639842. [Google Scholar] [CrossRef] [Green Version]
  21. de Souza Moreira, A.C.S.; Menezes, E.C.; Custódio, D.; Cardoso, F.L.; Mazo, G.Z. Senior fitness test no risco de queda em idosos: Um estudo prospectivo. Rev. Bras. Educ. Física Esporte 2020, 34, 195–203. [Google Scholar]
  22. Vagetti, G.C.; Barbosa Filho, V.C.; Oliveira, V.d.; Mazzardo, O.; Moreira, N.B.; Gomes, A.C.; Campos, W.d. Functional fitness in older women from southern brazil: Normative scores and comparison with different countries. Rev. Bras. Cineantropometria Desempenho Hum. 2015, 17, 472–484. [Google Scholar] [CrossRef]
  23. Chen, H.-H.; Chen, H.-L.; Lin, Y.-T.; Lin, C.-W.; Ho, C.-C.; Lin, H.-Y.; Lee, P.-F. The associations between functional fitness test performance and abdominal obesity in healthy elderly people: Results from the National Physical Fitness Examination Survey in Taiwan. Int. J. Environ. Res. Public Health 2021, 18, 264. [Google Scholar] [CrossRef] [PubMed]
  24. Sui, S.X.; Holloway-Kew, K.L.; Hyde, N.K.; Williams, L.J.; Leach, S.; Pasco, J.A. Muscle strength and gait speed rather than lean mass are better indicators for poor cognitive function in older men. Sci. Rep. 2020, 10, 10367. [Google Scholar] [CrossRef] [PubMed]
  25. Rikli, R.E.; Jones, C.J. Senior Fitness Test Manual; Human Kinetics: Champaign, IL, USA, 2013. [Google Scholar]
  26. Creavin, S.T.; Wisniewski, S.; Noel-Storr, A.H.; Trevelyan, C.M.; Hampton, T.; Rayment, D.; Thom, V.M.; Nash, K.J.; Elhamoui, H.; Milligan, R. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst. Rev. 2016, 2016, CD011145. [Google Scholar] [CrossRef]
  27. Barbosa-Silva, T.G.; Menezes, A.M.B.; Bielemann, R.M.; Malmstrom, T.K.; Gonzalez, M.C. Enhancing SARC-F: Improving sarcopenia screening in the clinical practice. J. Am. Med. Dir. Assoc. 2016, 17, 1136–1141. [Google Scholar] [CrossRef]
  28. Rikli, R.E.; Jones, C.J. Functional fitness normative scores for community-residing older adults, ages 60–94. J. Aging Phys. Act. 1999, 7, 162–181. [Google Scholar] [CrossRef]
  29. Hesseberg, K.; Bentzen, H.; Bergland, A. Reliability of the senior fitness test in Community-dwelling older people with cognitive impairment. Physiother. Res. Int. 2015, 20, 37–44. [Google Scholar] [CrossRef]
  30. Rose, D.J.; Lucchese, N.; Wiersma, L.D. Development of a multidimensional balance scale for use with functionally independent older adults. Arch. Phys. Med. Rehabil. 2006, 87, 1478–1485. [Google Scholar] [CrossRef]
  31. Rose, D.J. Fallproof!: A Comprehensive Balance and Mobility Training Program; Human Kinetics: Champaign, IL, USA, 2010. [Google Scholar]
  32. Rikli, R.E.; Jones, C.J. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist 2013, 53, 255–267. [Google Scholar] [CrossRef]
  33. Liguori, G.; Medicine, A.C.o.S. ACSM’s Guidelines for Exercise Testing and Prescription; Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2020. [Google Scholar]
  34. Liu, J.-D.; Quach, B.; Chung, P.-K. Further understanding of the Senior Fitness Test: Evidence from community-dwelling high function older adults in Hong Kong. Arch. Gerontol. Geriatr. 2019, 82, 286–292. [Google Scholar] [CrossRef]
  35. Milanović, Z.; Pantelić, S.; Trajković, N.; Sporiš, G.; Kostić, R.; James, N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin. Interv. Aging 2013, 8, 549. [Google Scholar] [CrossRef]
  36. Glenn, J.M.; Gray, M.; Binns, A. Relationship of Sit-to-Stand Lower-Body Power With Functional Fitness Measures Among Older Adults With and Without Sarcopenia. J. Geriatr. Phys. Ther. 2017, 40, 42–50. [Google Scholar] [CrossRef]
  37. Yang, M.; Hu, X.; Xie, L.; Zhang, L.; Zhou, J.; Lin, J.; Wang, Y.; Li, Y.; Han, Z.; Zhang, D. Screening sarcopenia in community-dwelling older adults: SARC-F vs. SARC-F combined with calf circumference (SARC-CalF). J. Am. Med. Dir. Assoc. 2018, 19, e271–277.e278. [Google Scholar] [CrossRef]
  38. Zasadzka, E.; Pieczyńska, A.; Trzmiel, T.; Pawlaczyk, M. Polish translation and validation of the SARC-F tool for the assessment of sarcopenia. Clin. Interv. Aging 2020, 15, 567. [Google Scholar] [CrossRef]
  39. Drey, M.; Ferrari, U.; Schraml, M.; Kemmler, W.; Schoene, D.; Franke, A.; Freiberger, E.; Kob, R.; Sieber, C. German version of SARC-F: Translation, adaption, and validation. J. Am. Med. Dir. Assoc. 2020, 21, 747–751.e741. [Google Scholar] [CrossRef]
  40. Gasparik, A.; Demián, M.; Pascanu, I. Romanian Translation and Validation of the SARC-F Questionnaire. Acta Endocrinol. 2020, 16, 216. [Google Scholar] [CrossRef]
  41. Gade, J.; Beck, A.M.; Rønholt, F.; Andersen, H.E.; Munk, T.; Vinther, A. Validation of the Danish SARC-F in hospitalized, geriatric medical patients. J. Nutr. Health Aging 2020, 24, 1120–1127. [Google Scholar] [CrossRef]
  42. Tsekoura, M.; Billis, E.; Tsepis, E.; Lampropoulou, S.; Beaudart, C.; Bruyere, O.; Yilmaz, O.; Bahat, G.; Gliatis, J. Cross-cultural adaptation and validation of the Greek Version of the SARC-F for evaluating sarcopenia in Greek older adults. J. Musculoskelet. Neuronal Interact. 2020, 20, 505. [Google Scholar]
  43. Wu, T.-Y.; Liaw, C.-K.; Chen, F.-C.; Kuo, K.-L.; Chie, W.-C.; Yang, R.-S. Sarcopenia screened with SARC-F questionnaire is associated with quality of life and 4-year mortality. J. Am. Med. Dir. Assoc. 2016, 17, 1129–1135. [Google Scholar] [CrossRef]
  44. Malmstrom, T.K.; Miller, D.K.; Simonsick, E.M.; Ferrucci, L.; Morley, J.E. SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J. Cachexia Sarcopenia Muscle 2016, 7, 28–36. [Google Scholar] [CrossRef] [PubMed]
  45. Ida, S.; Kaneko, R.; Murata, K. SARC-F for screening of sarcopenia among older adults: A meta-analysis of screening test accuracy. J. Am. Med. Dir. Assoc. 2018, 19, 685–689. [Google Scholar] [CrossRef] [PubMed]
  46. Voelker, S.N.; Michalopoulos, N.; Maier, A.B.; Reijnierse, E.M. Reliability and concurrent validity of the SARC-F and its modified versions: A systematic review and meta-analysis. J. Am. Med. Dir. Assoc. 2021, 22, 1864–1876. e1816. [Google Scholar] [CrossRef] [PubMed]
  47. Lu, J.-L.; Ding, L.-Y.; Xu, Q.; Zhu, S.-Q.; Xu, X.-Y.; Hua, H.-X.; Chen, L.; Xu, H. Screening accuracy of SARC-F for sarcopenia in the elderly: A diagnostic meta-analysis. J. Nutr. Health Aging 2021, 25, 172–182. [Google Scholar] [CrossRef]
  48. Kera, T.; Kawai, H.; Hirano, H.; Kojima, M.; Watanabe, Y.; Motokawa, K.; Fujiwara, Y.; Osuka, Y.; Kojima, N.; Kim, H. Limitations of SARC-F in the diagnosis of sarcopenia in community-dwelling older adults. Arch. Gerontol. Geriatr. 2020, 87, 103959. [Google Scholar] [CrossRef]
  49. Yi, Y.; Baek, J.Y.; Lee, E.; Jung, H.-W.; Jang, I.-Y. A Comparative Study of High-Frequency Bioelectrical Impedance Analysis and Dual-Energy X-ray Absorptiometry for Estimating Body Composition. Life 2022, 12, 994. [Google Scholar] [CrossRef]
Ijerph 20 02711 g001a 550Ijerph 20 02711 g001b 550
Figure 1. Probability of SARC-F ≥4 points according to the 30-s arm curl test and 6-min walk test (men, black dots (top); women white dots (bottom)).
Figure 1. Probability of SARC-F ≥4 points according to the 30-s arm curl test and 6-min walk test (men, black dots (top); women white dots (bottom)).
Ijerph 20 02711 g001aIjerph 20 02711 g001b
Table
Table 1. Descriptive characteristics of the participants: mean ± standard deviation or median (interquartile range) *.
Table 1. Descriptive characteristics of the participants: mean ± standard deviation or median (interquartile range) *.
Mean ± SD
All (n = 312)Male (n = 112)Female (n = 200)p-Value
Age, years72.63 ± 7.8173.07 ± 7.3172.39 ± 8.090.458
Body Height, cm153.65 ± 8.22159.99 ± 8.26150.10 ± 5.67<0.001
Body Mass, kg63.70 ± 12.6769.29 ± 11.6160.52 ± 12.18<0.001
BMI, kg/m226.88 ± 4.6527.08 ± 4.6426.76 ± 4.650.566
SARC-F score, pts1.75 ± 1.881.43 ± 1.681.92 ± 1.950.915
SARC-F ≥ 4 pts, n (%) #56 (17.9)14 (12.5)42 (21.0)0.061
Physical Fitness
Chair Stand Test, n10.86 ± 3.2211.08 ± 3.3410.74 ± 3.150.365
Arm Curl Test, n12.56 ± 3.8313.19 ± 4.0712.22 ± 3.660.031
CSAR, cm *4.00 (11)6.00 (11)3.00 (11)0.284
BST, cm *−19.00 (21)−23.00 (18)−17.00 (23)<0.001
FUG, seg8.08 ± 2.677.43 ± 2.068.44 ± 2.89<0.001
6MWT, m407.29 ± 108.43450.76 ± 125.58382.95 ± 88.99<0.001
FAB score, pts12.44 ± 3.6613.29 ± 3.0711.97 ± 3.880.002
Notes: SD, standard deviation, BMI, body mass index; SARC-F, sarcopenia screening questionnaire; CSAR, chair sit-and-reach test; BST, back scratch test; FUG, foot up-and-go test; 6MWT, 6-min walk test; FAB, Fullerton Advanced Balance Scale. Comparison between groups using the Chi-square # or Mann–Whitey test *.
Table
Table 2. Prevalence of symptoms of sarcopenia evaluated through the SARC-F questionnaire.
Table 2. Prevalence of symptoms of sarcopenia evaluated through the SARC-F questionnaire.
Male (n = 112)Female (n = 200)
SymptomsNoneSomeA Lot, or UnableNoneSomeA Lot, or Unablep-Value
1. Lack of strength, n (%)79 (70.5)20 (17.9)13 (11.6)133 (66.5)48 (24.0)19 (9.5)0.808
2. Assistance in walking, n (%)93 (83.0)18 (16.1)1 (0.9)156 (78.0)37 (18.5)7 (3.5)0.175
3. Difficulty rising from a chair, n (%)84 (75.0)26 (23.2)2 (1.8)142 (71.0)55 (27.5)3 (1.5)0.521
4. Difficulty climbing stairs, n (%)63 (56.3)41 (36.6)8 (7.1)115 (57.5)71 (35.5)14 (7.0)0.851
5. Falls, n (%)73 (65.2)39 (34.8)0 (0.0)150 (75.0)50 (25.0)0 (0.0)0.124
Table
Table 3. Associations through logistic regression between the occurrence of significant symptoms of sarcopenia (≥4 points) based on the participants’ physical fitness.
Table 3. Associations through logistic regression between the occurrence of significant symptoms of sarcopenia (≥4 points) based on the participants’ physical fitness.
SARC-F (Score)
Male (n = 112)Female (n = 200)
Functional Fitness TestsBpOR95% CIBpOR95% CI
30-s chair stand test, n−0.2440.0140.7840.645–0.953−0.1050.0810.9000.800–1.013
30-s arm curl test, n−0.2460.0120.7820.646–0.947−0.1870.0010.8290.742–0.926
Chair sit-and-reach test, cm−0.0510.0280.9500.907–0.994−0.0070.6240.9930.964–1.022
Back scratch test, cm−0.0360.1260.9640.961–1.010−0.0310.0260.9690.943–0.996
Foot up-and-go test, seg0.1610.1821.1740.928–1.4860.1250.0241.1331.016–1.263
6-min walk test, m−0.0070.0320.9930.987–0.999−0.0080.0010.9920.988–0.997
Fullerton Advanced Balance, n−0.0840.3050.9190.783–1.079−0.0950.0260.9100.837–0.989
CST, 30 s chair stand test. ACT, 30-s arm curl test CSAR, chair sit-and-reach test. BST, back scratch test. FUG, foot up-and-go test. 6MWT, 6-min walk test. 4-MGS, m/s, 4-m gait speed; FAB, Fullerton Advanced Balance Scale. B, betas coefficients.
Table
Table 4. Associations through logistic regression between the occurrence of each sarcopenia symptom based on the participants’ physical fitness.
Table 4. Associations through logistic regression between the occurrence of each sarcopenia symptom based on the participants’ physical fitness.
Difficulty in Lifting and Carrying 4.5 kg
Male (n = 112)Female (n = 200)
PredictorβpOR95% CIβpOR95% CI
30-s chair stand test, n−0.0700.2760.9320.822–1.0580.0130.7841.0130.923–1.112
30-s arm curl test, n−0.0870.1280.9170.820–1.025−0.0300.4760.9710.895–1.053
Chair sit-and-reach test, cm0.0020.9081.0020.966–1.040−0.0150.2570.9850.960–1.011
Back scratch test, cm0.0010.9251.0010.975–1.0280.0220.0461.0221.000–1.044
8-foot up-and-go test, seg0.0390.6891.0400.857–1.262−0.0230.6690.9780.882–1.084
6-min walk test, m−0.0020.1950.9980.994–1.001−0.0010.4410.9990.995–1.002
Fullerton Advanced Balance Scale, n−0.0690.2910.9340.822–1.0610.0460.2581.0470.967–1.132
Difficulty in Walking Across a Room
Male (n = 112)Female (n = 200)
PredictorβpOR95% CIβpOR95% CI
30-s chair stand test, n0.0080.9111.0080.870–1.169-0.0370.5040.9640.864–1.074
30-s arm curl test, n−0.0660.3360.9360.819–1.070−0.0250.5930.9750.889–1.070
Chair sit-and-reach test, cm0.0050.8151.0050.961–1.052−0.0250.0980.9750.947–1.005
Back scratch test, cm−0.0240.2150.9770.941–1.0140.0150.2181.0150.991–1.039
8-foot up-and-go test, seg−0.0150.9040.9850.772–1.2570.0120.8371.0120.903–1.134
6-min walk test, m0.0010.9561.0000.996–1.0040.0010.7301.0010.997–1.004
Fullerton Advanced Balance Scale, n−0.0360.6450.9650.828–1.1240.0330.4671.0340.945–1.131
Difficulty in Transferring from a Chair or Bed
Male (n = 112)Female (n = 200)
PredictorβpOR95% CIβpOR95% CI
30 s chair stand test, n−0.0310.6350.6960.851–1.103−0.0980.0650.9070.817–1.006
30 s arm curl test, n−0.0120.8190.9880.887–1.099−0.1010.0270.9040.827–0.989
Chair sit-and-reach test, cm0.0070.7281.0070.968–1.047−0.0220.1090.9780.952–1.005
Back scratch test, cm−0.0160.2990.9840.955–1.0140.0180.1031.0180.996–1.041
8-foot up-and-go test, seg−0.0900.4350.9140.729–1.1460.0130.8081.0130.913–1.125
6-min walk test, m−0.0010.6550.9990.996–1.003−0.0010.6720.9990.996–1.003
Fullerton Advanced Balance Scale, n0.0860.2971.0900927–1.2800.0490.2451.0500.967–1.141
Difficulty in Climbing a Flight of 10 Stairs
Male (n = 112)Female (n = 200)
PredictorβpOR95% CIβpOR95% CI
30-s chair stand test, n−0.0230.9620.9770.873–1.094−0.0360.4280.9640.881–1.055
30-s arm curl test, n−0.0500.3010.9510.864–1.046−0.0030.9290.9970.923–1.076
Chair sit-and-reach test, cm−0.0140.4140.9860.953–1.0200.0070.5811.0070.983–1.032
Back scratch test, cm0.0020.8411.0020.978–1.0270.0180.0911.0180.997–1.039
8-foot up-and-go test, seg0.0050.9571.0050.838–1.2050.0050.9171.0050.912–1.107
6-min walk test, m−0.0010.3940.9990.996–1.0020.0010.8681.0000.997–1.003
Fullerton Advanced Balance Scale, n−0.0840.1880.9190.811–1.0420.0290.4391.0290.957–1.108
Falls in the Past Year
Male (n = 112)Female (n = 200)
PredictorβpOR95% CIβpOR95% CI
30-s chair stand test, n0.0490.4111.0510.934–1.1820.0610.2301.0630.962–1.175
30-s arm curl test, n−0.0430.3990.9580.867–1.0590.0010.9911.0000.917–1.092
Chair sit-and-reach test, cm0.0160.3741.0170.980–1.0540.0160.2761.0160.988–1.044
Back scratch test, cm−0.0120.3710.9880.962–1.015−0.0190.1270.9810.958–1.005
8-foot up-and-go test, seg−0.0760.4530.9270.759–1.1310.0320.5641.0320.927–1.149
6-min walk test, m0.0010.7861.0000.996–1.003−0.0020.2450.9980.994–1.002
Fullerton Advanced Balance Scale, n0.0330.6261.0330.906–1.1790.0140.0430.1070.933–1.103
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Lima, A.B.d.; Baptista, F.; Henrinques-Neto, D.; Pinto, A.d.A.; Gouveia, E.R. Symptoms of Sarcopenia and Physical Fitness through the Senior Fitness Test. Int. J. Environ. Res. Public Health 2023, 20, 2711. https://doi.org/10.3390/ijerph20032711

AMA Style

Lima ABd, Baptista F, Henrinques-Neto D, Pinto AdA, Gouveia ER. Symptoms of Sarcopenia and Physical Fitness through the Senior Fitness Test. International Journal of Environmental Research and Public Health. 2023; 20(3):2711. https://doi.org/10.3390/ijerph20032711

Chicago/Turabian Style

Lima, Alex Barreto de, Fátima Baptista, Duarte Henrinques-Neto, André de Araújo Pinto, and Elvio Rúbio Gouveia. 2023. "Symptoms of Sarcopenia and Physical Fitness through the Senior Fitness Test" International Journal of Environmental Research and Public Health 20, no. 3: 2711. https://doi.org/10.3390/ijerph20032711

APA Style

Lima, A. B. d., Baptista, F., Henrinques-Neto, D., Pinto, A. d. A., & Gouveia, E. R. (2023). Symptoms of Sarcopenia and Physical Fitness through the Senior Fitness Test. International Journal of Environmental Research and Public Health, 20(3), 2711. https://doi.org/10.3390/ijerph20032711

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop