Experimental Gerontology 145 (2021) 111213

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Experimental Gerontology
journal homepage: www.elsevier.com/locate/expgero

Sit-to-stand muscle power test: Comparison between estimated and force

plate-derived mechanical power and their association with physical
function in older adults
Ivan Baltasar-Fernandez a, b, Julian Alcazar a, b, Carlos Rodriguez-Lopez a, b, José Losa-Reyna a, b, c,
María Alonso-Seco c, Ignacio Ara a, b, Luis M. Alegre a, b, *
a
GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain
b
CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
c
Division of Geriatric Medicine, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain

A R T I C L E I N F O A B S T R A C T

Section Editor: Christiaan Leeuwenburgh Objectives: This study aimed i) to assess the assumptions made in the sit-to-stand (STS) muscle power test [body
mass accelerated during the ascending phase (90% of total body mass), leg length (50% of total body height) and
Keywords: concentric phase (50% of total STS time)], ii) to compare force plate-derived (FPD) STS power values with those
Sit-to-stand muscle power test derived from the STS muscle power test; and iii) to analyze the relationships of both measurements with physical
Mechanical power
function.
Physical function
Material and methods: Fifty community-dwelling older adults (71.3 ± 4.4 years) participated in the present
investigation. FPD STS power was calculated as the product of measured force (force platform) and velocity
[difference between leg length (DXA scan) and chair height, divided by time (obtained from FPD data and video
analysis)], and compared to estimated STS power using the STS muscle power test. Physical function was
assessed by the timed-up-and-go (TUG) velocity, habitual gait speed (HGS) and maximal gait speed (MGS).
Paired t-tests, Bland-Altman plots and regressions analyses were conducted.
Results: Body mass accelerated during the STS phase was 85.1 ± 3.8% (p < 0.05; compared to assumed 90%), leg
length was 50.7 ± 1.3% of body height (p < 0.05; compared to 50%), and measured concentric time was 50.3 ±
4.6% of one STS repetition (p > 0.05; compared to assumed 50%). There were no significant differences between
FPD and estimated STS power values (mean difference [95% CI] = 6.4 W [− 68.5 to 81.6 W]; p = 0.251). Both
FPD and estimated relative (i.e. normalized to body mass) STS power were significantly related to each other (r
= 0.95 and ICC = 0.95; p < 0.05) and to MGS and TUG velocity after adjusting for age and sex (p < 0.05).
Conclusions: Estimated STS power was not different from FPD STS power and both measures were strongly
related to each other and to maximal physical performance.

1. Introduction
Human life expectancy has increased at a rapid rate in recent de­
cades; however the number of years lived with poor health due to
mobility limitations has also increased considerably (Coute et al., 2019).
In the current scenario, promoting healthy aging has become not only a
necessity, but also a challenge for health care systems (Kontis et al.,
2017). Approximately 25% of adults aged 65 years and older have
mobility limitations (Guralnik et al., 1995), which have been strongly
related to an increased risk of falls, health care utilization and mortality
(Landi et al., 2010; Musich et al., 2018). Therefore, knowledge of the
specific factors that mediate impairments in physical functioning is
crucial for developing effective interventions that preserve mobility and
future independence among older adults (Reid and Fielding, 2012).
Mechanical power has been demonstrated to decline earlier and
faster than muscle strength (Lauretani et al., 2003) as well as to predict
functional performance and functional independence in older adults
(Bean et al., 2003; Suzuki et al., 2001). However, assessing mechanical

* Corresponding author at: Universidad de Castilla-La Mancha, Avda. Carlos III, S/N, 45071 Toledo, Spain.
E-mail addresses: Ivan.Baltasar@uclm.es (I. Baltasar-Fernandez), Julian.Alcazar@uclm.es (J. Alcazar), Carlos.RLopez@uclm.es (C. Rodriguez-Lopez), Jose.Losa@
uclm.es (J. Losa-Reyna), marialonsoseco@gmail.com (M. Alonso-Seco), Ignacio.Ara@uclm.es (I. Ara), Luis.Alegre@uclm.es (L.M. Alegre).

https://doi.org/10.1016/j.exger.2020.111213
Received 15 September 2020; Received in revised form 25 November 2020; Accepted 13 December 2020
Available online 21 December 2020
0531-5565/© 2020 Elsevier Inc. All rights reserved.
I. Baltasar-Fernandez et al.
power in older people is not always an easy task. For example, several
investigations have evaluated mechanical power during the sit-to-stand
(STS) task with using force platforms (Lindemann et al., 2003; Regter­
schot et al., 2016; Chorin et al., 2016; Lindemann et al., 2007; Alvarez
Barbosa et al., 2016), linear position transducers (LPT) (Alvarez Barbosa
et al., 2016; Glenn et al., 2015; Fleming et al., 1991; Glenn et al., 2017;
Lindemann et al., 2015; Lindemann et al., 2016) or 3D accelerometers
(Regterschot et al., 2016; Millor et al., 2020). Unfortunately, these in­
struments can be expensive and may need periodic calibrations, tech­
nical support or offline data analysis, which can prevent clinicians and
other health professionals from assessing mechanical power (Alcazar
et al., 2018a). In contrast, a novel equation used during the so called STS
muscle power test has been recently demonstrated to be valid and
feasible to assess mechanical power in older people in the clinical and
other health-related settings (Alcazar et al., 2018b). Briefly, this test uses
the anthropometric characteristics of the subjects and some basic
biomechanical principles to estimate mean concentric (ascending phase
of the STS task) mechanical power from the performance achieved in the
traditional STS test. Thus, its feasibility is based on three assumptions
that contribute to its easy and rapid administration: 1) the participant’s
leg length is half the total body height, 2) the percentage of body mass
that is displaced during the concentric phase is 90% of total body mass,
and 3) the concentric time is half one STS repetition’s duration. It should
be noted that the validity of the STS muscle power estimate was similar
(r = 0.72–0.75) (Alcazar et al., 2018b; Alcazar et al., 2020) to that
shown between other accepted procedures and instruments (one STS
repetition power vs. Nottingham power rig-derived power (Lindemann
et al., 2003; Lindemann et al., 2015); and computerized leg press vs.
Nottingham power rig-derived power (Thomas et al., 1996); all r = 0.57
to 0.65). Therefore, this may suggest that the assumptions made in the
STS muscle power test are acceptable. However, these assumptions have
not been investigated in highly functioning older adults. Furthermore,
the power values derived from the STS muscle power test have not yet
been compared to force plate-derived (FPD) power values recorded
during the STS task. In addition, the relationship of both procedures
with physical function has never been assessed.
Therefore, the main goals of the present investigation were: 1) to
assess the accuracy of the assumptions made in the STS muscle power
test; 2) to compare FPD STS power with that derived from the STS
muscle power test; and 3) to compare the relationships of FPD and
estimated relative STS power with functional outcomes. We hypothe­
sized that no differences would exist between the assumptions and
measured data; no significant differences would exist between FPD and
estimated STS power; and both power measures would be similarly
associated with physical performance in older adults.
2. Material and methods
2.1. Participants
Fifty community-dwelling older adults (27 women and 23 men)
Table 1
Main characteristics of the study participants.
Variable Men (n = 21) Women (n = 27)
Mean ± SD Range Mean ± SD Range
Age (years) 72.3 ± 4.0 66.4–83.1 70.4 ± 4.6 65.1–80.6
BMI (kg∙m− 2) 30.3 ± 5.5 23.7–43.4 27.9 ± 6.1 17.5–47.9
HGS (m∙s− 1) 1.2 ± 0.3 0.8–2.0 1.2 ± 0.2 0.9–1.5
MGS (m∙s− 1) 2.2 ± 0.4 1.3–3.1 1.9 ± 0.3 1.2–2.3
5-STS time (s) 8.7 ± 2.5 5.3–13.6 8.6 ± 1.8 5.4–13.8
SPPB score (pts) 11.8 ± 0.5 10–12 11.8 ± 0.5 10–12
TUG velocity (m∙s− 1) 1.1 ± 0.2 0.6–1.4 1.0 ± 0.2 0.6–1.2
SD: standard deviation; BMI: body mass index; HGS: habitual gait speed; 5-STS:
five repetition sit-to-stand test; SPPB: short physical performance battery; MGS:
maximal gait speed; TUG: timed-up-and-go.
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Experimental Gerontology 145 (2021) 111213
participated in the present investigation (Table 1). The participants were
recruited through advertisements and community newsletters. Older
subjects (>65 years old) with a short physical performance battery
(SPPB) (Guralnik et al., 1994) score ≤7, neurological, musculoskeletal
or other disorders, knee prosthesis, uncontrolled hypertension, angina
pectoris or myocardial ischemia were excluded (Fig. 1). Participants
were also excluded if they had suffered from other medical conditions
that would interfere with testing or increase the risk of complications
and if they had performed regular resistance exercise within the previ­
ous three years (Fig. 1). The study protocol was registered at https://
clinicaltrials.gov/ (NCT03724461, October 30th, 2018) and approved
by the Clinical Research Ethics Committee of the Toledo Hospital
Complex [no. 10 (February 25, 2017)]. All the subjects gave their
informed consent and the study was performed in accordance with the
Helsinki Declaration.
2.2. Anthropometric measurements
Standard anthropometric assessment (height and body mass) was
conducted with a stadiometer and scale device (Seca 711, Hamburg,
Germany). Body mass index was calculated as body mass divided by
height2 (kg∙m− 2). Leg length (m) (distance between the superior border
of the greater trochanter and the inferior border of the calcaneus bone)
was measured from whole body scans obtained by dual energy X-ray
absorptiometry (DXA) (Hologic, Serie Discovery QDR, Bedford, USA)
and analyzed with specific image analysis software (ImageJ 1.52, Na­
tional Institutes of Health, USA).
2.3. Physical function measurements
The SPPB (Guralnik et al., 1994) included standing balance, habitual
gait speed (HGS) over a 4-m walking course, and the ability to rise and
stand from a chair five times. Then, maximum gait speed (MGS) was
measured with the 30-m walk test (Andersson et al., 2011). MGS was
calculated by dividing the distance covered by the recorded time.
Finally, the participant performed the timed-up-and-go (TUG) test
(Podsiadlo and Richardson, 1991), which consisted of rising from a
standard armless chair, walking to a line on the floor 3 m away, turning
180◦ , returning, and sitting down again as fast as possible. TUG velocity
was calculated by dividing the distance covered by the recorded time.
The participants were familiarized with all the functional tests through
verbal explanation, demonstration and performance of a sub-maximum
attempt. Tests were then performed three times with 1 min of rest be­
tween trials. All physical function measurements were assessed using a
stopwatch to the nearest 0.01 s. Finally, the best result of the three at­
tempts was selected and included in the analyses.
2.4. STS assessment
The five-repetition STS test measured the time spent in completing
five STS repetitions on a standardized armless chair (0.465 m). Firstly,
all the subjects performed 1 or 2 trials to become familiar with the test
and technique. The subjects were in the sitting position with a neutral
spine and arms crossed over the chest (Fig. 3A). Then, they were
instructed and verbally encouraged to perform five STS repetitions
(rising to a full standing position and return to the original sitting po­
sition) “as rapidly as possible” after the cue “ready, set, go!” (Fig. 3B and
C). All the subjects were instructed to safely position themselves on the
edge of the chair to standardize the starting position (Fig. 3A). Time was
recorded with a stopwatch to the nearest 0.01 s from the “go!” signal to
the instant when the subjects sat on the chair after the fifth repetition.
Those attempts in which the participants did not reach the full standing
position or did not touch the chair with their buttocks between repeti­
tions were discarded. Three correct attempts were finally recorded with
a resting period of 60 s between attempts and the best result of the three
attempts was selected and included in the analyses. Four out of fifty
I. Baltasar-Fernandez et al.
Fig. 1. Flow chart of study participants.
participants had to perform 4 attempts because 1 out of 3 attempts were
incorrect. The results of two participants were discarded from the final
analysis because their attempts were declared inadequate during pos­
terior offline (video) analysis according to the above-mentioned criteria.
Then, mechanical STS power was calculated according to the equations
shown in Fig. 2.
2.4.1. FPD STS power assessment
Mean concentric STS power was calculated as the product of
measured mean concentric STS force and velocity (Fig. 2). To asses mean
concentric STS force, a force platform (Type 9286BA, Kistler,
Switzerland) was positioned under the feet of the participants during the
STS task, thus vertical ground reaction force (z axis) exerted during the
Fig. 2. Calculation of force plate-derived and estimated mechanical power
during the sit-to-stand test. Note: FP, force plate. h, height. t, time. BM, body
mass. g, gravity (i.e. 9.81 m⋅s− 2). STS, sit-to-stand. n STS reps, number of rep­
etitions completed in the sit-to-stand test.
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Experimental Gerontology 145 (2021) 111213
STS task was obtained at a sampling rate of 1500 Hz (Fig. 3D). A video
camera (HD Pro Webcam C920 1080p, 30 Hz, Logitech, Switzerland)
was synchronized with the force plate data to visually ensure the correct
identification of the concentric and eccentric phases of the exercise
using specialized software (MyoResearch 3.10, Noraxon, USA). In
addition, mean concentric STS velocity was calculated as the ratio be­
tween the travelled vertical movement (m) and the duration (s) of the
concentric phase. Vertical movement was calculated as DXA scan-
derived leg length minus the height of the chair from the top of the
force plate (0.43 m). Finally, the proportion of body mass that was
accelerated during the STS phase was calculated as the ratio between
mean concentric STS force and the force exerted by the subject in a
standing position on the force platform.
2.4.2. STS muscle power test
Estimated mean concentric STS power was obtained using the
equation validated in Alcazar et al. (2018b). With this procedure, mean
concentric STS force (N) is estimated by assuming that 90% of body mass
is accelerated during the STS task. In addition, vertical movement is
estimated by assuming that leg length is half the total body height and
that the concentric phase of the timed STS test takes half the total
duration of the test.
A comparative and detailed description of estimated mean concen­
tric STS power calculations is shown in Fig. 2.
2.5. Statistical analysis
All data were examined for normality of distribution with the
Shapiro-Wilk test. Standard descriptive statistics were used for contin­
uous variables. Differences between assumed and measured proportion
of body mass accelerated during the concentric phase, leg length relative
to total height and concentric time relative to total STS time were
assessed with paired Student’s t-tests. Differences between FPD and
I. Baltasar-Fernandez et al.
Fig. 3. Sit-to-stand and stand-to-sit complete analysis of the first repetition. The
participant is in the sitting position with a neutral spine and arms crossed over
the chest in A (starting position). There is a forward leaning of the trunk from A
to B (onset of the concentric phase). From B to C (end of the concentric phase),
the participant transfers body weight to legs (momentum transfer’s event) and
exerts force with the aim of extending the ankle, knee and hip joints (exten­
sion’s event). In D, dashed lines represent non-analyzed data which correspond
to the weight of the legs at rest and the forward movement onset. The thick line
represents the mean values of percentage of the body mass displaced at each
percentage of total time of the first repetition. The gray area represents the
standard deviation. Dotted lines indicate the onset and the end of the concentric
and eccentric phases.
estimated STS force, velocity and power values were also assessed with
paired Student’s t-tests. Moreover, Cohen’s d effect sizes (ES) and 95%
confidence intervals (CI) were calculated and categorized as trivial
(<0.2), small (0.2–0.6), moderate (0.6–1.2) and large (>1.2) (Hopkins
et al., 2009). Pearson’s correlation (r) and intra-class correlation coef­
ficient (ICC) were used to assess the relationship between FPD and
estimated STS power. In addition, Bland-Altman plotting was used to
assess the level of agreement between FPD and estimated STS power.
Finally, as lower-limb power normalized to body mass has been
considered a stronger predictor of low physical function than absolute
power (Alcazar et al., 2018b; Hong et al., 2018), unadjusted linear
regression analyses and adjusted by age, and by age and sex, were
performed to compare the relationships of FPD and estimated relative
(both normalized to body mass) STS power values with physical function
parameters. In addition, differences in beta coefficients were assessed by
comparison of 95% confidence intervals in order to examine if the re­
lationships of FPD and estimated relative STS power with physical
function were statistically different. All statistical analyses were per­
formed using SPSS v23 (SPSS Inc., Chicago, Illinois, USA) and the
4
Experimental Gerontology 145 (2021) 111213
significance level was set at α = 0.05.
3. Results
In terms of the assessment of the 3 assumptions made in the esti­
mation equation (Fig. 4), the force plate-measured proportion of the
total body mass accelerated during the STS phase was 85.1 ± 3.8%,
which was significantly different from that of the equation (90% of body
mass) (p < 0.001). In addition, the DXA scan-measured leg length in
proportion to total body height was 50.7 ± 1.3%, which was signifi­
cantly different from that of the eq. (50% of body height) (p < 0.001).
Finally, no significant differences existed between the measured dura­
tion of the concentric phase in proportion to total test duration (50.3 ±
4.6%) when compared to the assumption made in the estimation eq.
(50% of total duration test) (p = 0.657). There were significant differ­
ences between force-plate derived and estimated STS force (655.3 ±
145.3 N vs. 695.3 ± 164.8 N; p < 0.001; ES [95% CI] = 0.26 [0.19,
0.32]) and velocity (0.52 ± 0.11 m∙s− 1 vs. 0.48 ± 0.12 m∙s− 1; p <
0.001; ES [95% CI] = 0.27 [0.13, 0.42]), while no significant differences
were found between FPD and estimated STS power values (339.0 ±
113.0 W vs. 332.6 ± 120.0 W; p = 0.251; ES [95% CI] = 0.05 [− 0.04,
0.15]) (Table 2).
There was a significant relationship between FPD and estimated STS
power (r = 0.95 and ICC = 0.95; both p < 0.001) (Fig. 5). The Bland-
Altman analysis demonstrated no significant bias between measured
and estimated STS power (mean [95% CI] = 6.4 W [− 68.5 to 81.3 W])
and no significant association between the difference and the average of
both measures (r = 0.04; p = 0.793) (Fig. 6).
The unadjusted linear regression analysis showed a significant as­
sociation between FPD relative STS power and HGS, MGS and TUG
velocity, as well as between estimated relative STS power and MGS and
TUG velocity (all p < 0.05) (Table 3). Neither FPD nor estimated relative
STS power were associated with HGS when adjusting for age or age and
sex (p > 0.05). In contrast, both FPD and estimated relative STS power
were significantly (p < 0.01) and similarly (p > 0.05) associated with
MGS and TUG velocity after adjusting for either age or age and sex
Fig. 4. Mean and standard deviation values of the variables assumed by the
estimation equation of Alcazar et al. The proportion of body mass that was
accelerated during the STS phase was calculated as the ratio between mean
concentric STS force and the force exerted by the subject in a stabilized standing
position on the force platform. Leg length relative to body height was measured
from whole body scans obtained by dual energy X-ray absorptiometry.
Concentric phase time relative to total test duration was assessed with video
analysis and force plate data synchronization.
I. Baltasar-Fernandez et al. Experimental Gerontology 145 (2021) 111213

Table 2 (Table 3).

Comparison between force plate-derived and estimated mean STS force, velocity
and power values. 4. Discussion
Variable Force plate- Estimated p value ES (95% CI)
derived The results of this study demonstrated that FPD STS power values
Force (N) 655.3 ± 145.3 695.3 ± <0.001 0.26 (0.19, were not different from estimated STS power values, showing a good
164.8 0.32) agreement level between both measurements. Moreover, the assump­
Velocity 0.52 ± 0.11 0.48 ± 0.12 <0.001 0.27 (0.13, tions made by the estimation equation (Alcazar et al., 2018b) were
(m∙s− 1) 0.42)
tested, emphasizing that measured body mass displaced during the
Power (W) 339.0 ± 113.0 332.6 ± 0.251 0.05 (− 0.04,
120.0 0.15) concentric phase and measured leg length were different (85 vs. 90%,
and 51 vs. 50%, respectively), while concentric time relative to total
ES: effect size; CI: confidence interval.
time was similar (50 vs. 50%, respectively). In addition, both FPD and
estimated relative STS power were independently related to physical
function measures after adjusting for age and sex.
In the current literature, there are other equations to estimate STS
power which are slightly different from the one included in this inves­
tigation. In this sense, Takai et al. (2009) proposed an equation to
calculate STS power using the subject’s body mass, measured leg length
and chair height. Their equation assumes 100% total body mass is
accelerated during the STS test and it does not differentiate between the
concentric and eccentric phases; therefore the result might be consid­
ered as an underestimation of STS power due to incorporating both the
concentric and eccentric phases. In any case, Takai’s equation has never
been validated against a valid measure of muscle power. On the other
hand, Alcazar’s equation (Alcazar et al., 2018b) assumes that 90% of the
body mass is accelerated during the STS task, which is based on the
premise that shanks and feet mass are not accelerated during the ascend
phase. The current study conducted in older adults observed that this
percentage was 85% of body mass instead of 90%. No previous in­
vestigations have studied the proportion of the total body mass that is
accelerated during the concentric phase of the STS task. However,
Chorin et al. (2012) and Chen et al. (2012) found that peak ground re­
action forces reached values equivalent to 135% and 126% of body
Fig. 5. Relationship between force plate-derived STS power and estimated STS mass, respectively. These peak percentages are similar to the peak per­
power in men (circles) and women (triangles) together. By separate, the Pear­ centages found in our study (127%). In the case that the proportional
son’s r values were 0.91 in men and 0.92 in women (both p < 0.05). STS: sit- relation between peak and mean values noted in our study were the
to-stand. same as in the aforementioned studies, their mean percentages would
have been 90% and 85% of the total body mass, respectively, which is
similar to the assumption made in the STS power test and to the results
of the present study, respectively.
For the purpose of estimating the vertical distance travelled by the
participant during the STS task, Alcazar’s equation (Alcazar et al.,
2018b) assumes that leg length is 50% of body height based on DXA
measurements, which albeit showing significant differences, was rela­
tively confirmed looking at the measured values presented in the current
study (51% of body height). Nevertheless, there is some disagreement in
the literature regarding the most adequate approach to evaluate this
parameter, since other authors suggest extracting the vertical displace­
ment from the difference in height between the sitting and standing
positions (Lindemann et al., 2003) or by measuring femur length (Ruiz-
Cardenas et al., 2018). In this regard, further research is needed to
compare the different mentioned methods with ‘gold standard’ tech­
niques of kinematic analysis.
In regard to the duration of the concentric phase of the STS task,
Alcazar’s equation (Alcazar et al., 2018b) estimates this parameter as
50% of the total STS test duration, showing excellent agreement with the
data measured in this investigation (namely 50.3%). Recently, Van Roie
et al. (2019) reported that the concentric phase lasted 52% of the total
Fig. 6. Bland-Altman plot for mechanical power values obtained from the force STS task time, which is in accordance with our results.
platform and the estimated STS power in men (circles) and women (triangles) Importantly, although two out of three assumptions were statistically
together. The mean difference was 0.9 W in men and 10.9 W in women (both p different from the measured variables, these differences may perhaps be
> 0.05). FP: force plate; STS: sit-to-stand; SD: standard deviation. considered not clinically relevant (0.7% or 0.02 m in terms of leg length
and 4.9% or 3.8 kg in terms of body mass) given that resulting differ­
ences in mechanical power (6.4 W) were not statistically (p = 0.251),
practically (ES = 0.05) or clinically (<18.3 W (Kirn et al. 2016) and
<28.4 W (Alcazar et al. 2018b)) significant.

5
I. Baltasar-Fernandez et al. Experimental Gerontology 145 (2021) 111213

Table 3
Associations of FPD relative STS power and estimated relative STS power with each physical performance measure by separate.
FPD relative STS power Estimated relative STS power
2
Std.β p Model R (95% CI) p Std.β p Model R2 (95% CI) p

Unadjusted
HGS (m∙s− 1) 0.28 0.058 0.08 (− 0.06, 0.22) 0.058 0.21 0.163 0.04 (− 0.06, 0.15) 0.163
MGS (m∙s− 1) 0.65 <0.001 0.42 (0.22, 0.62) <0.001 0.59 <0.001 0.35 (0.14, 0.56) <0.001
TUG velocity (m∙s− 1) 0.64 <0.001 0.41 (0.20, 0.61) <0.001 0.59 <0.001 0.35 (0.14, 0.55) <0.001

Adjusted for age

HGS (m∙s− 1) 0.25 0.148 0.08 (− 0.06, 0.22) 0.159 0.11 0.527 0.07 (− 0.06, 0.20) 0.207
MGS (m∙s-1) 0.65 <0.001 0.42 (0.22, 0.62) <0.001 0.56 <0.001 0.36 (0.15, 0.56) <0.001
TUG velocity (m∙s− 1) 0.64 <0.001 0.41 (0.21, 0.61) <0.001 0.56 <0.001 0.35 (0.15, 0.55) <0.001

Adjusted for age and sex

HGS (m∙s− 1) 0.10 0.579 0.22 (0.03, 0.41) 0.015 0.01 0.974 0.30 (0.10, 0.50) 0.002
MGS (m∙s− 1) 0.57 <0.001 0.44 (0.24, 0.63) <0.001 0.41 0.006 0.41 (0.22, 0.61) <0.001
TUG velocity (m∙s− 1) 0.56 <0.001 0.47 (0.28, 0.65) <0.001 0.45 0.001 0.47 (0.55, 0.82) <0.001

Note: the associations between relative power and each physical performance variable were assessed separately. FP: force plate; Std: standardized; STS: sit-to-stand;
HGS: habitual gait speed; MGS: maximal gait speed; TUG: timed-up-and-go. Bold values represent a statistically significant result (p < 0.05).

Consequently, the findings of the present investigation suggest that
Alcazar’s equation is not adequate for discerning between the force and
velocity components, but it is a valid equation to calculate mechanical
STS power per se. Despite these discrepancies between the above-
mentioned assumptions and measured data, estimated STS power
derived from the STS muscle power test equation (Alcazar et al., 2018b)
was proved to be a valid measure of mechanical power in older adults
according to the lack of meaningful differences (ES = 0.05 or trivial) and
the excellent correlation with FPD data (r = 0.95 and ICC = 0.95). This
relation was stronger than that observed between the STS power
measured with linear position transducer and Nottingham power rig (r
= 0.65) (Lindemann et al., 2015), and that observed between STS power
(measured with force platform and taking into account the difference
between the standing and sitting height) and Nottingham power rig-
derived power (r = 0.60) (Lindemann et al., 2003). Moreover, this
relation was also stronger than that observed between estimated STS
power and leg power obtained with the Nottingham power rig (r = 0.75)
(Alcazar et al., 2020) or with linear position transducers (r = 0.72)
(Alcazar et al., 2018b). Furthermore, both FPD and estimated relative
STS power were significantly and independently associated with MGS
and TUG velocity after adjusting for age and sex. Of note, the association
was higher but not statistically significant (p > 0.05) for FPD data
regarding MGS and TUG velocity. This is of great relevance since both
TUG velocity and MGS have been suggested as important predictors of
disability (Donoghue et al., 2014; Artaud et al., 2015) and mortality
(Bergland et al., 2017; Laukkanen et al., 1995) among community-
dwelling older adults. Besides, this association between relative power
and MGS and TUG velocity has been recently described and supported
by novel investigations (Alcazar et al., 2020; Parsons et al., 2020).
Surprisingly, we did not observe a significant association between
either FPD or estimated relative STS power and HGS after adjusting for
age and sex. In comparison, Glenn et al. (2017) and Lindemann et al.
(2016) found a significant relationship between STS power and MGS but
not HGS. In our case, the lack of association could be due to the well-
known curvilinear relationship between muscle function and physical
function (Alcazar et al., 2018b; Bean et al., 2002) and to the fact that our
participants were in general well-functioning older adults (SPPB ≥ 10)
that presented relatively high values of HGS (on average 1.2 m⋅s− 1).
Thus, more demanding physical tasks, such as the MGS and TUG test, are
likely more suitable for differentiating among the physical functions of
well-functioning older people.
Among the limitations of the current investigation, a kinematic
analysis with higher time resolution would have been required to ach­
ieve a more accurate evaluation of vertical displacement during the STS
test. Nevertheless, vertical displacement can also be obtained from the
difference between chair height and leg length, indicating the starting
and final vertical position of the hip, respectively. In this respect, leg
length was assessed as precisely as possible by analyzing whole body
scans obtained by DXA and using specific image analysis software.
Further studies comparing time-related changes in FPD and esti­
mated mechanical power values would help to expand the results pre­
sented in this investigation. Additionally, the development of sensors or
mobile applications that are capable of assessing STS power and/or
physical function to assist in the rapid and accurate implementation of
these tests could be a major advance for future studies (Van Roie et al.,
2019; Fudickar et al., 2020).
Finally, it has been recently reported that although muscle power is
superior to other measures such as muscle mass and strength (i.e. sar­
copenia) in terms of its contribution to physical function, its assessment
is still rarely conducted in the clinical setting due to limitations related
to the equipment and time needed for its assessment (Beaudart et al.,
2019). Importantly, we should highlight the easy adaptability of the STS
methodology to different versions of the STS test. However, it is also
important to note that different versions of the STS test may be not
interchangeable, since that the shortest versions (5-rep STS and 30-s
STS) are a reflection of the anaerobic power while the longer versions
(1-minute STS and 3-minute STS) could be a better reflection of the
participant’s aerobic power (Butcher et al., 2012; Zanini et al., 2015). In
addition, time-based STS versions may be more advantageous than
repetition-based STS versions for assessing mechanical power of older
people with higher levels of frailty, who in many cases, are unable to
stand up from the chair five times. To conclude, we should emphasize
the potential of the STS muscle power test (Alcazar et al., 2018b) as a
clinical tool to assess muscle power in older people, overcoming the
time- and resource-related limitations imposed by other procedures and
instruments.
5. Conclusion
FPD STS power was not different from estimated STS power obtained
with the STS muscle power test, and both measures were strongly
related to each other, even in the presence of some discrepancies
regarding the assumptions made in the estimation equation. In addition,
both FPD and estimated relative STS power values were similarly related
to physical function measures in well-functioning older adults.
Funding
This work was supported by the Ministry of Economy and Compet­
itiveness of the Government of Spain Ministerio de Economía (DEP2015-
69386-R) (MINECO/FEDER, EU), by the Biomedical Research
Networking Center on Frailty and Healthy Aging (CIBERFES) and

6
I. Baltasar-Fernandez et al.
FEDER funds from the European Union (CB16/10/00477 and CB16/10/
00456), and by the Ministry of Education and Science of the Govern­
ment of Spain (Red EXERNET DEP2005-00046). Ivan Baltasar-
Fernandez and Carlos Rodriguez-Lopez were partially supported by a
pre-doctoral grant from the Universidad de Castilla-La Mancha, I+D+i
own plan (2018-CPUCLM-7636) and by the Ministry of Economy and
Competitiveness of the Government of Spain (BES-2016-077199).
CRediT authorship contribution statement
IBF helped to the assessment, performed the data analysis and
interpretation, performed the statistical analysis and draft de manu­
script. JAC participated in the study design, helped to the assessment,
helped to data analysis and interpretation and helped to draft the
manuscript. CRL participated in the study design, carried out the
assessment and helped to draft the manuscript. JLR participated in the
study coordination, helped to data analysis and interpretation and hel­
ped to draft the manuscript. MAS performed the screening test of the
study, helped to the assessment and helped to draft the manuscript. IA
participated in the study coordination, helped to data analysis and
interpretation and helped to draft the manuscript. LMA conceived of the
study, participated in its design and coordination and helped to draft the
manuscript.
All authors have read and approved the final version of the manu­
script and agree with its order of presentation.
Declaration of competing interest
The authors declare no conflict of interest.
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