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Two-Minute Step Test of Exercise Capacity: Systematic Review of

Procedures, Performance, and Clinimetric Properties

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DOI: 10.1519/JPT.0000000000000164

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 Systematic Reviews
Two-Minute Step Test of Exercise Capacity:
Systematic Review of Procedures, Performance,
and Clinimetric Properties
Richard W. Bohannon, PT, DPT, EdD, NCS; Rebecca H. Crouch, PT, DPT, CCS

ABSTRACT INTRODUCTION
Background and Purpose: The 2-minute step test (TMST) is Aerobic exercise capacity is a fundamental component of
one of many alternatives for measuring exercise capacity. physical fitness. As such, aerobic exercise capacity is often
First introduced in 1999 as part of the Senior Fitness Test, measured in healthy and diseased populations. Treadmills
the TMST has the advantage of requiring limited space, only
a few minutes’ time, and no expensive equipment. These
and cycle ergometers can be used to measure exercise
advantages notwithstanding, the test must be clinimetrically capacity, but the devices are not always available outside
sound if it is to be recommended. We sought therefore to laboratory settings. As a consequence, other modes of test-
summarize the literature addressing TMST performance and ing have been developed. Among these modes are timed
measurement properties. walk tests (eg, 6- or 2-minute walk test),1,2 step-up tests
Methods: Relevant literature was identified by searches of (eg, YMCA step test),3 and sit-to-stand tests (eg, 1-minute
3 electronic databases (PubMed, Scopus, and Cumulative chair rise test).4 Each of these modes has a place, but all
Index of Nursing and Allied Health) and hand searches.
Inclusion of an article required that it described use of the have limitations as well. Timed walk tests, if performed
TMST of Rikli and Jones and that it focused on adults. Articles according to established protocols, require indoor cor-
published in a language other than English were excluded. ridors of lengths unavailable in many settings;1,2 step-up
Studies were abstracted for information on participants, TMST tests and sit-to-stand tests are dependent (at least in part)
description, and findings. on adequate muscle strength4 and may be painful for indi-
Results and Discussion: Thirty articles were deemed appropriate viduals with arthritis in their lower limbs.
based on inclusion and exclusion criteria. The participants in the
An alternative exercise capacity test that is easily con-
studies included community-dwelling healthy older adults and
adults with assorted pathologies. Studies described varied meth- ducted in almost any setting was introduced in by Rikli
ods of conducting the TMST. Among tests in which steps for and Jones as part of the Senior Fitness Test in 1999.5,6
one side were counted over a full 2 minutes, the mean number The test, known as the 2-minute step test (TMST),
of steps among populations ranged from 29.1 for patients with simply requires that tested individuals march in place
chronic stroke to 110.8 for older osteoporotic women. Numer- as fast as possible for 2 minutes while lifting the knees
ous reviewed studies provide support for the validity of the to a height midway between their patella and iliac crest
TMST. Only one study addressed reliability and none focused on
responsiveness. Normative data have been proffered.
when standing. Performance on the test is defined as the
Conclusions: The TMST has been widely used since first number of right-side steps of the criterion height com-
introduced, albeit not always as originally described. There is pleted in 2 minutes. Rikli and Jones5 found the TMST
considerable evidence for the validity of the test, but its reli- to demonstrate good interday test-retest reliability (intra-
ability and responsiveness are not yet firmly established. class correlation coefficient = 0.90). They also reported
Key Words: exercise capacity, step test, systematic review convergent validity relative to 1-mile walk time (r =
(J Geriatr Phys Ther 2017;00:1-8.) 0.73) and known group validity (differences between age
groups and between women who were high active vs low
Department of Physical Therapy, College of Pharmacy and active).5 They have published normative reference values
Health Sciences, Campbell University, Lillington, North for adults 60 to 94 years old.6
Carolina. Since the Rikli and Jones papers of the late 1990s,5,6
The authors declare no conflicts of interest. others have published information on the TMST.
Address correspondence to: Rebecca H. Crouch, PT, DPT, Nevertheless, our search revealed no synthesis of infor-
CCS, Doctoral Program of Physical Therapy, College mation on the test in RehabMeasures7 or in the litera-
of Pharmacy and Health Sciences, Campbell University, ture. Such a synthesis is useful to clinicians wanting to
Tracey F. Smith Hall, 4150 U.S. 421 South, Lillington, NC
27546 (rcrouch@campbell.edu).
make informed decisions regarding test selection, perfor-
mance, and interpretation. We, therefore, conducted this
Ann Medley was the Decision Editor.
systematic review of TMST procedures, performance,
Copyright © 2017 Academy of Geriatric Physical Therapy, and clinimetric properties. The clinimetric properties
APTA.
of interest were reliability, validity, responsiveness, and
DOI: 10.1519/JPT.0000000000000164 interpretability.
Journal of GERIATRIC Physical Therapy 1
Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
 Systematic Reviews

METHODS and Jones.5 Some included no specifics other than to note

that the number of steps was counted. Only a few studies
Data Sources and Searches addressed knee height, instructions, time notifications, and
On September 23, 2016, we conducted a search of 3 elec- scoring.
tronic databases (PubMed, Scopus, and CINAHL). The All authors used means or medians to summarize the
search string used was “two minute step test” OR “2 min- number of TMST steps completed by study participants.
ute step test” OR “2 min step test.” Searches were limited, For studies in which steps for 1 side were counted over a
as possible, to adults and English-language publications. full 2 minutes, the mean number of steps ranged from 29.1
The reference lists of identified articles were hand searched. for a sample patient with chronic stroke24 to 110.8 for a
Article titles and abstracts, and then full text, were exam- sample of older women with osteoporosis.15
ined to determine whether each article addressed the stand- The results of numerous studies support the validity
ing TMST and did so in English. of the TMST. Specifically, its convergent validity is delin-
eated by significant relationships between TMST steps
Data Extraction and Quality Assessment and exercise/activity history or fitness levels.5,17,22,26,28,34,36
We extracted information from each article on the sample Further evidence for validity is provided by the relationship
tested, test description, and findings. Specifically, the health between TMST steps and psycho/cognitive measures,9-11,22
status, size, and the country of residence of the samples activity performance,12,24 training and health status,27,34,35
were designated (Table 1). Regarding test description, an and age.6,9,10,20,27
indication of knee height during stepping, instructions as Only 1 study addressed the reliability of the TMST. In
to speed, notification as to time elapsed/remaining, and that study, Rikli and Jones5 reported a test-retest reliability
scoring were extracted. Findings involved the number of coefficient of 0.90.
TMST repetitions, and clinimetric properties. Clinimetric No reviewed study focused on the responsiveness of the
properties included reliability, validity, responsiveness, and TMST test. Nevertheless, 8 studies demonstrated that TMST
interpretability. Reliability focused on the test-retest repro- repetitions increased with training.13-16,23-25,30,31 For most
ducibility of measures. Validity focused on either conver- of these studies, we calculated effect sizes or standardized
gent validity or known-groups validity. Responsiveness response means that would be considered strong (>0.80).
focused on reported significant increases in performance or Presumptively, normative data were presented in 3 stud-
indices of responsiveness that we calculated using reported ies.6,20,26 The reference values provided therein are strati-
summary data (ie, effect size and standardized response fied by age and gender.
mean). Interpretability focused on reference values reported Table 2 shows the results of our quality assessment.
for specific strata of the population. The scores ranged from 2 to 9 out of a possible 12
Quality was assessed using a hybrid 6-item (12-point points. Only 2 studies explicitly indicated the type of
instrument) similar to one used previously in system- sample (eg, convenience) and specifics of enrollment (eg,
atic reviews of measurements of physical performance.8 consecutive). All but 3 studies were clear as to inclusion
Specifically, 1 point was given for indicating each of the and exclusion criteria. Most studies did not thoroughly
following: type of sample (eg, convenience), consecutive describe the stepping task, usually lacking was an indica-
enrollment, inclusion criteria, exclusion criteria, knee lift tion of the speed at which participants were to step. Some
height, speed of stepping, scoring of steps, statistical sum- studies made reference to the Senior Fitness Test of which
mary statistics (eg, mean and standard deviation) for steps the TMST is a component, but this did not ensure adher-
completed, and the validity, reliability, responsiveness, and ence to the test protocol. One study actually employed a
normative reference values for stepping measurements. 1-minute test period.18 Only 2 studies failed to indicate
how the test was scored. All but 2 studies provided sum-
RESULTS mary statistics (eg, mean and standard deviation) for the
Thirty articles (Table 1) were identified as appropriate number of steps completed. Of 4 measurement properties
based on inclusion and exclusion criteria (Figure).5,6,9-36 The of interest, 2 or less were addressed in the summarized
samples described in the articles consisted of older adults studies.
without reference to health status (eg, community dwell-
ing) or adults with specific pathologies; these included heart DISCUSSION
failure, chronic kidney disease, osteoporosis, Parkinson’s Aerobic exercise capacity is a key component of physical
disease, stroke, hypertension, depression, and Alzheimer fitness. Although the measurement of exercise capacity is
disease. Study sample sizes ranged from 10 to 3309. Most commonplace, established protocols are often impracti-
samples incorporated residents of the United States (n= 10), cable because of the space, time, or equipment they require.
but residents of 11 other countries were studied as well. The TMST is a notable exception. We undertook a system-
Authors’ descriptions of how the TMST was con- atic review to synthesize what has been published regarding
ducted varied widely in regard to thoroughness. Some TMST procedures, performance , and clinimetrics.
authors simply indicated that the TMST was conducted Our review revealed that the TMST, which requires
according to the original description provided by Rikli no expensive equipment and only a few square meters

2 Volume • Number • 000 2017

Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
 Systematic Reviews

Table 1. Summary of Studies Describing the Use of the 2-Minute Step

Study Sample [Country] Test Description Findings
Alosco et al9 Older adults with heart Knee height: midway between patella and Mean TMST reps: 58.9
failure (n= 145) iliac crest Validity: TMST reps correlated significantly
[United States] Instructions: NS with global cognitive function, executive
Time notifications: NS function, language, attention, age, and
Score: number of times right knee met depression
marked target
Alosco et al10 Older adults with heart Knee height: midway between hip and knee Mean TMST reps: 61.5
failure (n= 122) Instructions: NS Validity: TMST reps correlated
[United States] Time notifications: NS significantly with ambulation, driving, and
Score: number of times right knee met housekeeping
target
Alosco et al11 Older adults with heart Knee height: midpoint between knee cap Mean TMST reps: 58.8
failure (n = 157) and iliac crest Validity: TMST reps correlated significantly
[United States] Instructions: march in place with attention, executive function,
Time notifications: NS and language
Score: number of times right knee met
target
Alosco et al12 Adults with heart failure Knee height: midpoint between patella and Mean TMST reps: 70.3 (men), 57.3 (women)
(n= 69) iliac crest Validity: TMST reps correlated significantly
[United States] Instructions: march in place with brain volume and thickness and with
Time notifications: NS age and education
Score: number of times right knee met
target
Aoike et al13 Sedentary, overweight Knee height: NS Mean TMST reps: 189.5 (control), 180.0
patients with chronic Instructions: maximum number (exercise)a
kidney disease (n= 29) Time notifications: NS Responsiveness: TMST reps ↑ significantly in
[Brazil] Score: number of steps achieved exercise group (effect size= 1.08)b
Aoike et al14 Overweight patients with Knee height: NS Mean TMST reps: 190.5a
chronic kidney disease Instructions: maximum number Responsiveness: TMST reps ↑ significantly
(n = 10) Time notifications: NS after 12 wk of training (effect size = 1.15)b
[Brazil] Score: number of steps achieved
Arabaci and Topsaç15 Older women with Knee height: NS Mean TMST reps: 76.9 (strength group),
osteoporosis (n = 24) Instructions: NS 110.8 (balance group)
[Turkey] Time notifications: NS Responsiveness: TMST reps ↑ significantly
Score: number of steps after 12 wk of strength training (effect
size = 1.42)b
Bates et al16 Older community-dwelling Knee height: NS Mean TMST reps: 94.7
adults (n = 109) Instructions: NS Responsiveness: TMST reps ↑ significantly
[Australia] Time notifications: NS after 10 wk of strength training (standard-
Score: number of steps ized response mean = 0.80)b
Brito et al17 Older healthy women Knee height: midway between patella and Mean TMST reps: 61.9
(n = 37) iliac crest Validity: TMST reps correlated signifi-
[Brazil] Instructions: alternate steps cantly with Veteran’s Specific Activities
Time notifications: NS Questionnaire
Score: number of times right knee reached
required height
Cancela et al18 Patients with Parkinson’s Knee height: halfway between iliac crest and Mean TMST reps: 23.8 (men), 21.1
disease (n = 30) middle of patella (women)c
[Spain] Instructions: NS
Time notifications: NS
Score: number of times step in place
Chang et al19 Older community-dwelling Knee height: midway between patella and Mean TMST reps: 87.4
adults (n = 628) iliac crest
[Taiwan] Instructions: NS
Time notifications: NS
Score: number of repetitions
(continues)

Journal of GERIATRIC Physical Therapy 3

Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
Systematic Reviews

Table 1. Summary of Studies Describing the Use of the 2-Minute Step Test (Continued)
Study Sample [Country] Test Description Findings
Cicioglu20 Older physically indepen- Knee height: per Senior Fitness Test manual Mean TMST reps: 66.8
dent men (n = 849) Instructions: per Senior Fitness Test manual Validity: TMST reps significantly different
[Turkey] Time notifications: per Senior Fitness Test between most age groups
manual Norms: presented for men in 60-64 y,
Score: per Senior Fitness Test manual 65-69 y, 70-74 y, 75-79 y, 80+ y groups
Freene et al21 Middle-aged sedentary Knee height: NS Mean TMST reps: 89.2 (home-based
community-dwelling Instructions: NS exercise), 95.0 (group exercise)
adults (n = 158 Time notifications: NS
[Australia] Score: number of steps
Garcia et al22 Older patients with heart Knee height: midway between knee cap Mean TMST reps: 69.6
failure (n = 41) and iliac crest Validity: TMST reps correlated significantly
[United States] Instructions: walk in place with stress test metabolic equivalents and
Time notifications: NS with attention and executive function
Score: number of steps
Holmerová et al23 Older adults in residential Knee height: height between patella and Mean TMST reps: 35.3 (experimental),
care facilities (n = 52) iliac crest 30.0 (control)
[Czech Republic] Instructions: NS Responsiveness: change in TMST reps
Time notifications: NS significantly different between experimental
Score: number of repetitions and control groups
Lee et al24 Older women (n = 54) Knee height: as described in Senior Fitness Mean TMST reps: 74.1 (virtual reality group),
[Korea] Test Manual 68.5 (group exercise group)
Instructions: as described in Senior Fitness Responsiveness: TMST reps ↑ significantly
Test Manual after 8 wk of virtual reality training (stan-
Time notifications: as described in Senior dardized response mean= 0.86) and
Fitness Test Manual group exercise (standardized response
Score: as described in Senior Fitness Test mean = 1.06)b
Manual
Lee et al25 Adults with chronic stroke Knee height: halfway between patella and Mean TMST reps: 29.1
(n= 68) iliac crest Validity: community ambulators completed
[Korea] Instructions: NS significantly more steps than limited com-
Time notifications: NS munity ambulators. Area under curve =
Score: number of times lifted 0.81
Milanović et al26 Older physically indepen- Knee height: midway between patella and Mean TMST reps: 95.1 (men 60-69 y), 84.7
dent adults (n = 1288) iliac crest (men 70-80 y), 82.5 (women 60-69 y),
[Serbia] Instructions: NS 81.7 (women 70-80 y)
Time notifications: NS Validity: men 60-69 y completed significantly
Score: number of full steps more TMST reps than men 70-80 y
TMST reps correlated significantly with physi-
cal activity level
Norms: presented for men 60-69 y and 70-
80 y, women 60-69 y, 70-80 y
Nascimento et al27 Older adult women Mean TMST reps: 79.4 (aquatic training
Knee height: midway between patella and
(n = 540) group), 84.4 (multifunctional fitness train-
iliac crest
[Brazil] ing group), 71.1 (sedentary group)
Instructions: NS
Validity: women in training groups completed
Time notifications: NS
significantly more TMST reps than seden-
Score: number of times right knee reached
tary women. Older women completed sig-
target
nificantly fewer reps than younger women
Pedrosa and Older hypertensive women Knee height: midpoint between patella and Mean TMST reps: 62.7
Holanda28 (n = 32) anterior superior iliac spine Validity: TMST reps correlated significantly
[Brazil] Instructions: as many as possible without with 6-min walk test distance and Timed
running Up and Go time
Time notifications: When 1 min completed
and 30 s remaining
Score: number of right knee raises
(continues)

4 Volume • Number • 000 2017

Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
 Systematic Reviews

Table 1. Summary of Studies Describing the Use of the 2-Minute Step Test (Continued)
Study Sample [Country] Test Description Findings
Rikli and Jones5 Older adults residing in Knee height: midway between patella and Mean TMST reps: 100.4 (60-69 y), 92.6
community, ambulatory iliac crest (70-79 y), 83.5 (80-89 y)
without device (total Instructions: complete as many steps as Validity: TMST reps correlated signifi-
n = 190; reliability possible, rests allowed cantly with 1-mile walk time and treadmill
n = 82) Time notifications: 1 min and 30 s performance
[United States] Score: number of times right knee reaches TMST reps significantly different between age
the minimum height groups (60-69 y, 70-79 y, and 80-89 y),
between high-active and low-active groups
and between men and women
Reliability: test-retest ICC = 0.90
Rikli and Jones6 Older adults residing in Knee height: midway between patella and Mean TMST reps: 93 (men), 83 (women)
community, ambulatory iliac crest Validity: TMST reps significantly different
without device Instructions: complete as many steps between some age groups
(n= 3309) as possible without overexertion, rests Norms: presented for men and women in
[United States] allowed 60-64 y, 65-69 y, 70-74 y, 75-79 y,
Time notifications: 1 min and 30 s 80-84 y, 85-89 y, and 90-94 y age groups
Score: Number of times right knee reaches
target
Sannicandro et al29 Older women (n = 74) Knee height: NS Mean TMST reps: 102.9
[Italy] Instructions: NS Responsiveness: TMST reps ↑ significantly
Time notifications: NS after a 12-wk training program (effect
Score: number of steps size = 0.72)b
Tanaka et al30 Patients with heart failure Knee height: midway between patella and Mean TMST reps: 50.0
(n = 16) iliac crest Responsiveness: TMST reps ↑ significantly
[United States] Instructions: NS after intra-aortic balloon pump placement
Time notifications: NS and exercise (effect size = 4.89)b
Score: number of steps
Taylor-Piliae et al31 Older adults with chronic Knee height: nonaffected side halfway be- Mean TMST reps: 37.9 (Tai Chi group), 44.4
stroke (n = 145) tween middle of patella and iliac crest (Silver Sneakers group), 41.1 (usual care
[United States] Instructions: as many times as possible group)
Time notifications: NS Responsiveness: TMST reps ↑ significantly
Score: number of steps with nonaffected in Tai Chi (effect size = 0.31) and Silver
side Sneaker (effect size = 0.65) groupsb
Taylor-Piliae et al32 Older adults with chronic Knee height: nonparetic side halfway be- Mean TMST reps: 39.7
stroke (n = 100) tween middle of patella and iliac crest Validity: TMST reps correlated significantly
[United States] Instructions: as many times as possible with with gait velocity, modified Rankin score,
nonparetic side lower limb strength and balance
Time notifications: NS
Score: number of steps with nonparetic side
Toraman and Older retirement home Knee height: Senior Fitness Test protocol Median TMST reps: 51.0
Yildirim33 residents (n = 60) applied Validity: TMST reps correlated significantly
[Turkey] Instructions: Senior Fitness Test protocol with Berg Balance Test scores and uni-
applied pedal stance time.
Time notifications: Senior Fitness Test
protocol applied
Score: number of steps
We˛ grzynowska- Men with heart failure Knee height: midway between patella and Mean TMST reps: 88.0
Teodorczyk et al34 (n = 168) iliac crest Validity: TMST reps for patients with NYHA
[Poland] Instructions: as many steps as possible class I or II significantly more for patients
Time notifications: time left till end of trial with NYHA class III or IV. TMST reps
Score: number of steps correlated significantly with 6-min walk
test distance, peak oxygen consumption,
exercise time, and quadriceps strength

(continues)

Journal of GERIATRIC Physical Therapy 5

Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
Systematic Reviews

Table 1. Summary of Studies Describing the Use of the 2-Minute Step Test (Continued)
Study Sample [Country] Test Description Findings
Zanco et al35 Older adults with major Knee height: midway between patella and Median TMST reps: 41 (major depression),
depression (n = 20), iliac crest 34 (Alzheimer disease), 60 (healthy)
Alzheimer disease Instructions: NS Validity: TMST reps significantly greater for
(n = 17), good health Time notifications: NS healthy than for depression and Alzheimer
(n = 20) Score: number of times right knee reaches groups (but not when adjusted for mental
[Brazil] target status)
Zhao and Chung36 Older adults with no falls Knee height: midlevel between patella and Mean TMST reps: 82.7 (risk of falling), 92.3
in previous 12 months iliac crest (no risk of falling)
(n = 78) Instructions: NS Validity: TMST reps were significantly higher
[Hong Kong] Time notifications: NS for adults with no risk of falling. For all
Score: number of steps groups together TMST reps correlated sig-
nificantly with Veterans Specific Activities
Questionnaire scores
Abbreviations: ICC, intraclass correlation coefficient; NS, not stated; NYHA, New York Heart Association; TMST, 2-minute step test.
aBoth left and right steps counted.
bCalculated rather than reported.
cOne-minute time.

of space, has been used internationally with both healthy This makes it difficult to interpret the TMST performance
and diseased individuals. The procedures for the TMST, across studies.
although thoroughly described by Rikli and Jones,5,6 have There is considerable evidence for the validity of the
not necessarily been followed by subsequent investigators. TMST, both convergent and known groups. However, a

Figure. Prisma flow diagram for systematic review of the 2-minute step test.

6 Volume • Number • 000 2017

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 Systematic Reviews

Table 2. Summary of Article Quality Using a Hybrid Instrument

Sample Inclusion/ Task Scoring Summary Measurement
Study Describeda (2) Exclusion (2) Describedb (2) Described (1) Statisticsc (1) Propertiesd (4) Total (12)
Alosco et al12 2 2 1 1 1 1 8
Alosco et al10 1 2 1 1 1 1 7
Alosco et al11 2 2 1 1 1 1 8
Alosco et al9 1 2 1 1 1 1 7
Aoike et al13 0 2 1 1 1 1 6
Aoike et al14 0 2 0 1 1 1 5
Arabaci and Topsaç15 0 2 0 0 1 1 4
Bates et al16 0 2 0 1 0 1 4
Brito et al17 1 2 1 1 1 1 7
Cancela et al18 0 2 1 1 1 0 5
Chang et al19 0 2 1 1 1 0 5
Cicioglu20 0 2 2 1 1 2 8
Freene et al21 1 2 0 1 1 0 5
Garcia et al22 0 2 1 1 0 1 5
Holmerová et al23 1 2 1 1 1 1 7
Lee et al25 0 2 0 0 1 1 4
Lee et al24 0 2 1 1 1 1 6
Milanović et al26 1 2 1 1 1 2 8
Nascimento et al27 0 2 1 1 1 1 6
Pedrosa and Holanda28 0 2 2 1 1 1 7
Rikli and Jones5 0 2 2 1 1 2 8
Rikli and Jones6 0 2 1 1 1 2 7
Sannicandro et al29 0 0 0 1 1 0 2
Tanaka et al30 1 1 1 1 1 1 6
Taylor-Piliae et al31 1 2 2 1 1 2 9
Taylor-Piliae et al32 1 1 2 1 1 1 7
Toraman and Yildirim33 0 2 0 1 1 1 5
We˛ grzynowska-Teodorczyk et al34 0 2 2 1 1 1 7
Zanco et al35 1 2 1 1 1 1 7
Zhao and Chung36 0 2 0 1 1 1 5
aType, enrollment.
bKnee lift, speed.
cMeasure of central tendency and dispersion.
dValidity, reliability, responsiveness, reference values.

low correlation between the TMST and peak oxygen con- data include not only mean and standard deviations
sumption does not support its criterion validity—at least but percentile values for age and gender strata as well.
not in patients with heart failure.34 Only 1 study addressed Normative data provided by others are for Serbian men
the reliability of the TMST.5 Although the reliability coef- and women or Turkish men.20,26 The stratified mean values
ficient in that study (0.90) was good, further research with for the older Serbians are slightly lower than those of Rikli
other populations is necessary. Information on absolute and Jones; the stratified mean values for the Turkish men
reliability (eg, minimal detectable change) and respon- are 24% to 41% lower than those of Rikli and Jones.
siveness is also needed. The effect sizes and standardized Using the criteria of our quality checklist, none of
response means we calculated do not provide much help the studies we reviewed met all standards. We intention-
for interpreting changes in TMST performance over time. ally did not employ a cut score for study inclusion. This
Rikli and Jones6 provide useful normative data for the decision was based on a desire to capture all literature
TMST for residents of the United States. Their summary addressing the TMST. Using a hybrid checklist as we
Journal of GERIATRIC Physical Therapy 7
Copyright © 2017 Academy of Geriatric Physical Therapy, APTA. Unauthorized reproduction of this article is prohibited.
 Systematic Reviews

did is a limitation, but similar checklists have been used based strength training program for older adults. Health Promot J Aust.
2009;20(1):42-47.
previously. They allow us to capture test-specific criteria 17. Brito LV, Maranhao Neto GA, Moraes H, Emerick RFES, Deslandes AC.
of importance. Relationship between level of independence in activities of daily living and
estimated cardiovascular capacity in elderly women. Arch Gerontol Geriatr.
2014;59(2):367-371.
CONCLUSIONS 18. Cancela JM, Ayán C, Gutiérrez-Santiago A, Prieto I, Varela S. The Senior
As a whole our review provides support for use of the Fitness Test as a functional measure in Parkinson’s disease: a pilot study.
Parkinsonism Relat Disord. 2012;18(2):170-173.
TMST. Nevertheless, further research is required regarding 19. Chang KV, Hung CY, Li CM, et al. Reduced flexibility associated with metabolic
the validity, reliability, and responsiveness of the test. This syndrome in community-dwelling elders. PLoS One. 2015;10(1):e0117167.
20. Cicioglu I. Assessment of physical fitness levels of elderly Turkish males over
applies to essentially healthy adults as well as adults with 60 years. Coll Antropol. 2010;34(4):1323-1327.
pathology. 21. Freene N, Waddington G, Davey R, Cochrane T. Longitudinal comparison of
a physiotherapist-led, home-based and group-based program for increasing
physical activity in community-dwelling middle-aged adults. Aust J Prim
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