rbcdh
Revista Brasileira de Cineantropometria & Desempenho
Humano
Rev. bras. cineantropom. desempenho
hum.
1415-8426
1980-0037
Universidade Federal de Santa Catarina
O teste Timed Up and Go (TUG) clássico e cognitivo é utilizado para identificar
idosos propensos a quedas, porém não foram encontrados estudos que comprovem sua
associação em idosos praticantes de exercícios físicos. O objetivo deste estudo foi
analisar a versão clássica e cognitiva do TUG, na previsão e explicação da ocorrência
de quedas, em idosos praticantes de EF. Participaram 82 idosos fisicamente ativos.
Foram coletados dados sobre ocorrência de quedas, nos últimos 12 meses, e realizado o
teste TUG clássico e o cognitivo por meio da pronúncia de animas enquanto executa o
teste. Utilizou-se estatística descritiva e inferencial com nível de significância de
5%. Uma regressão logística binária foi realizada para associar o desfecho (quedas) e
o desempenho nos testes. Para identificar os valores preditivos, utilizou-se a Curva
ROC. A ocorrência de quedas na amostra foi de 19,5%. Observou-se diferença
significativa entre os valores obtidos no TUG clássico e cognitivo (9,0 ±1,9 e 10,0
±2,2 segundos, respectivamente). Não houve diferença entre idosos com e sem histórico
de quedas, em ambos os testes, apesar das médias serem superiores nos idosos com
histórico. Na análise de regressão logística, o desempenho de ambas as versões não
explicou a ocorrência de quedas. Na curva ROC, o TUG clássico apontou acurácia de
65,3% (p= 0,058) e o TUG cognitivo de 58,1% (p= 0,324). Os testes TUG clássico e
cognitivo não se associam com a ocorrência de quedas e devem ser utilizados com
cautela para previsão de quedas em idosos praticantes de EF.
INTRODUCTION
Many studies have shown significant social and economic epidemiological relevance in the
occurrence of falls because they are the most common type of accident and are among the
main causes of morbidity and mortality in the old people population1
-
5, since approximately 30% of old people fall at least once a year3
,
6. In addition, it has become relevant to establish trustworthy standardized
assessments for use in clinical practice so that health professionals can provide
support for falls in old people and establish more appropriate interventions. Figueiredo
et al.7 identified through a systematic review the instruments used in the assessment of
static, dynamic body balance and risk of falls among old people in Brazil and
internationally. Among the tests, the "Timed Up and Go" (TUG), which was developed by
Podsiadlo in 1991, stands out8.
The guidelines of the American and British Society for the Prevention of Falls recommend
the use of TUG for the evaluation and selection of interventions in old people who seek
the services of health organizations9. In addition, some authors8
,
10
-
12 affirm that TUG is a valid instrument for risk screening of falls in the old
people of their communities. For Barbosa13, the realization of a second task, cognitive or manual, during the execution of
the TUG, was the most appropriate way to identify the propensity of occurrence of falls
because the dual task increased the motor demand needed to maintain balance.
In spite of its wide use, TUG's clinical importance in its classical or cognitive
versions is still imprecise and divergent, especially when considering different groups
with specific characteristics among the old people population. Even among old people
practicing physical exercises, in which the incidence of falls reaches 22%14, it becomes necessary to identify quick instruments of easy application and
accessibility to health professionals so that they can assist in the prediction of this
occurrence.
In this sense, it should be noted that there is a lack of studies using the classic and
cognitive TUG tests in the prediction and explanation of the occurrence of falls among
old people practicing physical exercises. According to Perracini et al.15, there is a difference in the factors related to the occurrence of falls, as the
level of physical activity among old people patients. Therefore, this information should
be considered in planning interventions for this population. From a research study with
old people tied to a systematized program of physical exercises, we intend to contribute
to the choice of appropriate instruments for the identification of potential risks for
falls since falls are extremely harmful to the quality of life of this population, and
our contribution will meet the recommendations of the "WHO Global Report on Falls
Prevention in Older Age" report, which demonstrates the concern with falls in the entire
world16.
Therefore, the objective of this study was to analyze the use of the classic and
cognitive test versions of TUG on prediction and explanation of the occurrence of falls
in the old people practicing physical exercises.
METHODOLOGICAL PROCEDURES
This study was approved by the Committee for Ethics in Research with Human Beings of the
State University of Santa Catarina, under protocol nº 185/07. It was a descriptive study
whose population was composed of old people practicing physical exercises linked to the
Program of University Extension Group of Studies of the Third Age, which includes
approximately 300 old people of the community17. The classes of this program have a duration of 50 minutes and are held two to
three times per week. These classes are moderate by intensity value, which is determined
by means of self-report of sensation of greater physical effort and increase in
respiratory rate during the execution of the exercises.
The sample was selected intentionally, taking as inclusion criteria: being old people
(≥60 years of age), of both genders, and regularly enrolled in the program. All of the
program's old people were invited to participate in the study, and we scheduled a date
for the tests realization. In this way, participants took part in a voluntary way. The
resulting participants included 82 old people practicing physical exercises, with an
average age of 67.3 ± 6.73 years, 56 women (68.30%) and 26 men (31.70%). After receiving
all the information, the participants signed a free consent form and clarified any
concerns they might have had.
For sample characterization, we used a diagnostic test relating to age, gender, and
information about last year's occurrence of falls, which factors were based on other
studies15
,
18
,19 that also used the self-report occurrence of falls in the past 12 months.
To evaluate the risk of falls, we used the test "Timed Up and Go" (TUG) in its classical
version, developed by Podsiadlo8 in 1991. The test consists of raising of a standardized chair (seat height 43
cm; arm height 61 cm; seatback height 43 cm; depth 42 cm; width 40 cm), walking 3 meters
in a straight line, turning around, returning to the place of departure, and sitting
down again. The individual must walk on a comfortable and secure platform using their
usual shoes, without any physical assistance or support.
To start the test, the test administrator gives the verbal command "go." The timer is
triggered by the first movement of the old person's trunk and finished when the same
leans on the chair. The cognitive variable of TUG (cognitive TUG) was obtained by adding
to the classic test a simple cognitive task. In this task, the examiner guided the old
people by asking them to "Say all the names of animals that you can remember during the
test. It can be any kind of animal." This test was adapted from Alvarenga et al.20 and we did not carry out a new test unless the participant repeated names.
The data were collected by two previously on-the-spot trained researchers to perform
physical exercises. At the beginning, we applied the diagnostic test as individual
interviews. Afterward, we explained and demonstrated to the old people the procedure of
the classic TUG and the cognitive TUG. The first attempt was to familiarize them with
the test, and we only counted the second attempt. The break for rest between both tests
was two minutes. All the old people executed first the classical version followed by the
cognitive version.
The data were organized in Microsoft Excel(r) and analyzed in the statistical program
SPSS (Statistical Package for Social Sciences version 17.0 for
Windows.) The nominal/dichotomous variables of fall history (with and without) and
gender (male and female) were treated by means of simple and relative frequency, while
we treated the numerical values of age in the classic and cognitive TUGs by using the
mean and standard deviation.
In the inferential analysis, the comparison between groups was performed by means of a t
test for independent samples or a Mann-Whitney U-test as the distribution of the data.
The intra-group comparison was performed by a Wilcoxon test. We used the Chi-Square test
or Fisher Exact in the association between nominal variables. To verify the association
between the history of falls (outcome) and the values obtained in the classic TUG and
the cognitive TUG (explanatory variables), we performed a binary logistic regression,
adjusting age and gender. To identify the predictive values of both tests in the
occurrence of falls, the ROC Curve was used. We adopted a statistical significance level
of 5%.
RESULTS
Participants in this research included 82 old people practicing physical exercises, with
women (n= 56) who had an average age of 66.2 ± 6.65 years, while men (n= 26) of 69.7 ±
6.38 years. It was found that this difference was statistically significant
(U= 494.5; d.f. = 80; p =
0.02).
In relation to the history of falls in the past 12 months, the occurrence in the sample
was 19.5%. There was no association between the history of falls and gender
(X
2= 0,413; p= 0.765), since the occurrence in men was 15.4% and in
women was 21.4%.
To compare the values obtained in the TUGs, the average time of realization of the
classic test was 9.0 ±1.9 seconds, while of the cognitive version, the average was 10.0
± 2.2 seconds. We found a statistically significant difference between the values (Z=
-5.151; p< 0.001), as shown in Figure
1.
Figure 1
Graphical representation of the difference of time of classic and cognitive
TUG test performance
The values obtained in the classic TUG and the cognitive TUG were compared according to
the occurrence of falls (history of falls) in the past 12 months (Table 1), and we found no significant difference in both tests. In
spite of this, we observed that old people with falls presented higher average values
for both tests.
Table 1
Comparison between the values of classic and cognitive TUGs and the history
of falls among old people practicing physical exercises.
TUG
with history of falls (n= 16)
without history of falls (n= 66)
E
p
Average (SD)
Average (SD)
Classic
9.57 (1.60)
8.86 (1.95)
366,00¥
0.058
Cognitive
10.37 (1.60)
9.90 (2.28)
0,771£
0.443
TUG
= Timed up and Go
SD
= Standard Deviation
E
= Statistical test
p
= Statistical significance
¥
Statistical test U of Mann-Whitney
£
Statistic the t test for independent samples.
As seen in Table 2, there was no association
(p>0.05) between the occurrence of falls (outcome) and the values
obtained in classic and cognitive TUG (explanatory variables), demonstrating that both
tests did not explain the occurrence of falls in the old people practicing physical
activities.
Table 2
Logistic regression analysis of the values obtained in TUG (classic and
cognitive) in the occurrence of falls in the old people practicing physical
exercises.
Variable¥
B
OR
CI 95%
p
TUG classic
- 0.176
0.839
0.644
1.093
0.193
TUG cognitive
0.004
1.004
0.665
1.516
0.985
TUG
= "Timed Up & Go"
B
= Logistic Coefficient
OR (Odds Ratio)
= Ratio of Risk for falls
CI 95%
=Confidence Interval for the Hazard Ratio
p
= level of significance
¥
Adjust by gender and age.
To evaluate the quality of the classic and cognitive TUGs in prediction of old people
falls, we used the ROC curve (Figure 2). The area
under the curve for the classic TUG pointed to an accuracy of 65.3% (p=
0.058), and in the cognitive TUG, an accuracy of 58.1% (p= 0.324). The
lack of significance demonstrates that both tests cannot be used for prediction of falls
in the old people practicing physical exercises.
Figure 2
ROC curve of performance of classic and cognitive TUG tests as for the
occurrence of falls in old people practitioners of physical exercises.
DISCUSSION
The occurrence of falls varied according to the old people profile evaluated and can be
associated with several factors. Siqueira et al.3, while investigating 4,003 old people residents in areas of basic health units
of various Brazilian municipalities, showed that the prevalence of falls was of 34.8%
and was associated with factors such as advanced age, sedentary lifestyle, poor
perception of health, and great number of medications. Among old people practicing
physical exercises, the research developed by Beck et al.
21 showed an incidence of 7.63%, which value is below what we found in the present
study (19.5%). We believe that there is a relationship in the form of "U" between the
occurrence of falls and the practice of physical exercises since practicing little
exercise or too much can be considered risk factors22
,
23. This premise can explain the occurrence of falls among old people practicing
physical exercises. However, this relationship was not confirmed by Peeters et al.24 in a longitudinal study of 1,337 older adults, which implies that several
factors may be involved in the occurrence of falls, beyond the level of physical
activity.
Silva Duarte and Arantes25 compared the performance of the classic TUG among old women with different
levels of physical activity (inactive, moderately active, and active). The results of
the TUG were 11.47 (± 2.70), 9.98 (± 1.73), and 8.45 (± 1.55) seconds, respectively.
Such results suggest that old women with moderately active and active levels of physical
activity have lower execution time and, therefore, a lower risk of falls, compared to
sedentary old people. So, the functional mobility TUG test is showed to be sensitive to
differentiate the groups of different levels of physical activity and the risk of falls.
The old people practicing physical exercises presented a similar performance in the
classic TUG to the moderately active old people group.
In this study, a statistically significant difference was found (p< 0.001) between
the values obtained in the classic test TUG (9.0 ± 1.9 seconds) and the TUG with
cognitive variation (10.0 ± 2.2 seconds). Such evidence comes to meet to the study
carried out by Barbosa et al.,13 found that the interference of one task, cognitive or manual, in the final time
obtained in test TUG. In this study, the authors affirmed that the old people had a
worse performance in the test when associated with the realization of a second task,
whether cognitive or motor. During the present study, we used the repetition of animal
names. Despite its being a simple task, it significantly changed the values of agility
and dynamic balance, even if only for a second.
Goncalves and Coimbra26, when evaluating and comparing the functional balance of 96 elders of the
community, equally divided into three groups according to the history of falls (without
history of falls, with one fall and with recurrent falls), revealed that old people with
a history of falls (including one or more) took longer to complete the TUG test (14.57 ±
4.23 seconds and 14.48 ± 4.46 seconds, respectively) than old people without a history
of falls (11.43 ± 2.95 seconds), and this difference is significant (p=
0.002). However, for Shumway-Cook et al.10, the ability to predict the fall did not increase with the addition of a
secondary task.
In this study, the performance of the classic TUG and its cognitive variation (cognitive
TUG) did not explain the occurrence of falls. This observation concurs with the study
carried out by Thrane et al. 27 with 974 old people of the community (average age of 77.5 years) in which they
evaluated using the TUG and a questionnaire covering the falls over the past 12 months.
Thrane et al. came to the conclusion that the TUG was statistically associated with the
history of men falling, but not of women. In the same way, another test widely used to
predict falls in old people, the Scale of Balance of BERG, is also not advised for
application in old people practicing physical exercises, because a ceiling effect is
observed in this population28. It is believed that the profile of the samples being composed of old people
practicing physical exercises can justify the lack of association and deserves more
studies that focus on adjustments.
With respect to the accuracy of the TUG test, the study of Alexander et al.29 found a value of 68% for the classical version, suggesting that 12.47 seconds is
considered a predictive value ideal for Brazilian old people residents in the community.
However, as observed in the present study, both versions of the TUG test may not be used
for prediction of falls since the ROC curve did not show significant values and,
therefore, has low accuracy values. This result confirms the lack of association of
tests with the occurrence of falls in old people practicing physical exercises.
A systematic review30 investigates the effects of physical exercise programs in reducing the risk of
falls in the old people of the community, concluding that there is a need for
appropriate methods to identify the most susceptible people to this occurrence, and
suggesting that the exposition be controlled to experimental situations similar to the
real conditions of a fall.
CONCLUSION
The findings of this study indicate that the classic and cognitive TUG tests do not
correlate with the occurrence of falls and, therefore, are not indicated for prediction
of this event in old people practicing physical exercises. The measurement of the level
of physical activity by means of direct measurement, the identification of some control
variables such as the time of practice of physical exercise and a larger sample size
could enhance the inferences made. In addition, the randomization in the implementation
of the procedures and tests of reliability among researchers could reduce the biases in
the study. However, we believe that these results bring important contributions for the
clinical practice of health professionals who work with old people practicing physical
exercises because it demonstrates that its application should be performed with caution.
This finding is in concordance with the Model for the Prevention of Falls in Active
Aging of the OMS,16 which proposes, between the strategies for reducing this event, the investment
in the improvement of evaluations with procedures based on evidence and that are
culturally appropriate for the evaluated population.
In addition, it is noted that further studies are needed to find instruments that are
sensitive and specific for the screening of falls in the physically active old people
population since the use of equipment, such as force platforms, are expensive and
infeasible in daily practice. The fall, being an event of multi-factorial cause, may be
associated with several factors, both intrinsic and extrinsic; therefore, its prediction
must be analyzed in a wide manner within the protocols of old people evaluation.
Acknowledgment
The National Council for Scientific and Technological Development (CNPq) for research
productivity grant aimed at guiding this study.
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Autoria
Janeisa Franck Virtuoso
Universidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. BrasilUniversidade do Estado de Santa
CatarinaBrasilFlorianópolis, SC, BrasilUniversidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. Brasil
Luis Paulo Perdona Gregório
Universidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. BrasilUniversidade do Estado de Santa
CatarinaBrasilFlorianópolis, SC, BrasilUniversidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. Brasil
Paulo Adão de Medeiros
Universidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. BrasilUniversidade do Estado de Santa
CatarinaBrasilFlorianópolis, SC, BrasilUniversidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. Brasil
Giovana Zarpellon Mazo
Universidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. BrasilUniversidade do Estado de Santa
CatarinaBrasilFlorianópolis, SC, BrasilUniversidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. Brasil
Universidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. BrasilUniversidade do Estado de Santa
CatarinaBrasilFlorianópolis, SC, BrasilUniversidade do Estado de Santa Catarina.
Centro de Ciências da Saúde e do Esporte. Florianópolis, SC. Brasil
Table 2
Logistic regression analysis of the values obtained in TUG (classic and
cognitive) in the occurrence of falls in the old people practicing physical
exercises.
imageFigure 1
Graphical representation of the difference of time of classic and cognitive
TUG test performance
open_in_new
imageFigure 2
ROC curve of performance of classic and cognitive TUG tests as for the
occurrence of falls in old people practitioners of physical exercises.
open_in_new
table_chartTable 1
Comparison between the values of classic and cognitive TUGs and the history
of falls among old people practicing physical exercises.
TUG
with history of falls (n= 16)
without history of falls (n= 66)
E
p
Average (SD)
Average (SD)
Classic
9.57 (1.60)
8.86 (1.95)
366,00¥
0.058
Cognitive
10.37 (1.60)
9.90 (2.28)
0,771£
0.443
table_chartTable 2
Logistic regression analysis of the values obtained in TUG (classic and
cognitive) in the occurrence of falls in the old people practicing physical
exercises.
Variable¥
B
OR
CI 95%
p
TUG classic
- 0.176
0.839
0.644
1.093
0.193
TUG cognitive
0.004
1.004
0.665
1.516
0.985
Como citar
Virtuoso, Janeisa Franck et al. O "Timed Up and Go" na previsão e explicação de quedas em idosos praticantes de exercícios físicos. Revista Brasileira de Cineantropometria & Desempenho Humano [online]. 2014, v. 16, n. 04 [Acessado 8 Abril 2025], pp. 381-389. Disponível em: <https://doi.org/10.5007/1980-0037.2014v16n4p381>. ISSN 1980-0037. https://doi.org/10.5007/1980-0037.2014v16n4p381.
Universidade Federal de Santa CatarinaUniversidade Federal de Santa Catarina, Campus Universitário Trindade, Centro de Desportos - RBCDH, Zip postal: 88040-900 - Florianópolis, SC. Brasil, Fone/fax : (55 48) 3721-8562/(55 48) 3721-6348 -
Florianópolis -
SC -
Brazil E-mail: rbcdh@contato.ufsc.br
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