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The Reliability and Validity of a Chair Sit-and-Reach Test as a Measure of

Hamstring Flexibility in Older Adults

Article  in  Research quarterly for exercise and sport · January 1999

DOI: 10.1080/02701367.1998.10607708 · Source: PubMed

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-&ea& Cluarterly for Exercise and Sport
81998 by the American Alliance for Health,
a
Physical Education, Recreation and Dance
Vol. 69, No. 4, pp. 338-343 &
-.

~r .
6% ..-. .

The Reliability and Validity of a Chair Sit-and-Reach Test

as a Measure of Hamstring Flexibility in Older Adults
C. Jessie Jones, Roberta E. Rikli, Julie Max, and Guillermo Noffal

The purpose of this study was to examine the test-retest reliability and the n'terimr validity ofa newly developed chair sit-and-
reach (CSR) test as a measure of hamstringflexibility in older adults. CSR perfonance was also compared to sit-and-reach (SR)
and back-saver sit-and-reach (BSR) measures of hamstringflnnbtlity. To estimate ~el.iability,76 ma and wmna age = 70.5
years) p e r f m d the CSR on 2 different days, 2-5 days apart. I n the validity phase ofthe study, scores o f 8 0 men and w o r n
age = 74.2 years) were obtained on threefield test measures of hamstringflexibility (CSR, SR, and BSR) and on a cracraimion test
(piometer measurement of a passive straight-leg raise). Results indicate that the CSR has good intrclass test-retest reliability (R
= .92for ma; r = .96for w o r n ) , and has a moderate-to-good relationship with the criterion measure (r = .76f m men; r = .81
for w m ) . The crilaon validity ofthe CSRfor the male and female participants is comparable to that ofthe SR (r = .74 and r
=. 71, respectively) and BSR (r =. 70 and r =. 71, respectively). Results indicate that the CSR test produces reasonably accurate
and stable measures of hamstringflexibility. In addition, it appears t h k the CSR is a safe and socially acceptabk alterndiue to
traditionalfloor sit-and-mh tests as a measure of hamstringjhzbility in older aduki.

Key wards: aging, field test, assessment, mobility the Ys Way to Physical Fitness (Gelding, Myers, & Sin-
ning, 3989), the AAHPERD Functional Fitness Test for

L ack of hamstring flexibility has been associated with

low back pain, postural deviations, gait limitations,
risk of falling, and susceptibility to musculoskeletal in-
juries (American College of Sports Medicine, 1995;
Grabiner, Koh, Lundin, &Jahnigen, 1993; Kendall, Mc-
Creary & Proyance, 1993;Liemohn, Snodgrass, & Sharpe,
1988). In older adults, tight .hamstrings especially can
lead to reduced stride length and walking speed, which
in turn can cause problems with dynamic balance
(Brown, 1993).Due to the importance of hamstring flex-
ibility, its measurement is included in most current fit-
ness test programs including the AAHPERD Physical
Best (AmericanAlliance for Health, Physical Education,
Recreation and Dance, 1988), the Prudential FITNESS
GRAM (Cooper Institute for Aerobics Research, 1994),
Submitted: January 27, 1998
Accepted: May 4, 1998
C. Jessie Jones, Roberta E. Rikli, Julie Max, and Guillermo Noffal
are with the Division of Kinesiology and Health Promotion at
California State University-Fullerton.
Adults Qver 60 (Osness et al., 1996),and the President's
Challenge Fimess Test (President's Council on Physical
Fitness and Sports, 1990).
- The most common method of assessing hamstring
flexibility in the field setting has been the floor sit-and-
reach (SR) test, originally reported by Wells and Dillon
(1952). Recently, a modified one-leg version of the SR,
the back-saver sit-and-reach (BSR), has been recom-
mended as an altemative to the two-leg SR (Cooper In-
stitute for Aerobics Research, 1994). The rationale for
the BSR is based on the work of Cailliet (1988) who sug-
gested that stretching one hamsuing at a time, instead
of both at once, results in less stress and risk of injury for
the low back and spine. Studies have shown that both the
SR and BSR tests are highly reliable, with R values con-
sistently above .90, and they have at least moderate cri-
terion validity relative to goniometer-measured hamstring
flexibility (rtalues range from .51 to 39;Jackson & Baker,
1986;Jackson & Langford, 1989;Patterson, Wiksten, Ray,
Flanders, & Sanphy, 1996).
Although the SR and BSR are generally considered
acceptable field test measures of hamstring flexibility for

most age groups, many older people, due to their medi-
cal conditions or functional limitations (e.g., obesity,
lower back pain, lower body weakness, hip and knee re-
placements, and severely reduced flexibility), find it dif-
ficult or impossible to get down and up from the floor
position for these tests. Also, we have found that some
older adults, possibly due to weak abdominal musclq as
well as tight hamstrings, cannot hold a sitting posi&a.f
on a flat surface, especially with both legs extended, and
will start to fall backward during testing. Therefore, to
increase the rate of participation for our older adult cli-
ents and decrease the risk of injury, we experimented
with a chair sit-and-reach (CSR) test as an alternative to
the SR and BSR The CSR test might best be described
as a modified version of the BSR test, in that only one
leg at a time is involved in the testings thus, reducing the
stress on the lower back and spine. The CSR requires
participants to sit near the front edge of a chair, extend-
ing one leg straight out in front ofthe hip, with the other
leg bent and slightly off to the side. The two-fold purpose
of this study was to (1) determine the test-retest reliabil-
ity of the CSR, and (2) to evaluate the validity of the CSR
by comparing CSR scores to a criterion (goniometer)
measure of hamstring flexibility in older adults. CSR
pe?formance also was compared to other common field
test measures of hamstring flexibilivhe SR and BSR.
Methods
m sures. Participants were reminded to exhale as they bent
Participants
Seventy-six older adults (34 men and 42 women, M
age = 70.5 years) were solicited from a university-based
exercise program to participate in the reliability phase
of the study. A different group of 80 volunteers (32 men
and 48 women, Mage = 74.2 years) were recruited from
nutrition and exercise classes at a nearby retirement
community. The criteria for inclusion in the study were
that the participants be over the age of 60 years, have
no musculoskeletal limitations which would prohibit
their performance on the tests, and agree to sign astate-
ment of informed consent.
Procedures
Prior to all testing, participants performed an 8-min
warm-up and static stretch routine emphasizing the lower
body. Participants in the reliability study, conducted a p
proximately 4 weeks prior to the validity study, performed
the CSR on 2 different days, 2-5 days apart-Testing p r u
tocols during reliability testing, including technician
training procedures, were the same as those described
below in the validity phase of the study. So that interrater
reliability would be reflected in the reliability analysis,
&~ca, w, Max;-.
-A-
-:- . .
different technicians were used to c&
Day 1 and Day 2. Day 2 technicians w
the scores obtained on Day 1.
Participants in the validity study were asskssed on the
CSR, SR, and BSR in a counterbalanced (rotating) or-
der determined prior to the test day and indicated on
the score card. The CSR, SR, and BSR tests were con-
h c & d by a team of six graduate students and six older
adult volunteer technicians, all of whom had participated
in a group training session led by the study coordinators.
During the h i n h g , technicians practiced on each other
until they demonstrated proper procedures to the study
coordinators. The goniometer assessment of hamstring
flexibility, administered after completion of the other
three tests, was administered by three experienced clini-
cians (two physical therapy aides and one athletic
trainer). A pilot study, utilizing a subsample of 19 par-
ticipants, indicated that the interrater reliability of the 3
clinicians was .92. The clinicians administering the g u
niometer tests were unaware of scores received on the
CSR, SR, and BSR tests.
Only the p-4med leg score (the leg yielding the best
score) was used for the CSR, BSR and goniometer tests.
Once the preferred leg was determined, that score was
held constant throughout all three of the single-leg mea-
sures. Following a demonstration of each test, 2 practice
trials and two test trials were given for each of the mea-
forward, avoid bouncing or rapid, forceful movement,
and never stretch to the point of pain. On all sit-and-
reach measures, if the knee(s) started to bend, the par-
ticipants were asked to slowly sit back until the knee(s)
were straight before scoring. The best of the two test tri-
als' (scored to the nearest 1/2 in.) was used for subse-
quent analysis on the SR, BSR, and CSR. The average of
the two test trials (scored to the nearest degree) was used
k r the goniorneter test. All measures were administered
on the same day, and all tests were conducted with the
participants' shoes on. With older adults, -the time re-
quired for removing shoes can be extensive and is often
prohibitive when testing groups within the field setting.
Measures
Chair Sit-and-Reach. Following a demonstration, par-
ticipants sat on a folding chair (17-in. high seat) and
moved forward until they were sit- near the front edge.
(The chair was placed against a wall and checked to see
that it would remain stable throughout the testing). Par-
ticipants were asked to extend their preferred leg in front
of their hip, with the heel on the floor and foot
dorsiflexed (at approximately a 90"angle), and bend the
other leg so that the sole of the foot was flat on the floor
about 6-12 in. to the side of the body's midline. With the
extended leg as straight as possible and hands on top of
each other with palms down (tips of the middle fingers
Jones~iddi,Max, and Noffal

em@, participants were to "slowly bend forward at the NESSGRAM (Coo- In.sti~~~prh&pbPics Research,
hip joint, keeping the spine as straight as possible and 1994),with the major e x c e ~ ; .$at w the foot was
the head in normal alignment with the spine (not not positioned agaihst a sit-and-reach bx.'~nscea$,foot
tucked)."Participants were instructed to reach down the placement was similar to that used for the SR (i.s,, heel
extended leg in an attempt to touch the toes. The par- positioned even with the 20-in, mark on a yardstick and
ticipant heM a brief static pwktion (for 2 s), while the 6 in. to the side). Participants were asked to extend their
adminitrator recorded the "reached score" using an 18- preferred leg only and bend the other leg so that the sole
in. ruler positioned p a e l to the lower leg (shin; see of the foot was flat on the floor, 6712 in. to the side of
Figure 1). The mki& of the toe at the end of the shoe the yardstick. The 2Wi. mark represented a zero score,
represented a "aeso*WQre.Reaches short of the toes were with reaches short of the mark recorded as minus scores
recorded as minus scores*and reaches beyond the toes and reaches beyond,the mark as plus scores. BSR mea-
were recorded as plus scores. Test-retest reliability esti- sures have been found to be highly reliable for both male
mates for the CSR are reported in the results section of and female participants (R= 99)(Patterson et al., 1996).
this paper, Gmkmetm-Mau-. The goniometer assess-
Sitand-Reuch.The SR test was administered using the ment of hamstring flexibility was administered after
procedures outlined in the Osness et al. manual (1995). completion of the other three tqts by experienced ex-
A yardstick was placed on the floor, with a 12-in. strip of aminers who were unaware of ,&e %ores participants
masking,tape positioned at the 20-in. mark (6 in. on each - received on the earlier tests, Follqwj~gpracedures out-
side of the yardstick).Following a demonstration,partici- lined by the American ~cade&~.of.~rtho~edic Surgeons
pants sat on the floor with their shoes on, legs M y ex- (1966),a goniometer was used to measure hamstringflex-
tended, a yardstick between their legs ("On mark of ibilig during a passive straightlleg raise, This test was
yardstick toward the hips), and their heels 12 in. apart. selected because of its prevalent acceptance as a crite-
Throughout testing, the administrator checked to ensure . .rionmea,sure . f ~hanns;tring.flexibility
r and its high reli-
that the heels remained at the 2&n. mark. With the ex- <
a W $ $95 < R .99) (Jackson & Baker, 1986;Jackson &
tended leg as stiaight as possible, hands on top of e ~ h bngford, 1989; Patterson, et al., 1996). As indicated
other (tips of the middle fingers even), and palms do.4ln, e&ikr;$ke irrtemrer reliability for the examiners in this
the participant slowly reached forward sliding the hack 4m4ii3#z$, .92,&sed on a subsample of 19 participants.
along the yardstick as far as possible. In this study, die,. && $r6tdc~~J~involved ahgmng the axis of the goni-
20-in.mark represented a zero scare, with reaches sh& ' -'a&ter
- .- - with the axisof the hip joint The stationary arm
of the mark recorded as mfnb scores and reaches b was placed in hel&ith the trunk, with the movable arm
yond 20 in. as plus scores. Scores were recorded to t b positioned in line with the femur. With the knee held
nearest 1/2 inch. Previous studies indicate that reliabiil- - straig>t, the participant's preferred leg was passively
ity estimates for the SR are consistently high (.% 1: R< 'moved into hip flexion until tightness was felt. A techni-
.99; Bravo et al., 1994;Jackson & Baker, 1986;~ a c G o a & cian assisted *th"moving the leg through flexion and
Langford, 1989; Shaulis, Golding, & Tandy, 1994). keeping the participant in the correct position, while the
Back SaverSit-and-Reach.The procedures for the BSR clinician recorded the scores to the nearest degree.
were similar to those described in the Prudential FIT-
Data Analysis
Test-retest reliability was estimated by calculating the
intraclass coefticiknt (R) using one-way analysis of vari-
ance (ANOVA) procedures appropriate for a single trial
(Baumgartner &Jackson, 1995). Pearson correlation
analysiswas used to determine the relationships between
the (2% SR, BSR, a n d h e criterion goniometer measure-
ment. Niiety-five percent confidence intervals were com-
puted for all correlation coefficients using Fisher's "Z
transformation" procedures (Glass & Hopkins, 1984;
Morrow &Jackson, 1993).

Results
Descriptive statistics of participants in the reliaviity
Figure 1: Chair sit-and-reach. phase of the study are presented in Table 1. Test-retest

nnrlr. n ---- L-- rnna

 means and standard deviations, inuaclass R d u e s ; &d ~ I I B S pmwd-diffem
S I ~ ~somewbat from the SR and
reliability confidence intervalsare prese~nkd5n~akde"2 . BSR. @i4BedCSSs c o r e s - r e p r e tthe distance reached
The high intraclass cortehrim t R 2292 f ' r men and R relative t;cr the tip oftk toes. On the SRand MR, scores
=.96for women), t o g e ~ e ' r ~ : ac h' q~e ~ r~e p~r e n t t the dis-e reached rehtive to a k e on the
in scores from '& 1itesting
f to Iday 2 { p > .05),'irrdicate floor even with the heel@)of the foot,
that irlmurements are highly stable. Mthough data Table 4 contains the correlation r values and 95%
i n i d l y werk recorded hi in. ( f o ~ease in interpreting c d d e n c e intervals indicating the relationship between
results to ofder adults), scores weie transformed into cm the field sit-and-reach tests and the criterion measure.
for data an* and repoi-ti%. As indi&ed m the table, the correlations between the
'
Descriptive chzmkteiisti'csand mean flexibilityscores CSR-and the caerion (goniometer-measured flexibility)
of the validity study partiC:lpmts are presented in Table for both male and female participants ( r = .76 and 31,
?.'independent t test analyses 'of the data indicate that respectivdxy) Ws comparable to and, in fact, slightly
fie women were more flexibk than irhe men on all four greater than-the correlations of the SR (r = .74 and .71,
ha;nscriclg measures ( p < .~obl').'&o, M W A analysis respectively) and BSR with the criterion measures ( r =
inqcates significant differknkes in Sedbility scores p r e ; f ,

duced by the CSR, SR,a .) I

98.2,p < .0001.Post hoc co

ibilii scores are better with
or B!3R (pc .OOT). Gores
not significantly'different &;'a, iii Sc?t.&,
within participant groups
all flexibility measures).
ever, should be i n t q r e
74.53 (5.69) 74.02 (6.67)
175.18 (11.67) 159.38 (7.96)
79.36 (10.71) 62.07 (9.29)

Table 1. Means and standard deviations of descriptive and-reach (cm) -9.69 (13.43)' 3.18 (12.27) 4.41"
characteristics for reliability study participants Sit-and-reach (cm) -20.84 (12.81)? -5.73 (11.57) 5.48"
Back saver (cm) -20.90 (14.4412 -5.37 (12.04) 5.21"
Men (n = 34) Women ( n = 42) Goniometer (") 74.72 (14.24) 91.29 (12.04) 5.50"
M SD M SD
Note. M = mean; SD = standard deviation. Chair sit-and-reach and
Age (years) 72.62 (6.57) 69.11 (5.12) backsaver scores represent only the preferred leg (defined as
Height (cm) 177.01 (7.37) 163.14 (5.79) the leg which results in the better score).
Weight (kg) 83.14 (16.61) 71.19 (14.33) 'Scores represent distance reached relative to tip of toes
'Scores represent distance reached relative to line on the floor
Note. M = mean; SD = standard deviation. even with heel(s)of the feet
* t ratios comparing flexibility scores of men and women are
statistically significant ( p < .0001, df= 78).

Table 2 Test-retest means, standard deviations, intraclass -- --

reliability estimates, and 95% confidence intervals for the chair

sit-and-reach reliability study Table 4. Correlations and 95% confidence intervals of chair sit-
and-reach, sit-and-reach,and back-saver sit-and-reachscores
Test 1 Test 2" R GI with goniometer-measured flexibility
M SD M SD
Men ( n = 32) Women (n = 48)
Chair sit-and-reach (cm) r CI r CI
Total (n = 76) -4.83 (14.48) -5.33 (14.22) .95 (.92-.97)
CSR .76 (.57-.88) .81 (.69-.89)
Men (n = 34) -13.46 (13.72) -12.45 (14.22) -92 (.85--96)
SR .74 (.54-.86) .71 (.54-.83)
Women ( n = 42) .23 (12.20) .25 (11.68) .96 (.93-.98)
BSR .70 (.48-.84) .71 (.54-.83)
Note. M = mean; SD = standard deviation; R = intraclass reliability
estimate; CI = 95% confidence interval. Note. r = correlation; CI = 95% confidence interval; CSR = chair
"ANOVA analysis revealed no significant differences between sit-and-reach;SR = sit-and-reach;BSR = back-saver sit-and-
Test 1 and Test 2 scores for male or female participants ( p > .05). reach.
.lone% R i a Max, and Noifal
.70 m d .71, respectively). However, none of the differ-
'ences between the correlation values reached statistical
significance at the .05 level.
Discussion aT i
Although the SR and the BSR are the most com-
monly used field measures of hamstring flexibility in
current fitness test batteries, both tests have inherent
limitations for older adults who may have difficulty get-
ting down and up from the floor or have difficulty sit-
ting on a level surface with legs extended. Therefore, a
chair sit-and-reach was proposed as an alternative pro-
cedure for psessiog hamstring flexibiliya procedure
which would presumably enable more older adults to
participate and minimize the possibility'of injury during
testing. The purpose of this study was to examine the
relationship of the CSR to other measures of hamstring
flexibility in older adults, particularly with respect to the
test-retest reliability and criterion validity of the CSR.
Results indicate that the CSR test has good stability
reliability for both men (R =.92) and women (R = .96)
and that its criterion validity correlations (r=.76 for men
and .81 for women) are slightly greater (although not
statistically different) than for SR or BSR procedures
(seeTable 4). The validity coefficients faund in this stu$
for CSR, SR, and BSR (.70 > R> .81) are similar to those
found in other studies with other age groups. Jacksun
and Baker (1986) andJackson and Langford (1989) re-
ported validity coefficients for the SR test ranging from
.64 to .88 in studies involving teenage and middle-age
participants, respectively. Also, Patterson et al. (1996),
in a study involving 11-15-year-olds, reported fairly com-
parable BSR coefficients for male participants (left leg
= .68; right leg = .72 ), but somewhat lower values for
female participants (left leg = .51; right leg =.52). The
.
high CSR reliability values for the older adults in this
study were also similar to the SR and BSR values reported
in other studies, with R coefficients in all cases consis-
tently above .90.
Although the findings of this study and others indi-
cate that the CSR, SR, and BSR all have comparable re-
liability and validity coefficients for participants who can
perform the tests, 8 (approximately 10%) of the origi-
nal volunteer participants in the validity study had to be
excluded because they either could not or would not get
down on the floor for sit-and-reach testing. No partici-
pants, on the other hand, were eliminated due to their
inability to perform the chair sit-and-reach test. Also, in
spite of our emphasis on proper spotting of the partici-
pants in this study, one female participant did fall back-
ward during the SR testing, hitting her head on the
gymnasium floor. As indicated earlier, weakened uunk
muscles or tight hamstrings, or both, make it difficult
for some older adults to-.maim& a straight-leg sitting
position on the fioor. No injuries occurred during test-
ing on the CSR. However, careful spotting is recom-
mended when assessing frail participants or individuals
with balance problems.
In concl~~sion, the measurement of hamstring flex-
ibility is an important component of health-related fit-
ness. Results of this study indicate that the CSR is highly
reliable and has moderate validity as a measure of ham-
string flexibility. Further, the CSR appears to be a safe
and socially acceptable assessment procedure for older
adults and can measure each leg separately to detect any
bilateral differences in hamsuing flexibility. Early detec-
tion of shortened hamstrings would be valuable for the
practitioner in providing feedback for exercise prescrip
tion to help correct or reduce imbalances that may lead
to mobility problems and potential injuries. Furthermore,
in an era of assessment and accountability for health care
(Russek,Wooden, Ekedahl &Bush, 1997), the CSR could
potentially provide practitioners an excellent outcome
measure for assessing the benefits of therapeutic inter-
vention with this population, although additional stud-
ies are needed to test the ability of the CSR to detect
cbange over time. Also, more studies are recommended
to investigate the reliability and validity of the CSR with
physically frail and disabled populations. The relation-
ship of the CSA in this study to other hamstring flexibil-
i q meisures must be delimited to the population
studied, apparently healthy older adults with no major
-
orthopedic limi
- w
. ~ d ~
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Note
1. Test theory suggests that with multiple trials the aver-
age score is normally a more reliable indication of per-
formance than the best score. However, because SR, BSR,
and CSR performance has been found to be quite reli-
able using the "best score" protocol (above .90), we be-
lieve this method isjustified and, in fact, recommended
in gouptestingsituations where efficiency in testing time
L &tical.
This research was supported by a grant from Pacificare
Health Systems: The authors thank the s-and all voI-
unteer partkipants from the Leisure World and
Morningside Retirement Communities and from the
Lifespan Wellness Clinic f o their
~ assistance with this
study. Please address all correspondence regarding this
article to C. Jessie Jones, Division of Kinesiology and
Health Promotion, California State University-Fullerton,
Fullerton, CA 92834.
E-mail: jjones@fidlerton.edu