Forward and Lateral Sitting Functional Reach in Younger,

Middle-aged, and Older Adults

Mary Thompson, PT, PhD, GCS;1 Ann Medley, PT, MS1

number of older Americans has spurred research in the area

to develop methods of preventing falls. In fact, public health
concerns are such that the prevention of unintentional injury,
including those from falls, are included in core documents
such as Healthy People 2010.4
To develop effective interventions to prevent falls we
must have reliable and valid measures of static and dynamic
balance. Numerous researchers have developed objective
standing balance measures11-14 to test the effectiveness of
various interventions.15 Standing lateral and forward reach
have been addressed in several studies.16-18 These standing
balance measures are appropriate for well to frail older adults
who can stand. However, frail individuals who are unable to
stand unsupported cannot perform the tests.13 Unfortunately,
researchers have neglected the development and study of
objective measurements of sitting balance.
Lack of objective sitting balance measures is problematic when an increasing number of older Americans spend
the majority of their day sitting because of conditions such
as stroke, spinal cord injury, and frailty. In 1994, 2.2 million
Americans relied on wheelchairs for mobility and the majority
of users were older than 65.19 In addition, an estimated 36,559
nonfatal, wheelchair-related accidents (often during dynamic
activities) require emergency department attention each year
in the United States.20 This figure does not take into account
falls from other chair-types or falls from sitting on the edge of
a bed.
Clearly, falls from the seated position are a concern. To
develop effective interventions to improve sitting balance
and prevent falls from sitting, clinicians must first develop
objective ways to measure dynamic sitting balance. One such
method is the modified functional reach test developed by
Lynch and associates,21 who tested its reliability in a sample of
male participants with spinal cord injuries sitting on mat tables
with an 80o back board. The authors examined movement in
one direction, forward.21 However, people reach to the side to
complete tasks such as answering the telephone or picking
up an object located to their side. Therefore, examining lateral
reach while sitting is as important as forward reach. Lateral
sitting reach is likely to be different from forward reach in that
the base of support is different. What is not known is how people without disability or sitting balance impairments perform
sitting reach in multiple directions. Furthermore, other factors
such as age11-14 and anthropometrics13 may influence the limits
of stability in sitting when reaching forward or laterally.
Therefore, the purposes of this study were threefold. The
first purpose was to determine whether sitting forward reach

Texas Womans University, School of Physical Therapy, Dallas,

TX
1

ABSTRACT
Purpose: We adapted the original Functional Reach so that
sitting balance could be quantifiably measured in 2 directions.
Purposes of the study were to determine if sitting forward or
lateral reach: (1) are reliable among younger, middle-aged, and
older adults without balance problems; (2) provide reference
values for clinicians; and (3) examine factors (age and anthropometrics) that may influence such measures. Methods: This
descriptive study involved 146 apparently healthy adults in 3
age groups: 62 younger (21 to 39 yr), 41 middle-aged (40 to
59 yr), and 43 older (60 to 97 yr). After anthropometric measurements were obtained, participants reached forward and
laterally (shoulder elevated 90o) with a closed fist while sitting
in a chair. Intrarater reliability was calculated on a subset of 84
participants. Results: Intrarater reliability of sitting forward and
lateral reach measured with a yardstick was excellent (ICC3,1 =
.98 and .96 respectively). Means and standard deviations by age
group and sex are reported. Regression analysis showed that
body segment anthropometrics did not affect performance.
Differences between age groups for both the sitting reaches
were found. Post hoc analysis revealed that older participants
differed from both younger and middle-aged participants.
Conclusions: Forward and lateral reach from the seated position can be reliably measured and offer therapists a way to
quantify sitting balance. This study provides reference values
for younger, middle-aged, and older adults for clinical use.
While anthropometrics do not affect performance, older adults
perform differently from younger and middle-aged adults.
Key Words: sitting balance, aging, functional reach
INTRODUCTION
The United States population continues to shift to increasing numbers of older adults with longer life expectancies.1 At
the same time, 30% to 60% of community dwelling older adults
fall each year and that rate increases with age.2 For older adults
living in nursing homes, the annual fall rate is as high as 75%.3
The high rate of falls combined with the growth in percent and
Address all correspondence to: Mary Thompson, Texas
Womans University, School of Physical Therapy, 8194 Walnut
Hill Lane, Dallas, TX 74231 Ph: 214-585-1332, Fax: 214-7062361 (MThompson@twu.edu).

Journal of Geriatric Physical Therapy Vol. 30;2:07

43

and sitting lateral reach can be reliably measured in younger,

middle-aged, and older adults without balance problems. The
second purpose was to provide clinically relevant reference
values. The final purpose was to determine factors, if any, that
influence sitting forward or lateral reach.
METHODS
This was a descriptive study involving 3 age groups. The
dependent variables were the distance achieved during sitting
forward reach and lateral reach. The Texas Womans University
Institutional Review Board approved the study. Each participant provided written informed consent in compliance with
Institutional Review Board requirements at Texas Womans
University.
We recruited a convenience sample of 152 apparentlyhealthy community dwelling volunteers from the North Texas
area. To qualify for the study, participants had to be able to
follow simple commands, raise one arm to 120o of shoulder
flexion and abduction, ambulate without an assistive device,
and have no acute medical conditions. Five individuals were
excluded because they did not meet the inclusion criteria for
the study. In addition, 1 person was eliminated as a statistical
outlier. The remaining 146 participants ranged in age from 21
to 97 years. The sample was divided into 3 groups on the basis
of age. There were 62 people in the younger group (age 21
to 39, mean=27 + 5 yrs), 41 participants in the middle-aged
group (age 40 to 59, mean=51 + 6 yrs), and 43 people in the
older group (age 60 to 97, mean=80 + 9 yrs).
Prior to testing, the participants provided information on
their functional status. A gross screen determined whether
potential participants had the shoulder range of motion needed to perform the reach tests. In addition, anthropometric
measurements, measured in centimeters with a metal tape,
were taken with each participant seated in the standard metal
folding chair (front seat height 17 inches, seat width 15.5
inches) used for testing. Femoral length was measured from
the greater trochanter to the lateral condyle of the femur. Arm
length was measured from the acromion process to the ulnar
styloid with the arm supported in 90o of abduction. Trunk
length was measured in centimeters from the C7 spinous
process to the seat of the chair. Weight and height were also
measured with a standard, calibrated scale and standiometer
respectively.
To perform the reaching tasks, participants were asked to sit
unsupported with feet flat on the floor and lift the arm forward
or laterally (at approximately 90o) with a closed fist (Figure 1,
A and C). The position of the third metacarpal along the yardstick was recorded as position 1. Participants were then asked
to lean forward or laterally as far as they could while remaining
seated (Figure 2, B and D). The placement of the third metacarpal head was recorded again as position 2. Participants were
not allowed to contact the wall with their arm or lift their feet
off the floor during the tasks. Each task was repeated 3 times.
As in Duncan and associates,13 reach was defined as the mean
differences between positions 1 and 2, over 3 trials.

Figure 1. Starting and ending positions for forward and lateral sitting reach. A. Starting position for forward reach. B.
Ending position for forward reach. C. Starting position for
lateral reach. D. Ending position for lateral reach.
All data were analyzed using SPSS software, version 12.
Intraclass coefficient (ICC3,1) determined intrarater reliability
across the 3 trials on a subset of 84 participants. Height, weight,
age, and gender were used to calculate body mass index for
each subject. The mean performance of the 146 participants
on each task was used for all remaining analyses. Group means
and standard deviations were calculated for each task. The old
group was further divided into young-old and old-old groups
to make the age span comparable to the other two groups.
Regression analysis was performed to determine the contribution of anthropometric characteristics (body mass index and
arm, trunk, and femur lengths) to forward or lateral reach. A
multivariate analysis of variance (MANOVA) was calculated to
determine differences between age groups on the two tasks
with post-hoc analysis as necessary.
RESULTS
Participants were very similar to each other in that 87% had
college education. In addition, 77% of the participants lived
with someone and 51% used no medications. Sixty-six percent
participated in some form of regular exercise. They were also
similar in terms of anthropometric characteristics (Table 1).
The intrarater reliability (ICC3,1) of sitting forward and lateral
reach performed with a yardstick was .98 and .96 respectively.
Mean scores on the sitting forward reach and lateral reach by
group are presented in Table 2. The MANOVA revealed differences between age groups for both the sitting forward reach (F
= 17.5, p = .0001) and sitting lateral reach (F = 15.4, p = .0001).
Post hoc analysis revealed that participants in the 2 older age
groups did not differ from each other. Furthermore, the older
participants (in total and also divided into young-old and

44

Journal of Geriatric Physical Therapy Vol. 30;2:07

Table 1. Mean Subject Anthropometric Characteristics by Age Group

Age 21-39
n=62

Characteristic

Age 40-59
n=41

Age 60-97
n=43

Entire Sample
n=146

Height (cm)

167.0

167.6

165.8

166.9

Weight (kg)

67.2

70.6

66.9

68.1

Body Mass Index (kg/m2)

24.0

24.5

24.3

24.2

Arm Length (cm)

55.6

55.1

53.6

54.9

Femur Length (cm)

42.0

41.5

41.3

41.7

Trunk Length (cm)

66.6

68.1

66.5

66.9

Note: There were no significant differences between groups on any of the characteristics.

Table 2. Mean Sitting Reach (cm) by Sex and Age Group

Group

Forward Reach (cm)

Mean

SD

Male (n=6)

45.4

9.3

Female (n=56)

44.8

Total (n=62)

Lateral Reach (cm)

Min-Max

Mean

SD

Min-Max

29.6-55.0

31.6

8.8

21.2-44.2

6.7

25.7-58.4

29.3

5.8

17.8-47.4

44.9

6.9

25.7-58.4

29.5

6.1

17.8-47.4

Male (n=17)

44.4

6.9

33.8-63.3

28.5

5.0

18.2-36.1

Female (n=24)

40.4

6.7

25.0-53.3

24.8

4.7

16.3-33.3

Total (n=41)

42.1

7.0

25.0-63.3

26.3

5.1

16.3-36.1

Male (n=7)

36.6

9.2

26.7-54.1

25.8

8.2

14.0-37.9

Female (n=13)

33.5

9.9

16.0-51.6

17.9

6.2

7.4-26.2

Total (n=20)

34.6

9.5

16.0-54.1

20.6

7.8

7.4-37.9

Male (n=8)

35.6

10.9

21.6-51.6

24.8

3.4

19.5-28.8

Female (n=15)

31.8

9.3

16.1-48.3

19.9

7.7

11.9-36.0

Total (n=23)

33.1

9.8

16.1-51.6

21.6

6.8

11.9-36.0

Male (n=38)

41.3

9.3

21.6-63.3

27.7

6.3

14.0-44.2

Female (n=108)

40.7

9.0

16.0-58.4

25.6

7.3

7.4-47.4

Total (n=146)

40.8

9.1

16.0-63.3

26.2

7.1

7.4-47.4

21-39 Years

40-59 Years

60-79 Years

80-97 Years

Entire Sample

DISCUSSION
Sitting balance is important for functional independence,
especially for people who cannot stand. Any limitations in the
ability to safely shift the center of gravity toward stability limits may limit wheelchair mobility and activities of daily living.

old-old groups) differed from both younger and middle-aged

participants on both variables but the younger and middleaged groups did not differ from each other (Figures 2 and 3).
In addition, regression analysis showed that body segment
anthropometrics did not affect performance (p = .25).

Journal of Geriatric Physical Therapy Vol. 30;2:07

45

is based on time and a description of performance from 0,

meaning the resident was able to sit for 10 seconds without
support, to 3, not able to attempt test without physical help.
50
The resident scores 1 if unsteady but able to rebalance self, or
40
scores 2 if only able to perform part of the activity or refused
to participate. This measure of static balance may not be useful
30
given that most wheelchair related injuries are due to dynamic
20
movements resulting in falls and tips during activities such as
10
transfer tasks and reaching while seated in the wheelchair.24
One way of assessing functional dynamic sitting balance is
0
to use a reaching activity that simulates volitional real-world
Younger
Middle-aged
Young-old
Old-old
functional movement like the Functional Reach described by
Age Group
Duncan and associates.13 Reaching from a seated position,
Figure 2. Bar graph illustrating the mean and standard deviation of sitting forwardwhile
reach for
not4 as demanding as reaching from a standing position,
Figure 2. Bar graph illustrating the mean and standard destillthechallenges
balance control beyond static sitting. However,
viation
sitting
forward
for 4 different
age
groups.
different
ageofgroups.
The
younger reach
and middle-aged
participants
reached
further than
older
research
on
objective
measures of this type of movement has
The younger and middle-aged participants reached further
participants
(p
=
.0001).
been limited to one study. Lynch et al21 studied reaching in
than the older participants (p=.0001).
participants following a spinal cord injury but only investigated
reach in one direction, forward. We extended their work by
investigating lateral reach as well as forward. We also studied
40
individuals without pathology to allow for comparisons with
35
Lynch and associates study. The male participants with spinal
30
cord injuries ranged in age from 18 to 45; consequently they
25
would be placed in the younger or middle-aged groups for
20
our study. Lynch et al did not report a mean forward sitting
15
reach but forward excursions ranged from 2.5 cm to 29.1 cm.21
10
In comparison, apparently healthy younger and middle-aged
5
adults in our study reached 45.4 cm and 44.3 cm respectively.
0
At best, the participants with spinal cord injuries were able to
Younger
Middle-aged
Young-old
Old-old
reach forward only 6% to 66% as far as those without patholAge Group
ogy. Thus, sitting forward reach appears to differ between participants with spinal cord injury and apparently healthy adults.
Figure 3. Bar graph illustrating the mean and standard deWhile reliability of the measure in males with spinal cord
Figure
3. Bar
illustrating
mean and
deviation
sitting lateral reach for 4
viation
ofgraph
sitting
lateralthereach
for standard
4 different
ageof groups.
injury was high, reliability in other populations has not been
The younger and middle-aged participants reached further
established.
Our results indicate that seated reaching can
different age groups. The younger and middle-aged participants reached further than
the older
than the older participants (p=.0001).
be reliably measured using a yardstick in apparently healthy
participants (p = .0001).
adults. Screening for difficulty in functional activities including
While sitting balance is important to assess, objective meadynamic sitting balance requires reliable measures with known
sures have been neglected. The use of force plates to objecreference values. However, reference values have not been
tively measure postural responses in15sitting is not practical.
established for sitting reach. A review of the literature suggests
Therefore clinical documentation of functional sitting balance
that in standing, forward reach is expected to be at least 22 cm
often focuses on the amount of physical assistance needed
and lateral reach, 12 cm.25 Similarly, based on our results, sitting
to maintain sitting balance (independent or no assistance to
forward reach should be at least 32 cm and lateral reach, 18 cm
maximum assistance). In addition, examination of sitting bal(Table 2).
ance is often imbedded in another task such as transfer ability
One might expect sitting forward and lateral reach to be
on the Barthel Index.22
influenced by base of support and anthropometric measurePerhaps the most commonly performed sitting balance
ments. For example, when moving the center of gravity toward
measure for nursing home residents is item G3b (balance
the limits of seated stability, we expected that forward reach
while sitting) on the Minimum Data Set (MDS).23 Completed
would be greater than lateral reach due to the larger base of
on admission and periodically thereafter, the MDS attempts to
support for forward reach. Our findings were consistent with
provide an objective assessment of static sitting balance. The
this expectation. However, unlike Duncan and associates13 who
protocol requires the use of a chair with a firm, solid seat at a
studied standing reach, anthropometric measurements did
height that allows the residents feet to rest on the floor. The
not affect seated forward or lateral reach scores in our study. It
tester instructs the resident to sit with arms folded across the
may be that the larger base of support and shorter lever arm in
chest without using the chair back or arms for support. Scoring
sitting compared to standing allowed greater limits of stability.
Lateral Reach (cm)

Forward Reach (cm)

60

16

46

Journal of Geriatric Physical Therapy Vol. 30;2:07

In addition, our groups were very similar in size and shape and
none of our participants were obese so excess adipose tissue did
not limit movement.
Age is another factor that affects balance. Declines in standing balance have been attributed to sensory, musculoskeletal,
and cognitive changes, typically in some combination as multiple systems fall below minimal functional thresholds. These
same changes may influence sitting balance as well. Based on
results from cohort studies of standing balance,13,25 we expected
the sitting functional reach excursions to be smaller for the older
adult group. This finding was true for both forward and lateral
reach. An alternative explanation for the age differences in performance may be group differences on anthropometric measures, but this was not the case. Other unmeasured factors such
as medications, hydration status, and perceived functional ability may also contribute to differences in performance between
the age groups.
While not assessed directly in this sample, fear of falling could
influence sitting functional reach performance, more so in older
adults than the younger age groups. To establish baseline values
we collected performance data on healthy participants without
sitting balance problems, who did not express a fear of falling
from a seated position. Therefore, fear of falling from a seated
position did not appear to be a factor in their performance. This
lack of fear may not be the case for persons with or without a
history of falls who have impairments that limit sitting balance.
Newton16 found fear of falling in a sample of older adults contributed to a decreased amount of backward reach while standing. Therefore, future studies should examine the relationship
between fear of falling and sitting functional reach performance
in people with sitting balance impairments, falls, or both.
In addition to examining people with sitting balance impairments, further examination of the psychometric properties of
the sitting forward and lateral reach need to be explored in
larger sample sizes. Specifically, the clinical usefulness of the
measures should be addressed as well as concurrent and predictive validity.
In conclusion, forward and lateral reach from the seated
position can be reliably measured in apparently healthy adults.
These sitting reach tests challenge balance beyond static sitting
and simulate functional movements. This study provides reference values for younger, middle-aged, and older adults that may
be useful for clinical comparisons. While anthropometrics do
not affect performance, older adults perform differently from
younger and middle-aged adults.
Acknowledgement
We thank our graduate students who assisted with this
work.
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