There is limited evidence comparing center and home-based sit-to-stand (STS) tests in individuals with chronic respiratory disease (CRD). This study aimed to estimate the level of agreement and performance differences among center-based, remotely supervised, and self-administered STS tests in individuals with CRD.
Methods:
A repeated-measures design was used to compare the 30-s and 1-min STS across 3 test conditions. The sample size was one of convenience and included subjects with CRD from an out-patient pulmonary rehabilitation program in Toronto, Canada. Bland–Altman analysis was used to estimate STS agreement across conditions, reporting mean difference and 95% limits of agreement (LoA). Analysis of variance was used to estimate differences in STS performance across conditions, controlling for testing order. Secondary measures included indicators of safety and acceptability of the remotely supervised and self-administered conditions. All analyses were completed using Stata/BE 17.0 with a significance level of P ≤ .05.
Results:
Twenty-seven participants (mean age 69.4 ± 11.8 years, 52% female) completed STS testing in all 3 conditions. Bland–Altman plots revealed limited bias across all comparisons (mean difference < 1 repetition). LoA illustrated individual variation across comparisons for the 30-s STS (LoA −3.4 to 4.1) and 1-min STS (LoA: −7.4 to 8.6). Analysis of variance models indicated no effect of test condition on either 30-s STS (P = .12) or 1-min STS (P = .33). There was an observed order effect for the 30-s STS (P = .005) and 1-min STS (P = .005). There were no serious adverse events for remotely supervised and self-administered tests. The majority (≥ 80%) of participants found the instructions clear, and felt safe and confident while performing the remotely supervised and self-administered STS.
Conclusions:
Performance on the 30-s and 1-min STS did not differ across test conditions. Remotely supervised and self-administered tests may be safe and acceptable.
SpruitMA, SinghSJ, GarveyC, et al.; ATS/ERS Task Force on Pulmonary Rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013; 188(8):e13–e64; doi: 10.1164/rccm.201309-1634ST
5.
HollandAE, SpruitMA, TroostersT, et al.An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J, 2014; 44(6):1428–1446; doi: 10.1183/09031936.00150314
6.
JohnstonKN, PotterAJ, PhillipsA. Measurement properties of short lower extremity functional exercise tests in people with chronic obstructive pulmonary disease: systematic review. Phys Ther, 2017; 97(9):926–943; doi: 10.1093/ptj/pzx063
7.
VilarinhoR, CaneirasC, MontesAM. Measurement properties of step tests for exercise capacity in COPD: A systematic review. Clin Rehabil, 2021; 35(4):578–588; doi: 10.1177/0269215520968054
8.
LeeAL, HarrisonSL, BeauchampMK, et al.Alternative field exercise tests for people with respiratory conditions. Curr Phys Med Rehabil Rep, 2015; 3(3):232–241; doi: 10.1007/s40141-015-0097-y
9.
HollandAE, MalagutiC, HoffmanM, et al.Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review. Chron Respir Dis, 2020; 17:1479973120952418; doi: 10.1177/1479973120952418
10.
RochesterCL. Patient assessment and selection for pulmonary rehabilitation. Respirology, 2019; 24(9):844–853; doi: 10.1111/resp.13616
11.
SpruitMA, PittaF, GarveyC, et al.; ATS Pulmonary Rehabilitation Assembly and the ERS COPD Audit team. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J, 2014; 43(5):1326–1337; doi: 10.1183/09031936.00145613
12.
KeatingA, LeeA, HollandAE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis, 2011; 8(2):89–99; doi: 10.1177/1479972310393756
13.
CoxNS, Dal CorsoS, HansenH, et al.Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev, 2021; 1(1):CD013040; doi: 10.1002/14651858.CD013040.pub2
14.
UzzamanMN, AgarwalD, ChanSC, et al.Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis. Eur Respir Rev, 2022; 31(165):220076; doi: 10.1183/16000617.0076-2022
15.
TaylorD, JenkinsAR, ParrottK, et al.Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis. Thorax, 2021; 76(6):591–600; doi: 10.1136/thoraxjnl-2020-216007
16.
PaixaoC, RochaV, BrooksD, et al.Unsupervised physical activity interventions for people with COPD: A systematic review and meta-analysis. Pulmonology, 2024; 30(1):53–67; doi: 10.1016/j.pulmoe.2022.01.007
17.
VerweelL, NewmanANL, EllertonC, et al.Virtual pulmonary rehabilitation in Canada: A national survey of programs during the COVID-19 pandemic. Can J Respir Crit Care Sleep Med, 2025; 9(1):3–13; doi: 10.1080/24745332.2024.2416203
18.
RochesterCL, AlisonJA, CarlinB, et al.Pulmonary rehabilitation for adults with chronic respiratory disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med, 2023; 208(4):e7–e26; doi: 10.1164/rccm.202306-1066ST
19.
VaidyaT, ChambellanA, de BisschopC. Sit-to-stand tests for COPD: A literature review. Respir Med, 2017; 128:70–77; doi: 10.1016/j.rmed.2017.05.003
20.
CrookS, BuschingG, SchultzK, et al.A multicentre validation of the 1-min sit-to-stand test in patients with COPD. Eur Respir J, 2017; 49(3):1601871; doi: 10.1183/13993003.01871-2016
21.
ZaniniA, CrisafulliE, D’AndriaM, et al.Minimum clinically important difference in 30-s sit-to-stand test after pulmonary rehabilitation in subjects with COPD. Respir Care, 2019; 64(10):1261–1269; doi: 10.4187/respcare.06694
22.
MavronasouA, AsimakosA, VasilopoulosA, et al.Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment. Disabil Rehabil, 2024; 46(22):5334–5344; doi: 10.1080/09638288.2023.2297928
23.
Nunez-CortesR, Flor-RufinoC, Martinez-ArnauFM, et al.Feasibility of the 30 s sit-to-stand test in the telehealth setting and its relationship to persistent symptoms in non-hospitalized patients with long COVID. Diagnostics (Basel), 2022; 13(1):24; doi: 10.3390/diagnostics13010024
24.
LarrateguyS, Otto-YañesM, BogadoJ, et al.Reliability of remote 1-minute sit-to-stand test to measure physical capacity in patients with chronic respiratory diseases. Eur Respir J, 2023:PA512; doi: 10.1183/13993003.congress-2023.PA512
25.
LarrateguyS, Otto-YáñezM, BogadoJ, et al.Agreement and reliability between tele-assessment and in-person assessment of the one-minute sit-to-stand test in patients with chronic respiratory diseases. J Clin Med, 2025; 14(14):5049; doi: 10.3390/jcm14145049
26.
OzsoyI, KodakMI, KarartiC, et al.Intra- and inter-rater reproducibility of the face-to-face and tele-assessment of timed-up and go and 5-times sit-to-stand tests in patients with chronic obstructive pulmonary disease. Copd, 2022; 19(1):125–132; doi: 10.1080/15412555.2022.2038119
27.
MorganA, BeginD, HeiszJ, et al.Measurement properties of remotely or self-administered lower extremity mobility performance measures in adults: a systematic review. Phys Ther, 2022; 102(8):pzac078; doi: 10.1093/ptj/pzac078
28.
HollandAE, CoxNS, Houchen-WolloffL, et al.Defining modern pulmonary rehabilitation. An official American thoracic society workshop report. Ann Am Thorac Soc, 2021; 18(5):e12–e29; doi: 10.1513/AnnalsATS.202102-146ST
29.
KeatingSE, BarnettA, CrociI, et al.Agreement and reliability of clinician-in-clinic versus patient-at-home clinical and functional assessments: implications for telehealth services. Arch Rehabil Res Clin Transl, 2020; 2(3):100066; doi: 10.1016/j.arrct.2020.100066
30.
StaartjesVE, SchroderML. The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine. J Neurosurg Spine, 2018; 29(4):380–387; doi: 10.3171/2018.2.SPINE171416
31.
LareauSC, MeekPM, RoosPJ. Development and testing of the modified version of the pulmonary functional status and dyspnea questionnaire (PFSDQ-M). Heart Lung, 1998; 27(3):159–168; doi: 10.1016/s0147-9563(98)90003-6
32.
CrisafulliE, CliniEM. Measures of dyspnea in pulmonary rehabilitation. Multidiscip Respir Med, 2010; 5(3):202–210; doi: 10.1186/2049-6958-5-3-202
33.
KhanMA, ShafiS, AhmadSS, et al.Chapter 9 - Regulatory affairs in clinical trials. In: Regulatory Affairs in the Pharmaceutical Industry. (AliJ, BabootaS, eds.)Academic Press; 2022:241–261.
34.
SekhonM, CartwrightM, FrancisJJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res, 2017; 17(1):88; doi: 10.1186/s12913-017-2031-8
35.
BlandJM, AltmanDG. Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet, 1986; 327(8476):307–310; doi: 10.1016/S0140-6736(86)90837-8
36.
LudbrookJ. Confidence in Altman-Bland plots: a critical review of the method of differences. Clin Exp Pharmacol Physiol, 2010; 37(2):143–149; doi: 10.1111/j.1440-1681.2009.05288.x
37.
LeeJ, NguyenHQ, JarrettME, et al.Effect of symptoms on physical performance in COPD. Heart Lung, 2018; 47(2):149–156; doi: 10.1016/j.hrtlng.2017.12.007
38.
TodtK, SkargrenE, KentsonM, et al.Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD. Int J Chron Obstruct Pulmon Dis, 2014; 9:17–25; doi: 10.2147/COPD.S52506
39.
WangL, ZhangX, LiuX. Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis. BMC Pulm Med, 2023; 23(1):164; doi: 10.1186/s12890-023-02454-z
40.
LiLSK, CaugheyGE, JohnstonKN. The association between co-morbidities and physical performance in people with chronic obstructive pulmonary disease: A systematic review. Chron Respir Dis, 2014; 11(1):3–13; doi: 10.1177/1479972313516879
41.
CoxNS, Dal CorsoS, BurgeAT, et al.Remote assessment of exercise capacity in adults with chronic respiratory disease: Safety, reliability and acceptability. Chron Respir Dis, 2025; 22:14799731251318033; doi: 10.1177/14799731251318033
42.
AktanR, YılmazH, Demirİ, et al.Agreement between tele-assessment and face-to-face assessment of 30-s sit-to-stand test in patients with type 2 diabetes mellitus. Ir J Med Sci, 2023; 192(5):2173–2178; doi: 10.1007/s11845-022-03238-w
43.
PolgarO, AljishiM, BarkerRE, et al.Digital habits of PR service-users: Implications for home-based interventions during the COVID-19 pandemic. Chron Respir Dis, 2020; 17:1479973120936685; doi: 10.1177/1479973120936685
44.
VerweelL, PackhamT, GoldsteinR, et al.Implementation of virtual pulmonary rehabilitation during the COVID-19 pandemic: Experiences and perceptions of patients and healthcare providers. Respir Med, 2024; 225:107588; doi: 10.1016/j.rmed.2024.107588
45.
ChangJE, LaiAY, GuptaA, et al.Rapid transition to telehealth and the digital divide: implications for primary care access and equity in a post-COVID Era. Milbank Q, 2021; 99(2):340–368; doi: 10.1111/1468-0009.12509
46.
RobinsonSA, BamontiP, RichardsonCR, et al.Rural disparities impact response to a web-based physical activity self-management intervention in COPD: A secondary analysis. J Rural Health, 2024; 40(1):140–150; doi: 10.1111/jrh.12765
47.
MettingE, van LuenenS, BaronAJ, et al.Overcoming the digital divide for older patients with respiratory disease: Focus Group Study. JMIR Form Res, 2023; 7:e44028; doi: 10.2196/44028
48.
WickersonLM, de Paula FerreiraM, RozenbergD, et al.In-person versus remote 6-minute walk and incremental shuttle walk distances in advanced lung disease. Respir Care, 2024; 69(5):557–565; doi: 10.4187/respcare.11417
49.
KramerCB, LeRoyL, DonahueS, et al.Enrolling African-American and Latino patients with asthma in comparative effectiveness research: Lessons learned from 8 patient-centered studies. J Allergy Clin Immunol, 2016; 138(6):1600–1607; doi: 10.1016/j.jaci.2016.10.011
50.
HuangB, De VoreD, ChirinosC, et al.Strategies for recruitment and retention of underrepresented populations with chronic obstructive pulmonary disease for a clinical trial. BMC Med Res Methodol, 2019; 19(1):39; doi: 10.1186/s12874-019-0679-y
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
