Why Some Ski Black Diamonds at 75 years old While Others Struggle with Stairs: Unlocking Vitality Through Function and Mobility

"We don’t stop playing because we grow old; we grow old because we stop playing"

-George Bernard Shaw

As we age (or as we watch our loved ones age) we notice that some are not as frail as others. Why is one 75-year-old person out there still playing pickleball and skiing black diamond runs while another 75-year-old person can barely go up and down the stairs without fear of falling? Is it genetics? Lifestyle? Luck? A major aim of longevity medicine is focusing on keeping us active as we get older so we end up more like the former than the latter. But how do we classify the overall vitality of a person? We often screen for frailty and evaluate functional capacity through various types of testing. For the purposes of this article, we will focus on evaluation of function and mobility; one of the cornerstones of preventing frailty.

Functional decline often precedes frailty, manifesting as having increasing difficulty with activities of daily living, reduced mobility, and increased dependence on caregivers. This decline does not happen overnight and is inevitable for everyone but there are interventions that can be introduced that will hopefully stave off the start of decline. One of the first steps is early recognition and instituting targeted interventions, such as physical activity, nutritional support, and comprehensive geriatric assessment.

Recognizing functional decline and getting an honest assessment

There are many tests but one of the most validated screenings, which can be done in the home with minimal equipment, is called the Short Physical Performance Battery (SPPB) and gait speed measurement. The SPPB is an objective measurement for balance, lower extremity strength and functional capacity in older adults (typically >65yo). This test, first developed in 1994 by Dr. Jack Guralnik, MD, is a validated test that can predict hospital fall risk and onset of disability.1

The SPPB is easy to administer and takes approximately 10 minutes. It includes three sections: Chair stand test, Balance Test, and Gait Speed test.

1. 1.) Balance test:

   1. Side by Side: The participant will stand with their feet together side-by-side for 10 seconds. The participant may use their arms, bend knees, or move their body to maintain balance but should not move their feet. The participant should be able to do this for a full 10 seconds they will then move to the semi-tandem test. If they are unable to maintain this position for 10 seconds then this part of the test is over and they will move on to the gait test. *For safety someone should be able to stand next to the participant in case they fall or lose their balance.

   2. Semi-Tandem: The participant will stand with the side of the heel of one foot touching the big toe of the other foot. This position should be held for 10 seconds. If they are able to hold it for 10 seconds they will go to the next test the Tandem stand. If not, this portion of the test is over and they will proceed to the gait test

   3. Tandem stand: now the participant will stand with the heel of one foot in front of and touching the toes of the other foot for 10 seconds.

2. Gait Speed Test:

   1. First gait speed test: The length should be 3 or 4 meters. Have the participant start walking to a marked end point (like tape on the floor). The participant may use a cane or other walking aid. The time it takes the participant to walk should be recorded and whether the participant walked 3 or 4 meters.

   2. Second gait speed test: Repeat the same as above and record the time.

   3. Only the fastest time will be scored.

3. Chair stand test: The participant is asked to sit in a chair (like a dining room chair) and asked to stand up as quickly as possible. If they are able to stand without using their arms we will proceed to the repeated chair stand test. If the participant is not able to stand without using arms this part of the test will end and will score a 0.

   1. Repeated chair test: The participant will stand from sitting 5 times. The total time will be recorded.

4. Scoring:

   1. Balance test: if unable to hold for 10 seconds, then the score is 0

      1. Side by side: held for 10 sec = 1 pt

      2. Sem-tandem: held for 10 sec= 1 pt

      3. Tandem stand: held for 10 sec =2 pt

      4. Total balance score_____(sum points)

   2. Gait Speed test:

      1. For 4-meter walk:

         1. <4.82sec=4 pts

         2. 4.82-6.20sec= 3 pts

         3. 6.21-8.7 sec = 2 pts

         4. >8.7 sec = 1 pt

         5. Unable to do the walk = 0

      2. OR for a 3-meter walk:

         1. <3.63sec = 4 pts

         2. 3.63-4.65sec = 3 pts

         3. 4.66-6.52sec = 2 pts

         4. >6.52 sec = 1 pts

   3. Chair stand test

      1. Time to complete 5 stands:

         1. <11.19 sec = 4 pts

         2. 11.20-13.69sec = 3 pts

         3. 13.7-16.69sec =2 pts

         4. >16.7sec =1 pts

         5. Unable to complete 5 stands or >60 sec = -0 pts

   Totals:

   1. Scores 10-12: Nonfrail; these individuals generally have good physical function and low risk for disability or adverse outcomes.

   2. Scores 3–9: Frail; this range is associated with increased risk of mobility impairment, disability, falls, hospitalization, and mortality. Within this range, lower scores indicate greater severity of frailty.

   3. Scores ≤2: Disabled; this threshold reflects severe functional impairment and very high risk for adverse health outcomes.

Conclusion

Maintaining vitality as we age is not just about luck or genetics—it's about taking proactive steps to preserve function and mobility. Tools like the Short Physical Performance Battery (SPPB) offer a clear, objective way to assess and monitor physical capacity, helping to catch functional decline early. By integrating regular exercise, balanced nutrition, and routine assessments into our lives, we can tilt the odds toward staying active and independent, whether that means hitting the pickleball court or simply climbing stairs with confidence. Don't wait for frailty to set in—talk to your healthcare provider about the SPPB, start a tailored exercise plan, or consult a geriatric specialist to build a stronger, healthier future today.

References

1.      Lower-Extremity Function in Persons over the Age of 70 Years as a Predictor of Subsequent Disability Authors: Jack M. Guralnik, M.D., Ph.D., Luigi Ferrucci, M.D., Ph.D., Eleanor M. Simonsick, Ph.D., Marcel E. Salive, M.D., M.P.H., and Robert B. Wallace, M.D.

2.      Measuring physical capacity and performance in older people. Lamb SE, Keene DJ. Best Pract Res Clin Rheumatol. 2017 Apr;31(2):243-254. doi: 10.1016/j.berh.2017.11.008. Epub 2017 Nov 22. Review. PMID: 29224699