# Walking, gripping and standing up: the tests that take five minutes

Source: https://onco.cc/technologies/rejuv-measure-functional-tests/  
OnCo record `rejuv-measure-functional-tests` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

How far somebody walks in six minutes, how hard they can squeeze a handle, and how fast they can stand up from a chair five times. These need almost no equipment, they predict what happens to people, and they measure something a questionnaire cannot.

## Summary

Four tests account for most of the objective function measurement in this field, and all four can be done in a corridor.

The six-minute walk. The American Thoracic Society statement of 2002 standardised it: a flat 30-metre corridor, standard encouragement at fixed intervals, distance recorded in metres. It measures submaximal exercise capacity, which is closer to daily life than a maximal test. What counts as a meaningful change in cancer has been studied directly: in 97 patients having colorectal cancer surgery, an anchor-based study estimated the minimal clinically important difference of the six-minute walk distance from before to one week after surgery at between -75 and -60 metres, with responsiveness measured as an effect size of 0.69 and a standardised response mean of 0.91. That is a figure for one setting and one time window, and it should not be transported to a twelve-week exercise programme.

Grip strength. A hand dynamometer, three attempts, best recorded in kilograms. The Prospective Urban Rural Epidemiology study measured grip in 139,691 people across 17 countries of varying income and followed them for a median 4.0 years. "Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1.16, 95% CI 1.13-1.20)", and after adjustment the association held across country-income strata for most outcomes, with cancer and respiratory admission the exceptions. The authors conclude that it "is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease". It is also the strength component of every current sarcopenia definition.

The chair stand and the short physical performance battery. Guralnik's battery combines standing balance in three positions, an eight-foot walk and the time to rise from a chair and return to sitting five times, each scored categorically and summed. It was validated in more than 5,000 people aged 71 and over. Its important finding for this front is that the performance tests added information that self-report did not: "in those at the high end of the functional spectrum, who reported almost no disability, the performance test scores distinguished a gradient of risk for mortality and nursing home admission". A person who says they are fine and cannot rise five times from a chair is telling you two different true things.

Gait speed. Usual walking speed over four metres, part of the battery above and usable alone. It is the single most portable measure of physical function in older adults and is routinely embedded in geriatric assessment before cancer treatment.

Where this matters on this front. These are the measures that detect the deconditioning that treatment causes and the recovery that training produces, in units nobody can argue with. They are the outcome measures of prehabilitation and of exercise oncology programmes, and they are the entry point of a geriatric assessment.

What they miss. They measure capacity on the day, in a corridor, with encouragement, which is not the same as what a person does at home; that is the argument for wearable step counts. They are effort-dependent and can be depressed by pain, breathlessness, fear of falling or low mood rather than by muscle. Published normative values come mostly from older white populations in high-income countries. And a single measurement is close to useless: the information is in the change.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-10-02
- Tags: rejuvenation; survivorship; measurement; objective
- Principle: Physical performance tests measure capacity under standardised conditions, which is a different construct from self-reported function and adds independent prognostic information. Distance walked, force generated and time taken are ratio-scaled, so change is interpretable without a value set or a scoring manual.
- Since: 1994
- Strengths: Almost no equipment, five minutes, repeatable anywhere including a community clinic; Grip strength predicts all-cause and cardiovascular mortality across 17 countries and all income strata; Performance adds prognostic information beyond what people report about themselves; A published minimal clinically important difference for the six-minute walk in colorectal cancer surgery
- Limitations: Capacity in a corridor is not behaviour at home; Effort-dependent, and depressed by pain, breathlessness or fear of falling rather than by muscle; Normative data come mostly from older high-income populations; A single reading means little; the information is in the change

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Six-minute_walk_test
- ATS statement: guidelines for the six-minute walk test (Am J Respir Crit Care Med 2002): https://doi.org/10.1164/ajrccm.166.1.at1102
- Yanagisawa et al., Responsiveness and minimal clinically important difference of the 6-minute walk distance in patients undergoing colorectal cancer surgery (Support Care Cancer 2024): https://doi.org/10.1007/s00520-024-08596-y
- Leong et al., Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study (Lancet 2015): https://doi.org/10.1016/S0140-6736(14)62000-6
- Guralnik et al., A short physical performance battery assessing lower extremity function (J Gerontol 1994): https://doi.org/10.1093/geronj/49.2.M85

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- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
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- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)

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