The Timed Up and Go test and the ageing heart: findings from a national health screening of 1,084,875 community-dwelling older adults

The study authored by Chun et al.1 aimed at evaluating the relationship between the Timed Up and Go (TUG) test performance and the incidence of older adult heart diseases and mortality. This was a retrospective cohort study including more than 1 million participants aged 66 years undergoing the TUG test. The main finding is that slower TUG speed is associated with an increased risk of developing myocardial infarction (MI), congestive heart failure (CHF) and mortality in older adults.1 The TUG test was developed in the 1990s as a modified timed version of the Get Up and Go test.2,3 Usually, the TUG test is commonly used for falls risk screening in the inpatient and the community setting.2–4 However, as falls assessment and prevention programmes are multifactorial, the use of the TUG for identifying the risk of falls is uncertain.5 The TUG test is currently commonly adopted for performance evaluation in several different cohorts of patients.6,7 In this case, the authors evaluated the predictive value for heart diseases and mortality of TUG test performance in older adults1 demonstrating that the TUG test is useful to predict two major cardiovascular events (MI and CHF) and overall mortality. These data highlighted the importance of preserving mobility and preventing disability in order to modify longitudinal trajectories of life. The TUG test is relatively simple to execute and, given its strong predictive value, it is time to assess TUG performance routinely in clinical practice.8,9 In fact, the TUG test requires minimal equipment or training and can be used in a variety of settings. Therefore, physicians will have more opportunities to identify patients who are at a higher risk of cardiovascular disease and who will benefit from preventive interventions (i.e. physical activities, structured exercise training programmes). The early detection of high-risk individuals may provide a window of opportunity for more proactive preventive interventions.10 Notably, in the study by Chun et al.1 subjects with lower TUG performance were more likely to be women, non-smokers and non-drinkers. This is probably due to the greater prevalence of non-fatal disabling conditions (i.e. fractures, osteoporosis, back problems, osteoarthritis and depression) that substantially contribute to greater disability and diminished quality of life among ageing women compared with men.11,12 Moreover, individuals with lower TUG performance also had a higher body mass index and were more likely to have depressive symptoms, lower income and lower physical activity level, thus suggesting a ‘frailty pattern’ that should be carefully evaluated for preventing cardiovascular disease.1,8,13–15 Unfortunately, the authors failed to demonstrate an association between the TUG performance test and cardiovascular mortality. The lack of data on cardiovascular mortality limits the conclusions of the study, although this national health screening programme carefully and systematically collected several variables adjusting regression analysis models for several potential confounders. In addition, it should be noted that several questionnaires or self-reports were used, which are open to bias. However, this is the best way to gather plenty of information in a huge population. The TUG performance test provides a reliable measure that can be easely used by physicians and that can overcome some of the reasons for not assessing patient physical activity levels. In fact, the TUG is inexpensive and requires little investment of time, space or staff training. In this view, objective data provided by the TUG can be useful to generate hypotheses about factors that may be contributing to reduced physical capacity and mobility. The TUG can serve as a baseline evaluation against which progress can be measured as patients engage in exercise training, physical therapy or other rehabilitation programmes. In addition, an objective measure of physical mobility allows physicians to monitor patients’ progress towards treatment goals and alert them to possible issues (i.e. lack of adherence or motivation) if results are not as expected. Further studies are eagerly awaited in order to shed light on the interplay role between the loss of mobility/disability and its impact on cardiovascular diseases, hospitalisations and mortality across different age groups. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article.