Fitness Reference Values to Identify Health Risks in Severe Mental Disorders: A Multicenter Cross-Sectional Study from the PsychiActive Project

Fitness Reference Values to Identify Health Risks in Severe Mental Disorders: A Multicenter Cross-Sectional Study from the PsychiActive Project | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fitness Reference Values to Identify Health Risks in Severe Mental Disorders: A Multicenter Cross-Sectional Study from the PsychiActive Project Javier Bueno-Antequera, Diego Munguía-Izquierdo, Miguel Ángel Oviedo-Caro, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6375080/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : One factor that could reduce the burden associated with severe mental disorders is to improve the detection of people at health risk to prioritize the application of therapeutic interventions. Having specific risk values for robust health variables that can be measured through easy-to-use, inexpensive, feasible and reliable tools would make it possible to overcome the usual lack of resources in mental health services. Aims : To provide reference values for levels of physical fitness (a more powerful predictor of disease, disability and mortality than smoking, hypertension, hypercholesterolaemia and diabetes) evaluated through low-resource tools in people with severe mental disorders. Method : In total, 305 people (83 women) with severe mental disorders aged between 20 and 82 years were evaluated on a set of components of physical fitness (aerobic fitness, strength, flexibility, agility and balance) using the Senior Fitness Test battery. Results : Reference values were provided by quartiles according to sex and age (20–39 years, 40–59 years, > 60 years). Women had significant lower performance than men in the aerobic fitness test (p <0.001; Cohen’s standardized effect size [d]: -0.83, 95 % confidence interval [CI]: -0.54, -1.12) and men had significant lower performance in the lower limb flexibility test (p <0.001; d: -0.55, CI: -0.83, -0.26). Performance in all tests was lower as age increased (standardized regression coefficients [β] ranged from -0.10 to -0.40). Conclusions : This study provides the first reference values for physical fitness components specific to adults with severe mental disorders, helping identify individuals at potential health risk and prioritize therapeutic interventions. The main contribution was to provide the first reference values of a set of physical fitness components specific for adults with severe mental disorders. Sports Medicine and Kinesiology Psychiatry Physical Medicine & Rehab Early diagnosis health risk physical fitness reference values severe mental disorders Introduction Severe mental disorders (SMDs), such as schizophrenia, depression, anxiety and bipolar disorder, are a leading cause of illness [ 1 ], disability and premature death from all causes [ 2 ] worldwide. In 2010, the global economic burden of SMDs was comparable to that of cardiovascular diseases and higher than that of cancer, chronic respiratory diseases, and diabetes, and is expected to double by 2030 [ 3 ]. Therefore, reducing the growing burden associated with SMDs is a global priority [ 4 ]. One factor that could reduce the burden associated with SMDs is to improve the detection of people with SMDs at health risk in order to prioritize the application of therapeutic interventions. The evidence accumulated for more than 30 years [ 5 ] maintains that low physical fitness – an aspect consistently more common in people with SMDs compared to the population without SMDs [ 6 , 7 ] – is a more powerful predictor of disease, disability and mortality than traditional risk factors such as smoking, hypertension, hypercholesterolaemia and type 2 diabetes mellitus. In fact, scientific support for the prognostic use of physical fitness is so robust that scientific-health institutions, such as the American Heart Association, advocate its routine evaluation as a vital clinical sign [ 8 ]. Unfortunately, physical fitness is not usually assessed in people with SMDs, probably due to the lack of resources (material, temporal and personal) in mental health services, which is even more acute in countries with low income. One aspect that could facilitate the assessment of physical fitness in mental health services is to have reference values of easy-to-use, inexpensive, feasible and reliable assessment tools for people with SMDs that allow the level of physical fitness to be interpreted for those with similar characteristics. To our knowledge, the only reference values available for physical fitness levels in people with SMDs come from a study that assessed aerobic fitness, using the 6-minute walk test, in 237 people (101 women) with schizophrenia aged 22–70 years [ 9 ]. Given that physical fitness includes components additional to aerobic fitness, such as muscular strength, flexibility, agility and balance, the objective of this work was to provide reference values for levels of physical fitness components (aerobic fitness, muscular strength, flexibility, agility and balance) evaluated through low-resource tests in people with SMDs. We hypothesize that men and young people will have higher levels than women and older people for most physical fitness components. Methods Participants and procedure This cross-sectional study was part of the PsychiActive project, which included an integrated approach to positive health behaviour and healthy lifestyle for people with SMDs from Spain. The protocol was approved by the XXX and XXX Ethics Committee (1674-N-17). All participants gave their informed written consent prior to enrolling in the study and after receiving information about the aims and protocol. There was no compensation for participation. From July 2014 to February 2022, a convenience sample of people with SMDs was recruited from 19 different outpatient mental healthcare settings in Southern Spain. Project pamphlets and posters were placed in waiting rooms and interested people contacted the researchers directly or through staff members. People with a range of ICD-10 SMD diagnoses (see Table 1 ) established by experienced psychiatrists were included if they were aged 20 years or older and were stable on antipsychotic medication during the last month. Those with clinical instability, substance abuse or any other condition contraindicating participation were excluded. Participants were required to undergo fitness and anthropometric measures. Data analysis was conducted in September 2023 and included participants who performed at least one of the fitness tests. Table 1 Characteristics of the participants (n = 305) All Men Women n Values n Values n Values Age (years) 305 41.4 (10.5) 222 40.9 (9.8) 83 43.0 (12.0) Height (cm) 303 171.3 (8.9) 221 175.1 (6.4) 82 161.8 (5.9) Weight (kg) 303 88.4 (19.1) 221 91.5 (18) 82 80.1 (21) Body mass index (kg/m 2 ) 303 30.1 (6.0) 221 29.8 (5.3) 82 30.9 (7.4) Diagnoses Schizophrenia. schizotypal and delusional disorders 162 53.1 134 60.4 28 33.7 Mood [affective] disorders 48 15.7 27 12.2 21 25.3 Disorders of adult personality and behaviour 20 6.6 13 5.7 7 8.4 Neurotic, stress-related and somatoform disorders 11 3.6 3 1.4 8 9.6 Disorders due to psychoactive substance use 2 0.7 2 0.9 - - Mental retardation 2 0.7 1 0.45 1 1.2 Values are presented as the mean (standard deviation) or percentage. Measures Physical fitness Physical fitness was assessed through the Senior Fitness Test battery, which allows different components of physical fitness to be assessed in a standardized manner using easy-to-use, inexpensive, feasible and reliable assessment tools [ 10 ]. In brief: Aerobic fitness was assessed with the 6-minute walk test, which consists of walking around a 46-m rectangular space, with the objective of covering the greatest distance possible in 6 minutes. Lower body muscular strength was assessed with the 30-second chair stand test, which consists of getting up and sitting down on a chair as many times as possible, with arms crossed on the chest. A valid repetition was considered when a full body extension was performed. Upper body muscular strength was assessed with the arm curl test, which consists of performing the greatest number of elbow flexion–extensions for 30 seconds with a dumbbell (3.6 kg for men and 2.3 kg for women) while sitting on a chair. A valid repetition was considered when a complete elbow flexion was performed. Lower body flexibility was assessed with the chair sit-and-reach test, which consists of moving the hands together towards the tips of the toes, trying to reach and/or surpass them if possible. The elbows must be extended and the knee of the foot on which the test is performed must be flexed. Upper body flexibility was assessed with the back scratch test, which consists of trying to touch and/or extend the tips of the fingers on the back. One hand is placed behind the shoulder on the same side with the palm down, and the other behind the back with the palm up. Agility/dynamic balance was assessed with the 8-foot up-and-go test, which consists of getting up from a chair, walking 2.44 m, turning 180º and walking back to sit on the same chair in the shortest time possible. The tests were performed in the following order, with at least 1 minute of rest between attempts and/or 3 minutes between tests to reduce the influence of fatigue: back scratch test; chair sit-and-reach test; arm curl test; 8-foot up-and-go test; 30-second chair stand test; and 6-minute walk test. All participants performed several trials before recording the results to ensure correct execution. The best of two attempts for each test was used in the analysis, except for the 30-second chair stand test and the 6-minute walk test, which were performed only once. Explanation, supervision and support during execution of all the tests were carried out by the same experienced physical exercise professional (J.B.A.). More details about execution and scoring of the tests in the original text [ 10 ] and in the free-access video tutorials prepared by the researchers themselves are available at https://upotv.upo.es/series/58da216a238583e0478b48f0 . Sociodemographic and clinical data Weight and height (used to derive body mass index) were measured following standard procedures with a scale (TANITA BC-420; Tanita, Tokyo, Japan) and a wall-mounted stadiometer, respectively. Age, sex, and diagnoses were obtained from the participants’ medical records. Statistical analysis Between-sex comparisons of physical fitness were performed using Welch’s unpaired t -test, with adjustments for multiple comparisons using the Bonferroni method by dividing the significance level of 0.05 by the number of comparisons; in this case, 0.05 x 6 − 1 = 0.0083. The associations between physical fitness and age were explored using regression analysis adjusted for sex. The physical fitness reference values were displayed by sex and age group (20–39, 40–59 and > 60 years; according to the previous study in people with SMDs [ 9 ]) and categorized into 25th, 50th and 75th percentiles as low, average and high performance groups, respectively. Data were analysed using SPSS Statistics for Windows, Version 27.0 (IBM Corp.; Armonk, NY, USA), with statistical significance set at α = 0.050. Between-sex comparisons were assessed using an approach based on the standardized effect size, with Cohen’s d adjusted by correcting for small sample bias, also known as Hedges’ g , and the associated 95% confidence intervals determined using a free online effect size calculator [ 11 ]. Cohen’s d was calculated as follows: the difference between the mean values for both groups divided by the pooled standard deviation for both groups. The formulae for estimation of Cohen’s d and the associated 95% confidence intervals are available on GitHub [ 12 ]. Cohen’s d ≥ 0.50 was considered to be a minimally important difference [ 13 ]. Results The sample included 305 people with SMDs aged 20–82 years. The sociodemographic characteristics and average physical fitness values for all participants and by sex are presented in Table 1 and Table 2 , respectively. Men had higher performance in the 6-minute walk test and women in the chair sit-and-reach test. Table 2 Mean and standard deviation (SD) of all physical fitness tests. All Men Women Statistics Test n Mean (SD) n Mean (SD) n Mean (SD) p d (95%CI) 6-Minute walk (m) 244 568.5 (104.2) 176 591.2 (95.1) 68 509.7 (104.3) < 0.001 0.83 (0.54, 1.12) 30-Second chair stand (reps) 301 22.1 (6.5) 218 22.6 (6.6) 83 20.8 (6.3) 0.0317 0.27 (0.02, 0.53) Arm curl (reps) 301 26.3 (6.7) 218 27.0 (6.8) 83 24.6 (6.0) 0.0038 0.36 (0.1, 0.61) 8-Foot up-and-go (s) † 244 4.9 (2.0) 176 4.7 (2.0) 68 5.5 (1.9) 0.0034 -0.41 (-0.7, -0.13) Chair sit-and-reach (cm) 243 -2.2 (12.8) 175 -4.1 (13.1) 68 2.8 (10.3) < 0.001 -0.55 (-0.83, -0.26) Back scratch (cm) 242 -4.1 (11.9) 174 -4.9 (12.7) 68 -2.0 (9.6) 0.0608 -0.24 (-0.52, 0.04) Statistically significant p -values and minimally important differences were set at 0.0083 (i.e. 0.050/6 comparisons = 0.0083) and 0.50, respectively. CI, confidence interval; d , Cohen’s standardized effect size, adjusted by correcting for small sample bias; reps, repetitions; SD, standard deviation. † Lower values indicate higher performance. The association between physical fitness and age is shown in Table 3 . In general, performance on all fitness tests was lower as age increased. Table 3 Standardized regression coefficients (β) of physical fitness and age. Test n β p 6-Minute walk 244 -0.25 < 0.001 30-Second chair stand 301 -0.36 < 0.001 Arm curl 301 -0.40 < 0.001 8-Foot up-and-go † 244 0.39 < 0.001 Chair sit-and-reach 243 -0.12 0.058 Back scratch 242 -0.10 0.139 β indicates standardized coefficient and statistically significant t p -values were set at 0.050. † Lower values indicate higher performance. The reference values of the physical fitness tests by quartiles for all participants and by sex according to age are shown in Table 4 . Table 4 Age and gender reference values of physical fitness by quartiles. All Men Women Test Age (years) n P25 P50 P75 n P25 P50 P75 n P25 P50 P75 6-Minute walk (m) All 244 511.6 569.6 626.3 176 540.4 590.6 640.0 68 452.5 522.5 585.6 20–39 107 536.5 591.3 637.3 82 546.9 604.0 646.4 25 496.5 565.2 599.9 40–59 126 498.0 560.1 622.1 88 523.1 575.0 640.7 38 450.4 516.6 569.7 60+ 11 353.1 540 568.8 6 543.0 558.1 597.6 5 244.3 353.1 385.4 30-Second chair stand (reps) All 301 18.0 22.0 27.0 218 18.0 22.5 27.0 83 16.0 19.0 25.0 20–39 131 20.0 24.0 28.0 99 21.0 25.0 29.0 32 18.0 22.5 27.0 40–59 158 16.0 20.0 24.3 112 16.3 20.0 24.8 46 15.8 19.0 24.3 60+ 12 12.0 16.5 25.0 7 16.5 24.0 27.5 5 10.5 16.0 17.5 Arm curl (reps) All 301 23.0 26.0 30.0 218 23.0 27.0 31.0 83 22.0 25.0 28.0 20–39 130 25.0 29.0 32.0 98 25.0 29.0 33.0 32 24.0 27.0 31.0 40–59 160 20.3 25.0 28.0 114 20.0 25.0 29.0 46 20.8 25.0 27.0 60+ 11 17.0 22.0 23.0 6 20.8 23.0 23.8 5 11.5 17.0 22.0 8-Foot up-and-go (s) † All 244 4.1 4.6 5.2 176 4.0 4.4 4.8 68 4.5 5.0 5.9 20–39 107 3.9 4.3 4.7 82 3.8 4.2 4.5 25 4.2 4.7 5.0 40–59 125 4.3 4.7 5.4 87 4.2 4.6 5.2 38 4.7 5.2 5.8 60+ 12 4.9 6.8 11.2 7 4.7 5.0 7.8 5 6.6 8.4 14.1 Chair sit-and-reach (cm) All 243 -10.0 -1.0 7.0 175 -13.0 -3.5 5.0 68 -2.0 3.3 10.0 20–39 106 -9.0 0.0 9.0 81 -13.0 -3.5 8.1 25 -1.5 3.5 10.0 40–59 125 -11.0 -0.5 6.0 87 -14.5 -3.0 4.5 38 -1.1 5.0 12.0 60+ 12 -12.5 -5.8 1.0 7 -13.0 -7.5 1.5 5 -17.5 -4.0 0.0 Back scratch (cm) All 242 -10.0 -2.5 4.0 174 -12.0 -3.3 4.0 68 -7.9 -1.8 4.9 20–39 104 -10.8 -1.0 3.9 79 -12.0 -4.0 3.5 25 -5.5 0.0 5.0 40–59 126 -10.0 -2.5 5.9 88 -11.9 -3.0 5.9 38 -10.0 -1.8 5.9 60+ 12 -11.9 -3.3 2.8 7 -31.0 0.5 3.5 5 -10.8 -3.5 0.5 P25, P50 and P75 indicate the 25th, 50th and 75th percentiles, respectively; reps, repetitions. Values are displayed by sex and age group (20–39, 40–59 and 60 + years; according to the previous study in people with SMDs [ 9 ]) and categorized into the 25th, 50th and 75th percentiles as low, average and high performance groups, respectively. † Lower values indicate higher performance. Discussion The main contribution of the study was to provide reference values of a set of physical fitness components for adults with SMDs attending outpatient mental healthcare settings. Men had higher performance than women in the cardiorespiratory fitness test and women had higher performance in the lower limb flexibility test. Performance on all tests was lower as age increased. The results for the influence of sex and age on physical fitness agree with those reported in previous research on people with SMDs [ 6 ] other pathologies and on healthy people [ 5 , 14 ], suggesting the detection of health risk profiles due to low physical fitness in people with SMDs by taking into account sex and age, which could be improved by comparing the results for accessible diagnostic tests against specific reference data stratified by sex and age, as we propose in this work. Our values in the 6-minute walk test, considered as low performance (i.e. lower than the 25th percentile values) for men and women in the age ranges 20–39 and 40–59 years, are higher than those provided by the only previous study on physical fitness reference values for people with SMDs [ 9 ]. This fact may be due to differences in the procedure followed in the 6-minute walk test. Huang's study [ 9 ] included a straight course (out and back) with 180º turns that, compared to the continuous course (rectangular) with 90º turns in our study, could involve greater decelerations in each turn, making it difficult to maintain a high walking speed during the test and therefore achieving a lower result, as was found in a study of people with severe emphysema [ 15 ]. Additionally, participants in Huang's study [ 9 ] were instructed to “walk as fast as possible”, which, compared to the “walk as far as possible without jogging or running” in our study, could lead to “earlier fatigue and possible excessive cardiac stress”, as pointed out by the American Thoracic Society Statement in the guidelines for the 6-minute walk test [ 16 ]. The latter represents a call to attention for researchers and professionals in the mental health area to carefully and consistently apply the procedures described in the literature in order to reduce any influence of the evaluator on the performance of participants and facilitate comparison of results between studies employing similar methods. The difference in performance for the 6-minute walk test compared to Huang's study [ 9 ] may also be due to the geographical situation in which the research was carried out (Spain vs. Taiwan), as suggested by a study in healthy adults from seven different countries who performed the 6-minute walk test following American Thoracic Society guidelines [ 17 ], as well as the lower age and higher average height (in men) of our participants, as suggested by Huang's own study [ 9 ]. On the other hand, the fact that the participants in our study were recruited from outpatient settings and have a higher average body mass index value than the participants in Huang's study [ 9 ] who were recruited mostly (72%) from inpatient settings, seems to contradict the findings of a meta-analysis on moderators of the 6-minute walk test in adults with SMDs [ 18 ]. However, the authors of the meta-analysis [ 18 ] propose further research to clarify whether the clinical setting is a considerable moderator of the 6-minute walk test, and point out that including cross-sectional studies prevents a causal relationship to be established between physical fitness and body mass index; this is questioned in numerous studies [ 19 ], including a meta-analysis of people with SMDs, whose discussion is worth reading [ 6 ]. Given that we are not aware of additional studies on reference values for the physical fitness of people with SMDs, the rest of the discussion will focus on comparing our results with those of similar studies developed in other populations. In all tests of the Senior Fitness Test battery (except for the 6-minute walk test), our values that were considered as low (i.e. lower than the 25th percentile values) in women aged 20–59 years are higher than the values considered as low (i.e. lower than the 20th percentile values) in Spanish women with fibromyalgia aged 35–45 years [ 20 ]. For the 6-minute walk test, our values that were considered as low in women aged 20–39 years and 40–59 years are higher than the values considered as low in Spanish women with fibromyalgia aged 35–45 years and 45–55 years, respectively [ 20 ]. The particular characteristics associated with SMDs and fibromyalgia could explain all these differences and reinforce the need to have reference data from specific populations to interpret the results using more sensitive tools. On the other hand, the values considered as low (i.e. lower than the 25th percentile values) in the 6-minute walk test of men and women aged 40–59 years in our study are lower than those that were considered low (i.e. lower than the 20th percentile values) in healthy older Spanish aged 65–69 years (for men) and 70–74 years (for woman) [ 21 ], suggesting premature physical aging of people with SMDs according to Zechner [ 22 ] which could partially explain why people with SMDs have a life expectancy of up to 32 years lower compared to a healthy population [ 2 ]. Additionally, our values considered as low (i.e. lower than the 25th percentile values) in the 6-minute walk test of men and women aged 20–59 years are lower than the criterion-referenced fitness standards for maintaining physical independence in healthy older Americans aged 70–84 years [ 23 ], which could partially explain why diagnoses linked to SMDs, such as depression and anxiety, were two of the 25 main causes of disability worldwide in 2019 [ 24 ]. Considering the latest comments, there appears to be a need to promote adequate levels of aerobic fitness in people with SMDs. A meta-review by the European Psychiatric Association [ 25 ] includes clinical practice recommendations to improve aerobic fitness in people with SMDs by using physical activity. Limitations This work has several strengths. Physical fitness was assessed through valid tests that require few resources to apply, developed by the same evaluator following standardized protocols and who created free-access video tutorials to facilitate reading comprehension and their application in mental health services. The work provides the first reference values in people with SMDs on components of physical fitness additional to those available in aerobic fitness [ 9 ], such as strength, flexibility, agility and balance, which allow a more complete assessment of physical fitness for developing more individualized therapeutic interventions for this population. Participants have different types of SMDs, as commonly occurs in mental health services, thus increasing the applicability of the results in real-world settings. The work also has limitations: the non-representative convenience sample, composed mainly of men and those under 60 years of age, limits generalization of the results; and the cross-sectional design precludes causal relationships. Conclusion The main contribution of the study was to provide reference values for a set of fitness components in adults with severe mental disorders that could facilitate the detection of people with potential health risk and therefore with priority needs to start therapeutic interventions. Implication for practice This work allows the scientific community and mental health professionals to improve the detection of people at health risk to prioritize the application of therapeutic interventions through easy-to-use, inexpensive, feasible and reliable tools would make it possible to overcome the usual lack of resources in mental health services. Declarations Acknowledgements The authors gratefully acknowledge all patients for their collaboration. We also acknowledge the health clinic members involved in the recruitment for their effort and great enthusiasm. This work is dedicated to Pedro Mario Tirado Portilla for his attention, affection and kindness. Funding source information The work was funded by the MCIN (Ref. PID2020-118262RB-I00) and the Research Group CTS-948, Universidad Pablo de Olavide, Andalusian Government. J.B.A. was supported by the Junta de Andalucía through the Consejería de Transformación Económica, Industria, Conocimiento y Universidades (Ref. POSTDOC_21_00059). A.L.M. was supported by the Universidad Pablo de Olavide (Ref. PPI1803). The funders had no role in the study design, the collection, analysis and interpretation of data, writing the report or the decision to submit the report for publication. Ethics statement The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. All procedures involving human subjects/patients were approved by the ethics committees of the Virgen Macarena and Virgen del Rocío University hospitals (1674-N-17). Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. CRediT Authorship contribution statement Javier Bueno-Antequera: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing. Álvaro López-Moral: Writing – review & editing. Miguel Ángel Oviedo-Caro: Writing – review & editing. Diego Munguía-Izquierdo: Conceptualization, Writing – review & editing. Consent for Publication Consent for publication was obtained from all individual participants included in the study. Participants were informed about the nature, purpose, and potential implications of the research, and they provided written consent, acknowledging their understanding and agreement to the publication of the findings. Availability of Data and Materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Correll CU, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P et al (2017) Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. 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Arch Gerontol Geriatr 55:406–416. https://doi.org/10.1016/j.archger.2012.02.004 Zechner MR, Anderson EZ, Gill KJ (2021) Old Before Their Time: Comparisons of People With SMI and Healthy Older Adults. Psychiatr Rehabil J 45:89–94. https://doi.org/10.1037/prj0000496 Rikli RE, Jones CJ (2013) Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist 53:255–267. https://doi.org/10.1093/geront/gns071 Murray CJL, Afshin A, Alam T, Ashbaugh C, Barthelemy C, Biehl M et al (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9 Stubbs B, Vancampfort D, Hallgren M, Firth J, Veronese N, Solmi M et al (2018) EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental. Eur Psychiatry 54:124–144. https://doi.org/10.1016/j.eurpsy.2018.07.004 Álvarez-Gallardo IC, Carbonell-Baeza A, Segura-Jiménez V, Soriano-Maldonado A, Intemann T, Aparicio VA et al (2017) Physical fitness reference standards in fibromyalgia: The al-Ándalus project. Scand J Med Sci Sports 27:1477–1488. https://doi.org/10.1111/sms.12741 Pedrero-Chamizo R, Gómez-Cabello A, Delgado S, Rodríguez-Llarena S, Rodríguez-Marroyo JA, Cabanillas E et al (2012) Physical fitness levels among independent non-institutionalized Spanish elderly: The elderly EXERNET multi-center study. Arch Gerontol Geriatr 55:406–416. https://doi.org/10.1016/j.archger.2012.02.004 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6375080","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":438385288,"identity":"74a5427b-ce22-4db7-a1e4-e0766dc0629c","order_by":0,"name":"Javier Bueno-Antequera","email":"","orcid":"https://orcid.org/0000-0001-8063-3980","institution":"Universidad Pablo de Olavide","correspondingAuthor":false,"prefix":"","firstName":"Javier","middleName":"","lastName":"Bueno-Antequera","suffix":""},{"id":438385289,"identity":"8fd4dfb4-e3b6-4026-8fc9-574a60c764c8","order_by":1,"name":"Diego Munguía-Izquierdo","email":"","orcid":"https://orcid.org/0000-0001-7817-747X","institution":"Universidad Pablo de Olavide","correspondingAuthor":false,"prefix":"","firstName":"Diego","middleName":"","lastName":"Munguía-Izquierdo","suffix":""},{"id":438385290,"identity":"ac2965a1-97b7-44e7-a6fc-30355386280c","order_by":2,"name":"Miguel Ángel Oviedo-Caro","email":"","orcid":"https://orcid.org/0000-0003-1032-0529","institution":"Universidad de Sevilla","correspondingAuthor":false,"prefix":"","firstName":"Miguel","middleName":"Ángel","lastName":"Oviedo-Caro","suffix":""},{"id":438385291,"identity":"8428b5cc-22e2-4356-9fbe-9f232ebadc73","order_by":3,"name":"Álvaro López-Moral","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYDACdgjFw8/A3ECkFmYIJSPZwEiiFhuDA8Rq4W9mPvboRsU9HuPjB9skGNvuyDGwtz/Aq0XiMFu6cc6ZYh6zM4kgLc+MGXjOGOC35jCPmXRuWwKP2QGwlsOJDRI5+HXIw7QY9z+EapF/jt9hBjAtBhJwWxjwO8wQ4pcEHokbD5stEs49M2bjycGvRe5487HHORUJ9vz9yQdvfCi7I8fPfhy/w4CADcFMYDiAzCVGCwNQyygYBaNgFIwCdAAAgQRBm0uoLEMAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-0862-8655","institution":"Universidad Pablo de Olavide","correspondingAuthor":true,"prefix":"","firstName":"Álvaro","middleName":"","lastName":"López-Moral","suffix":""}],"badges":[],"createdAt":"2025-04-04 09:53:25","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6375080/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6375080/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80025769,"identity":"09f2cdb2-4551-4e19-b121-68d507d3f307","added_by":"auto","created_at":"2025-04-07 06:21:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":944138,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6375080/v1/613295c3-b836-4510-ac1c-88e87b7f0cb6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eFitness Reference Values to Identify Health Risks in Severe Mental Disorders: A Multicenter Cross-Sectional Study from the PsychiActive Project\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSevere mental disorders (SMDs), such as schizophrenia, depression, anxiety and bipolar disorder, are a leading cause of illness [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], disability and premature death from all causes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] worldwide. In 2010, the global economic burden of SMDs was comparable to that of cardiovascular diseases and higher than that of cancer, chronic respiratory diseases, and diabetes, and is expected to double by 2030 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, reducing the growing burden associated with SMDs is a global priority [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne factor that could reduce the burden associated with SMDs is to improve the detection of people with SMDs at health risk in order to prioritize the application of therapeutic interventions. The evidence accumulated for more than 30 years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] maintains that low physical fitness \u0026ndash; an aspect consistently more common in people with SMDs compared to the population without SMDs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] \u0026ndash; is a more powerful predictor of disease, disability and mortality than traditional risk factors such as smoking, hypertension, hypercholesterolaemia and type 2 diabetes mellitus. In fact, scientific support for the prognostic use of physical fitness is so robust that scientific-health institutions, such as the American Heart Association, advocate its routine evaluation as a vital clinical sign [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Unfortunately, physical fitness is not usually assessed in people with SMDs, probably due to the lack of resources (material, temporal and personal) in mental health services, which is even more acute in countries with low income.\u003c/p\u003e \u003cp\u003eOne aspect that could facilitate the assessment of physical fitness in mental health services is to have reference values of easy-to-use, inexpensive, feasible and reliable assessment tools for people with SMDs that allow the level of physical fitness to be interpreted for those with similar characteristics. To our knowledge, the only reference values available for physical fitness levels in people with SMDs come from a study that assessed aerobic fitness, using the 6-minute walk test, in 237 people (101 women) with schizophrenia aged 22\u0026ndash;70 years [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Given that physical fitness includes components additional to aerobic fitness, such as muscular strength, flexibility, agility and balance, the objective of this work was to provide reference values for levels of physical fitness components (aerobic fitness, muscular strength, flexibility, agility and balance) evaluated through low-resource tests in people with SMDs. We hypothesize that men and young people will have higher levels than women and older people for most physical fitness components.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants and procedure\u003c/h2\u003e\n \u003cp\u003eThis cross-sectional study was part of the PsychiActive project, which included an integrated approach to positive health behaviour and healthy lifestyle for people with SMDs from Spain. The protocol was approved by the XXX and XXX Ethics Committee (1674-N-17). All participants gave their informed written consent prior to enrolling in the study and after receiving information about the aims and protocol. There was no compensation for participation.\u003c/p\u003e\n \u003cp\u003eFrom July 2014 to February 2022, a convenience sample of people with SMDs was recruited from 19 different outpatient mental healthcare settings in Southern Spain. Project pamphlets and posters were placed in waiting rooms and interested people contacted the researchers directly or through staff members. People with a range of ICD-10 SMD diagnoses (see Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) established by experienced psychiatrists were included if they were aged 20 years or older and were stable on antipsychotic medication during the last month. Those with clinical instability, substance abuse or any other condition contraindicating participation were excluded. Participants were required to undergo fitness and anthropometric measures. Data analysis was conducted in September 2023 and included participants who performed at least one of the fitness tests.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of the participants (n\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 14.2429%;\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eValues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eValues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eValues\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e41.4 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.9 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.0 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e171.3 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e175.1 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161.8 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e88.4 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.5 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.1 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.1 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.8 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.9 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDiagnoses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSchizophrenia. schizotypal and delusional disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMood [affective] disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisorders of adult personality and behaviour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurotic, stress-related and somatoform disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisorders due to psychoactive substance use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental retardation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.1994%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 4.1979%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003eValues are presented as the mean (standard deviation) or percentage.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003ePhysical fitness\u003c/h2\u003e\n \u003cp\u003ePhysical fitness was assessed through the Senior Fitness Test battery, which allows different components of physical fitness to be assessed in a standardized manner using easy-to-use, inexpensive, feasible and reliable assessment tools [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. In brief:\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eAerobic fitness was assessed with the 6-minute walk test, which consists of walking around a 46-m rectangular space, with the objective of covering the greatest distance possible in 6 minutes.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eLower body muscular strength was assessed with the 30-second chair stand test, which consists of getting up and sitting down on a chair as many times as possible, with arms crossed on the chest. A valid repetition was considered when a full body extension was performed.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eUpper body muscular strength was assessed with the arm curl test, which consists of performing the greatest number of elbow flexion\u0026ndash;extensions for 30 seconds with a dumbbell (3.6 kg for men and 2.3 kg for women) while sitting on a chair. A valid repetition was considered when a complete elbow flexion was performed.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eLower body flexibility was assessed with the chair sit-and-reach test, which consists of moving the hands together towards the tips of the toes, trying to reach and/or surpass them if possible. The elbows must be extended and the knee of the foot on which the test is performed must be flexed.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eUpper body flexibility was assessed with the back scratch test, which consists of trying to touch and/or extend the tips of the fingers on the back. One hand is placed behind the shoulder on the same side with the palm down, and the other behind the back with the palm up.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAgility/dynamic balance was assessed with the 8-foot up-and-go test, which consists of getting up from a chair, walking 2.44 m, turning 180\u0026ordm; and walking back to sit on the same chair in the shortest time possible.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eThe tests were performed in the following order, with at least 1 minute of rest between attempts and/or 3 minutes between tests to reduce the influence of fatigue: back scratch test; chair sit-and-reach test; arm curl test; 8-foot up-and-go test; 30-second chair stand test; and 6-minute walk test. All participants performed several trials before recording the results to ensure correct execution. The best of two attempts for each test was used in the analysis, except for the 30-second chair stand test and the 6-minute walk test, which were performed only once. Explanation, supervision and support during execution of all the tests were carried out by the same experienced physical exercise professional (J.B.A.).\u003c/p\u003e\n \u003cp\u003eMore details about execution and scoring of the tests in the original text [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e] and in the free-access video tutorials prepared by the researchers themselves are available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://upotv.upo.es/series/58da216a238583e0478b48f0\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSociodemographic and clinical data\u003c/h3\u003e\n\u003cp\u003eWeight and height (used to derive body mass index) were measured following standard procedures with a scale (TANITA BC-420; Tanita, Tokyo, Japan) and a wall-mounted stadiometer, respectively. Age, sex, and diagnoses were obtained from the participants\u0026rsquo; medical records.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eBetween-sex comparisons of physical fitness were performed using Welch\u0026rsquo;s unpaired \u003cem\u003et\u003c/em\u003e-test, with adjustments for multiple comparisons using the Bonferroni method by dividing the significance level of 0.05 by the number of comparisons; in this case, 0.05 x 6\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e = 0.0083. The associations between physical fitness and age were explored using regression analysis adjusted for sex. The physical fitness reference values were displayed by sex and age group (20\u0026ndash;39, 40\u0026ndash;59 and \u0026gt;\u0026thinsp;60 years; according to the previous study in people with SMDs [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]) and categorized into 25th, 50th and 75th percentiles as low, average and high performance groups, respectively. Data were analysed using SPSS Statistics for Windows, Version 27.0 (IBM Corp.; Armonk, NY, USA), with statistical significance set at \u0026alpha;\u0026thinsp;=\u0026thinsp;0.050.\u003c/p\u003e\n \u003cp\u003eBetween-sex comparisons were assessed using an approach based on the standardized effect size, with Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e adjusted by correcting for small sample bias, also known as Hedges\u0026rsquo; \u003cem\u003eg\u003c/em\u003e, and the associated 95% confidence intervals determined using a free online effect size calculator [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e was calculated as follows: the difference between the mean values for both groups divided by the pooled standard deviation for both groups. The formulae for estimation of Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e and the associated 95% confidence intervals are available on GitHub [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;\u0026ge;\u0026thinsp;0.50 was considered to be a minimally important difference [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe sample included 305 people with SMDs aged 20\u0026ndash;82 years. The sociodemographic characteristics and average physical fitness values for all participants and by sex are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, respectively. Men had higher performance in the 6-minute walk test and women in the chair sit-and-reach test.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean and standard deviation (SD) of all physical fitness tests.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003ed\u003c/em\u003e (95%CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-Minute walk (m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e568.5 (104.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e591.2 (95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e509.7 (104.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.83 (0.54, 1.12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-Second chair stand (reps)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.1 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.6 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e20.8 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.0317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.27 (0.02, 0.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArm curl (reps)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.3 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27.0 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24.6 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e0.0038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.36 (0.1, 0.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8-Foot up-and-go (s)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.7 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.5 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e0.0034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.41 (-0.7, -0.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChair sit-and-reach (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.2 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-4.1 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.8 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e-0.55 (-0.83, -0.26)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBack scratch (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.1 (11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-4.9 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-2.0 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.0608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.24 (-0.52, 0.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eStatistically significant \u003cem\u003ep\u003c/em\u003e-values and minimally important differences were set at 0.0083 (i.e. 0.050/6 comparisons\u0026thinsp;=\u0026thinsp;0.0083) and 0.50, respectively.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eCI, confidence interval; \u003cem\u003ed\u003c/em\u003e, Cohen\u0026rsquo;s standardized effect size, adjusted by correcting for small sample bias; reps, repetitions; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eLower values indicate higher performance.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe association between physical fitness and age is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In general, performance on all fitness tests was lower as age increased.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandardized regression coefficients (β) of physical fitness and age.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-Minute walk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30-Second chair stand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArm curl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8-Foot up-and-go\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChair sit-and-reach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBack scratch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eβ indicates standardized coefficient and statistically significant t \u003cem\u003ep\u003c/em\u003e-values were set at 0.050.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eLower values indicate higher performance.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe reference values of the physical fitness tests by quartiles for all participants and by sex according to age are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge and gender reference values of physical fitness by quartiles.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"17\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c17\" namest=\"c14\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eP75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eP25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eP50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003eP75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e6-Minute walk (m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e511.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e569.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e626.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e540.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e590.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e640.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e452.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e522.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e585.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e536.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e591.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e637.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e546.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e604.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e646.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e496.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e565.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e599.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e498.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e560.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e622.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e523.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e575.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e640.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e450.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e516.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e569.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e353.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e568.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e543.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e558.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e597.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e244.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e353.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e385.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e30-Second chair stand (reps)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e 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colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e 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colname=\"c14\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e8-Foot up-and-go (s)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e 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\u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e 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\u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eChair sit-and-reach (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBack scratch (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-31.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e-10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"17\"\u003eP25, P50 and P75 indicate the 25th, 50th and 75th percentiles, respectively; reps, repetitions.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"17\"\u003eValues are displayed by sex and age group (20\u0026ndash;39, 40\u0026ndash;59 and 60\u0026thinsp;+\u0026thinsp;years; according to the previous study in people with SMDs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]) and categorized into the 25th, 50th and 75th percentiles as low, average and high performance groups, respectively.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"17\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eLower values indicate higher performance.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe main contribution of the study was to provide reference values of a set of physical fitness components for adults with SMDs attending outpatient mental healthcare settings. Men had higher performance than women in the cardiorespiratory fitness test and women had higher performance in the lower limb flexibility test. Performance on all tests was lower as age increased. The results for the influence of sex and age on physical fitness agree with those reported in previous research on people with SMDs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] other pathologies and on healthy people [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], suggesting the detection of health risk profiles due to low physical fitness in people with SMDs by taking into account sex and age, which could be improved by comparing the results for accessible diagnostic tests against specific reference data stratified by sex and age, as we propose in this work.\u003c/p\u003e \u003cp\u003eOur values in the 6-minute walk test, considered as low performance (i.e. lower than the 25th percentile values) for men and women in the age ranges 20\u0026ndash;39 and 40\u0026ndash;59 years, are higher than those provided by the only previous study on physical fitness reference values for people with SMDs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This fact may be due to differences in the procedure followed in the 6-minute walk test. Huang's study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] included a straight course (out and back) with 180\u0026ordm; turns that, compared to the continuous course (rectangular) with 90\u0026ordm; turns in our study, could involve greater decelerations in each turn, making it difficult to maintain a high walking speed during the test and therefore achieving a lower result, as was found in a study of people with severe emphysema [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, participants in Huang's study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] were instructed to \u0026ldquo;walk as fast as possible\u0026rdquo;, which, compared to the \u0026ldquo;walk as far as possible without jogging or running\u0026rdquo; in our study, could lead to \u0026ldquo;earlier fatigue and possible excessive cardiac stress\u0026rdquo;, as pointed out by the American Thoracic Society Statement in the guidelines for the 6-minute walk test [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The latter represents a call to attention for researchers and professionals in the mental health area to carefully and consistently apply the procedures described in the literature in order to reduce any influence of the evaluator on the performance of participants and facilitate comparison of results between studies employing similar methods.\u003c/p\u003e \u003cp\u003eThe difference in performance for the 6-minute walk test compared to Huang's study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] may also be due to the geographical situation in which the research was carried out (Spain vs. Taiwan), as suggested by a study in healthy adults from seven different countries who performed the 6-minute walk test following American Thoracic Society guidelines [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], as well as the lower age and higher average height (in men) of our participants, as suggested by Huang's own study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. On the other hand, the fact that the participants in our study were recruited from outpatient settings and have a higher average body mass index value than the participants in Huang's study [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] who were recruited mostly (72%) from inpatient settings, seems to contradict the findings of a meta-analysis on moderators of the 6-minute walk test in adults with SMDs [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, the authors of the meta-analysis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] propose further research to clarify whether the clinical setting is a considerable moderator of the 6-minute walk test, and point out that including cross-sectional studies prevents a causal relationship to be established between physical fitness and body mass index; this is questioned in numerous studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], including a meta-analysis of people with SMDs, whose discussion is worth reading [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven that we are not aware of additional studies on reference values for the physical fitness of people with SMDs, the rest of the discussion will focus on comparing our results with those of similar studies developed in other populations. In all tests of the Senior Fitness Test battery (except for the 6-minute walk test), our values that were considered as low (i.e. lower than the 25th percentile values) in women aged 20\u0026ndash;59 years are higher than the values considered as low (i.e. lower than the 20th percentile values) in Spanish women with fibromyalgia aged 35\u0026ndash;45 years [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. For the 6-minute walk test, our values that were considered as low in women aged 20\u0026ndash;39 years and 40\u0026ndash;59 years are higher than the values considered as low in Spanish women with fibromyalgia aged 35\u0026ndash;45 years and 45\u0026ndash;55 years, respectively [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The particular characteristics associated with SMDs and fibromyalgia could explain all these differences and reinforce the need to have reference data from specific populations to interpret the results using more sensitive tools. On the other hand, the values considered as low (i.e. lower than the 25th percentile values) in the 6-minute walk test of men and women aged 40\u0026ndash;59 years in our study are lower than those that were considered low (i.e. lower than the 20th percentile values) in healthy older Spanish aged 65\u0026ndash;69 years (for men) and 70\u0026ndash;74 years (for woman) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], suggesting premature physical aging of people with SMDs according to Zechner [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] which could partially explain why people with SMDs have a life expectancy of up to 32 years lower compared to a healthy population [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Additionally, our values considered as low (i.e. lower than the 25th percentile values) in the 6-minute walk test of men and women aged 20\u0026ndash;59 years are lower than the criterion-referenced fitness standards for maintaining physical independence in healthy older Americans aged 70\u0026ndash;84 years [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], which could partially explain why diagnoses linked to SMDs, such as depression and anxiety, were two of the 25 main causes of disability worldwide in 2019 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Considering the latest comments, there appears to be a need to promote adequate levels of aerobic fitness in people with SMDs. A meta-review by the European Psychiatric Association [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] includes clinical practice recommendations to improve aerobic fitness in people with SMDs by using physical activity.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis work has several strengths. Physical fitness was assessed through valid tests that require few resources to apply, developed by the same evaluator following standardized protocols and who created free-access video tutorials to facilitate reading comprehension and their application in mental health services. The work provides the first reference values in people with SMDs on components of physical fitness additional to those available in aerobic fitness [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], such as strength, flexibility, agility and balance, which allow a more complete assessment of physical fitness for developing more individualized therapeutic interventions for this population. Participants have different types of SMDs, as commonly occurs in mental health services, thus increasing the applicability of the results in real-world settings. The work also has limitations: the non-representative convenience sample, composed mainly of men and those under 60 years of age, limits generalization of the results; and the cross-sectional design precludes causal relationships.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe main contribution of the study was to provide reference values for a set of fitness components in adults with severe mental disorders that could facilitate the detection of people with potential health risk and therefore with priority needs to start therapeutic interventions.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eImplication for practice\u003c/h2\u003e \u003cp\u003eThis work allows the scientific community and mental health professionals to improve the detection of people at health risk to prioritize the application of therapeutic interventions through easy-to-use, inexpensive, feasible and reliable tools would make it possible to overcome the usual lack of resources in mental health services.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge all patients for their collaboration. We also acknowledge the health clinic members involved in the recruitment for their effort and great enthusiasm. This work is dedicated to Pedro Mario Tirado Portilla for his attention, affection and kindness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe work was funded by the MCIN (Ref. PID2020-118262RB-I00) and the Research Group CTS-948, Universidad Pablo de Olavide, Andalusian Government. J.B.A. was supported by the Junta de Andalucía through the Consejería de Transformación Económica, Industria, Conocimiento y Universidades (Ref. POSTDOC_21_00059). A.L.M. was supported by the Universidad Pablo de Olavide (Ref. PPI1803). The funders had no role in the study design, the collection, analysis and interpretation of data, writing the report or the decision to submit the report for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013. All procedures involving human subjects/patients were approved by the ethics committees of the Virgen Macarena and Virgen del Rocío University hospitals (1674-N-17).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT Authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJavier Bueno-Antequera: Conceptualization, Formal analysis, Writing – original draft, Writing – review \u0026amp; editing. Álvaro López-Moral: Writing – review \u0026amp; editing. Miguel Ángel Oviedo-Caro: Writing – review \u0026amp; editing. Diego Munguía-Izquierdo: Conceptualization, Writing – review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication was obtained from all individual participants included in the study. Participants were informed about the nature, purpose, and potential implications of the research, and they provided written consent, acknowledging their understanding and agreement to the publication of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCorrell CU, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P et al (2017) Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. 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Scand J Med Sci Sports 27:1477\u0026ndash;1488. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/sms.12741\u003c/span\u003e\u003cspan address=\"10.1111/sms.12741\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePedrero-Chamizo R, G\u0026oacute;mez-Cabello A, Delgado S, Rodr\u0026iacute;guez-Llarena S, Rodr\u0026iacute;guez-Marroyo JA, Cabanillas E et al (2012) Physical fitness levels among independent non-institutionalized Spanish elderly: The elderly EXERNET multi-center study. Arch Gerontol Geriatr 55:406\u0026ndash;416. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.archger.2012.02.004\u003c/span\u003e\u003cspan address=\"10.1016/j.archger.2012.02.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Universidad Pablo de Olavide","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Early diagnosis, health risk, physical fitness, reference values, severe mental disorders","lastPublishedDoi":"10.21203/rs.3.rs-6375080/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6375080/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e: One factor that could reduce the burden associated with severe mental disorders is to improve the detection of people at health risk to prioritize the application of therapeutic interventions. Having specific risk values for robust health variables that can be measured through easy-to-use, inexpensive, feasible and reliable tools would make it possible to overcome the usual lack of resources in mental health services.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAims\u003c/strong\u003e\u003c/em\u003e: To provide reference values for levels of physical fitness (a more powerful predictor of disease, disability and mortality than smoking, hypertension, hypercholesterolaemia and diabetes) evaluated through low-resource tools in people with severe mental disorders.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/em\u003e: In total, 305 people (83 women) with severe mental disorders aged between 20 and 82 years were evaluated on a set of components of physical fitness (aerobic fitness, strength, flexibility, agility and balance) using the Senior Fitness Test battery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e: Reference values were provided by quartiles according to sex and age (20–39 years, 40–59 years, \u0026gt; 60 years). Women had significant lower performance than men in the aerobic fitness test (p \u0026lt;0.001; Cohen’s standardized effect size [d]: -0.83, 95 % confidence interval [CI]: -0.54, -1.12) and men had significant lower performance in the lower limb flexibility test (p \u0026lt;0.001; d: -0.55, CI: -0.83, -0.26). Performance in all tests was lower as age increased (standardized regression coefficients [β] ranged from -0.10 to -0.40).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/em\u003e: This study provides the first reference values for physical fitness components specific to adults with severe mental disorders, helping identify individuals at potential health risk and prioritize therapeutic interventions. The main contribution was to provide the first reference values of a set of physical fitness components specific for adults with severe mental disorders.\u003c/p\u003e","manuscriptTitle":"Fitness Reference Values to Identify Health Risks in Severe Mental Disorders: A Multicenter Cross-Sectional Study from the PsychiActive Project","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-07 06:05:26","doi":"10.21203/rs.3.rs-6375080/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2c6ffa9a-1caa-4389-b811-a11d24bf0e99","owner":[],"postedDate":"April 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46682159,"name":"Sports Medicine and Kinesiology"},{"id":46682160,"name":"Psychiatry"},{"id":46682161,"name":"Physical Medicine \u0026 Rehab"}],"tags":[],"updatedAt":"2025-04-07T06:05:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-07 06:05:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6375080","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6375080","identity":"rs-6375080","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}