Making Your Yearly "Physical" More Physical

Each year, you might visit various healthcare professionals for an annual check-up or “physical.” This could include your primary care physician, dentist, or specialists like a cardiologist or dermatologist. These visits typically include vital sign assessment, blood tests, medication changes, biopsies, or maybe a referral to another specialist for a specific problem. 

I always found it interesting that these visits were called “physicals” when most of the tests that are done are passive. There is really nothing physical about them. That doesn’t make them unimportant, however. All of those tests, and more that I haven’t listed, all provide important information in regards to your current health status, but I don’t think they provide a complete picture. Your strength, balance, mobility, cardiorespiratory fitness, and functional movement patterns should all be tested to get a well-rounded picture of your current and future health, and the great news is a lot of these tests can be done by yourself with minimal equipment.

Grip Strength 

From helping maintain your insulin sensitivity to developing strong and healthy bones, accumulating and maintaining lean muscle mass is probably the best thing you can do in order to keep yourself mobile and healthy as you age. But how do we test strength without making you step into a trap bar for a one-rep max deadlift? 

It turns out that grip strength is a great indicator of your current strength level and can even give you insight into your future functional capabilities. One study looked at the grip strength of 6,089 healthy, middle-aged Japanese-American men between the ages of 46 - 68 (average age of 54.0 at initial testing). The men’s grip strength was assessed at baseline, three years later, and 25 years later. 

For the men who made it back 25 years later, they were taken through several functional tests, completed subjective questionnaires about their functional abilities, and were assessed for current and past medical history. They were also able to track the participants who passed away prior to the 25 year mark. Functional testing included rising from a chair and walking speed. Self-reported disability asked about difficulty with walking ½ mile, walking up a flight of stairs, lifting 10 pounds, doing heavy household work, getting dressed, bathing, eating, and toileting. 

The participant’s baseline grip strength was divided into three groups: low (≤ 37.0 kg), medium (37.1 - 41.9 kg) and high (≥42.0 kg). The average was 39.2 kg. As you can see from the chart below, those with the lowest grip strength at baseline had the highest risk and functional limitation 25 years later. 

Although this study only followed men, other studies have also shown associations for both men and women between grip strength and bone mineral density, malnutrition, cognitive function, quality of life, chronic disease, and risk for hospitalization. A study published in 2018 in the Journal of Orthopedic Sports Physical Therapy provided normative data for men and women in the United States between the ages of 18-85 for both dominant and non-dominant arms. 

*Note: 1 kg = 2.2 lb 

When comparing this study of normative data and the others that provided specific cut-off points for poor health outcomes, I would say generally if you are in the 50th or above percentile then you are above the cut-off risk for most of the outcomes studied. 

How to Test Grip Strength

The easiest and cheapest way to test your grip strength is to purchase a digital hand dynamometer.  In the clinic, we use the Vald digital dynamometer which gives us a reliable and accurate measure. For you at home, you can purchase one off Amazon for $30 which will get the job done. There are more expensive options out there that are more accurate but I think the cheaper version is reliable enough for an at-home test. The most important thing to do for a test at home is to keep the way you are testing consistent. Considering grip strength can be a useful tool in objectively assessing your recovery, a hand dynamometer is worth considering as it gives you a ton of useful information on current and future health, as well as your recovery status. 

Balance 

Maintaining good balance is not only important for preventing injuries related to falling as you age, but if you want to be a good athlete in any sport at any age, you also need a certain level of balance to help you perform. 

There are numerous ways to test your balance: static, dynamic, eyes open and closed, uneven surfaces, and single-leg vs double-leg. There are even functional tests such as the Timed Up and Go (TUG) test that determine your risk for falls. Depending on your activity level, certain tests might be more appropriate than others. 

For athletes and active adults, I like to test single-leg balance with eyes open/closed and the Y-Balance Test. For older adults who aren’t as mobile I still might use those two tests, but I would start them off with something like the TUG or Berg Balance Test and determine from there if the higher level tests are appropriate for them. 

Single-Leg Balance Eyes Open and Closed

Assessing single-leg balance is important because walking is a controlled fall from one limb to the next. As we walk, we have one leg on the ground while the other is in the swing phase where the foot is in the air. Testing your single-leg balance gives me an idea of how stable you are on one limb. Not only am I looking to see how long you can hold for (≥30 seconds), but I also want to observe how you stand on one leg. Are you tall and straight? Do you let your trunk lean to one side? How you stand gives me just as much information as how long you stand. 

If you can stand for 30 seconds with your eyes open then we immediately will test with your eyes closed. This often surprises people how difficult it is. We really rely on vision as part of our balance system and when we take that away it can really make things hard. I am looking at the same two things as we tested with your eyes open: how long (≥30 seconds) and what you look like while standing on one leg. 

You can easily test this at home. Testing yourself in the mirror is a great way to observe how you stand on one leg. The biggest thing to look for is what your trunk is doing while on one leg. Are you straight or are you leaning to one side? With your eyes closed you won’t be able to observe yourself but maybe you can have someone take a picture of you while you’re doing it. Don’t forget to time yourself as well. You want ≥30 seconds on each leg with eyes open and closed. 

Y-Balance Test 

The Y-Balance Test assesses your dynamic motor control at the limits of your stability. This is just a fancy way of saying it tests your ability to maintain stability on one leg while reaching outside of your base of support. It requires stability, coordination, flexibility, range of motion, proprioception, and neuromuscular control. Not only does it test balance and stability, it has been shown to be somewhat predictive of injury in high school and college athletes. It is a great all-around test for balance and stability.

To perform a true Y-Balance Test, you do need the Y-Balance Test kit (shown below). The test involves standing on one leg and reaching the other leg as far as you can forward and diagonally backwards to your left and right. The distance you are able to slide the platform along the pole is recorded in each direction. You get a score for each direction and a composite score that incorporates all directions together. 

You can also perform this with tape on the ground. Instead of pushing the platform along the pole, you measure where you can tap your foot and return to the start position. 

There are normative scores based on age, gender, and even the sport you play. The Shirley Ryan Ability Lab is a great resource for that data. 

Mobility

When I think of mobility, I am really thinking about two things:

• How much you are moving throughout the day

• Your individual joint mobility

Steps Per Day

When thinking about how much you are moving throughout the day there are several metrics you can use to measure your movement, but I think the one that is easiest to measure and provides good return on investment for health is the amount of steps you get per day. Almost everyone wears some sort of device that records the number of steps you get per day so you don’t need to purchase anything new to track this. All you need to do is set a goal for the amount of steps to get per day.

So how many should you get? The magic number seems to be 8,000 steps per day. One study showed that compared with taking 4,000 steps per day (the Average American takes 5,117), reaching 8,000 steps was associated with a 51% lower risk of death from all causes. Taking 12,000 steps per day was associated with a 65% lower risk. 

Look back at the last seven days of your device to determine what your average daily steps are. This will give you a good enough idea of what your starting point is. Next, pick a goal of at least 8,000 steps per day. My wife and I chose 10,000 steps but you are in charge of what you want to do. What really helped us was we made a competition to see who could get the most days in a row with 10,000 steps. That simple mindset change made it so much more important to us because we are both competitive people. I currently hold the record for 71 days in a row, just FYI. 

You don’t have to go for long walks to accomplish this goal either. That would certainly help, but the whole point is here to move a little bit more throughout the day. Getting up and moving around for “exercise snacks” is a great way to limit the amount of time per day you are sedentary. 

Besides the amount you move per day, I want to know how mobile your individual joints are and what it looks like for you to access that mobility. In order to do that, I like to take people through two different movement assessments:

• The sitting-rising test

• Functional movement testing

Sitting-Rising Test

The Sitting-Rising Test (SRT) assesses your ability to move from a standing position to a seated position on the floor, and then back up to a standing position. You are given a separate score from 0-5 for standing to sitting on the floor floor and floor to standing. You add the two scores together for a composite score out of 10. If you are able to complete the task without using your hands or other limbs for support, you get a 5 for each movement and 10 composite score. One point is subtracted each time your hand, forearm, knee or side of the leg assists you in the movement. 0.5 point is subtracted if a partial loss of balance occurs during the test. 

What makes the SRT so important is that it is strongly associated with all-cause mortality in people 51-80 years of age. Your score determines what category you are in:

• C1: 0 - 3

• C2: 3.5 - 5.5

• C3: 6 - 7.5

• C4: 8-10

Those who scored in the lower range (C1) had a 5-6x higher risk of death compared to C4. A  composite score below 8 was associated with a 2-5x higher death rate. Your score now does not mean that is your score for the future, however. Just a one point rise in your score resulted in a 21% reduction in mortality. 

To test at home all you need is an open area of floor where you can perform the test. A yoga mat works great as it is a little bit softer than a hard floor and gives you a little more grip. The instructions are, “Without worrying about the speed of movement, try to sit and then to rise from the floor, using the minimum support that you believe is needed." Use the system above to score yourself. 

Functional Movement Testing

The next way to assess your mobility is to take you through a functional movement test where I can observe your movement patterns. This test is hard to really perform by yourself as it requires another set of eyes to look at your movement quality. You can, however, perform these by yourself and assess if you experience pain with any of these movements. If you do have pain with any of these movements I would recommend going to see your local clinician for an assessment. 

The movement patterns I like to assess are:

1. Forward bend

2. Squat

3. Forward Lunge

4. Lateral Lunge

5. Single-leg forward reach

6. Trunk rotation

7. Overhead reach

8. Pulling

9. Pushing

These are all foundational movement patterns that we perform everyday. The goal for this is for me to assess what your movement capacity is. If you can pass all movements (even with some compensations) without pain then I feel pretty confident in your movement capabilities. If there are certain patterns that you struggle with then that will give me an opportunity to show certain things you can do to improve with that movement. 

The whole goal of the mobility assessment is to learn how much you move (steps/day) and how well you move (SRT and functional movements). Learning those two things will give you a good idea of how mobile you are. 

Cardiorespiratory Fitness

Your cardiorespiratory fitness is directly related to health and longevity and is quantified by measuring your VO2 max. Your VO2 max is the maximum amount of oxygen your body can absorb and use during exercise. The higher your VO2 max, the higher your cardiovascular fitness. 

Why is VO2 max important?

VO2 max is important because it is directly related to your current fitness level and your longevity/healthspan. The fitter you are now, the more likely you are to live healthier longer. Studies have shown that each unit increase in your VO2 max adds ~45 days of life.

To help you understand a little further, let’s say currently your VO2 max is “below normal” for a population. If you raise your VO2 max to just a “normal” level, you get a 2.1 year increase in life expectancy. If you increase it to “high normal”, where ~50% of the population lies, then you increase life expectancy by 3 years. If you get to the “elite” level, you would get a 5 year increase in life expectancy compared to “below normal” levels. 

Studies also show that there isn’t really an upper limit to the longevity benefit of improving your VO2 max. This means that the more you improve your cardiorespiratory fitness, the more likely you will live healthier longer. There isn’t a cutoff point to where you see a plateau in benefits so it pays to keep improving your VO2 max and not reaching a certain point and leveling off. 

Another reason increasing your VO2 max is so important is that those who have a low fitness level have a similar risk of death and all-cause mortality as those with type 2 diabetes, cardiovascular disease, and smoking. We all know the poor health outcomes related to those diseases, but how often have you been told that having a poor fitness level is just as detrimental to your health as developing one of those conditions. 

How to Measure VO2 Max

VO2 max has traditionally been measured in a laboratory setting using a treadmill or stationary bike. Throughout the test, you progressively increase the intensity of exercise by increasing speed, incline (treadmill), or resistance (bike). The intensity is increased until you reach your point of exhaustion. The whole object is to get you exercising at your maximum capacity and achieving your maximum heart rate. While you are doing this, you wear an airtight mask that measures your inspirations and expirations, and the volume and gas concentrations of the air you’re breathing. I’ve never personally participated in a VO2 max test, but I have heard from people who have and they say it is absolutely brutal. 

While using a treadmill/bike and wearing a mask is considered the gold standard for measuring VO2 max, there are other methods that yield similar results. The first is Cooper’s 12 Minute Run (or walk) test. The great thing about this test is you can perform it all by yourself. All you need is something to track the distance you run and a flat area to run (preferably a track). 

Before performing the test, make sure you are sufficiently warmed up. The objective of the test is to run or walk as far as you can in 12 minutes. The amount of distance you cover in those 12 minutes is closely correlated with your VO2 max. A simple formula will give you an estimation of what your VO2 max is: 

• Kilometers: VO2max = (22.351 x kilometers) - 11.288

• Miles: VO2max = (35.97 x miles) - 11.29

An even better tool is to use this calculator. 

What is a Good VO2 Max Score? 

Your VO2 max score depends on your age and sex. The maximum amount of oxygen your muscles use during exercise is measured in ml/kg/min. The charts below show VO2 max values based on testing that would be done in the lab setting and using the Cooper 12 Minute Run Test.  

VO2 Max Chart for Men (mL/kg/min)

						Age (years)
Rating	18-25	26-35	36-45	46-55	56=65	65+
Excellent	>60	>56	>51	>45	>41	>37
Good	52-60	49-56	43-51	39-45	36-41	33-37
Above Average	47-51	43-48	39-42	36-38	32-35	29-32
Average	42-46	40-42	35-38	32-35	30-31	26-28
Below Average	37-41	35-39	31-34	29-31	26-29	22-25
Poor	30-36	30-34	26-30	25-28	22-25	20-21
Very Poor	<30	<30	<26	<25	<22	<20

VO2 Max Chart for Women (mL/kg/min)

						Age (years)
Rating	18-25	26-35	36-45	46-55	56-65	65+
Excellent	>56	>52	>45	>40	>37	>32
Good	47-56	45-52	38-45	34-40	32-37	28-32
Above Average	42-46	39-44	34-37	31-33	28-31	25-27
Average	38-41	35-38	31-33	28-30	25-27	22-24
Below Average	33-37	31-34	27-30	25-27	22-24	19-21
Poor	28-32	26-30	22-26	20-24	18-21	17-18
Very Poor	<28	<26	<22	<20	<18	<17

Cooper Test Result Rankings (meters) 

Age	Excellent	Above Average	Average	Below Average	Poor
Male 20-29	>2800 m	2400-2800 m	2200-2399 m	1600-2199 m	<1600 m
Female 20-29	>2700 m	2200-2700 m	1800-2199 m	1500-1799m	<1500 m
Male 30-39	>2700 m	2300-2700 m	1900-2299 m	1500-1899 m	<1500 m
Female 30-39	>2500 m	2000-2500 m	1700-1999 m	1400-1699 m	<1400 m
Male 40-49	>2500 m	2100-2500 m	1700-2099 m	1400-1699 m	<1400 m
Female 40-49	>2300 m	1900-2300 m	1500-1899 m	1200-1499 m	<1200 m
Male 50+	>2400 m	2000-2400 m	1600-1999 m	1300-1599 m	<1300 m
Female 50+	>2200 m	1700-2200 m	1400-1699 m	1100-1399 m	<1100 m

How to Improve Your VO2 Max

How to improve your VO2 max really goes beyond the scope of this article but it basically comes down to consistent high intensity interval training (HIIT). The goal is to get your heart rate as close to your maximum as possible but only for a short period of time. Check out this blog on everything you need to know about VO2 max to learn how to improve yours. 

Consistent check ups with your healthcare providers are essential for living a long and healthy life. While those yearly visits are impactful and important, I think there is a little bit more that we can learn about your current and future health through a little bit of movement. Remember, this “physical” is not to take the place of other visits throughout the year, but it is meant to be an adjunct to those visits. 

If you are interested in scheduling a physical with us, follow this link or call our office at 561-203-5460.