Time the balance stands, 4-meter walk and five chair stands, and get the NIA score out of 12.
The Short Physical Performance Battery (SPPB) scores lower-body function in older adults from three short tests: standing balance, a 4-meter walk at usual pace and five chair stands. Each part scores 0 to 4, for a total out of 12. It takes about 10 minutes and needs a stopwatch, a chair and a marked 4-meter course. The timers below are built in, or you can type your own times.
Stand next to the patient for every balance stand and walk with them on the course. Skip any part you or the patient feel is unsafe; it scores 0. Stop for chest pain, dizziness or shortness of breath, and call 911 for chest pain, fainting or severe shortness of breath.
Do the tests in this order. The NIA protocol asks you to read the patient instructions exactly as written; key lines are under each test.
Side-by-side: “I want you to try to stand with your feet together, side-by-side, for about 10 seconds. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop.”
Semi-tandem: “Now I want you to try to stand with the side of the heel of one foot touching the big toe of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you.”
Tandem: “Now I want you to try to stand with the heel of one foot in front of and touching the toes of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you.”
Help the patient into position, supplying just enough support at the arm to prevent loss of balance. Ask “Are you ready?”, let go and start timing as you say “Ready, begin.” Stop after 10 seconds or when the patient steps out of position or grabs your arm. If a stand is not held for 10 seconds, the remaining balance stands are not done (they score 0); go on to the gait test.
“This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking down the street to go to the store. Walk all the way past the other end of the tape before you stop. I will walk with you. Do you feel this would be safe?”
A cane or other walking aid may be used if the patient needs it for a short walk. Start with both feet touching the starting line. Start timing as the patient begins walking after “Ready, begin,” walk behind and to the side, and stop timing when one foot is completely across the end line. Do two walks; the faster one is scored.
Single stand: “Do you think it would be safe for you to try to stand up from a chair without using your arms? First, fold your arms across your chest and sit so that your feet are on the floor; then stand up keeping your arms folded across your chest.”
Five stands: “Please stand up straight as QUICKLY as you can five times, without stopping in between. After standing up each time, sit down and then stand up again. Keep your arms folded across your chest. I’ll be timing you with a stopwatch.”
Say “Ready? Stand” and start timing. Count each rise out loud up to five. Stop the watch when the patient has straightened up completely for the fifth time. Also stop if the patient uses their arms, after 1 minute if the rises are not done, or if you are concerned for safety. If the patient stops and seems tired, ask “Can you continue?”
This is a measure of physical performance, not a diagnosis. Read the score alongside the patient’s history, exam and goals.
| Points | 4-meter walk | 3-meter walk | Five chair stands |
|---|---|---|---|
| 4 | Under 4.82 s | Under 3.62 s | 11.19 s or less |
| 3 | 4.82 to 6.20 s | 3.62 to 4.65 s | 11.20 to 13.69 s |
| 2 | 6.21 to 8.70 s | 4.66 to 6.52 s | 13.70 to 16.69 s |
| 1 | Over 8.70 s | Over 6.52 s | 16.70 s or more |
| 0 | Unable to walk | Unable to walk | Unable, used arms, or over 60 s |
Balance: side-by-side 10 s = 1, semi-tandem 10 s = 1, tandem 10 s = 2 or 3 to 9.99 s = 1. Balance total 0 to 4. SPPB total = balance + gait + chair stands, 0 to 12.
| Value | Points | Source |
|---|---|---|
| Small meaningful change | about 0.5 | Perera 2006, older adults |
| Substantial meaningful change | about 1.0 | Perera 2006, older adults |
| Minimal detectable change (95%) | 1.88 | Olsen & Bergland 2017, Norwegian version |
| Minimal detectable change | 2.9 | Mangione 2010, older African American adults |
Perera and colleagues noted that for clinical use, substantial change in the SPPB is detectable but small change is not.
Sources. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85-M94. doi:10.1093/geronj/49.2.M85. National Institute on Aging. Short Physical Performance Battery (SPPB) and its SPPB Protocol and Score Sheet (copy hosted by the Shirley Ryan AbilityLab). Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556-561. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743-749. doi:10.1111/j.1532-5415.2006.00701.x. Shirley Ryan AbilityLab, Rehabilitation Measures Database: Short Physical Performance Battery (cut-offs, MDC and norms, citing Pavasini 2016, Vasunilashorn 2009, Olsen & Bergland 2017 and Mangione 2010). McDonough CM, Harris-Hayes M, Kristensen MT, et al. Physical therapy management of older adults with hip fracture. J Orthop Sports Phys Ther. 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
Permissions. Developed by the National Institute on Aging and “available for use without permission or royalty fees” (NIA). Holsman Physical Therapy is not affiliated with the NIA, these authors or journals, and they do not endorse this website.
Clinically reviewed by Dr. Richard Holsman, PT, DPT, NCS. Last reviewed: November 12, 2026.
Next step: A low or falling SPPB score is a good reason for strength, balance and gait training. Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits. Refer a patient or call 1-855-465-7626.
The SPPB is a short set of tests of lower-body function in older adults, developed at the National Institute on Aging by Dr. Jack Guralnik and colleagues (J Gerontol 1994). It combines three standing balance positions, a timed 4-meter (or 3-meter) walk at usual pace and five timed chair stands.
Each part scores 0 to 4 and the total is 0 to 12. Balance: side-by-side and semi-tandem stands score 1 point each if held 10 seconds; tandem scores 2 points for 10 seconds or 1 point for 3 to 9.99 seconds. Gait: the faster of two 4-meter walks scores 4 (under 4.82 s), 3 (4.82 to 6.20 s), 2 (6.21 to 8.70 s) or 1 (over 8.70 s). Chair stands: 4 (11.19 s or less), 3 (11.20 to 13.69 s), 2 (13.70 to 16.69 s), 1 (16.70 s or more), or 0 if not completed within 60 seconds or the patient needs their arms.
Perera and colleagues (J Am Geriatr Soc 2006) estimated a small meaningful change near 0.5 point and a substantial change near 1.0 point. They noted that for clinical use, a substantial change can be detected but a small change in the SPPB cannot.
In community-dwelling adults 71 and older without disability, people scoring 4 to 6 were about 4 times, and people scoring 7 to 9 about 1.6 times, as likely to develop disability over 4 years as people scoring 10 to 12 (Guralnik 1995, as summarized by the Shirley Ryan AbilityLab). A score under 10 is linked with mobility limitations and higher all-cause mortality.
No. The National Institute on Aging states that the SPPB is available for use without permission or royalty fees.
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Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.
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