The Timed Up and Go (TUG) test is a simple, quick, and widely used clinical performance-based measure designed to assess lower extremity function, mobility, and fall risk in older adults and other populations.[1] Developed in 1991 by Podsiadlo and Richardson, the test evaluates functional mobility by timing how long it takes a participant to rise from an arm chair, walk three meters forward, turn around, walk back to the chair, and sit down again, starting from the verbal command "go" and ending when the participant is fully seated.[2] It is reliable and valid for quantifying basic functional mobility and monitoring clinical changes over time, particularly in geriatric settings.[2] A completion time of 12 seconds or more is commonly interpreted as indicating an increased risk of falls, though normative values vary by age and population, with community-dwelling older adults typically averaging around 9-10 seconds.[3][4] The TUG test's brevity—taking less than a minute to administer—makes it a practical tool in clinical environments for screening dynamic balance and gait impairments, and it correlates with broader measures of physical function and biomechanical factors like lower extremity strength.[5][6]
History and Development
Origins
The Timed Up and Go (TUG) test was developed in 1991 by Dianne Podsiadlo and Stephen Richardson as a timed modification of the Get-Up and Go test, which had been introduced five years earlier by Sydney Mathias, Udaya S. L. Nayak, and Bernard Isaacs to assess balance in elderly patients.[2][7] The TUG added a stopwatch to quantify the time taken for the sequence of rising from a chair, walking three meters, turning, returning, and sitting down, aiming to provide a more objective evaluation of functional mobility.[2]This innovation was first published in the Journal of the American Geriatrics Society, driven by the need for a simple, standardized tool to measure mobility in frail older adults during routine clinical evaluations, without requiring specialized equipment or extensive training.[2] The original study validated the test in 60 patients (mean age 79.5 years) referred to a geriatric day hospital, an outpatient clinical setting, where it showed strong inter-rater and intra-rater reliability, as well as correlations with established metrics like the Berg Balance Scale (r = -0.81) and Barthel Index (r = -0.78), confirming its feasibility for identifying mobility limitations and tracking progress.[2]The TUG emerged amid the 1980s and 1990s surge in geriatric research, which emphasized practical functional assessment instruments to address the growing challenges of falls and independence loss in aging populations, as geriatric medicine formalized screening protocols for comprehensive patient evaluation.[8][9]
Evolution and Adoption
Following its initial publication in 1991, the Timed Up and Go (TUG) test underwent refinements in the 2000s and 2010s to enhance its utility in clinical settings, including modifications for dual-task paradigms that incorporated cognitive challenges to better assess fall risk in real-world scenarios.[10] During this period, the TUG was frequently integrated alongside the Tinetti Performance-Oriented Mobility Assessment (POMA) to provide a more comprehensive evaluation of gait and balance, allowing clinicians to combine timing-based mobility data from the TUG with the POMA's ordinal scoring of postural stability and ambulation.[11] Additionally, the test gained prominence in randomized controlled trials (RCTs) for fall prevention, such as a 2003 study by Barnett et al. (with Lord SR as co-author) that demonstrated exercise interventions improving TUG performance and reducing fall rates among older adults in community settings.[12]The TUG's adoption accelerated through endorsements by major organizations, beginning with its recommendation as a key mobility screening tool in the American Geriatrics Society (AGS) and British Geriatrics Society (BGS) clinical practice guideline update in 2011, which emphasized its role in identifying fall risk factors like impaired gait and balance. In the 2010s, the Centers for Disease Control and Prevention (CDC) incorporated the TUG into its Stopping Elderly Accidents, Deaths & Injuries (STEADI) program, launched in 2013 and updated throughout the decade, positioning it as a core component of gait, strength, and balance assessments in primary care to guide interventions for at-risk older adults.[13]Technological advancements expanded the TUG's scope in the mid-2010s, with the development of instrumented versions using wearable inertial sensors to capture detailed kinematics, such as turn duration and stride variability, beyond simple timing; a seminal 2015 study validated this approach in dual-task conditions among young adults, paving the way for broader clinical application in older populations.[14] By 2017, the test was integrated into the World Health Organization's (WHO) Integrated Care for Older People (ICOPE) framework, which highlighted mobility assessments like the TUG in strategies to maintain intrinsic capacity and prevent falls through person-centered care.Key milestones underscore the TUG's widespread impact, including over 5,000 citations of the original 1991 paper by 2020, reflecting its influence across geriatric research and practice. During the COVID-19 pandemic, the test was adapted for telehealth delivery in studies from 2020 to 2022, enabling remote administration via video to assess mobility while minimizing in-person contact. In the 2020s, further innovations include smartphone app-based self-administration of the TUG for fall risk screening, validated as of 2025 for high reliability and accessibility in community-dwelling older adults.[15]
Test Procedure
Step-by-Step Instructions
The administration of the Timed Up and Go (TUG) test requires careful preparation to ensure standardization and safety. The participant is instructed to sit comfortably in an armchair with a seat height of approximately 44-47 cm and armrests present, positioned such that their back is against the chair back and feet are flat on the floor; a clear walkway is marked 3 meters ahead using tape or a cone.[16] The participant wears regular footwear and uses their customary walking aid, if applicable.[3]The administrator demonstrates the test once for clarity and then provides the following standardized verbal instructions: "When I say 'Go,' I want you to stand up from the chair, walk to the line 3 meters away at your normal pace, turn around, walk back to the chair at your normal pace, and sit down."[3] A single untimed practice trial is allowed to familiarize the participant with the procedure.[17]Upon the "go" command, the administrator starts the stopwatch as the participant begins to rise. The sequence proceeds as follows:
Stand up from the chair.
Walk 3 meters forward at a normal pace.
Execute a 180-degree turn.
Walk back 3 meters to the chair.
Turn and sit down in the chair.[18]
Timing concludes when the participant's buttocks contact the chair seat. The test is repeated for up to three trials, recording the fastest completion time across trials.[17]Safety is paramount during administration; a spotter must remain nearby, particularly for individuals at risk of falls, to provide assistance if needed and ensure a clear, obstacle-free environment.[3]
Required Equipment and Setup
The Timed Up and Go (TUG) test requires minimal equipment to ensure accurate and safe administration, focusing on items that support precise timing and standardized spatial measurements. Essential tools include a stopwatch or timer capable of measuring to 0.1 seconds accuracy, either manual or app-based, to record the duration from the "go" command until the participant is fully seated. A measuring tape is necessary to demarcate the 3-meter walkway distance from the front edge of the chair seat. The primary furniture is a standard armchair equipped with armrests, with a seat height of approximately 44-47 cm to facilitate rising without undue difficulty, as specified in the test's foundational protocol.[19][18][20]Setup for the TUG test involves preparing a flat, non-slip surface to minimize fall hazards during ambulation, with a clear 3-meter path free of obstacles such as rugs, cords, or furniture. The armchair should be positioned at the start of this path, free-standing and stable (not against a wall), allowing the participant to sit with their back fully against the chair back and hips aligned. An optional cone or similar marker can be placed at the 3-meter turnaround point to clearly indicate the turning location, though tape on the floor suffices for marking the path. These arrangements ensure the test space supports natural mobility without external influences on performance.[21][16][17]Environmental factors play a key role in maintaining test validity by reducing distractions and promoting safety. The testing area should be well-lit to allow clear visibility of the path and any markers, and a quiet setting is recommended to minimize auditory or visual interruptions that could affect concentration or pacing.[22]The TUG test's design emphasizes cost-effectiveness, with the total equipment and setup costs typically under $20, utilizing everyday or inexpensive items like a basic stopwatch ($5-10), measuring tape ($3-5), and a standard clinic chair, making it highly suitable for low-resource clinical environments worldwide.[3][23]
Scoring and Interpretation
Timing and Measurement
The timing for the Timed Up and Go (TUG) test commences with the examiner's verbal command "go" and terminates when the participant's buttocks contact the seat and their back rests fully against the chair backrest, capturing the complete sequence of rising, walking 3 meters forward, turning 180 degrees, walking back, and sitting. This protocol ensures a comprehensive assessment of functional mobility without isolating subcomponents such as turns or walking phases, and the total duration is recorded exclusively as the outcome measure. The time is measured in seconds using a stopwatch, with decimal precision typically to the nearest 0.01 second for accuracy.[24][3][17]To minimize variability and account for learning effects, the test is administered for 1 to 3 trials following an initial untimed practice trial, with participants resting for approximately 1 minute between scored trials to prevent fatigue. The fastest completion time among the scored trials is selected as the representative score, as performance often improves across repetitions due to familiarity.[25][17][26]Techniques such as video recording enhance measurement precision by allowing frame-by-frame review in cases of timing disputes, contributing to excellent intra-rater reliability with intraclass correlation coefficients (ICC) exceeding 0.98. Common procedural errors include premature initiation by the participant before the "go" command, which invalidates the trial and necessitates a repeat; hesitation or pauses attributable to pain or discomfort should be documented qualitatively without adjusting the recorded time, though severe interruptions may require restarting the trial.[17][27][28]
Normative Values and Cutoffs
Normative values for the Timed Up and Go (TUG) test provide benchmarks for interpreting performance in healthy and clinical populations, typically expressed as mean times with confidence intervals or percentiles. For community-dwelling adults under 70 years, times under 10 seconds are generally considered normal, reflecting good mobility and low fall risk.[29] In frail elderly individuals, times range from 10 to 20 seconds, indicating moderate impairment, while times exceeding 30 seconds suggest severe mobility limitations and high dependency.[17]Age-stratified normative data from meta-analyses highlight increasing TUG times with advancing age in healthy older adults. A seminal 2006 meta-analysis of studies involving over 1,000 participants aged 60 years and older reported the following mean times (95% confidence intervals):
Age Group
Mean TUG Time (seconds)
95% CI (seconds)
60–69
8.1
7.1–9.0
70–79
9.2
8.2–10.2
80–99
11.3
10.0–12.7
These values represent community-dwelling elders without significant comorbidities, with overall mean of 9.4 seconds (95% CI: 8.9–9.9) for those 60 years and older.[29] More recent population-based data from a 2021 Norwegian study of over 5,000 community-dwelling adults aged 60–84 years confirm similar trends, with medians stable around 8 seconds at ages 60–65, rising to 10.3 seconds by age 80, and slight sex differences (women ~0.2–0.5 seconds slower).[30]Cutoffs for TUG times are used to categorize fall risk and mobility status, often derived from predictive studies. A time greater than 12 seconds predicts falls in community-dwelling older adults, with reported sensitivity of 87% and specificity of 87%.[31] In institutional or high-risk settings, such as falls clinics, a cutoff of greater than 14 seconds indicates elevated fall probability.[17] Population-specific adjustments are necessary; for individuals with Parkinson's disease, a threshold exceeding 11.5 seconds identifies those at significant fall risk.[32] Similarly, post-stroke patients require higher cutoffs, with times over 14 seconds signaling increased fall risk in older adults.[17]
Clinical Applications
Fall Risk Assessment
The Timed Up and Go (TUG) test serves as a key tool for identifying individuals at elevated risk of falls by evaluating dynamic balance and mobility in a single, composite measure. Developed for frail elderly patients, longer completion times on the TUG indicate impaired functional mobility that predisposes to falls, with prospective studies demonstrating its utility in predicting future fall events over periods such as 12 months. In the seminal 1991 study, TUG times exceeding 30 seconds indicated high dependence in basic mobility, and later prospective research has shown that thresholds around 12–13.5 seconds predict increased fall risk in community-dwelling older adults.[2][33]Systematic evidence supports the TUG's predictive validity for falls, particularly when analyzing continuous time measures. A 2014 meta-analysis of community-dwelling older adults found that fallers had significantly longer TUG times than non-fallers, with a pooled odds ratio of 1.01 (95% CI 1.00–1.02) per second increase for future falls.[34] Further, a prospective cohort study reported that each additional second on the TUG was associated with a 9% increase in odds of future falls (OR 1.09, 95% CI 1.00–1.19).[35]The TUG is integrated into multifactorial fall risk assessments, such as the CDC's STEADI toolkit, where it complements history-taking and other gait-balance tests to guide targeted interventions. Serial TUG testing is valuable for monitoring progress, as exercise programs—incorporating strength, balance, and aerobic components—have been shown to reduce completion times and thereby lower fall incidence in at-risk groups. For instance, a combined exercise intervention in community-dwelling elderly decreased TUG times from 8.4 seconds to approximately 6.9 seconds while improving overall fall prevention outcomes.[3][36] As of 2024, additional evidence links prolonged TUG times to higher risk of injurious falls (e.g., OR 1.59 in women with certain comorbidities).[37]Primarily applied to adults over 65 years, the TUG is especially relevant for those with comorbidities like osteoporosis, where prolonged times independently predict major osteoporotic and hip fractures beyond bone density measures. It facilitates screening in diverse settings, including community-based programs for independent older adults and hospital environments for acute care patients, enabling early identification and tailored prevention strategies.[38][17]
Mobility and Balance Evaluation
The Timed Up and Go (TUG) test evaluates key functional domains of mobility, including dynamic balance during turning, gait speed over a short distance, and the ability to perform transfers between sitting and standing.[2] By integrating these elements into a single timed sequence, the TUG provides a comprehensive profile of lower extremity function and overall locomotor control, distinguishing it from static balance assessments.[1] It demonstrates strong correlations with activities of daily living (ADL) scales, such as the Barthel Index (r = -0.78), indicating its utility in gauging independence in routine tasks like walking and self-care.[2]In rehabilitation settings, particularly following hip fracture, the TUG serves as a baseline measure to predict long-term walking ability and functional recovery, with longer completion times associated with poorer one-year ambulatory outcomes and greater reliance on walking aids.[39] In neurology, it tracks mobility progression in conditions like multiple sclerosis, where it correlates strongly with disability status (r = 0.80) and ambulatory limitations, enabling clinicians to monitor disease impact on everyday movement.[40] For stroke survivors, serial TUG assessments capture longitudinal improvements, such as median reductions from 17 seconds in the first week to 12 seconds at three months post-event, while highlighting persistent deficits in older patients.[41]Among populations with cognitive impairments, such as dementia patients, the TUG—often adapted with dual-task elements—differentiates levels of functional decline by revealing reductions in gait parameters like step length alongside cognitive demands, aiding in the identification of mild versus more severe mobility restrictions.[42] These insights guide personalized therapy plans, focusing on targeted interventions for balance and gaittraining. A reduction exceeding the minimal detectable change threshold (e.g., 2.92 seconds in populations with knee osteoarthritis) signifies meaningful progress.[43]
Psychometric Properties
Reliability Measures
The Timed Up and Go (TUG) test exhibits excellent test-retest reliability when administered over short intervals, such as days to one week, particularly in older adults. In a foundational study of frail elderly individuals, test-retest reliability was reported as an intraclass correlation coefficient (ICC) of 0.99 over a short retest period. Similarly, in community-dwelling older adults, ICC values exceeding 0.95 have been observed with one-week intervals, indicating strong stability in performance under consistent conditions.[17] However, reliability decreases to moderate levels (e.g., ICC ≈ 0.56) over longer periods like several months, attributable to natural fluctuations in health and mobility rather than inconsistencies in the test itself.[17]Inter-rater reliability of the TUG test is also exceptionally high when standardized training and protocols are followed, with ICC values often surpassing 0.99 in geriatric populations. For example, among frail elderly participants, inter-rater ICC reached 0.99, reflecting negligible differences in timing between observers. This consistency is supported by minimal measurement variability, such as mean differences of approximately 0.04 seconds between raters in community-dwelling older adults, underscoring the test's robustness to observer subjectivity.[17]In multi-trial administrations of the TUG test, internal consistency remains high, with ICCs between consecutive trials typically above 0.90, allowing for reliable averaging of results to enhance precision without introducing significant variability. This consistency holds across minor procedural variations, such as slight differences in walking distance (3-9 meters) or seat height adjustments, where test-retest ICCs range from 0.89 to 0.96 in older adults.[44]
Validity and Correlations
The Timed Up and Go (TUG) test exhibits strong construct validity, reflecting its ability to measure underlying constructs of mobility and balance. It correlates highly with gait speed (r = -0.75) among older adults, indicating that longer TUG times align with slower walking speeds as a key indicator of functional mobility.[27] A 2010 review further highlighted robust associations with the Berg Balance Scale (r = -0.70 to -0.78 across populations such as those with stroke and Parkinson's disease), supporting its alignment with established balance assessments.[17]Criterion validity of the TUG test is well-supported, both concurrently and predictively. Concurrently, it shows strong agreement with the 6-minute walk test (r = -0.88), underscoring its role in evaluating endurance and overall walking capacity in clinical settings like strokerehabilitation.[45] Predictively, the test forecasts adverse outcomes such as hospitalization-associated functional decline, with an area under the curve (AUC) of 0.66 for 30-day morbidity in older surgical patients, where times exceeding 20 seconds triple the odds of major complications after adjusting for confounders like nutrition and surgery type.[46]Content validity is affirmed by the TUG test's comprehensive coverage of core domains in the International Classification of Functioning, Disability and Health (ICF), particularly body functions related to mobility (e.g., walking) and balance maintenance during transfers. Content experts in geriatric rehabilitation have rated the test highly for its relevance and representativeness of everyday functional tasks, as it integrates rising from a chair, turning, and gait without requiring specialized equipment.[17]The TUG test demonstrates adequate responsiveness to clinical changes, particularly following rehabilitation interventions. In post-stroke recovery, effect sizes range from 0.48 to 1.0 for detecting improvements in mobility over three months, allowing clinicians to monitor progress beyond baseline stability measures.[41]
Limitations and Variations
Influencing Factors
Several intrinsic factors can significantly influence performance on the Timed Up and Go (TUG) test, primarily by affecting mobility, balance, and coordination. Age is a key determinant, with older adults typically exhibiting slower TUG times due to age-related declines in muscle strength, gait speed, and balance; for instance, TUG performance worsens progressively from age 60 onward, with times increasing by approximately 0.5-1 second per decade in community-dwelling older adults.[47] Comorbidities, such as osteoarthritis of the hip or knee, further prolong TUG duration by impairing joint mobility and increasing pain during transitions and walking.[48] Similarly, cognitive impairment, including dementia, slows overall TUG execution, particularly during turning phases where executive function and spatial planning are required, resulting in increased hesitation and longer completion times.[49]Extrinsic factors related to the participant's state and equipment also alter TUG outcomes. Appropriate footwear, such as minimal shoes, enhances stability and reduces slip risk, with studies showing that minimal shoes can decrease TUG times by approximately 0.3 seconds compared to conventional shoes or barefoot conditions, as they improve grip and proprioception during gait and turns.[50]Fatigue, especially following physical exertion, impairs lower limb muscle endurance and coordination, leading to TUG times that are 10-30% longer immediately post-exercise due to reduced walking speed and increased postural sway.[51]Environmental conditions during testing can introduce variability that affects TUG reliability. Surface texture plays a role, with carpeted or uneven floors increasing completion times relative to smooth tile surfaces, as they demand greater effort for propulsion and balance adjustments.[52] Poor lighting exacerbates visual processing demands, particularly in older adults with reduced contrast sensitivity, resulting in slower gait and turning speeds by hindering obstacle detection and path planning.[53]To mitigate these influencing factors and ensure accurate interpretation of TUG results, clinicians should standardize testing conditions, such as using a consistent chair height, flat non-slip flooring, adequate lighting, and allowing participants to wear their usual supportive footwear while rested. Documenting any notable confounders, like recent fatigue or specific comorbidities, in the assessment report allows for adjusted clinical judgments without altering the standard protocol.[44]
Modified Versions
The Instrumental Timed Up and Go (iTUG) test represents an enhanced adaptation of the standard TUG, incorporating inertial sensors worn on the body to capture detailed kinematic data during task execution. Developed in 2010, this version extends the walking distance to 7 meters to allow for more gait cycles and analyzes subcomponents such as sit-to-stand transition, straight-line walking, turning duration, and turn velocity, providing greater sensitivity to mobility impairments than total time alone. For instance, turn duration measured by iTUG has been shown to discriminate fall risk more effectively in older adults, with prolonged turns indicating balance deficits.[54]The Cognitive Timed Up and Go (Cognitive TUG or TUG-cog) modifies the standard test by adding a dual-task cognitive component, such as counting backward by threes while performing the mobility sequence, to assess executive function and divided attention alongside physical performance. This version is particularly useful for populations with neurological conditions like Parkinson's disease, where it reveals dual-task interference that correlates with cognitive decline. Studies have reported a strong negative correlation (rho = -0.68) between Cognitive TUG completion time and Montreal Cognitive Assessment (MoCA) scores, supporting its validity as a screening tool for cognitive-motor interactions.[55]A short-form variant of the TUG, often called the 8-Foot Up and Go test, reduces the walking distance to 2.44 meters (8 feet) to accommodate space-constrained environments like small clinics or home settings, while maintaining high fidelity to the original protocol's demands on balance and mobility. This adaptation demonstrates excellent concurrent validity with the standard 3-meter TUG, with correlations typically exceeding r = 0.90, making it a practical alternative for routine assessments without compromising predictive value for fall risk.[56]Technological integrations have further expanded TUG applications in the 2020s, including app-based systems that automate timing and analysis via smartphone sensors. For example, the "up&go" app enables self-administered assessments by processing accelerometer data from multiple TUG repetitions, showing strong concurrent validity (intraclass correlation coefficient > 0.90) against clinician-timed measures in older adults. Additionally, artificial intelligence models trained on inertial sensor data from TUG performances can predict completion times and mobility decline with high accuracy (e.g., mean absolute error of 2.7 seconds). Wheelchair-adapted versions replace ambulation with self-propulsion in a wheelchair over the specified distance, allowing evaluation of upper-body strength and maneuverability in individuals with lower-limb impairments, though normative data remain limited compared to ambulatory variants.[15][57]