Timed Up and Go (TUG)

The Timed Up and Go Test (TUG) is a standardized functional assessment designed to evaluate fall risk, balance, sit-to-stand ability, and gait function in older adults and individuals with neurological or orthopedic conditions.¹

It is widely used as a screening tool and has demonstrated high sensitivity and specificity for identifying people at increased risk of falls.¹ Recent research also suggests that TUG is a strong predictor of mortality, sometimes outperforming traditional risk factors such as chronic diseases.²

Target Population

TUG is validated for and routinely used in a wide range of conditions, including:

• Parkinson’s disease

• Multiple sclerosis

• Alzheimer’s disease

• Hip fractures

• Total hip and knee replacements

• Stroke

• Huntington’s disease¹

Equipment

• Chair with armrests

• Stopwatch

• Tape (to mark 3 meters from the chair)

Test Procedure

The patient should wear regular footwear and use any walking aid they normally require.

1. The patient starts seated in the chair.

2. On command, the patient stands up, walks 3 meters, turns around, walks back, and sits down again.

3. Timing begins at the command (“Go”) and stops when the patient returns to the seated position.

4. Any walking aid used must be documented.

5. One practice trial is recommended before the test to ensure correct execution.¹

Clinical Observations

During the test, the clinician should note:

• Postural stability

• Gait quality – stride length, rhythm, arm swing

• Lateral sway or instability

• Signs of hesitation, slow pace, loss of balance, shuffling gait, en bloc turns, wall support, or improper use of aids

These findings may indicate neurological problems and should prompt further assessment.³

Interpretation and Risk Scores

In older adults, a TUG time of ≥12 seconds indicates an increased risk of falls.³

Population-specific cut-off values have also been established:

• Community-dwelling older adults: 13.5 sec

• Older adults with stroke: 14 sec

• Frail elderly: 32.6 sec

• Amputees: 19 sec

• Parkinson’s disease: 11.5 sec

• Hip osteoarthritis: 10 sec

• Vestibular disorders: 11.1 sec⁴

Cut-offs may vary slightly between studies.

Reliability and Validity

TUG has consistently shown high inter- and intratester reliability across populations:

• Hip osteoarthritis: ICC = 0.87⁵

• Total knee replacement: r = 0.98⁶

• Total hip replacement: r = 0.96⁷

• Alzheimer’s disease: ICC = 0.985–0.988⁸

• Parkinson’s disease: ICC = 0.80, r = 0.97⁹ ¹⁰

• Older adults: ICC = 0.92–0.99¹⁴

• Community-dwelling elderly: moderate reliability, r = 0.56¹⁴

Correlations: TUG correlates strongly with gait speed, postural stability, step length, Barthel Index, and step frequency.¹⁴Sensitivity & specificity in older adults: 87 %.¹⁵

Advantages

• Quick and easy to perform

• Requires minimal equipment

• High reliability and validity

• Clinically useful for identifying increased fall risk

Limitations

• Cannot predict all falls, particularly in community-dwelling populations¹⁶

• Performance may vary with repeated testing

• Turning is only assessed in the patient’s preferred direction¹⁰

Variants: TUG Manual and TUG Cognitive

For Parkinson’s disease, TUG can be adapted with dual-task variations:¹²

• TUG Manual: patient carries a glass of water.

  • Sensitivity: 29 %, Specificity: 68 %

• TUG Cognitive: patient counts backwards in threes while walking.

  • Sensitivity: 76.5 %, Specificity: 73.7 %

  • More discriminative for fall risk than standard TUG.

Best cut-offs for Parkinson’s disease:

• TUG: 12 sec

• TUG Cognitive: 14.7 sec

• TUG Manual: 13.2 sec¹²

Example Documentation: TUG Score

When recording TUG results, always note:

• Walking aid used

• Time to complete test

• Observed gait and balance characteristics

• Deviations from the standard protocol

Clinical Relevance and New Research

• A 2022 study demonstrated TUG as a strong predictor of mortality in older adults, even in low- and middle-income countries—sometimes more relevant than chronic disease status.²

• A more recent cross-sectional study highlighted the influence of age and visual impairment on TUG performance, particularly under dual-task or visually challenging conditions.¹⁷

Sources:

1. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000 Sep 1;80(9):896-903.:https://academic.oup.com/ptj/article/80/9/896/2842520

2. Ascencio EJ, Cieza-Gómez GD, Carrillo-Larco RM, Ortiz PJ. Timed up and go test predicts mortality in older adults in Peru: a population-based cohort study. BMC geriatrics. 2022 Dec;22(1):1-3.

3. CDC govt. TUG :https://www.cdc.gov/steadi/pdf/TUG_Test-print.pdf

4. SR ability lab TUG :https://www.sralab.org/rehabilitation-measures/timed-and-go

5. Wright AA, Cook CE, Baxter GD, Dockerty JD, Abbott JH. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. The Journal of Orthopaedic and Sports Physical Therapy/Journal of Orthopaedic and Sports Physical Therapy [Internet]. 2011 May 1;41(5):319–27.

6. Yuksel E, Kalkan S, Cekmece S, Unver B, Karatosun V. Assessing minimal detectable changes and Test-Retest reliability of the Timed up and Go Test and the 2-Minute Walk test in patients with total knee arthroplasty. The Journal of Arthroplasty/The Journal of Arthroplasty [Internet]. 2017 Feb 1;32(2):426–30.

7. Yuksel E, Unver B, Kalkan S, Karatosun V. Reliability and minimal detectable change of the 2-minute walk test and Timed Up and Go test in patients with total hip arthroplasty. Hip International/Hip International [Internet]. 2020 Jan 13;31(1):43–9.

8. Ries J, Echternach J, Nof L, Blodgett M. Test-retest reliability and minimal detectable change scores for the timed "up go" test, the six-minute walk test, and gait speed in people with alzheimer disease. Phys Ther. 2009;89(6):569-579.

9. Huang S, Hsieh C, Wu R, Tai C, Lin C, Lu W. Minimal detectable change of the timed "up go" test and the dynamic gait index in people with parkinson disease. Phys Ther. 2011;91(1):114-121.

10. Haas B, Clarke E, Elver L, Gowman E, Mortimer E, Byrd E. The reliability and validity of the L-test in people with Parkinson’s disease. Physiotherapy. 2017 Dec 5.https://www.physiotherapyjournal.com/article/S0031-9406(17)30338-3/fulltext

11. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Timed “Up & Go” test in people with Parkinson disease. Physical therapy. 2001 Feb 1;81(2):810-8.

12. Vance RC, Healy DG, Galvin R, French HP. Dual Tasking With the Timed “Up & Go” Test Improves Detection of Risk of Falls in People With Parkinson Disease. Physical Therapy [Internet]. 2015 Jan 1;95(1):95–102.

13. Huang SL, Hsieh CL, Wu RM, Tai CH, Lin CH, Lu WS. Minimal detectable change of the timed “up & go” test and the dynamic gait index in people with Parkinson disease. Physical Therapy. 2011 Jan 1;91(1):114-21. https://www.ncbi.nlm.nih.gov/pubmed/20947672

14. Steffen T, Hacker T, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, berg balance scale, timed up go test, and gait speeds. Phys Ther. 2002;82(2):128-137.

15. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896-903.

16. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC geriatrics. 2014 Dec;14(1):14.

17. Almajid R, Tucker C, Wright WG, Vasudevan E, Keshner E. Visual dependence affects the motor behavior of older adults during the Timed Up and Go (TUG) test. Archives of gerontology and geriatrics. 2020 Mar 1;87:104004.