The Functional Movement Screen and Active Older Clients
By identifying asymmetries, this assessment can help older exercisers avoid falls and lead healthier, more active lives.
Study reviewed: Mitchell, U.H., et al. 2016. Performance on the Functional Movement Screen in older active adults. Journal of Sport and Health Science, 5 (1), 119–25.
The Functional Movement Screen (FMS™) is a seven-movement assessment that evaluates a person’s readiness for physical activity and exercise. Research shows that the tool has been extremely useful for assessing collegiate and professional athletes, firefighters, soldiers and martial arts practitioners, but until recently, scientists had not explored its utility for older exercisers (Mitchell et al. 2016).
Mitchell et al. set out to change that. Their findings should prove useful for fitness pros working with active older clients, especially those who are overweight, obese or dealing with movement asymmetries.
Background on the FMS
The Functional Movement Screen is an inexpensive, easily administered tool for evaluating functional movement patterns essential to normal body movements. It is used in a wide variety of areas, from rehabilitation to athletic performance.
The FMS is not designed to identify orthopedic problems. Instead, it helps us recognize limitations and asymmetries in people’s basic movements. The screen has seven functional movement tests (see the sidebar “7 Parts of the Functional Movement Screen”).
Unlike fitness assessments that count repetitions or measure weight lifted, the FMS identifies imbalances in stability and mobility that show up during fundamental movements. This is especially relevant to older people because they often develop functional limitations and asymmetries as a result of aging, poor flexibility, weak muscles, neurological disorders and poor posture. Mitchell et al. noted that if untreated, some of these irregularities can lead to chronic limitations or a long-term disability. Read on to see what the researchers found when they studied the value of the FMS for active older people.
Ninety-seven study volunteers (53 men, 44 women) were recruited at a health fair at the 2012 World Senior Games. Ages ranged from 52 to 83, with an average of 65.7. The average body mass index was 25.8 ± 4.2 (kilograms/meters2), which would be considered overweight for a younger population but was healthy for this one (Vorvick 2016). All volunteers filled out a preparticipation questionnaire focusing on their nutrition habits, sleep patterns and current medications and an activity questionnaire to quantify current physical activity.
The seven FMS tests were video-recorded under the guidance of a trained FMS instructor. Each test was scored by two raters, and video was used to find a consensus in cases of inconsistent scoring. FMS tests were scored 0–3 for each of the seven movements:
- 3 points for correct completion of the movement without compensation
- 2 points if the participant showed compensation, faulty form or poor alignment
- 1 point if the movement was incomplete
- zero points if the participant perceived pain during the movement
Participants received a total score that summed up their performance in the seven movements—hence the top score was 21.
FMS scores decreased with age, and some volunteers experienced functional limitations. The oldest participants had the lowest FMS scores. The researchers expected this, because factors like neuromuscular coordination, balance, flexibility and core strength, which the FMS assesses, do tend to decline as people age. Skelton et al. (1994) found that in adults aged 65–89, muscle strength decreases by about 1%–2% per year, while power decreases by 3.5% per year.
Mitchell et al. also found that FMS scores decreased as BMI increased toward overweight and obesity. In other words, this widely used screening tool indicates that functional movement patterns used in everyday life degrade as body weight rises. The Mitchell study emphasized that excess weight affects an older person’s balance, flexibility, mobility and stability. This finding suggests that for active aging clients, a concentrated effort to keep active and manage body weight will likely help to preserve their quality of life and their ability to perform activities of daily living.
Traditionally, fitness professionals tend to focus on the health risks of obesity in aging populations. The results from Mitchell et al. shine a new light on another concern—functional movement limitations resulting from creeping obesity and aging.
Less active study participants also scored lower on the FMS screen. Mitchell et al. stressed that a lack of physical activity degrades stability, balance, neuromuscular control and proprioception. Once again, an important message to trainers is to encourage older clients to keep moving.
As for gender, the study found no overall differences in this population. But it did find differences in specific FMS measures. For instance, women outscored men on flexibility and mobility, while men scored better on the pushup test, a measure of upper-body strength and stability.
Perhaps the most worrying finding of the study was the high prevalence of asymmetries in strength and flexibility—which occurred in 55 of the 97 participants. Previous research has shown a correlation between leg strength asymmetry and falling in older adults (Perry et al. 2007). It is important to note that physical inactivity may also increase the fear of falling in older adults, compromising quality of life, health and leisure opportunities. Asymmetries may lead to long-term disability and dysfunctions.
The bilateral assessments in shoulder mobility found the most asymmetries. Mitchell et al. explained that shoulder hypermobility or hypomobility can ultimately affect older adults’ ability to care for themselves and complete occupational activities. Core stability was another area where asymmetry occurred quite often. Asymmetrical core strength, to which a number of neural and muscle-tissue issues may contribute, places the spine at risk and thus may jeopardize balance, postural control and basic functional movement.
A Great Tool for Older Clients
The Functional Movement Screen pinpoints functional deficits in mobility, stability and proprioception that traditional fitness and health-related screening tools can miss, making the FMS especially useful for assessing the functional fitness of active older adults.
The tool also clearly identifies two functional-movement concerns that can coincide with aging: increasing body weight and decreasing levels of physical activity. The correlation between leg strength asymmetry and falling in older adults is worth repeating. If personal trainers can identify such a discrepancy early, they may be able to successfully incorporate an individualized fall-prevention program for active older clients.
Cook, G., Burton, L., & Hoogenboom, B.J. 2006a. Pre-participation screening: The use of fundamental movements as an assessment of function—part 1. North American Journal of Sports Physical Therapy, 1 (2), 62–72.
Cook, G., Burton, L., & Hoogenboom, B.J. 2006b. Pre-participation screening: The use of fundamental movements as an assessment of function—part 2. North American Journal of Sports Physical Therapy, 1 (3), 132–39.
Perry, M.C., et al. 2007. Strength, power output and symmetry of leg muscles: Effect of age and history of falling. European Journal of Applied Physiology, 100 (5), 553–61.
Skelton, D.A., et al. 1994. Strength, power and related functional ability of healthy people aged 65–89 years. Age and Ageing, 23 (5), 371–77.
Vorvick, L.J. 2016. Body mass index. U.S. National Library of Medicine. MedlinePlus Medical Encyclopedia. Accessed: June 22, 2017: https://med