Measures maximal grip strength using the Eforto Vigorimeter. Participants perform three maximal grip efforts, with the highest value representing neuromuscular strength and physical reserve capacity.
Maximal grip strength test
The maximal grip strength test assesses an individual’s maximal handgrip force using the Eforto Vigorimeter. Participants perform three consecutive maximal grip efforts, each separated by a short rest of 30 seconds. The highest value of the three trials is reported as maximal grip strength, providing a reliable indicator of neuro-muscular function and overall muscle strength.1
Maximal grip strength is predictive for future function, bone mineral density, fractures, cognition, depression, multimorbidity, hospitalization complications, all-cause and disease-specific mortality.2
Key outcome: maximal grip strength
Duration: ~2 minutes
Combines the maximal grip strength test with a fatigue resistance task to assess muscle endurance and fatigability.
Muscle capacity test
The muscle capacity test builds on the maximal grip strength assessment by adding a fatigue resistance measurement. Participants first complete three maximal grip efforts, after which they perform a sustained grip measurement until exhaustion. The Eforto Vigorimeter records pressure output continuously to determine when the participant’s strength drops below 50% of their maximal grip strength. Based on that, it calculates the following outcomes:
- Grip work: total effort calculated from the area under the force-time curve.3
- Grip work / kg: grip work corrected for body weight.3
- Fatigue resistance: time of sustained grip above 50% of max strength.3
These muscle fatigability biomarkers are a clinical indicator for energy metabolism, resilience and inflammation (IL-6, TNF-α ).4-6 In addition, muscle fatigability is sensitive to early, subtle changes in muscle health, inflammation and recovery 7-9, and predictive for recovery after discharge.10,11
Key outcomes: maximal grip strength and muscle fatigability (grip work, grip work/kg, fatigue resistance)
Approximate duration: ~3 minutes
Measures vitality capacity to support screening and early detection of sub-clinical frailty (e.g. in pharmacies or primary care).
Vitality capacity test
The vitality capacity test integrates both physical and subjective measures of fatigue. Participants first complete three maximal grip efforts, after which they perform a sustained grip measurement until exhaustion. Additionally, they complete a short 4-item physical fatigue questionnaire, which is based on the Multidimensional Fatigue Inventory.12
Using the muscle fatigability and self-perceived fatigue results, the system calculates the participant’s vitality capacity (Capacity-to-Perceived-Vitality ratio), a novel biomarker, aligned with the WHO Intrinsic Capacity framework.4
Capacity-to-perceived vitality ratio = grip work / (body weight * physical fatigue)
Vitality capacity detects sub-clinical frailty and fatigue early4 and predicts loss of gait speed, balance and ADL in older persons.13
Key outcomes: maximal grip strength, muscle fatigability (grip work, grip work/kg, fatigue resistance), physical fatigue (score), and vitality capacity (CPV-ratio)
Approximate duration: ~3-5 minutes
Combines the vitality test with comprehensive fatigue questionnaires (such as the MFI-20) for a deeper, multidimensional evaluation of fatigue and recovery.
Multi fatigue test
The multi fatigue test integrates both physical and subjective measures of fatigue. Participants first complete three maximal grip efforts, after which they perform a sustained grip measurement until exhaustion. In addition, the multi fatigue test provides a detailed assessment of perceived fatigue using the Multidimensional Fatigue Inventory (MFI-20) questionnaire, consisting of 20 items across five domains: general fatigue, physical fatigue, mental fatigue, reduced motivation, and reduced activity. Participants can complete the questionnaire independently, and responses are scored to provide both domain-specific values and an overall fatigue profile.12
Key outcomes: maximal grip strength, muscle fatigability (grip work, grip work/kg, fatigue resistance), vitality capacity (CPV-ratio), subscale scores for general fatigue, physical fatigue, mental fatigue, reduced motivation, reduced activity, and total fatigue score
Approximate duration: ~5-7 minutes
Provides a comprehensive assessment of frailty, integrating vitality and locomotor tests (e.g., chair stand, gait speed) to support diagnostic workflows.
Vitality capacity test
The vitality capacity test integrates both physical and subjective measures of fatigue. Participants first complete three maximal grip efforts, after which they perform a sustained grip measurement until exhaustion. Additionally, they complete a short 4-item physical fatigue questionnaire, which is based on the Multidimensional Fatigue Inventory.12
Using the muscle fatigability and self-perceived fatigue results, the system calculates the participant’s vitality capacity (Capacity-to-Perceived-Vitality ratio), a novel biomarker, aligned with the WHO Intrinsic Capacity framework.4
Capacity-to-perceived vitality ratio = grip work / (body weight * physical fatigue)
Vitality capacity detects sub-clinical frailty and fatigue early 4 and predicts loss of gait speed, balance and ADL in older persons.13
Key outcomes: maximal grip strength, muscle fatigability (grip work, grip work/kg, fatigue resistance), physical fatigue (score), and vitality capacity (CPV-ratio)
Approximate duration: ~3-5 minutes
Balance test
The progressive balance test assesses static balance and postural control, key elements of locomotor and functional capacity. The test consists of three increasingly challenging standing positions:
- Side-by-side stand: feet together, side by side.
- Semi-tandem stand: the heel of one foot placed beside the big toe of the other foot.
- Tandem stand: one foot placed directly in front of the other, heel to toe.
Participants are instructed to maintain each position for up to 10 seconds without support. If a participant cannot hold a position for the full duration, the test stops at that level. The assessment progresses only if the previous stance is successfully maintained.
Key outcomes: balance score, duration held for each standing position
Approximate duration: ~3 minutes
4-meter gait speed test
The 4-meter gait speed test evaluates walking speed, a key indicator of locomotor capacity, functional mobility, and overall frailty risk. Participants are instructed to walk at their usual, comfortable pace along a straight 4-meter course. Timing starts when the first foot crosses the start line and stops when the first foot crosses the 4-meter mark. The test is repeated twice, and the fastest time is used to calculate gait speed (in meters per second).
Key outcomes: gait speed
Approximate duration: ~2 minutes
30-second chair stand test
The 30-second chair stand test assesses lower-body strength and functional mobility, key components of locomotor capacity. Participants sit upright in a standard chair, feet flat on the floor, and arms crossed over the chest. On the signal, they repeatedly stand up and sit down as many times as possible within 30 seconds without using their arms for support. The assessor counts the total number of completed stands within the time limit.
Key outcomes: number of completed chair stands in 30 seconds (indicator of lower-limb strength and endurance)
Approximate duration: ~2 minutes
Physical activity questionnaire
The physical activity questionnaire is a brief self-reported assessment used to estimate a person’s general level of physical activity. This measure provides a quick indicator of whether the individual meets the World Health Organization (WHO) recommendation for daily moderate-intensity physical activity, serving as a simple screening tool for lifestyle-related vitality and mobility support.
Key outcomes: self-reported physical activity status
Approximate duration: ~1 minute
Weight loss questionnaire
The weight loss questionnaire is a short self-reported screening tool used to identify unintentional weight loss, an important indicator of frailty and potential nutritional risk. When a person loses more than 4.5 kg unintentionally over a period of a year, this qualifies as unintentional weight loss. This measure contributes to the evaluation of vitality and frailty risk within the intrinsic capacity framework.
Key outcomes: self-reported unintentional weight loss status
Approximate duration: ~1 minute
Exhaustion questionnaire
The exhaustion questionnaire is a brief self-reported measure used to assess perceived fatigue and low energy, which are key indicators of reduced vitality and potential frailty. It consists of two questions from the Center for Epidemiologic Studies Depression Scale (CES-D). A positive response to one or both questions suggests self-reported exhaustion, contributing to the evaluation of vitality and physical resilience within the intrinsic capacity framework.
Key outcomes: self-reported exhaustion status
Approximate duration: ~1 minute
Body composition and malnutrition measurements
The body composition and malnutrition measurements assess malnutrition and muscle atrophy using simple anthropometric indicators. The test consists of two circumference measurements:
- Waist circumference
- Calf circumference
Key outcomes: waist circumference, calf circumference
Approximate duration: ~2 minutes
Risk factors questionnaire
The risk factors questionnaire is a brief, self-reported screening tool designed to identify key health, psychological, and social risk factors that may contribute to declining intrinsic capacity or frailty. It includes questions across several domains related to continence, oral health, and psychosocial well-being. Responses are used to highlight potential modifiable risk factors and provide a quick overview of the participant’s mental, emotional, and social well-being, complementing the physical assessments.
Key outcomes: presence or absence of risk factors related to continence, oral health, and psychosocial well-being
Approximate duration: ~3-4 minutes
Mini Mental State Examination (MMSE)
The Mini Mental State Examination should be administered only if there is reason to suspect cognitive difficulties, for example when a person does not understand or follow the instructions during physical tests. The Mini-Mental State Examination is a standardized cognitive screening test designed to evaluate global cognitive function. It assesses several key domains, including orientation, attention, memory, language, and visuospatial ability. It provides an overall measure of cognitive status and is widely used for screening cognitive impairment, monitoring changes over time, and supporting frailty and intrinsic capacity assessment. A score below 25 indicates cognitive impairment.
Key outcomes: cognitive impairment (total MMSE score)
Approximate duration: ~7–10 minutes
Comments about the testing
The healthcare professional can add notes during testing, which will appear in the final frailty assessment report.
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