In healthy ageing, capacity declines in the neural, muscular, and skeletal systems, and each system decline has its effect on the execution of complex motor tasks. This decline in capacity can result in the inability to stand up (sit-to-stand, sit-to-walk), which is a key movement for independence. The mechanisms leading to mobility limitations or inabilities are complex, overlapping, and interdependent and the complementary fields of biomechanics, motor control, and physiology need to be combined to understand these mechanisms. The aim of this review is to provide an overview of the current knowledge of age-related compensation in standing up and to consider the limitations of these results when analysing standing up in daily life using the Capacity, Reserve, Movement Objectives, and Compensation (CaReMoOC) framework that combines biomechanics, motor control, and physiology. A literature search was performed in the search engine Scopus, using the keywords and their synonyms: strateg*(approach, technique, way) AND, sit-to-walk OR sit-to-stand OR rise (raise, arise, stand, stand-up) AND chair (seat). Inclusion criteria were: biomechanics or motor control on sit-to-stand or sit-to-walk in healthy and/or frail adults (<60y) and elderly (>60y), and/or osteoarthritis patients as a specific case of ageing related decline. The review shows that movement compensations in standing up manifest as changes in planned trajectory (Compensation by Selection) and in muscle recruitment (Compensation by Reorganisation). However, as most studies in the literature typically use standardized experimental protocols where movement compensation is restricted, these studies cannot be directly translated to functional tasks, such as the mobility of the elderly in their homes, communities, and clinic. Compensation must be included in future studies in order to facilitate clinical translation. Specifically, future studies in the standing up task should 1) determine the effect of varying arm use strategies (e.g., armrests, knees, chair, cane) on trunk and both lower limb and upper limb joint loading, 2) analyse control strategies in elderly people, 3) determine the biomechanical implications of asymmetry, and 4) incorporate assessments of age-related physical and neural decline as well as changes in psychological priorities.

The prevention, mitigation and treatment of movement impairments, ideally, requires early diagnosis or identification. As the human movement system has physiological and functional redundancy, movement limitations do not promptly arise at the onset of physical decline. A such, prediction of movement limitations is complex: it is unclear how much decline can be tolerated before movement limitations start. Currently, the term ‘homeostatic reserve’ or ‘physiological reserve’ is used to refer to the redundancy of the human biological system, but these terms do not describe the redundancy in the muscle architecture of the human body. The result of functional redundancy is compensation. Although compensation is an early predictor of movement limitations, clear definitions are lacking and the topic is underexposed in literature. The aim of this article is to provide a definition of compensation and emphasize its importance. Compensation is defined as an alteration in the movement trajectory and/or altering muscle recruitment to complete a movement task. Compensation for capacity is the result of a lack in neuromusculoskeletal reserve, where reserve is defined as the difference between the capacity (physiological abilities of the neuromusculoskeletal system) and the task demand. Compensation for movement objectives is a result of a shift in weighting of movement objectives, reflecting changing priorities. Studying compensation in biomechanics requires altered protocols in experimental set-ups, musculoskeletal models that are not reliant on prescribed movement, and inclusion of alternative movement objectives in optimal control theory.