Handgrip strength and mortality in older Mexican Americans

Prevalence and factors associated with sarcopenia and dynapenia in elderly people

Objectives

There is little information about the risk factors for sarcopenia and dynapenia. This study aimed to assess the prevalence of sarcopenia and dynapenia and to verify which risk factors are associated with the elderly population.

Methods

A total of 387 elderly people were evaluated. We used a questionnaire to identify socio-demographic and behavioral aspects. For physical performance, we used the Short Physical Performance Battery. Using the European Working Group of Sarcopenia in Older People consensus, we defined sarcopenia that includes the occurrence of low muscle mass, added to low muscle strength or low physical performance. Dynapenia was defined using handgrip strength.

Results

Sarcopenia and dynapenia were identified in 15.3% and 38.2% of the elderly people, respectively; 15.8% of women and 14.2% of men had sarcopenia, and 52.4% of women and 13.5% of men had dynapenia. Sarcopenia was associated with the increase in aging, white race, smoking, and risk of malnutrition. Dynapenia is more likely to occur in women and hospitalized patients.

Conclusion

Sarcopenia had a greater association with the risk factors evaluated here, mainly with smoking and nutritional status. On the other hand, dynapenia was different, having a greater association with hospital intervention.

The Association of Handgrip Strength and Mortality: What Does It Tell Us and What Can We Do With It?

The relationship between grip strength and mortality is often used to underscore the importance of resistance exercise in physical activity guidelines. However, grip strength does not appear to appreciably change following traditional resistance training. Thus, grip strength could be considered reflective of strength independent of resistance exercise. If true, grip strength is not necessarily informing us of the importance of resistance exercise as an adult, but potentially highlighting inherent differences between individuals who are stronger at "baseline" compared to their weaker counterpart. The purpose of this article is to discuss: (1) potential factors that may influence grip strength and (2) hypothesize strategies that may be able to influence grip strength and ultimately attain a higher baseline level of strength. Although there appears to be a limited ability to augment grip strength as an adult, there may be critical periods during growth/development during which individuals can establish a higher baseline. Establishing a high baseline of strength earlier in life may have long-term implications related to mortality and disease.

Get a grip: individual variations in grip strength are a marker of brain health

Demonstrations that grip strength has predictive power in relation to a range of health conditions-even when these are assessed decades later-has motivated claims that hand-grip dynamometry has the potential to serve as a "vital sign" for middle-aged and older adults. Central to this belief has been the assumption that grip strength is a simple measure of physical performance that provides a marker of muscle status in general, and sarcopenia in particular. It is now evident that while differences in grip strength between individuals are influenced by musculoskeletal factors, "lifespan" changes in grip strength within individuals are exquisitely sensitive to integrity of neural systems that mediate the control of coordinated movement. The close and pervasive relationships between age-related declines in maximum grip strength and expressions of cognitive dysfunction can therefore be understood in terms of the convergent functional and structural mediation of cognitive and motor processes by the human brain. In the context of aging, maximum grip strength is a discriminating measure of neurological function and brain health.

Combined Effect of Dynapenia (Muscle Weakness) and Low Vitamin D Status on Incident Disability

BACKGROUND AND OBJECTIVE

There is little epidemiologic evidence considering the combined effect of dynapenia and low 25-hydroxyvitamin D [25 (OH) D] on incident disability. Our aim was to investigate whether the combination of dynapenia and low 25 (OH) D serum levels increases the risk of activities of daily living (ADL) incident disability.

DESIGN

Prospective cohort study.

SETTINGS

English Longitudinal Study of Aging.

PARTICIPANTS

A total of 4630 community-dwelling adults aged 50 years and older without ADL disability at baseline.

MEASUREMENTS

The baseline sample was categorized into 4 groups (ie, nondynapenic/normal 25 (OH) D, low 25 (OH) D only, dynapenic only, and dynapenic/low 25 (OH) D according to their handgrip strength (<26 kg for men and <16 kg for women) and 25 (OH) D (≤50 nmol/L). The outcome was the presence of any ADL disability 2 years after baseline according to the modified Katz Index. Incidence rate ratios (IRRs) adjusted by sociodemographic, behavioral, and clinical characteristics were estimated using Poisson regression.

RESULTS

The fully adjusted model showed that older adults with dynapenia only and those with lower serum levels of 25 (OH) D combined with dynapenia had higher incident ADL disability risk compared with nondynapenic and those with normal serum levels of 25 (OH) D. The IRRs for lower 25 (OH) D serum levels combined with dynapenia were higher than for dynapenia only, however, the confidence intervals (CIs) showed similar effect for these 2 groups. The IRRs were 1.31 for low 25(OH) D only (95% CI 0.99-1.74), 1.77 for dynapenia only (95% CI 1.08-2.88), and 1.94 for combined dynapenia and low 25(OH)D (95% CI 1.28-2.94).

CONCLUSIONS

Dynapenia only and dynapenia combined with low 25 (OH) D serum levels were important risk factors for ADL disability in middle-aged individuals and older adults in 2 years of follow-up.

Coronary flow response to remote ischemic preconditioning is preserved in old cardiac patients

BACKGROUND

The effect of remote ischemic preconditioning (RIPC) on coronary flow in elderly cardiac patients has not been investigated yet. Thus, we aimed to study the change of coronary flow subsequent to RIPC in old patients with heart diseases and to identify its main correlates.

METHODS

Ninety-five elderly patients (aged ≥ 65 years) accessing cardiac rehabilitation ward underwent transthoracic ultrasound evaluation of peak diastolic flow velocity of left anterior descending artery. Measurements of coronary flow velocity were performed on baseline and after an RIPC protocol (three cycles of 5 min ischemia of right arm alternating 5 min reperfusion). Differences between subjects with coronary flow velocity change over or equal the 75° percentile (high-responders) and subjects with a coronary flow velocity change under the 75° percentile (low-responders) were assessed.

RESULTS

In enrolled elderly heart patients, coronary flow velocity significantly augmented from baseline after RIPC [0.23 m/s (0.18-0.28) vs 0.27 m/s (0.22-0.36); p < 0.001 by Wilcoxon test]. High-responders to RIPC were significantly younger and in better functional status than low-responders. Heart failure resulted as the main variable associated with impairment of RIPC responsiveness (R ² = 0.202; p = 0.002)].

CONCLUSIONS

Our sample of old cardiac patients presented a significant median increment of coronary flow velocity after RIPC. The magnitude of the observed change of coronary flow velocity was comparable to that previously described in healthy subjects. The coronary response to RIPC was attenuated by heart failure. Further research should define whether such RIPC responsiveness is associated with cardioprotection and carries prognostic implications.

Associations of Grip Strength and Change in Grip Strength With All-Cause and Cardiovascular Mortality in a European Older Population

Objective:

(1) To examine the associations between 3 measures of grip strength: static grip strength, change in grip strength, and the combination of grip strength and its change, with all-cause and cardiovascular mortality, and (2) to determine which measure is the most powerful predictor of all-cause and cardiovascular mortality among the European older population.

Method:

Data come from the first 4 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). A Cox proportional hazard model and a competing risk regression model were used to assess the associations. To determine the best predictor, Akaike information criterion was applied.

Results:

Grip strength and the combination of grip strength and its change were associated with all-cause and cardiovascular mortality. Change in grip strength was correlated with only all-cause mortality. Among the 3 measures, the static measure of grip strength was the best predictor of cardiovascular mortality whereas the combined measure is that of all-cause mortality.

Discussion:

Grip strength is a significant indicator of all-cause and cardiovascular mortality. The combination of grip strength and its change can be used to increase the accuracy for prediction of all-cause mortality among older persons.

The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study

OBJECTIVE

Ageing is associated with a progressive decline in physical function and cognitive performance which could result in a shift from an independent to a more dependent lifestyle. The aim of this research study was to assess the fitness, functional performance and cognitive ability in independently living older South Africans and to determine which fitness parameters and functional performance tests best explain the variance in cognitive function.

DESIGN

Descriptive observational study.

PARTICIPANTS

Older adults with a mean age 71±4.7 years (n = 70; 28 men and 42 women) were recruited. Sixty percent of the sample completed at least secondary schooling and more than two-thirds were taking medication for a chronic medical condition.

MEASUREMENTS

Self-reported physical activity was assessed using the Yale Physical Activity Survey. Fitness tests included the 6-minute walk test and Bicep Curls. The functional performance tests were; Static and Dynamic balance, Timed Up and Go, Sit to Stand, Grip strength and Functional Reach. The Stroop Task and 6-Item cognitive impairment test were used to measure cognitive performance. Bivariate and multivariate analyses were conducted between performance on the novel cognitive Stroop Task and functional and cognitive tests.

RESULTS

We found significant relationships between the number of correct responses on the Stroop Task and scores on the 6-Item Cognitive Impairment test (-0.520, p < 0.01) and grip strength (r = 0.42, p< 0.01). The number of incorrect responses was inversely associated with functional reach (r = -0.445, p< 0.01). The final regression model included: age, dynamic balance, right arm grip strength and the score on the 6-item cognitive impairment test, and explained 44% of the variance in performance of the Stroop Task.

CONCLUSIONS

The results of this study showed that measures of physical function were associated with cognitive performance even in highly functioning older South African adults. Further research is needed to determine the extent to which exercise training can improve functional capacity and the effect on cognitive performance.

Combined Measures of Upper and Lower Body Strength and Subgroup Differences in Subsequent Survival Among the Older Population of England

OBJECTIVE

To provide an example of a new methodology for using multiple characteristics in the study of population aging and to assess its usefulness.

METHOD

Using the English Longitudinal Study of Aging (ELSA), we investigate three characteristics of each person 60 to 85 years old, by level of education, hand-grip strength in 2004 (measured in kilos), chair rise speed in 2004 (measured in rises per minute), and whether the person survived from 2004 to 2012. Because the three characteristics are measured in different units, we convert them into a common metric, called alpha-ages.

RESULTS

We find that the average of the alpha-age differentials in the measures of upper body and lower body strength predicts educational differentials in subsequent survival better than either physical measure alone.

DISCUSSION

This result demonstrates the benefit of combining characteristics, using alpha-ages to convert incommensurate observations into a common metric.

Physical fitness improvement in overweight postmenopausal women who do not lose fat mass in response to exercise training

OBJECTIVE

The aim of this study was to examine if overweight postmenopausal women who do not experience fat mass loss after a 1-year aerobic exercise (AE) and resistance training (RT) program can still improve physical fitness.

METHODS

Thirty-one overweight women (body mass index 28-40 kg/m or waist circumference ≥88 cm) participated in three weekly supervised AE and RT sessions for 1 year. All women were categorized according to their fat mass changes after the intervention: 14 women were considered as responders (fat mass loss ≥5% of initial fat mass) and 17 as nonresponders (fat mass loss <5% of initial fat mass). The main outcome measures were absolute and relative body strength, peak aerobic capacity, lower limbs power, flexibility, and body composition (DXA). Total energy intake (3-day dietary record) and physical activity level (physical activity scale for the elderly questionnaire) were also measured before, halfway through and after the intervention.

RESULTS

At baseline, nonresponders participants had higher body mass index (P = 0.04). After the intervention, relative and absolute upper and lower body strength, peak aerobic capacity (all P < 0.005), and flexibility increased similarly in the nonresponders and responders groups (P = 0.01).

CONCLUSIONS

Although some participants did not respond to exercise by decreasing fat mass, they still experienced important physical fitness benefits from AE and RT. These results suggest that body composition changes should not be the sole indicator of the benefits of exercise in overweight postmenopausal women.

Short Physical Performance Battery for cardiovascular disease inpatients: implications for critical factors and sarcopenia

We examined the relationship between Short Physical Performance Battery (SPPB) and clinical and laboratory factors and the effect of sarcopenia and sarcopenic obesity (SO) on clinical and laboratory factors for cardiovascular disease (CVD) inpatients. CVD male (n = 318) and female (n = 172) inpatients were recruited. A stepwise multiple-regression analysis was performed to predict total SPPB scores and assess clinical and laboratory factors (physical characteristics, functional and morphological assessments, etc.). Each test outcome were compared among sarcopenia, SO and non-sarcopenic groups. To predict total SPPB scores, the predicted handgrip, Controlling Nutritional Status score, % body fat, anterior mid-thigh muscle thickness, standing height and systolic blood pressure were calculated for males and anterior mid-thigh MTH, BMI, knee extension and fat mass were calculated for females. There were no differences in blood pressure, total SPPB scores and functional assessments between sarcopenia and SO groups for CVD male and female inpatients. In conclusion, the physical performance of CVD inpatients can be predicted by nutritional, functional, clinical and anthropometric variables, regardless the gender and the presence of sarcopenia. Furthermore, the presence of sarcopenia has a negative effect on the clinical and laboratory factors, but there is a difference in impact between sarcopenia and SO regardless the gender.

Low Normalized Grip Strength is a Biomarker for Cardiometabolic Disease and Physical Disabilities Among U.S. and Chinese Adults

BACKGROUND

Evidence highlights the importance of muscular strength as a protective factor for health and function across aging populations. The purpose of this study was to examine the extent to which low normalized grip strength (NGS) serves as a biomarker for both cardiometabolic disease and physical disability in U.S. and Chinese adults.

METHODS

Middle aged and older adults from the U.S. National Health and Nutrition Examination Survey 2011-2012 and 2013-2014 combined surveys (n = 4,544), and the 2011 wave of the China Health and Retirement Longitudinal Study (n = 6,030) were included. Strength was assessed using a handgrip dynamometer, and was normalized to body mass. Weighted logistic regression models were used to assess the association between NGS and diabetes, hyperglycemia, hypertriglyceridemia, low HDL-cholesterol, hypertension, and physical disability status, while controlling for age, sex, and sociodemographic characteristics.

RESULTS

Every 0.05 lower NGS was independently associated with a 1.49 (95% confidence interval [CI]: 1.42-1.56) and 1.17 (95% CI: 1.11-1.23) odds for diabetes; a 1.46 (95% CI: 1.39-1.53) and 1.11 (95% CI: 1.07-1.15) odds of hyperglycemia; a 1.15 (95% CI: 1.07-1.25) and 1.11 (95% CI: 1.08-1.14) odds of hypertriglyceridemia; a 1.22 (95% CI: 1.17-1.27) and 1.15 (95% CI: 1.12-1.18) odds of low HDL-cholesterol; a 1.19 (95% CI: 1.14-1.24) and 1.10 (95% CI: 1.07-1.14) odds of hypertension; and a 1.36 (95% CI: 1.29-1.42) and 1.10 (95% CI: 1.05-1.15) odds for physical disability status in U.S. and Chinese adults, respectively.

CONCLUSIONS

NGS was robustly associated with both cardiometabolic disease risk and physical disabilities in U.S. and Chinese aging adults.

The combination of dynapenia and abdominal obesity as a risk factor for worse trajectories of IADL disability among older adults

Background/Objectives

The concept of dynapenic obesity has been gaining great attention recently. However, there is little epidemiological evidence demonstrating that dynapenic abdominal obese individuals have worse trajectories of disability than those with dynapenia and abdominal obesity alone. Our aim was to investigate whether dynapenia combined with abdominal obesity can result in worse trajectories of instrumental activities of daily living (IADL) among English and Brazilian older adults over eight and ten years of follow-up, respectively.

Methods

We used longitudinal data from 3374 participants from the English Longitudinal Study of Ageing (ELSA) and 1040 participants from the Brazilian Health, Well-being and Aging Study (SABE) who were free from disability as assessed by IADL at baseline. IADL disability was defined herein as a difficulty to perform the following: preparing meals, managing money, using transportation, shopping, using the telephone, house cleaning, washing clothes, and taking medications according to the Lawton IADL modified scale. The study population in each country was categorized into non-dynapenic/non-abdominal obese (reference group), abdominal obese, dynapenic and dynapenic abdominal obese according to their handgrip strength (<26 kg for men and <16 kg for women) and waist circumference (>102 cm for men and >88 cm for women). We used generalized linear mixed models with IADL as the outcome.

Results

The estimated change over time in IADL disability was significantly higher for participants with dynapenic abdominal obesity compared to those with neither condition in both cohorts (ELSA: 0.023, 95% CI = 0.012–0.034, p < 0.001; SABE: +0.065, 95% CI = 0.038–0.091, p < 0.001). Abdominal+obesity was also associated with changes over time in IADL disability (ELSA: +0.009, 95% CI = 0.002–0.015, p < 0.05; SABE: +0.021, 95% CI = 0.002–0.041, p < 0.05), which was not observed for dynapenia.

Conclusions

Abdominal obesity is an important risk factor for IADL decline but participants with dynapenic abdominal obesity had the highest rates of IADL decline over time among English and Brazilian older adults.

Association between hand muscle thickness and whole-body skeletal muscle mass in healthy adults: a pilot study

[Purpose] Handgrip strength is a surrogate indicator for assessing disease-related and age-related skeletal muscle loss. Clinical utility as such a surrogate can be at least partially explained by the close relationship between handgrip strength and whole-body skeletal muscle mass. The handgrip strength is related to hand muscle size. Thus, the present study examined whether hand muscle thickness is associated with whole-body skeletal muscle mass. [Subjects and Methods] Thirty healthy male adults participated in this study. All subjects were right-hand dominant. Two muscle thicknesses (lumbrical and interosseous muscles) in the right hand were measured using ultrasonography. Whole-body and appendicular skeletal muscle masses were assessed using dual-energy X-ray absorptiometry. [Results] Although lumbrical muscle thickness was not correlated with whole-body skeletal muscle mass, there was a significant correlation with appendicular skeletal muscle mass. Furthermore, interosseous muscle thickness was significantly correlated with both whole-body and appendicular skeletal muscle masses. [Conclusion] The present findings suggest that two muscle thicknesses in the hand are related to whole-body and/or appendicular skeletal muscle mass in healthy adults. Therefore, we propose that despite being smaller than other limb muscles, hand muscle thickness may be useful as surrogate indicator for assessing disease-related and age-related skeletal muscle loss.

Valores normativos de la fuerza de puño en la población española en edad laboral. Influencia de las variables antropométricas de la mano y el antebrazo

Objetivos: Determinar si en los individuos adultos sanos existe una apertura óptima del dinamómetro para conseguir la máxima fuerza de puño y si esta se relaciona con los valores de los parámetros antropométricos del antebrazo y la mano. Saber si a través de las medidas antropométricas del antebrazo y la mano es posible predecir la fuerza de puño que puede desarrollar un persona.

Métodos: 99 hombres y 103 mujeres (20-60 años). Cada mano se testó 10 veces, utilizando 5 aperturas del dinamómetro TKK. Las medidas antropométricas tomadas fueron ancho de la mano abierta, longitud del segundo, el tercer y el cuarto dedos, anchura de la palma, longitud de la palma, longitud de la mano, longitud del antebrazo, perímetro del antebrazo y grosor de la eminencia tenar.

Resultados: Con solo 2 aperturas (5,5-6 cm en varones, 5-5,5 cm en mujeres) se consiguió la máxima fuerza de puño en más del 60% de los individuos. El tamaño de la mano y el antebrazo influyó en la posición de apertura óptima en las mujeres, no en los varones. Los parámetros antropométricos que mejor definieron la fuerza fueron diferentes según el sexo y el lado, pero en ningún caso se logró que el valor de R2 superase el 0,50.

Conclusiones: La máxima fuerza de puño se consigue utilizando las posiciones medias del dinamómetro, siendo en mujeres la apertura menor que en varones. Empleando exclusivamente los parámetros antropométricos de la mano y el antebrazo no se consigue un valor predictivo útil, como el obtenido por otros autores con otras medidas antropométricas.

Handgrip strength values of Portuguese older adults: a population based study

Background

Handgrip strength is used to identify sarcopenia and frailty phenotypes, being a potential predictor of mortality in older adults. However, uniformity is lacking in the reference values. This study aimed to describe handgrip strength values of older population aged ≥65 years in Portugal, considering the possible influence of anthropometric parameters.

Methods

A cross-sectional study was conducted in Portugal, among 1500 older adults aged ≥65 years old, according to “The Nutrition UP 65 Study Protocol”. Demographic data were collected and cognitive performance, subjective general health, physical activity, anthropometric parameters and nutritional status were assessed and analysed. Handgrip strength data was obtained with a Jamar dynamometer. A Pubmed/Medline search was carried out to compare handgrip strength data between Portuguese older adults and other older populations.

Results

Handgrip strength was higher among men than among women (30.3 ± 9.2 Kgf vs 18 ± 5.4 Kgf, p < 0.001, respectively). In general, handgrip strength values of Portuguese older adults were lower than other older populations. In our sample, age, cognitive and nutritional status, self-reported sitting time and practice of physical activity were significantly correlated with handgrip strength in both sexes. Concerning anthropometric parameters, height was the most significantly correlated with handgrip strength (r = 0.34, p < 0.001, in women and r = 0.40, p < 0.001, in men).

Conclusion

This study described, for the first time, handgrip strength values of Portuguese population aged ≥65 years, according to age and to sex-specific tertiles of height. The definition of handgrip strength reference values in this age group merits further reflection.

Functional capacities of Polish adults of 60-87 years and risk of losing functional independence

AIM

To characterise the functional capacities of Polish men and women aged 60-87 years and evaluate their status relative to criteria for functional independence.

SUBJECTS AND METHODS

Four hundred and thirty-one women and 125 men, aged 60-87 years, who were residents of Wrocław, southwestern Poland, were recruited. Height and weight were measured and BMI was calculated. The Fullerton Functional Fitness Test was administered to test upper and lower body strength, upper and lower body flexibility, agility-dynamic balance and aerobic endurance. The Paffenbarger physical activity questionnaire was completed. Characteristics of individuals classified by the number of tests which equalled or exceeded criterion-referenced standards for functional independence (excluding flexibility) were compared.

RESULTS

Polish older adults compared favourably to American reference values. Percentages meeting the criteria for all four, for two or three and for one or no tests were, respectively, 21%, 54% and 25% in women and 37%, 45% and 18% in men. Adults meeting the criteria for all four tests were lighter, with a lower BMI and more physically active than those meeting the criteria on two or three tests and on one or no tests.

CONCLUSION

The majority of Polish older adults were not at risk for loss of physical independence. The most functionally independent adults of both sexes had a lower BMI and less obesity, and were physically more active; the converse was true for those not meeting the criteria.

The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents

Objectives:

To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test.

Methods:

This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed.

Results:

A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 ± 8.2 years were included in the study. The residents’ annual falling averages were 1.0 ± 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass.

Conclusions:

The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents.

The Combined Association of Skeletal Muscle Strength and Physical Activity on Mortality in Older Women: The HUNT2 Study

OBJECTIVE

To assess the isolated and combined associations of leg and arm strength with adherence to current physical activity guidelines with all-cause and cause-specific mortality in healthy elderly women.

PATIENTS AND METHODS

This was a prospective cohort study of 2529 elderly women (72.6±4.8 years) from the Norwegian Healthy survey of Northern Trøndelag (second wave) (HUNT2) between August 15, 1995, and June 18, 1997, with a median of 15.6 years (interquartile range, 10.4-16.3 years) of follow-up. Chair-rise test and handgrip strength performances were assessed, and divided into tertiles. The hazard ratio (HR) of all-cause and cause-specific mortality by tertiles of handgrip strength and chair-rise test performance, and combined associations with physical activity were estimated by using Cox proportional hazard regression models.

RESULTS

We observed independent associations of physical activity and the chair-rise test performance with all-cause and cardiovascular mortality, and between handgrip strength and all-cause mortality. Despite following physical activity guidelines, women with low muscle strength had increased risk of all-cause mortality (HR chair test, 1.37; 95% CI, 1.07-1.76; HR handgrip strength, 1.39; 95% CI, 1.05-1.85) and cardiovascular disease mortality (HR chair test, 1.57; 95% CI, 1.01-2.42). Slow chair-test performance was associated with all-cause (HR, 1.32; 95% CI, 1.16-1.51) and cardiovascular disease (HR, 1.41; 95% CI, 1.14-1.76) mortality. The association between handgrip strength and all-cause mortality was dose dependent (P value for trend <.01).

CONCLUSION

Handgrip strength and chair-rise test performance predicted the risk of all-cause and CVD mortality independent of physical activity. Clinically feasible tests of skeletal muscle strength could increase the precision of prognosis, even in elderly women following current physical activity guidelines.

Muscle Weakness Thresholds for Prediction of Diabetes in Adults

BACKGROUND

Despite the known links between weakness and early mortality, what remains to be fully understood is the extent to which strength preservation is associated with protection from cardiometabolic diseases, such as diabetes.

PURPOSE

The purposes of this study were to determine the association between muscle strength and diabetes among adults, and to identify age- and sex-specific thresholds of low strength for detection of risk.

METHODS

A population-representative sample of 4066 individuals, aged 20-85 years, was included from the combined 2011-2012 National Health and Nutrition Examination Survey (NHANES) data sets. Strength was assessed using a handheld dynamometer, and the single highest reading from either hand was normalized to body mass. A logistic regression model was used to assess the association between normalized grip strength and risk of diabetes, as determined by haemoglobin A1c levels ≥6.5 % (≥48 mmol/mol), while controlling for sociodemographic characteristics, anthropometric measures and television viewing time.

RESULTS

For every 0.05 decrement in normalized strength, there were 1.26 times increased adjusted odds for diabetes in men and women. Women were at lower odds of having diabetes (odds ratio 0.49; 95 % confidence interval 0.29-0.82). Age, waist circumference and lower income were also associated with diabetes. The optimal sex- and age-specific weakness thresholds to detect diabetes were 0.56, 0.50 and 0.45 for men at ages of 20-39, 40-59 and 60-80 years, respectively, and 0.42, 0.38 and 0.33 for women at ages of 20-39, 40-59 and 60-80 years, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

We present thresholds of strength that can be incorporated into a clinical setting for identifying adults who are at risk of developing diabetes and might benefit from lifestyle interventions to reduce risk.

Association of Muscle Weakness With Post-Fracture Mortality in Older Men and Women: A 25-Year Prospective Study

Osteoporotic fracture increases the risk of premature mortality. Muscle weakness is associated with both increased fracture risk and low bone mineral density (BMD). However, the role of muscle strength in post-fracture mortality is not well understood. This study examines the change of muscle strength measured at quadriceps (QS) before and after fracture and defines the relationship between muscle strength and post-fracture mortality. The study involved 889 women and 295 men (who were participating in the Dubbo Osteoporosis Study) who had at least one low-trauma fracture (ascertained from X-ray reports) after the age of 50 years. Median follow-up time was 11 years (range 1 to 24). To determine the change in muscle strength before and after a fracture, we selected a subset of 344 women and 99 men who had had at least two muscle strength measurements before the fracture event and a subset of 407 women and 105 men who had had at least two measurements after the fracture. During the follow-up period, 366 (41.2%) women and 150 (50.9%) men died. The annual rate of decrease in height-adjusted muscle strength before fracture was 0.27 kg/m (1.85%) in women and 0.40 kg/m (1.79%) in men. Strength loss after fracture was not significantly different from that before fracture. In women, after adjusting for baseline age and BMD, each SD (5 kg/m) lower height-adjusted pre- and post-fracture quadriceps strength was associated with a 27% (hazard ratio [HR] = 1.27; 95% confidence interval [CI] 1.07, 1.50) and 18% (HR = 1.18; 95% CI 1.01, 1.38) increase in post-fracture mortality risk, respectively. Similarly, in men, each SD (5 kg/m) lower height-adjusted pre- and post-fracture QS was associated with increased mortality before fracture (HR = 1.33; 95% CI 1.09, 1.63) and after fracture (HR = 1.43; 95% CI 1.16, 1.78). Muscle weakness accounted for 15% (95% CI 0.05, 0.24) of premature deaths after fracture in women and 23% (95% CI 0.11, 0.35) in men. These results indicate that in the older individuals, lower muscle strength is an independent risk factor for post-fracture mortality. © 2017 American Society for Bone and Mineral Research.

Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study

OBJECTIVE

To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality.

DESIGN

Nationally representative cohort study.

SETTING

Health and Retirement Study.

PARTICIPANTS

7,492 U.S. adults aged ≥65 years.

MEASUREMENTS

Grip strength was measured by a hand dynamometer and classified as normal (≥16 kg for female; ≥26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (≥0.60 m/s for female; ≥0.52 m/s for male) and slow.

RESULTS

Over an average follow-up time of 6.0 years, 1,870 (25.0%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (≥150 mmHg) and DBP (≥90 mmHg) was associated with a 24% (95% CI, 7-43%) and 25% (95% CI, 5-49%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6% (95% CI, 31 to -27%) and a 16% (95% CI, 46 to -26%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death was 0.85 (95% CI, 0.56-1.29) and 0.53 (95% CI, 0.30-0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, associations of BP with death varied modestly by gait speed.

CONCLUSION

Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death.

The Impact of Three Cognitive Training Interventions on Older Adults' Physical Functioning Across 5 Years

OBJECTIVE

Physical functioning is closely associated with cognition. The current study assessed the impact of three cognitive training programs on objective measures of physical functioning across 5 years.

METHOD

Older adults randomized to a processing speed ( n = 702), reasoning ( n = 694), or memory ( n = 703) training intervention were compared with those randomized to a no-contact control condition ( n = 698). Intention-to-treat (ITT) and treatment-received/dosage (time-varying number of training sessions) analyses were conducted.

RESULTS

There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength.

DISCUSSION

This is the first study to demonstrate differential longitudinal cognitive training transfer effects to three performance-based physical functioning measures. Future research should investigate mechanisms of far-transfer effects.

Reference ranges of handgrip strength from 125,462 healthy adults in 21 countries: a prospective urban rural epidemiologic (PURE) study

BACKGROUND

The measurement of handgrip strength (HGS) has prognostic value with respect to all-cause mortality, cardiovascular mortality and cardiovascular disease, and is an important part of the evaluation of frailty. Published reference ranges for HGS are mostly derived from Caucasian populations in high-income countries. There is a paucity of information on normative HGS values in non-Caucasian populations from low- or middle-income countries. The objective of this study was to develop reference HGS ranges for healthy adults from a broad range of ethnicities and socioeconomically diverse geographic regions.

METHODS

HGS was measured using a Jamar dynamometer in 125,462 healthy adults aged 35-70 years from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study.

RESULTS

HGS values differed among individuals from different geographic regions. HGS values were highest among those from Europe/North America, lowest among those from South Asia, South East Asia and Africa, and intermediate among those from China, South America, and the Middle East. Reference ranges stratified by geographic region, age, and sex are presented. These ranges varied from a median (25^th-75^th percentile) 50 kg (43-56 kg) in men <40 years from Europe/North America to 18 kg (14-20 kg) in women >60 years from South East Asia. Reference ranges by ethnicity and body-mass index are also reported.

CONCLUSIONS

Individual HGS measurements should be interpreted using region/ethnic-specific reference ranges.

Gender differences in the association between grip strength and mortality in older adults: results from the KORA-age study

Background

Reduced muscular strength in the old age is strongly related to activity impairment and mortality. However, studies evaluating the gender-specific association between muscularity and mortality among older adults are lacking. Thus, the objective of the present study was to examine gender differences in the association between muscular strength and mortality in a prospective population-based cohort study.

Methods

Data used in this study derived from the Cooperative Health Research in the Region of Augsburg (KORA)-Age Study. The present analysis includes 1,066 individuals (mean age 76 ± 11 SD years) followed up over 3 years. Handgrip strength was measured using the Jamar Dynamometer. A Cox proportional hazard model was used to determine adjusted hazard ratios of mortality with 95% confidence intervals (95% CI) for handgrip strength. Potential confounders (i.e. age, nutritional status, number of prescribed drugs, diseases and level of physical activity) were pre-selected according to evidence-based information.

Results

During the follow-up period, 56 men (11%) and 39 women (7%) died. Age-adjusted mortality rates per 1,000 person years (95% CI) were 77 (59–106), 24 (13–41) and 14 (7–30) for men and 57 (39–81), 14 (7–27) and 1 (0–19) for women for the first, second and third sex-specific tertile of muscular strength, respectively. Low handgrip strength was significantly associated with all-cause mortality among older men and women from the general population after controlling for significant confounders. Hazard ratios (95% CI) comparing the first and second tertile to the third tertle were 3.33 (1.53–7.22) and 1.42 (0.61-3.28), respectively. Respective hazard ratios (95% CI) for mortality were higher in women than in men ((5.23 (0.67–40.91) and 2.17 (0.27–17.68) versus 2.36 (0.97–5.75) and 0.97 (0.36–2.57)).

Conclusions

Grip strength is inversely associated with mortality risk in older adults, and this association is independent of age, nutritional status, number of prescribed drugs, number of chronic diseases and level of physical activity. The association between muscular strength and all-cause mortality tended to be stronger in women. It seems to be particularly important for the weakest to enhance their levels of muscular strength in order to reduce the risk of dying early.

Dynapenia and Metabolic Health in Obese and Nonobese Adults Aged 70 Years and Older: The LIFE Study

OBJECTIVE

The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults.

METHODS

A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions.

RESULTS

A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = 92.2 ± 11.2, P ≤ .01); and higher in NDYN-O compared with DYN-O (P = .008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared with DYN-O (70.9 ± 10.1 vs 67.7 ± 9.7, P ≤ .001). No significant differences were found across dynapenia and obesity status for all other metabolic components (P > .05). The odds of having MetS or its individual components were similar in obese and nonobese, combined or not with dynapenia (nonsignificant odds ratio [95% confidence interval]).

CONCLUSION

Nonobese dynapenic older adults had fewer metabolic disease risk factors than nonobese and nondynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting MetS criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or nonobese older adults.

Normative values for musculoskeletal- and neuromotor fitness in apparently healthy Norwegian adults and the association with obesity: a cross-sectional study

Background

Up-to-date research on musculoskeletal- and neuromotor fitness (MSMF) is lacking. The aims of the present paper were to a) establish normative values of MSMF by gender and age, and b) to assess how much of the variance in MSMF can be explained by obesity in adults.

Methods

A random selection of 726 Norwegians (20–65 years) participated in a national cross-sectional study. Muscular endurance, muscular strength, explosive power, flexibility and balance were assessed in addition to waist circumference (WC).

Results

Females displayed significantly higher scores compared to males on muscular endurance of the back extensors and on the flexibility tests (p < 0.001). Males displayed significantly higher scores than females (p < 0.001) on handgrip strength, modified push-ups, and explosive power. An inverse association was found between age and all MSMF scores for females (Beta:−0.06–(−0.92), p ≤ 0.044) and males (Beta:−0.15–(0.91), p ≤ 0.006), where younger participants displayed higher test scores on all MSMF tests, compared to older participants. Furthermore, participants showing higher scores on WC displayed lower scores on the following MSMF tests for both females and males: muscular endurance of the back extensors, balance, flexibility of the shoulder, and explosive power (p < 0.001). Additionally, male participants with higher WC scores showed lower scores on muscular endurance of the upper body and flexibility of the hamstrings compared to males with lower WC scores (p < 0.001).

Conclusions

The data provide normative values of MSMF for adults based on age and gender, and support an inverse relationship of MSMF to age and WC.

Electronic supplementary material

The online version of this article (doi:10.1186/s13102-016-0059-4) contains supplementary material, which is available to authorized users.

High muscular fitness has a powerful protective cardiometabolic effect in adults: influence of weight status

BACKGROUND

Low levels of muscular fitness (MF) are recognized as an important marker of nutritional status and a predictor of metabolic complications, cardiovascular disease and death, however, the relationship between MF, body mass index (BMI) and the subsequent cardiometabolic protective effects has been less studied among Latin American populations. This study identified an association between MF and the cardiometabolic risk score index (CMRSI) and the lipid-metabolic cardiovascular risk index (LMCRI) in a wide sample of university students grouped according to their BMI.

METHODS

Six thousand ninety five healthy males (29.6 ± 11.7 year-old) participated in the study. Absolute strength was measured using a T.K.K. analogue dynamometer (handgrip), and the participant's strength was then calculated relative to their body mass (MF/BM). The LMCRI was derived from the levels of triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and glucose levels in a blood sample. The CMRSI was calculated by summing the standardized residuals (z-score) for waist circumference, total cholesterol, LDL-c, triglycerides, HDL-c, and median blood pressure. Subjects were divided into six subgroups according to BMI (normal vs. overweight/obese) and MF/BM tertiles (unfit, average, fit).

RESULTS

The group of participants with low and moderate levels of MF/BM showed higher CMRSI values independent of BMI (P < 0.001). The group with normal BMI and high MF/BM had the highest levels of cardiometabolic protection. All overweight/obese BMI groups had significantly higher LMCRI values independent of the level of MF/BM (P < 0.001).

CONCLUSIONS

Participants with high MF/BM showed reduced cardiometabolic risk, which increased significantly when they were within normal parameters.

Muscle Weakness Is Associated With Diabetes in Older Mexicans: The Mexican Health and Aging Study

BACKGROUND

The risk of cardiovascular problems due to diabetes mellitus is highest among older Mexicans, and yet what remains to be determined is the association between muscle weakness and diabetes in this population. Therefore, the purpose of this study was to determine the association between muscle strength and diabetes among Mexican adults greater than 50 years of age.

DESIGN

Cross-sectional.

SETTING

National sample of households in both urban and rural areas.

PARTICIPANTS

A subsample of 1841 individuals aged 50 years and older was included from the 2012 Mexican Health and Aging Study.

MEASUREMENTS

Strength was assessed using a hand-held dynamometer, and the single largest reading from either hand was normalized to body mass (normalized grip strength [NGS]). Conditional inference tree analyses were used to identify sex-specific NGS weakness thresholds. Linear regression was used to examine the association between NGS and HbA1c, and logistic regression was used to assess the association between weakness and risk of diabetes (HbA1c ≥ 6.5% [≥48 mmol/mol]), after controlling for age, sex, and waist circumference.

RESULTS

NGS was inversely associated with HbA1c (β = -1.56; P < .001). Optimal sex-specific NGS weakness thresholds to detect diabetes were ≤0.46 and ≤0.30 for men and women, respectively. Weakness was associated with significantly increased odds of diabetes (odds ratio, 1.69; 95% confidence interval, 1.37-2.10), even after adjusting for age, sex, and waist circumference.

CONCLUSIONS

NGS was robustly associated with diabetes and other cardiometabolic risk factors in older Mexicans. This simple screen may serve as a valuable tool to identify adults that are at risk for negative health consequences or early mortality and who might benefit from lifestyle interventions to reduce risk.

Low Muscle Strength Thresholds for the Detection of Cardiometabolic Risk in Adolescents

INTRODUCTION

There is an association between strength and health among adolescents, yet, what remains to be determined is sex-specific cut points for low strength in the detection of risk in this population. The purpose of this study was to determine thresholds of low grip strength in a large cohort (N=1,326) of adolescents.

METHODS

All data were collected between 2005 and 2008, and analyzed in 2014-2015. A cardiometabolic risk score (MetScore) was computed from the following components: percent body fat, fasting glucose, blood pressure, plasma triglyceride levels, and high-density lipoprotein cholesterol. A high-risk cardiometabolic phenotype was characterized as ≥75th percentile of the MetScore. Conditional inference tree analyses were used to identify sex-specific, low normalized strength (grip strength/body mass) thresholds and risk categories.

RESULTS

Lower strength was independently associated with increased odds of the high-risk cardiometabolic phenotype, such that for every 5% decrement of normalized strength, there were 1.48 and 1.45 increased odds (p<0.001) for boys and girls, even after adjusting for cardiorespiratory fitness and physical activity. Conditional tree analysis revealed a high-risk threshold for boys (≤0.33) and girls (≤0.28), as well as an intermediate threshold (boys, >0.33 and ≤0.45; girls, >0.28 and ≤0.36).

CONCLUSIONS

These sex-specific thresholds of low strength can be incorporated into a clinical setting for identifying adolescents that would benefit from lifestyle interventions to improve muscular fitness and reduce cardiometabolic risk.

The ethnic gap in mobility: a comparison of Russian, Somali and Kurdish origin migrants and the general Finnish population

BACKGROUND

Many ethnic minority populations have poorer health than the general population. However, there is limited knowledge on the possible ethnic gap in physical mobility. We aim to examine the prevalence of mobility limitations in working-age Russian, Somali and Kurdish origin migrants in comparison to the general population in Finland. We also determine whether the association between ethnic group and mobility limitation remains after taking into account socio-economic and health-related factors.

METHODS

We used data from the Finnish Migrant Health and Wellbeing Study (Maamu) and the Finnish Health 2011 Survey. The participants comprised 1880 persons aged 29-64 years. The age-adjusted prevalence of difficulties in various mobility tasks was calculated using predictive margins. Logistic regression analysis was used to examine the association between socio-economic, health- and migration-related factors and mobility limitation (self-reported difficulty in walking 500 m or stair climbing). The association between ethnic group and mobility limitation was calculated using logistic regression analysis.

RESULTS

Mobility limitations were much more prevalent among Somali origin women (46 %) and Kurdish origin men (32 %) and women (57 %) compared to men and women in the general Finnish population (5-12 %). In Russian origin men and women, the prevalence of mobility limitation (7-17 %) was similar to the general Finnish population. Socio-economic and health-related factors, but not migration-related factors (time lived in Finland and language proficiency in Finnish or Swedish), were found to be associated with mobility limitation in the studied populations. Somali and Kurdish origin migrants were found to have increased odds for mobility limitation compared to the general Finnish population, even after adjusting for socio-economic and health-related factors (Somalis odds ratio [OR] 3.61; 95 % confidence interval [CI] 2.07-6.29, Kurds OR 7.40; 95 % CI 4.65-11.77).

CONCLUSIONS

This study demonstrates a functional disadvantage in Somali and Kurdish origin populations compared to the general Finnish population, even after adjusting for socio-economic and health-related factors. The high prevalence of mobility limitation among Somali origin women and Kurdish origin men and women in Finland demonstrates an acute need to promote the health and functioning of these populations.

Longitudinal development of manual motor ability in autism spectrum disorder from childhood to mid-adulthood relates to adaptive daily living skills

Many individuals with autism spectrum disorder (ASD) exhibit motor difficulties, but it is unknown whether manual motor skills improve, plateau, or decline in ASD in the transition from childhood into adulthood. Atypical development of manual motor skills could impact the ability to learn and perform daily activities across the life span. This study examined longitudinal grip strength and finger tapping development in individuals with ASD (n = 90) compared to individuals with typical development (n = 56), ages 5 to 40 years old. We further examined manual motor performance as a possible correlate of current and future daily living skills. The group with ASD demonstrated atypical motor development, characterized by similar performance during childhood but increasingly poorer performance from adolescence into adulthood. Grip strength was correlated with current adaptive daily living skills, and Time 1 grip strength predicted daily living skills eight years into the future. These results suggest that individuals with ASD may experience increasingly more pronounced motor difficulties from adolescence into adulthood and that manual motor performance in ASD is related to adaptive daily living skills.

Declines in Strength and Mortality Risk Among Older Mexican Americans: Joint Modeling of Survival and Longitudinal Data

BACKGROUND

Grip strength is a noninvasive method of risk stratification; however, the association between changes in strength and mortality is unknown. The purposes of this study were to examine the association between grip strength and mortality among older Mexican Americans and to determine the ability of changes in strength to predict mortality.

METHODS

Longitudinal data were included from 3,050 participants in the Hispanic Established Population for the Epidemiological Study of the Elderly. Strength was assessed using a hand-held dynamometer and normalized to body mass. Conditional inference tree analyses were used to identify sex- and age-specific weakness thresholds, and the Kaplan-Meier estimator was used to determine survival estimates across various strata. We also evaluated survival with traditional Cox proportional hazard regression for baseline strength, as well as with joint modeling of survival and longitudinal strength change trajectories.

RESULTS

Survival estimates were lower among women who were weak at baseline for only 65- to 74-year-olds (11.93 vs 16.69 years). Survival estimates were also lower among men who were weak at baseline for only ≥75-year-olds (5.80 vs 7.39 years). Lower strength at baseline (per 0.1 decrement) was significantly associated with mortality (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.01-1.19) for women only. There was a strong independent, longitudinal association between strength decline and early mortality, such that each 0.10 decrease in strength, within participants over time, resulted in a HR of 1.12 (95% CI: 1.00-1.25) for women and a HR of 1.15 (95% CI: 1.04-1.28) for men.

CONCLUSIONS

Longitudinal declines in strength are significantly associated with all-cause mortality in older Mexican Americans.

Age-related change in handgrip strength in men and women: is muscle quality a contributing factor?

Age-related changes in muscle quality and muscle mass in the forearm, which relate to decline in handgrip strength (HGS), have not been reported. The purpose of this study was to investigate the relationships between age-related declines in HGS and loss of muscle thickness and/or muscle quality in the forearm of 613 adults (306 men and 307 women) aged 20-89. Anterior forearm muscle thickness (MT-ulna) and HGS were measured using an ultrasound and a hand dynamometer, respectively, in the dominant hand. Muscle quality (fMQ) was defined as a ratio of HGS to MT-ulna. HGS was similar among younger (ages 20-29, 30-39, and 40-49) groups and was progressively lower with increasing age in both sexes. MT-ulna was similar between ages 20-29 and 60-69 in men and between ages 20-29 and 70-79 in women. In men, MT-ulna was lower in ages 70-79 and 80-89 compared with other age groups. In women, MT-ulna was lower in ages 80-89 compared with ages 20-29 and 40-49. In both men and women, fMQ was identical among younger (ages 20-29, 30-39, and 40-49) groups. After that fMQ was progressively lower with age in both men and women. The results indicated that age-related decline in HGS is associated with fMQ, but it appears to be accelerated after the seventh decade due to muscle loss.

Determining the Importance of Meeting Muscle-Strengthening Activity Guidelines: Is the Behavior or the Outcome of the Behavior (Strength) a More Important Determinant of All-Cause Mortality?

OBJECTIVE

To determine whether the behavioral participation in muscle-strengthening activity (MSA) or the strength outcome produces the largest reduction in all-cause mortality risk.

PATIENTS AND METHODS

The 1999-2002 National Health and Nutritional Examination Survey was used, with follow-up of up to 12.6 years (mean, 9.9 years) (N=2773 adults aged ≥50 years). Participants were placed into 4 groups based on 2 dichotomously categorized variables: lower-extremity strength (LES) of the knee extensors (top quartile) and adherence to MSA guidelines (≥2 MSA sessions per week). Approximately 21% of the population died during follow-up.

RESULTS

Compared with individuals not meeting MSA guidelines and not in top quartile for LES, the adjusted hazard ratios (HRs) and 95% CIs were as follows: (1) meets MSA guidelines but not in top quartile for LES (HR=0.96; 95% CI, 0.63-1.45; P=.84), (2) in top quartile for LES but does not meet MSA guidelines (HR=0.54; 95% CI, 0.42-0.71; P<.001), and (3) in top quartile for LES and meets MSA guidelines (HR=0.28; 95% CI, 0.12-0.66; P=.005). Further analyses revealed that individuals in the top quartile for LES who also met MSA and moderate to vigorous physical activity guidelines were at even further reduced risk for premature all-cause mortality (HR=0.23; 95% CI, 0.08-0.61; P=.005).

CONCLUSION

These results demonstrate that muscle strength seems to be more important than the behavioral participation in MSA for reducing the risk of premature all-cause mortality.

Age-related change in handgrip strength in men and women: is muscle quality a contributing factor?

Age-related changes in muscle quality and muscle mass in the forearm, which relate to decline in handgrip strength (HGS), have not been reported. The purpose of this study was to investigate the relationships between age-related declines in HGS and loss of muscle thickness and/or muscle quality in the forearm of 613 adults (306 men and 307 women) aged 20-89. Anterior forearm muscle thickness (MT-ulna) and HGS were measured using an ultrasound and a hand dynamometer, respectively, in the dominant hand. Muscle quality (fMQ) was defined as a ratio of HGS to MT-ulna. HGS was similar among younger (ages 20-29, 30-39, and 40-49) groups and was progressively lower with increasing age in both sexes. MT-ulna was similar between ages 20-29 and 60-69 in men and between ages 20-29 and 70-79 in women. In men, MT-ulna was lower in ages 70-79 and 80-89 compared with other age groups. In women, MT-ulna was lower in ages 80-89 compared with ages 20-29 and 40-49. In both men and women, fMQ was identical among younger (ages 20-29, 30-39, and 40-49) groups. After that fMQ was progressively lower with age in both men and women. The results indicated that age-related decline in HGS is associated with fMQ, but it appears to be accelerated after the seventh decade due to muscle loss.

Handgrip strength is associated with metabolic syndrome among middle-aged and elderly community-dwelling persons

The association of low muscle strength with cardio-metabolic risks remains controversial. The present study included 742 men aged 70 ± 9 years and 937 women aged 70 ± 8 years from a rural village. We examined the cross-sectional relationship between relative muscle strength defined by handgrip strength (HGS)/body weight (BW) ratio, and metabolic syndrome (MetS) based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report and its components. Of these, 203 men (27.4%) and 448 women (47.8%) had MetS. In men, increasing quartile of HGS/BW ratio was significantly and independently associated with high waist circumference {odds ratio, 0.31; 95% confidence interval (CI), 0.24-0.41} and elevated triglyceridemia (0.71, 0.59-0.86). In women, it was also significantly and independently associated with high waist circumference (0.41; 0.36-0.48), high blood pressure (0.78; 0.66-0.92), Low HDL-cholesterolemia (0.84; 0.73-0.98) and elevated triglyceridemia (0.65; 0.53-0.79). In both genders, the prevalence of MetS significantly decreased in relation to increasing HGS/BW ratio. After adjustment for age, smoking status, drinking status, LDL-C, estimated glomerular filtration ratio (eGFR), and medication, the respective odds ratio (95% CI) for the quartile of HGS/BW ratio for MetS was 1.00, 0.54 (0.34-0.85), 0.32 (0.19-0.53), and 0.16 (0.09-0.29) in men, and 1.00, 0.76 (0.50-1.16), 0.33 (0.22-0.51), and 0.16 (0.10-0.25) in women. These results suggest that HGS/BW ratio was significantly and negatively associated with an increased risk of cardio-metabolic disorders in Japanese-community dwelling persons.

Musculoskeletal fitness and balance in older individuals (65-85 years) and its association with steps per day: a cross sectional study

Background

There is limited normative, objective data combining musculoskeletal fitness (MSF), balance and physical activity (PA) among older adults. The aims were therefore to; 1) describe MSF and balance in older Norwegian adults focusing on age- and sex-related differences; 2) investigate the associations among MSF, balance and objectively-assessed PA levels.

Methods

This was part of a national multicenter study. Participants (65–85 years) were randomly selected from the national population registry. We used ActiGraph GT1M accelerometers to measure PA. Balance and MSF were assessed using: one leg standing (OLS), handgrip strength (HG), static back extension (SBE), sit and reach (SR), back scratch right, left arm over (BSR, BSL). Univariate analyses of variance were used to assess sex differences within the different MSF and balance tests and for comparisons among multiple age groups. Linear regression analysis was used to investigate how PA (expressed in 1000 steps increments) was associated with MSF and balance.

Results

85 women and 76 men were included. Mean age (standard deviation (SD)) was 73.2 (5.4) years for women and 72.3 (4.8) years for men. The youngest participants (65–69 years) had significantly better mean OLS- and SBE results compared with older participants. Women (65–85 years) had significantly better mean SR, BSR, BSL and SBE results compared with men (65–85 years). Men had significantly better mean HG results compared with women. No sex differences in mean OLS results were observed. A daily increment of 1000 steps was associated with better mean test scores for OLS- and SBE tests (b = 1.88, 95 % CI: 0.85 to 2.90 (p ≤ 0.001) and b = 4.63, 95 % CI: 1.98 to 7.29 (p = 0.001), respectively).

Conclusion

The youngest (65–69 years) had better static balance and muscular endurance in trunk extensors compared with older participants. Older women (65–85 years) had better joint flexibility than older men (65–85 years), whereas older men had better handgrip strength than older women. A higher PA level was associated with better static balance and muscular endurance in trunk extensors in older individuals. This study provides important normative data, and further investigation of trunk endurance and static balance as key foci for PA interventions in elderly is warranted.

Longitudinal Associations Between Changes in Physical Function and Driving Mobility Behaviors of Older Adults

OBJECTIVES

To examine time-varying correlations between multiple indices of physical function and driving mobility in older adults across five years.

DESIGN

Longitudinal.

PARTICIPANTS

Older drivers aged 65-91 (M = 73.6 ± 5.78) who were randomly assigned to the no-contact control arm of the Advanced Cognitive Training for Independent and Vital Elderly study (N = 598).

MEASUREMENTS

The driving mobility outcomes were self-reported driving space, driving exposure, driving frequency, and weekly mileage assessed at baseline, and first, second, third, and fifth follow-up visits. Physical functioning measures included grip strength, the Turn360 test, and self-reported physical function. Multilevel models examined relationships between changes in physical functioning and driving mobility outcomes over five years.

RESULTS

Driving space and driving frequency decreased over time, especially for older individuals. Changes in physical function were positively related to changes in driving mobility after controlling for demographics, attrition, baseline cognitive function and visual acuity, and changes in general health. Patterns of associations varied depending on the specific physical function measure and mobility outcome.

CONCLUSIONS

The findings highlight the time-varying nature of the relationships between physical functioning and driving mobility. Further research is needed to fully understand dynamic associations between driving mobility and key components of mobility that vary over time.

Impact of Protein Nutritional Status on Plasma BNP in Elderly Patients

BACKGROUND

Previous studies have demonstrated that the levels of B-type natriuretic peptide (BNP) in plasma are negatively correlated with Body Mass Index (BMI) whereas lean body mass is also closely related to plasma BNP. The purpose of this study is to determine the effect of protein nutritional status on plasma BNP in aged patients.

METHODS AND RESULTS

The cross-sectional study was applied and the anthropometric measurement and nutritional biochemical test was performed in 1118 elderly inpatients in a stable condition were enrolled in the study (mean age, 75 years; 54% women). The partial correlation and multivariate regression analysis were conducted to analyze the relation of plasma BNP with covariates. After adjustment for confounding factors such as age, smoking and coexisting diseases, we found that the concentrations of BNP were independently associated with serum albumin (β=-0.065, P<0.001), serum total cholesterol (β=-0.097, P<0.012) and calf circumference (β=-0.032, P<0.014) in female patients, and associated with the serum albumin (β=-0.051, P<0.001), prealbumin (β=-2.177, P<0.026), mid-arm circumference (β=-0.062, P<0.001) and grip strength (β=-0.100, P<0.048) in male patients. Every 1 gram per liter of increased serum albumin corresponded to the reduced plasma BNP in male patients by 13.9% (OR 0.861, 95% CI 0.817, 0.909) and in female patients by 13.4% (OR 0.866, 95% CI 0.819, 0.916).

CONCLUSIONS

Our study suggests that plasma BNP is negatively correlated with muscle mass, and it is also related to muscle force in male patients. The serum albumin is an independent determinant factor of BNP in both men and women. These findings suggest that good protein nutritional status could be beneficial in maintaining the cardiac function in elder population.

Prognostic Factors Related to Dementia with Lewy Bodies Complicated with Pneumonia: An Autopsy Study

Objective In patients demonstrating dementia with Lewy bodies (DLB), pneumonia is a common complication. However, the prognostic factors for the survival time in DLB with pneumonia have not been investigated by autopsy in patients with neuropathologically confirmed DLB. Methods We conducted a retrospective study of the medical and autopsy reports of 42 patients admitted to a Japanese hospital between 2005 and 2014. The patients were neuropathologically diagnosed as having DLB by post-mortem examinations. We analyzed the effects of various factors on the time from DLB onset to death. Results Thirty-nine of the 42 patients with DLB (92.9%) developed pneumonia during hospitalization. The median age at DLB onset was 78 years and the median time from DLB onset to death was 8 years. The Cox proportional hazard model demonstrated cerebral infarction [Hazard Ratio (HR), 2.36 (95% CI 1.12-4.96), p=0.023], muscle weakness [HR, 2.04 (0.95-4.39), p=0.067], male sex [HR, 2.84 (1.24-6.50), p=0.014], and age at onset (≥78 years.) [HR, 4.71 (1.82-12.18), p=0.001] to be prognostic factors for a shorter time from DLB onset to death. Conclusion Careful treatment of cerebral infarction and muscle weakness of the lower extremities is crucial for DLB patients with pneumonia, especially for those over 78 years of age, in order to maximize the patients' life expectancies.

Muscle Quality and Myosteatosis: Novel Associations With Mortality Risk: The Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study

Muscle composition may affect mortality risk, but prior studies have been limited to specific samples or less precise determination of muscle composition. We evaluated associations of thigh muscle composition, determined using computed tomography imaging, and knee extension strength with mortality risk among 4,824 participants aged 76.4 (standard deviation (SD), 5.5) years from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study (2002-2006). Cox proportional hazards models were used to estimate hazard ratios. After 8.8 years of follow-up, there were 1,942 deaths. For men, each SD-increment increase in muscle lean area, muscle quality, and strength was associated with lower mortality risk, with decreases ranging between 11% and 22%. Each SD-increment increase in intermuscular adipose tissue and intramuscular adipose tissue was associated with higher mortality risk (hazard ratio (HR) = 1.13 (95% confidence interval (CI): 1.06, 1.22) and HR = 1.23 (95% CI: 1.15, 1.30), respectively). For women, each SD-increment increase in muscle lean area, muscle quality, and strength was associated with lower mortality risk, with decreases ranging between 12% and 19%. Greater intramuscular adipose tissue was associated with an 8% higher mortality risk (HR = 1.08, 95% CI: 1.01, 1.16). This study shows that muscle composition is associated with mortality risk. These results also show the importance of improving muscle strength and area and lowering muscle adipose tissue infiltration.

Growth Charts for Muscular Strength Capacity With Quantile Regression

INTRODUCTION

Muscle strength preservation may play an important role in protecting against cardiometabolic diseases, functional decline, musculoskeletal deterioration, and early all-cause mortality. However, sex-specific strength growth charts and curves using data from a U.S.-representative sample and clinically feasible measurement remain to be established.

METHODS

A sample of 7,119 individuals, aged 6-80 years, was included from the 2011-2012 National Health and Nutrition Examination Survey. Analyses were performed in 2015. Grip strength was assessed using a hydraulic handheld dynamometer; peak force values were normalized per body mass. Parametric quantile regression was used to determine unique normalized and absolute strength percentiles for men and women. Responses were fitted with a parametric model, involving six powers of age.

RESULTS

Growth charts and curves were created using output from the quantile regression from reference values of normalized and absolute grip strength corresponding to the fifth, tenth, 25th, 50th, 75th, 90th, and 95th percentiles across all ages. For men, there was a small drop in normalized strength at age 6 years followed by quick growth until about age 25 years. Among women, normalized strength grew gradually until about age 15 years. For both men and women, normalized strength declined throughout middle age and later adulthood; however, these rates were greater among men. More-pronounced patterns of growth and decline were observed for absolute strength in men and women.

CONCLUSIONS

The established strength quantiles can easily be incorporated into a clinical setting for screening individuals that would benefit from lifestyle interventions to improve muscular fitness and reduce health risks.

Grip Strength as a Marker of Hypertension and Diabetes in Healthy Weight Adults

INTRODUCTION

Muscle strength may play a role in cardiometabolic disease. We examined the relationship between hand grip strength and diabetes and hypertension in a sample of healthy weight adults.

METHODS

In 2015, we analyzed the National Health and Nutrition Examination Survey 2011-2012 for adults aged ≥20 years with healthy BMIs (between 18.5 and <25) and no history of cardiovascular disease (unweighted n=1,467; weighted n=61,587,139). Hand grip strength was assessed with a dynamometer. Diabetes was based on hemoglobin A1c level and reported diabetes diagnosis. Hypertension was based on measured blood pressure and reported hypertension diagnosis.

RESULTS

Individuals with undiagnosed diabetes compared with individuals without diabetes had lower grip strength (51.9 vs 69.8, p=0.0001), as did individuals with diagnosed diabetes compared with individuals without diabetes (61.7 vs 69.8, p=0.008). Mean grip strength was lower among individuals with undiagnosed hypertension compared with individuals without hypertension (63.5 vs 71.5, p=0.008) as well as among individuals with diagnosed hypertension compared with those without hypertension (60.8 vs 71.5, p<0.0001). In adjusted analyses controlling for age, sex, race, smoking status, and first-degree relative with disease, mean grip strength was lower for undiagnosed diabetes (β=-10.02, p<0.0001) and diagnosed diabetes (β=-8.21, p=0.03) compared with individuals without diabetes. In adjusted analyses, grip strength was lower among individuals with undiagnosed hypertension (β=-6.6, p=0.004) and diagnosed hypertension (β=-4.27, p=0.04) compared with individuals without hypertension.

CONCLUSIONS

Among healthy weight adults, combined grip strength is lower in individuals with diagnosed and undiagnosed diabetes and hypertension.

Predicting cardiovascular disease from handgrip strength: the potential clinical implications

The measurement of handgrip strength has proven prognostic value for all-cause and cardiovascular death, and for cardiovascular disease. It is also an important indicator of frailty and vulnerability. The measurement of handgrip strength may be most useful in the context of multi-morbidity, where it may be a simple tool to identify the individual at particularly high risk of adverse outcomes, who may benefit from closer clinical attention. Research into dietary, exercise, and pharmacologic strategies to increase muscle strength is ongoing. Important issues will be the feasibility and sustainability of increases in muscle strength, and whether these increases translate into clinical benefit.

The associations of "fatness," "fitness," and physical activity with all-cause mortality in older adults: A systematic review

OBJECTIVE

This review explored whether cardiorespiratory fitness or physical activity act as either confounders or effect modifiers of the relationship between adiposity markers and all-cause mortality in older adults.

METHODS

Systematic searches were carried out to identify observational studies that examined the association of adiposity markers (BMI, waist circumference, and waist-hip ratio) with all-cause mortality in adults aged ≥ 60 which took into account cardiorespiratory fitness or physical activity. Data from each included study was analyzed to produce a graphical representation of this relationship.

RESULTS

Fourteen of the fifteen identified studies found that increasing BMI had a non-positive association with all-cause mortality, with persistence of the obesity paradox despite adjustment for physical activity or cardiorespiratory fitness. Physical activity measurement methods were all subjective and often unvalidated. The two studies stratifying for cardiorespiratory fitness did not find that fitness had a significant impact on the relationship between excess adiposity and mortality but found that overweight and fit people had better survival than normal-weight unfit people,

CONCLUSIONS

The predominant use of poor physical activity measurement suggests that studies are currently not adequately accounting for possible physical activity confounding. More studies are needed for addressing the modification of the relationship between adiposity markers and mortality by cardiorespiratory fitness.