Comparison of quadriceps strength and handgrip strength in their association with health outcomes in older adults in primary care

Comparison of Absolute and Relative Grip Strength to Predict Incidence of Diabetes Mellitus in Korea: A Prospective Cohort Study

Background: This study aimed to investigate the association between absolute grip strength (AGS), relative grip strength (RGS) levels, and the risk of developing diabetes in middle-aged adults, utilizing longitudinal data. Methods: A total of 1935 participants, 51-81 years of age, were engaged in surveys both in 2017-2018 and during the subsequent follow-up survey in 2019-2020. Diabetes diagnosis and treatment were the criteria for categorizing individuals as "diabetic." Grip strength was measured using the JAMA-5030J1 equipment (SAEHAN, Korea), and AGS and RGS were also categorized into tertiles by gender. A proportional hazards Cox regression model was used to evaluate the relationship among AGS, RGS, and the risk of developing diabetes. Subsequently, we computed the hazard ratio (HR) and 95% confidence interval (95% CI) for the risk of developing diabetes. Results: After adjusting for various confounding variables, a significant reduction in diabetes risk was observed in the high grip strength group, adjusted for body mass index (RGS1) and body weight (RGS2), compared with the low RGS1 and RGS2 groups (RGS1 HR = 0.54, 95% CI = 0.36-0.80; RGS2 HR = 0.50, 95% CI = 0.34-0.73). However, there were no significant associations between AGS and diabetes risk. Furthermore, significant differences in the relationship among AGS, RGS levels, and the risk of developing diabetes were found across gender and insulin resistance levels. Conclusion: This study underscores the importance of RGS levels in predicting the incidence of diabetes, with AGS, RGS1, and RGS2 emerging as significant predictive indicators for assessing diabetes risk.

Ten-year trends in values of joint space width and osteophyte area of knee joints: Comparison of the baseline and fourth ROAD study surveys

Objective

Considering the joint space width and osteophyte area (OPA) of the knee joints of Japanese adults, this study elucidated the ten-year trends in medial minimum joint space width (mJSW) and OPA using data of two independent cohorts from a population-based cohort study.

Methods

The baseline survey of the Research on Osteoarthritis/Osteoporosis Against Disability study was conducted from 2005 to 2007; 2975 participants (1041 men, 1934 women) completed all knee osteoarthritis (OA) examinations. The fourth survey was performed from 2015 to 2016; distinct 2445 participants (764 men, 1681 women) completed identical examinations. The medial mJSW and medial tibial OPA were measured bilaterally using an automated system.

Results

The mean medial mJSW (standard deviation) was 3.22 (0.96) mm and 2.65 (0.95) mm at baseline and 3.81 (1.20) mm and 3.13 (1.15) mm in the fourth survey for men and women, respectively. The mean medial mJSW in the fourth survey was significantly greater in both men and women in all age groups than at baseline (p ​< ​0.01). The mean OPAs in men aged 40-49 and 60-69 years and women aged 40-49, 50-59, 60-69, and 70-79 years were significantly smaller in the fourth survey (p ​< ​0.05). The trend in mJSW remained the same even after adjusting for confounding factors in the multivariate analysis, but the trend in OPA was weakened.

Conclusions

A significant improvement in the medial mJSW within 10 years could decrease the incidence and progression of knee OA and prevent the risk of walking disability.

Quality of life in patients with myositis is associated with functional capacity, body composition, and disease activity-Baseline data from a randomized controlled trial

OBJECTIVE

To investigate the potential associations between functional capacity, muscle strength, body composition, and disease-related measures and quality of life in patients with myositis.

METHODS

Baseline measures of functional capacity (functional index 3 (FI3), 2-minute walk test (2MWT), timed up and go (TUG) and 30-s sit-to-stand (30-STS)), muscle strength (incl. leg and handgrip strength), maximal leg extensor power, body composition (appendicular lean mass, fat percentage/mass) and disease-related measures (disease activity & damage core sets) were examined for their associations with quality of life (physical- and mental component summary scores, Short Form 36 questionnaire (SF-36)) by means of Spearman's correlation analysis.

RESULTS

A total of 32 patients with myositis were included. Positive correlations between SF-36 physical component summary score (PCS) and FI3, 30-STS, TUG, 2MWT, leg extensor power, leg strength, bench press strength, and handgrip strength were observed. In contrast, fat percentage and fat mass correlated negatively with PCS. In disease-related measures, Extramuscular global assessment, health assessment questionnaire, physician global damage, and patient global damage scores were negatively associated with SF-36 PCS. No correlations to the mental component summary score of SF-36 were observed.

CONCLUSION

All measures of functional capacity were positively related to the SF-36 physical component summary score, indicating higher functional capacity positively affects quality of life in patients with myositis. Health assessment questionnaire and patient global damage scores demonstrated the strongest correlations with SF-36 physical component summary scores, further supporting these patient-reported outcomes as viable monitoring tools in patients with myositis.

The reliability and suitability of strength assessments in frail and pre-frail older adults: recommendations for strength testing in older populations

BACKGROUND

Lifelong strength is fundamental to physical function, health, and quality of life. Reliable appropriate strength assessment measures for older adults play an important role in effective evaluation of baseline ability and exercise prescription to counter disease and disuse. This study aimed to investigate the within-session reliability of maximal isometric knee extension and flexion, hip abduction and adduction, and handgrip strength measures in frail and pre-frail older adults.

METHOD

The study was conducted at a residential care home in Birmingham, UK. All care home residents aged ≥ 65 years; pre-frail or frail according to the Fried Frailty phenotype criteria; able to speak and read English; not currently involved in any other clinical trial; without severe sensory impairments; and with a predicted life expectancy greater than the trial length were eligible. Maximal isometric lower limb testing was performed using specialised resistance training equipment and a portable measurement device, and grip strength was assessed using a portable dynamometer. All eligible participants attended a single testing session and performed three trials per measure. Peak force measures were obtained for analysis. Within-session reliability for each measure was calculated from repeated-measures analysis of variance, intraclass correlation coefficients (ICC), and coefficients of variation (CV) with 95% confidence intervals.

RESULTS

Eleven frail and eleven pre-frail older adults participated in the study. Within-session absolute and relative measures were found to be reliable with the highest overall repeatability indicated between trial 2 and trial 3 for knee extension, hip abduction, and handgrip (CV ≤ 4.65%, ICC ≥ 0.96) with variation evident across all measures, except knee extension, from trial 1 to 2.

CONCLUSIONS

Overall, maximal isometric strength in frail and pre-frail older adults with no previous testing experience can be measured with good to high reliability within their first testing session. An initial two familiarisation trials followed by two measurement trials is recommended to achieve the highest level of overall repeatability.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov: NCT03141879 on 05/05/2017.

Assessment and risk prediction of frailty using texture-based muscle ultrasound image analysis and machine learning techniques

The purpose of this study was to evaluate texture-based muscle ultrasound image analysis for the assessment and risk prediction of frailty phenotype. This retrospective study of prospectively acquired data included 101 participants who underwent ultrasound scanning of the anterior thigh. Participants were subdivided according to frailty phenotype and were followed up for two years. Primary and secondary outcome measures were death and comorbidity, respectively. Forty-three texture features were computed from the rectus femoris and the vastus intermedius muscles using statistical methods. Model performance was evaluated by computing the area under the receiver operating characteristic curve (AUC) while outcome prediction was evaluated using regression analysis. Models developed achieved a moderate to good AUC (0.67 ≤ AUC ≤ 0.79) for categorizing frailty. The stepwise multiple logistic regression analysis demonstrated that they correctly classified 70-87% of the cases. The models were associated with increased comorbidity (0.01 ≤ p ≤ 0.18) and were predictive of death for pre-frail and frail participants (0.001 ≤ p ≤ 0.016). In conclusion, texture analysis can be useful to identify frailty and assess risk prediction (i.e. mortality) using texture features extracted from muscle ultrasound images in combination with a machine learning approach.

The Possible Role of Food and Diet in the Quality of Life in Patients with COPD-A State-of-the-Art Review

Diet has been described as a modifiable risk factor for the development and progression of chronic diseases, and emerging evidence increasingly points to its preventive and therapeutic role in chronic obstructive pulmonary disease (COPD). While the relationship between the underlying disease and diet is natural in conditions such as metabolic disorders, obesity, diabetes, etc., the direct effect is not so evident in chronic obstructive pulmonary disease. Poor diet quality and the development of nutrient deficiencies in respiratory diseases, including COPD, can be associated with disease-specific factors such as the exacerbation of respiratory symptoms. These symptoms can be improved by dietary interventions, leading to positive changes in the pathogenesis of the disease and the quality of life of patients. Therefore, our aim was to review the latest randomized controlled trials (RCTs) of dietary interventions in chronic respiratory patients and describe their effects on respiratory function, physical activity, systemic inflammatory parameters, and quality of life. We conducted a literature search on dietary interventions for COPD patients in the PubMed, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, focusing on publications from 1 July 2018 to 1 July 2023. We used specific keywords and MESH terms, focusing on RCTs. A total of 26 articles and 1811 COPD patients were included in this review. On the basis of our findings, dietary interventions, in particular components of the Mediterranean diet such as protein, omega-3 polyunsaturated fatty acids, and vegetables, appear to have beneficial effects in patients with chronic respiratory diseases, and their application is beneficial. However, long-term follow-up studies are still needed to examine the effects of dietary interventions in this patient population.

Prevalence of sarcopenia in older women and level of agreement between the diagnostic instruments proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2)

BACKGROUND

The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposed the use of different diagnostic tools to assess sarcopenia. This study aimed to determine prevalence rates of sarcopenia according to the diagnostic instruments proposed by EWGSOP2 and to assess their level of agreement in older Brazilian women.

METHODS

A cross-sectional study with 161 community-dwelling older Brazilian women. Probable sarcopenia was assessed through Handgrip Strength (HGS) and the 5-times sit-to-stand test (5XSST). In addition to reduced strength, Appendicular Skeletal Muscle Mass (ASM) (obtained by Dual-energy X-ray absorptiometry) and ASM/height² were considered for diagnosis confirmation. Sarcopenia severity was determined by reduced muscle strength and mass and poor functional performance assessed by Gait Speed (GS), Short Physical Performance Battery (SPPB), and Timed Up and Go test (TUG). McNemar's test and Cochran's Q-test were used to compare sarcopenia prevalence. Cohen's Kappa and Fleiss's Kappa tests were used to assess the level of agreement.

RESULTS

The prevalence of probable sarcopenia was significantly different (p < 0.05) when using HGS (12.8%) and 5XSST (40.6%). Regarding confirmed sarcopenia, the prevalence was lower when using ASM/height² than with ASM. Regarding severity, the use of SPPB resulted in a higher prevalence in relation to GS and TUG.

CONCLUSION

There were differences in the prevalence rates of sarcopenia and low agreement between the diagnostic instruments proposed by the EWGSOP2. The findings suggest that these issues must be considered in the discussion on the concept and assessment of sarcopenia, which could ultimately help to better identify patients with this disease in different populations.

Relação entre força de preensão manual, funcionalidade e fragilidade física em pessoas idosas

Objetivo: analisar a produção científica nacional e internacional sobre a relação entre funcionalidade, força de preensão manual e a condição de fragilidade física em pessoas idosas. Método: revisão integrativa da literatura realizada nas bases de dados PubMed, CINAHL, Web of Science e Portal BVS, no período amostral de janeiro de 2010 a novembro de 2021. Para ilustrar a seleção dos artigos utilizou-se o fluxograma do Preferred Reporting Items for Systematic Reviews and Meta-analyses, o Oxford Centre for Evidence-Based Medicine para a classificação do nível de evidência e o EndNote Web para gerenciamento da bibliografia. Resultados: a busca inicial resultou em 211 artigos, após aplicação dos critérios de inclusão e exclusão, sete artigos perfizeram o corpus da revisão. A força de preensão manual (FPM) mostrou-se como indicadora da força muscular e determinante na funcionalidade dos idosos. A combinação entre a perda de força de preensão e outros eventos clínicos contribui para o declínio da funcionalidade e dependência nas atividades de vida diária em idosos, com maior prejuízo entre aqueles com 75 anos ou mais e de forma mais significativa entre as mulheres. Conclusão: a relação existente entre o baixo desempenho funcional e a diminuição da FPM determina a condição de fragilidade física em pessoas idosas. Isso reforça a importância do investimento dos profissionais de enfermagem em intervenções que viabilizam a manutenção da força muscular e da funcionalidade e a reversão da fragilidade física em idosos.

Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty

Purpose: To develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD).Materials and Methods: We conducted a retrospective analysis of post-TKA quadriceps strength recovery in a longitudinal dataset consisting of both clinical and research HHD data. We created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape. We created reference charts from the models to display the recovery of population centiles over the first six postoperative months.Results: A total of 588 patient records with 1176 observations were analyzed. Reference charts for both sexes demonstrated a rapid increase in quadriceps strength over the first 60 postoperative days followed by a more gradual increase over the next 120 days. Males appeared to demonstrate faster recovery and greater strength on average compared to females. The quadriceps strength recovery of three female patient records was plotted on the reference chart to illustrate the charts' potential clinical utility.Conclusions: These reference charts provide normative data for quadriceps strength recovery after TKA as assessed by HHD. The reference charts may augment clinicians' ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.Implications for RehabilitationHandheld dynamometry (HHD) is an objective and clinically feasible method for assessing muscle strength, but normative HHD values are lacking for quadriceps strength recovery after total knee arthroplasty (TKA).We created sex-specific reference charts which provide normative quadriceps strength HHD values for the first 180 days after TKA.These reference charts may improve clinicians' ability to monitor and intervene upon post-TKA quadriceps strength deficits.

Associations between dynapenia, cardiovascular hospitalizations, and all-cause mortality among patients on haemodialysis

BACKGROUND

Low muscle strength is associated with adverse clinical outcomes in patients undergoing haemodialysis (HD). No studies have reported the association between dynapenia, defined by both low handgrip strength (HGS) and quadriceps isometric strength (QIS), and long-term clinical outcomes in patients on HD. We examined the associations between dynapenia, cardiovascular (CV) hospitalizations, and all-cause mortality in the HD population.

METHODS

This retrospective study used data from outpatients undergoing HD at two dialysis facilities between October 2002 and March 2020. We defined low muscle strength as an HGS of <28 kg for men and <18 kg for women and a QIS of <40% dry weight. Furthermore, we categorized dynapenia into three groups: robust ('high HGS and high QIS'), either low HGS or low QIS ('low HGS only' or 'low QIS only'), and dynapenia ('low HGS and low QIS'). The outcomes were all-cause mortality and a composite of CV hospitalizations and mortality. Cox proportional hazards and negative binomial models were used to examine these associations.

RESULTS

A total of 616 patients (mean age, 65.4 ± 12.2 years; men, 61%) were included in the analyses. During the follow-up (median, 3.0 years), a total of 163 deaths and 288 CV hospitalizations occurred. Patients with the either low HGS or low QIS [hazard ratio (HR), 1.75; 95% confidence intervals (CIs), 1.46-2.10] and dynapenia (HR, 2.80; 95% CIs, 2.49-3.14) had a higher risk of mortality than those in the robust group. When compared with the robust group, the either low HGS or low QIS [incidence rate ratio (IRR): 1.41, 95% CI: 1.00-1.99] and dynapenia (IRR: 2.04, 95% CI: 1.44-2.89) groups were associated with a significantly higher incident risk of CV hospitalizations.

CONCLUSIONS

Dynapenia (muscle weakness in both upper and lower extremities) was associated with increased risks of all-cause mortality and CV hospitalizations among patients on HD. Screening for dynapenia using both HGS and QIS may be useful for prognostic stratification in the HD population.

Exploring the association between handgrip, lower limb muscle strength, and physical function in older adults: A narrative review

Widely used in daily practice, handgrip strength (HGS) is a low cost, easy-to-use, and portable test to assess overall muscle and physical function. It can be used as a stand-alone or a first-line tool for evaluating muscle weakness, though controversy surrounds its use for assessing global or lower limb muscle function. Lower limb mobility and physical activity are reduced with advancing age. This decline is difficult to quantify with isokinetic or isometric devices in routine settings (hospital and nursing home). For this narrative review we explored and summarized the findings of studies that investigated the association between HGS, lower limb muscle strength, and physical performance in older adults. The review also provides directions for future research. We noted contrasting findings for an association between HGS, lower limb strength, and physical performance. We found insufficient evidence for endorsing the handgrip dynamometer as a definitive tool for measuring overall muscle strength and physical function. More evidence is needed from comparable studies involving larger samples of men and women and investigating other areas such as lifestyle, daily physical activity levels, and health-related disorders.

Experimental Approach of Quadriceps Strength Measurement: Implications for Assessments in Critically Ill Survivors

(1) Background: The supine testing position is suitable for early quadriceps strength (QS) assessment in intensive care unit, while a seated position is more appropriate for survivors who have regained mobility. Acquiring consistent measurements is essential for longitudinal follow-up. We compared the QS generated in different settings in healthy volunteers. (2) Methods: Isometric QS was assessed using a MicroFet2 and standardised protocols comparing different modalities. Hip and knee flexion angles were, respectively, 45° and 40° (H45-K40) in the supine position, and both at 90° (H90-K90) in the seated position. Dynamometer was either handheld (non-fixed configuration, NFC), or fixed (FC) in a cubicle. (3) Results: QS in H90–K90 and H45-K40 positions were strongly correlated, but QS was higher in the later position regardless of the configuration. Compared to H45-K40, biases of 108.2N (or 28.05%) and 110.3N (27.13%) were observed in H90-K90 position, respectively, in the NFC and FC. These biases were independently and positively associated with QS (p < 0.001). For both position, there were no significant differences between QS measured in NFC or FC. (4) Conclusions: The quadriceps was less efficient in the seated position, compared to the supine position, in healthy volunteers. These findings have practical implications for further assessments and research in critically ill patients.

Respiratory Function and Muscle Strength Vs. Past Work Type: a Cross-Sectional Study Among Retirees

Objectives

The aim of this cross-sectional study was to assess the effects of past occupational activity on muscle strength and respiratory function among retirees.

Methods

A total of 205 community-dwelling older adults participated in the study. Age (≥60 years) and cessation of professional activity (retirement) constituted the inclusion criteria. The International Standardized Classification of Occupations (ISCO-08) was used to stratify the participants into white- or blue-collar groups. Forced vital capacity (FVC), forced expiratory volume (FEV) in the first second, inspiratory vital capacity (IVC) parameters, and hand grip strength were tested.

Results

Statistically significant differences in IVC and FVC scores were found in white- and blue-collar workers after adjusting for sex and age (ANCOVA). White-collar men had significantly higher IVC as compared to blue-collar men.

Conclusions

Blue-collar male workers may be prone to deteriorating respiratory function in older age. It is vital to promote physical activity and educate blue-collar workers about the need to use respiratory protective equipment.

Angiotensin II inhibition: a potential treatment to slow the progression of sarcopenia

Sarcopenia is defined as the progressive and generalized loss of skeletal muscle mass and strength, which is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability, and mortality. The etiology of sarcopenia has been postulated to be multifactorial with genetics, aging, immobility, nutritional deficiencies, inflammation, stress, and endocrine factors all contributing to the imbalance of muscle anabolism and catabolism. The prevalence of sarcopenia is estimated to range from 13 to 24% in adults over 60 years of age and up to 50% in persons aged 80 and older. As the population continues to age, the prevalence of sarcopenia continues to increase and is expected to affect 500 million people by the year 2050. Sarcopenia impacts the overall health of patients through limitations in functional status, increase in hospital readmissions, poorer hospital outcomes, and increase in overall mortality. Thus, there exists a need to prevent or reduce the occurrence of sarcopenia. Here, we explore the potential mechanisms and current studies regarding angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors on reducing the development of sarcopenia through the associated changes in cardiovascular function, renal function, muscle fiber composition, inflammation, endothelial dysfunction, metabolic efficiency, and mitochondrial function.

Absolute and Relative Handgrip Strength as Indicators of Self-Reported Physical Function and Quality of Life in Breast Cancer Survivors: The EFICAN Study

Simple Summary

Breast cancer is the most diagnosed type of cancer worldwide and it has a high survival rate. Thus, side effects related to breast cancer and treatments compromise lots of people’s physical functions and health-related quality of life. For this reason, it is important to manage these side effects in the follow up after treatments. The handgrip strength and the handgrip strength relative to body mass index may constitute useful, simple, quick and economically feasible tools that may help clinicians detecting these side effects, which is key to undertake actions for improving the physical function and health-related quality of life of breast cancer survivors.

Abstract

Background: Although breast cancer (BC) is the most prevalent type of cancer in the world, its high survival rate implies that many people live long after the treatments and face their side effects. The physical function (PF) and health-related quality of life (HRQoL) of people surviving BC decreases significantly, which makes important to identify markers that may be associated with a better health status and prognosis. Previous studies suggest that handgrip strength (HGS) and HGS relative to the body mass index (rHGS) are good indicators of PF and HRQoL in different populations. However, it is unknown whether this applies to BC survivors. This study aimed to evaluate the association of HGS and rHGS with PF and HRQoL in this population. Methods: Sixty female BC survivors participated. Handgrip strength was assessed with a dynamometer. Arm volume was estimated and upper limb impairments, as well as cancer-related fatigue, depression, life satisfaction and HRQoL, were assessed using standardized questionnaires. Results: Higher levels of HGS and rHGS were associated with higher levels of HRQoL, lower cancer-related fatigue, and fewer problems with the affected arm. Conclusions: These results suggest that HGS may be a good indicator of self-reported PF and HRQoL in female BC survivors.

Diagnostic accuracy of quadriceps strength-based criteria compared to handgrip-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults

AIM

. Handgrip strength (HS) is an established parameter for sarcopenia diagnosis; however, a considerable proportion of older adults have some kind of hand abnormality or limitation that can prevent reliable hand muscle power testing. This study set forth to investigate the diagnostic accuracy of quadriceps strength (QS)-based criteria compared to handgrip strength (HS)-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults.

SETTING AND PARTICIPANTS

. A total of 381 subjects aged ≥60 years who attended the outpatient geriatric clinic at Siriraj Hospital (Bangkok, Thailand) during 2015-2017 were recruited via convenience sampling. Patients who were ambulatory, able to communicate, and without metallic prosthesis or pacemaker were eligible for inclusion.

METHODS

. All consenting subjects underwent HS and QS testing, muscle mass measurement by bioelectrical impedance analysis, and gait speed analysis. The Asian Working Group for Sarcopenia (AWGS) 2019 consensus criteria were used as reference standard.

RESULTS

. The prevalence of sarcopenia and severe sarcopenia by HS-based criteria was 13.9% and 6.8%, respectively. In comparison, the prevalence of sarcopenia and severe sarcopenia by QS-based criteria was 14.7% and 10.2%, respectively. The sensitivity and specificity of QS-based criteria for diagnosing sarcopenia was 100% (95% confidence interval [CI]: 93.3-100%) and 99.1% (95%CI: 97.4-99.8%), respectively. The sensitivity and specificity of QS-based criteria for diagnosing severe sarcopenia was 88.5% (95%CI: 69.9-97.6%) and 95.5% (95%CI: 92.8-97.4%), respectively.

CONCLUSIONS

. With very high sensitivity and specificity, QS-based diagnostic criteria could be used to diagnose sarcopenia and severe sarcopenia in older adults whose HS measurements could not be reliably obtained. THAI CLINICAL TRIALS REGISTRY REGISTRATION NUMBER: . TCTR 20200717004.

Correlation of grip and knee extension strength in mature adults

BACKROUND AND OBJECTIVE: Grip and knee strength are commonly measured but controversy exists as to whether either is a proxy for the other. The purpose of this meta-analysis was to summarize the correlation between the 2 variables. METHODS: Relevant literature was sought using PubMed, Google, and a hand search. Information on populations, measurements, and correlations were extracted. Correlational data were subjected to meta-analysis. RESULTS: Results from 17 studies were consolidated. The summary correlation between grip and knee extension strength was 0.64 with 95% CI of 0.57 to 0.71. Data were highly heterogeneous but did not show publication bias. CONCLUSION: The correlation between the grip and knee extension strength is good. However, it is not good enough to justify using either as a proxy for the other.

Association between the handgrip strength and the isokinetic muscle function of the elbow and the knee in asymptomatic adults

Background:

The handgrip strength is a practical, valid, reliable, low-cost tool that presents strong correlations with several health conditions. However, handgrip strength may be inaccurate to prospectively predict the variability of muscular function since the decrease in muscular strength over the years varies according to a muscular group or between upper and lower limbs. Our hypothesis is that the handgrip strength cannot explain the variance of muscle function prospectively.

Purpose:

The aim of this study was to evaluate the cross-sectional and prospective association between handgrip strength and isokinetic muscle function of the knee and elbow in 780 asymptomatic adults.

Methods:

In a sample of 780 adults, we obtained handgrip strength and elbow and knee muscle function (for both flexion and extension at 60°/s and 300°/s) using, respectively, a hydraulic dynamometer and an isokinetic dynamometer. In a cross-sectional analysis, we analyzed the data obtained from baseline assessment. Then, we calculated the absolute change as a result of the variation data between the baseline and the 1-year follow-up assessment of each participant. The correlations were analyzed using Pearson or Spearman coefficients. We used multivariate models to investigate the association between handgrip strength and isokinetic muscle function.

Results and Discussion:

The cross-sectional correlations were significantly moderate-to-strong (r = 0.41–0.71, p < 0.01), but became weak-to-moderate (r = 0.26–0.34, p < 0.01) prospectively. In the cross-sectional analysis, the handgrip strength was selected as a strong predictor for isokinetic variables (∆R² = 0.171–0.583, p < 0.05) as expected. Although handgrip strength was also selected as a significant predictor in prospective analysis, it explained only a little variance in isokinetic muscle function of the knee (∆R² = 0.7–0.117, p < 0.05). Regarding the predictive models for the elbow, handgrip strength was not selected prospectively.

Conclusion:

The 1-year absolute change of the handgrip strength cannot explain the variance of the isokinetic muscle function. Thus, specific measures are required for assessing muscle function in epidemiological studies.

Using machine learning to investigate the relationship between domains of functioning and functional mobility in older adults

Previous studies have shown that functional mobility, along with other physical functions, decreases with advanced age. However, it is still unclear which domains of functioning (body structures, body functions, and activities) are most closely related to functional mobility. This study used machine learning classification to predict the rankings of Timed Up and Go tests based on the results of four assessments (soft lean mass, FEV1/FVC, knee extension torque, and one-leg standing time). We tested whether assessment results for each level could predict functional mobility assessments in older adults. Using support vector machines for machine learning classification, we verified that the four assessments of each level could classify functional mobility. Knee extension torque (from the body function domain) was the most closely related assessment. Naturally, the classification accuracy rate increased with a larger number of assessments as explanatory variables. However, knee extension torque remained the highest of all assessments. This extended to all combinations (of 2-3 assessments) that included knee extension torque. This suggests that resistance training may help protect individuals suffering from age-related declines in functional mobility.

Knee extension strength and handgrip strength are important predictors of Timed Up and Go test performance among community-dwelling elderly women: a cross-sectional study

BACKGROUND

Handgrip and knee extension strengths have each been used to characterize disability. However, it has been reported that the association between handgrip and knee extension strengths is weak.

OBJECTIVE

To evaluate the influence of knee extensor and handgrip muscle strength on Timed Up and Go (TUG) test results among elderly women with worse (≥ 10 seconds) and better (< 10 seconds) performance, after controlling for confounders.

DATA AND SETTING

Cross-sectional study on a sample selected according to convenience, carried out in a federal public institution of higher education.

METHODS

Assessment of handgrip was carried out using the Jamar dynamometer (Lafayette Instrument Company, Inc., Lafayette, United States). Knee extensor muscle performance was measured using an isokinetic dynamometer (Biodex System 3 Pro; Biodex Medical Systems, Inc., United States), The confounding factors were education, age, comorbidities, body mass index and Geriatric Depression Scale and Human Activity Profile scores. Functional performance was assessed through the TUG test. A backward linear regression model was used.

RESULTS

127 elderly women performed the TUG test in more than 10 seconds and 93 in less than 10 seconds. However, regardless of test performance, handgrip strength and knee extension strength comprised the reduced final model.

CONCLUSIONS

Knee extension strength and handgrip strength might be particularly useful indicators for measuring disability.

Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity

BACKGROUND

Muscle weakness is common in patients who survive a stay in the intensive care unit (ICU). Quadriceps strength (QS) measurement allows evaluation of lower limb performances that are associated with mobility outcomes.

OBJECTIVES

The objective of the study was to characterise the range of QS in ICU survivors (ICUS) during their short-term evolution, by comparing them with surgical patients without critical illness and with healthy participants. The secondary aim was to explore whether physical activity before ICU admission influenced QS during that trajectory.

METHODS

Patients with length of ICU stay ≥2 days, adults scheduled for elective colorectal surgery, and young healthy volunteers were included. Maximal isometric QS was assessed using a handheld dynamometer and a previously validated standardised protocol. The dominant leg was tested in the supine position. ICUSs were tested in the ICU and 1 month after ICU discharge, while surgical patients were tested before and on the day after surgery, as well as 1 month after discharge. Healthy patients were tested once only. Patients were classified as physically inactive or active before admission from the self-report.

RESULTS

Thirty-eight, 32, and 34 participants were included in the ICU, surgical, and healthy groups, respectively. Demographic data were similar in the ICUS and surgical groups. In the ICU, QS was lower in the ICU group than in the surgical and healthy groups (3.01 [1.88-3.48], 3.38 [2.84-4.37], and 5.5 [4.75-6.05] N/kg, respectively). QS did not significantly improve 1 month after ICU discharge, excepted in survivors who were previously physically active (22/38, 56%): the difference between the two time points was -6.6 [-27.1 to -1.7]% vs 20.4 [-3.4 to 43.3]%, respectively, in physically inactive and active patients (p = 0.002).

CONCLUSIONS

Patients who survived an ICU stay were weaker than surgical patients. However, a huge QS heterogeneity was observed among them. Their QS did not improve during the month after ICU discharge. Physically inactive patients should be early identified as at risk of poorer recovery.

Cigarette Smoking Is Associated With Lower Quadriceps Cross-sectional Area and Attenuation in Older Adults

INTRODUCTION

In addition to well-established links with cardiovascular and respiratory diseases, cigarette smoking may affect skeletal muscle; however, associations with quadriceps atrophy, density, and function are unknown. This study explored the associations of current and former smoking with quadriceps muscle area and attenuation as well as muscle force (assessed as knee extension peak torque) and rate of torque development-a measure of muscle power in older adults.

METHODS

Data from 4469 older adults, aged 66-95 years at baseline in the Age, Gene/Environment Susceptibility-Reykjavik Study with measurements of thigh computed tomography, isometric knee extension testing, self-reported smoking history, and potential covariates were analyzed.

RESULTS

Sex differences were observed in these data; therefore, our final analyses are stratified by sex. In men, both former smokers and current smokers had lower muscle area (with β= -0.10, 95% confidence interval [CI] = -0.17 to -0.03 and β = -0.19, 95% CI = -0.33 to -0.05, respectively) and lower muscle attenuation (ie, higher fat infiltration, β = -0.08, 95% CI = -0.16 to -0.01 and β = -0.17, 95% CI = -0.34 to -0.01, respectively) when compared with never smokers. Smoking status was not associated with male peak torque or rate of torque development. In women, current smoking was associated with lower muscle attenuation (β = -0.24, 95% CI = -0.34 to -0.13) compared to never smoking. Among female smokers (current and former), muscle attenuation and peak torque were lower with increasing pack-years.

CONCLUSIONS

Results suggest that cigarette smoking is related to multiple muscle properties at older age and that these relationships may be different among men and women.

IMPLICATIONS

This article presents novel data, as it examined for the first time the relationship between smoking and computed tomography-derived quadriceps muscle size (cross-sectional area) and attenuation. This study suggests that current cigarette smoking is related to higher muscle fat infiltration, which may have significant health implications for the older population, because of its known association with poor physical function, falls, and hip fractures.

THE ASSOCIATION BETWEEN VITAMIN D LEVELS AND HANDGRIP STRENGTH IN ELDERLY MEN

Context

Vitamin D is a steroid hormone that acts by binding to the vitamin D receptor (VDR) found in many tissues. According to the long-term mechanism, vitamin D causes the proliferation and differentiation of muscle cells by gene transcription.

Objective

We aimed to evaluate the relationship between muscle strength and serum vitamin D levels in elderly men.

Design

Cross-sectional study.

Subjects and Methods

Male patients over age 50 were included in the study. Study population was divided into 2 groups with handgrip strength according to body mass index, either as subjects with weak or with normal handgrip strength test (HGST). Vitamin D levels and other variables compared between weak and normal groups.

Results

Vitamin D level of weak and normal groups were 7.5 (3-19.9) μg/L, and 11.6 (11.6-34.9) μg/L, which means significant reduced vitamin D levels in weakness group (p=0.01). Vitamin D levels were significantly correlated with HGST levels (r:0.362, p=0.001). Vitamin D levels were found to be an independent predictor of weakness according to HGST in logistic regression analysis (OR: 0.453, 95% Cl:0.138-0.769, p=0.05).

Conclusions

Low vitamin D level is an independent risk factor for muscle weakness in men aged more than 50 years. Therefore, vitamin D levels should be screened and early replacement should be initiated for the sake of improvement of muscle strength in elderly subjects that vulnerable for frailty.

Prevalence of probable sarcopenia in community-dwelling older Swiss people - a cross-sectional study

BACKGROUND

The European Working Group on Sarcopenia in Older People has recently defined new criteria for identifying "(probable) sarcopenia" (EWGSOP2). However, the prevalence of probable sarcopenia, defined by these guidelines, has not been determined extensively, especially in the oldest old. This study aims to determine the prevalence of probable sarcopenia in older, community-living people and its association with strength-related determinants.

METHODS

Handgrip strength and reported determinants (age, height, weight, osteoarthritis of hands, medications, fall history, physical activity, activities of daily living (ADL) and global cognitive function) were collected in a cross-sectional study of 219 community-living Swiss people (75 years and over). Probable sarcopenia was estimated based on cut-off values for handgrip strength as recommended by EWGSOP2. Spearman correlations, binary-regression analyses and contingency tables were used to explore relationships between variables.

RESULTS

The prevalence of probable sarcopenia in women (n = 137, age 84.1 ± 5.7 years) and men (n = 82, age 82.6 ± 5.2 years) was 26.3 and 28.0%, respectively. In women, probable sarcopenia correlated positively with age and falls (rs range 0.332-0.195, p < .05), and negatively with weight, cognition, physical activity, using stairs regularly, participating in sports activities and ADL performance (rs range = - 0.141 - -0.409, p < .05). The only significant predictor of probable sarcopenia at the multivariate level was ADL performance (Wald(1) = 5.51, p = .019). In men, probable sarcopenia was positively correlated with age (rs = 0.33, p < .05) and negatively with physical activity, participation in sports and ADL performance (rs range - 0.221 - - 0.353, p < .05). ADL performance and age (Wald(1) = 4.46, p = .035 and Wald(1) = 6.30, p = .012) were the only significant predictors at the multivariate level. Men and women with probable sarcopenia were 2.8 times more likely to be dependent in ADL than those without.

CONCLUSION

Probable sarcopenia affected one in every four community-living, oldest old people and was independently associated with impaired ADL performance in both sexes. This highlights the importance of detection of handgrip strength in this age group in clinical practice. Although prospective studies are required, independence in ADL might help to protect against probable sarcopenia.

Reference Values and Correlations for Multiple Physical Performance Measures: A Cross-Sectional Study among Independently Mobile Older Men in Japan

Purpose: Japan is one of few countries with a male life expectancy over 80 years. The gap between the healthy life span and the total life expectancy is large, highlighting the importance of maintaining physical performance. The present study aims to establish reference values for multiple physical performance measures among high-functioning oldest-old Japanese men and to investigate the correlations among these measurements to understand how these variables are related. Methods: This study was conducted with 120 Japanese males aged 80 years or older who were able to walk independently. Seven measures of physical performance were assessed: handgrip strength, quadriceps strength, static balance ability (one-legged stance), dynamic balance ability (Functional Reach Test; FRT), walking ability (5-m walking time test), combined movement ability (Timed Up & Go test), and bone quality. Cognitive function was also measured (Mini-Mental State Examination; MMSE). Results: Specific reference values are reported for each physical performance measurement explored in this study. Only six participants were classified as cognitively impaired, and 16 had mild cognitive impairment. There were significant correlations of varying levels among all of the measures of physical performance. Age was significantly correlated with all performance measures except FRT, and there was no correlation between age and MMSE. MMSE was weakly correlated with FRT and unrelated to the other performance measures. Conclusions: The reference ranges can be used by older men who have not yet reached 80 years and their health care providers as physical performance targets to facilitate the maintenance of independent mobility in later life.

Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis

Background Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are essential for independent living and are predictors of morbidity and mortality in older populations. Older adults who are dependent in ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities. The aim of this systematic review and meta-analysis was to determine if muscle measures are predictive of ADL and IADL in older populations. Methods A systematic search was conducted using four databases (MEDLINE, EMBASE, Cochrane, and CINAHL) from date of inception to 7 June 2018. Longitudinal cohorts were included that reported baseline muscle measures defined by muscle mass, muscle strength, and physical performance in conjunction with prospective ADL or IADL in participants aged 65 years and older at follow-up. Meta-analyses were conducted using a random effect model. Results Of the 7760 articles screened, 83 articles were included for the systematic review and involved a total of 108 428 (54.8% female) participants with a follow-up duration ranging from 11 days to 25 years. Low muscle mass was positively associated with ADL dependency in 5/9 articles and 5/5 for IADL dependency. Low muscle strength was associated with ADL dependency in 22/34 articles and IADL dependency in 8/9 articles. Low physical performance was associated with ADL dependency in 37/49 articles and with IADL dependency in 9/11 articles. Forty-five articles were pooled into the meta-analyses, 36 reported ADL, 11 reported IADL, and 2 reported ADL and IADL as a composite outcome. Low muscle mass was associated with worsening ADL (pooled odds ratio (95% confidence interval) 3.19 (1.29-7.92)) and worsening IADL (1.28 (1.02-1.61)). Low handgrip strength was associated with both worsening ADL and IADL (1.51 (1.34-1.70); 1.59 (1.04-2.31) respectively). Low scores on the short physical performance battery and gait speed were associated with worsening ADL (3.49 (2.47-4.92); 2.33 (1.58-3.44) respectively) and IADL (3.09 (1.06-8.98); 1.93 (1.69-2.21) respectively). Low one leg balance (2.74 (1.31-5.72)), timed up and go (3.41 (1.86-6.28)), and chair stand test time (1.90 (1.63-2.21)) were associated with worsening ADL. Conclusions Muscle measures at baseline are predictors of future ADL and IADL dependence in the older adult population.

Correlation between Health-Related Quality of Life and Hand Grip Strength among Older Adults

Background: With advanced age, the progressive loss of muscle strength estimated by the handgrip strength (HGS) may result in a poorer health-related quality of life (HRQoL). Studying this association becomes a vital area of research for promoting aging-well. The aim of this study was to examine the correlation between HRQoL and HGS among community-dwelling older adults above 60 years old.Methods: Participants comprised of 176 older adults (mean age: 68.15 ± 6.74). The HGS was tested with Jamar® Dynamometer, and the EuroQuol-5 Dimensions 5Levels (EQ-5D-5L) questionnaire was used to assess HRQoL.Results: Both HGS and HRQoL were negatively correlated with age (p < .001). Lower values of HGS and HRQoL were recorded among older adults who had diagnosed with one or more chronic diseases (p < .001). Significant correlations were recorded between HGS and functioning, and subjective well-being domains of EQ-5D-5L. A relatively higher association was recorded between the functioning variables of EQ-5D-5L and HGS compared to subjective well- being variables.Conclusion: Handgrip strength is a simple and practical measure in identifying older adults at risk of physical decline. Maintaining handgrip strength may contribute to improving HRQoL, and can add an imperative dimension to promote aging-well in older adults ≥60 years old.

Assessing Low Skeletal Mass in Patients Undergoing Hip Surgery: The Role of Sonoelastography

Purpose

To analyze the utility of sonoelastography—a radiation-free procedure to characterize muscle properties—as an instrument to qualitatively and quantitatively assess the rectus femoris muscle.

Materials and Methods

Fifty-one consecutive patients who underwent a pelvic computed tomography (CT) exam were enrolled prospectively. The final analysis was conducted using data from 39 patients after 12 were removed due to exclusion criteria (muscle strength could not be measured due to poor cognition [n=11]; too young [n=1]). The potential correlation between average Hounsfield unit (HFU) at the rectus femoris muscle (measured by CT) and muscle quality grade (determined by sonoelastography) was assessed along with a retrospective analysis of the relationship between hand grip strength, knee extensor power, history of intensive care unit stay, length of hospital day and sonoelastographic grade.

Results

There was a significant correlation between sonoelastographic grade and the average HFU (P<0.001). Furthermore, hand grip strength (P<0.001) and knee extensor power (P<0.001) decreased significantly as the sonoelastographic grade increased. The likelihood of an intensive care unit stay and prevalence of low skeletal mass increased significantly with an increase in sonoelastography grade (P=0.037, P<0.001, respectively). The sensitivity, specificity, and accuracy of sonoelastographic images for predicting low skeletal mass were 77.3%, 100%, and 87.5%, respectively.

Conclusion

Sonoelastography advantages, including the lack of radiation and greater accessibility, may make it a valuable alternative to qualitatively and quantitatively identify sarcopenia and low skeletal mass.

Physical Activity and Fitness in White- and Blue-Collar Retired Men

The average life expectancy has increased and despite a distinct feminization of aging, the number of older males continues to grow. Physical activity has a positive effect on health and helps to slow down the negative consequences of aging. The aim of the study was to evaluate possible relationships between physical fitness, physical activity and type of work during occupational activity among retired men (aged ≥65 years), no longer professionally active. The study included 104 men (aged from 65 to 90 years), further stratified into blue- and white-collar groups (66 and 38 subjects, respectively). The International Physical Activity Questionnaire (IPAQ) was used to assess their physical activity levels. Physical performance was assessed using the Short Physical Performance Battery test (SPPB) and handgrip strength (HGS) measurement. Geriatric Depression Scale (GDS) was used to identify the risk for depression. Mean physical activity in the study population was moderate in almost 70%, high in 19% and low in 11% of the subjects. Men with high physical activity levels had better SPPB and GDS scores (p = .01 and p = .001, respectively). In the blue-collar group, the IPAQ scores were lower than in the white-collar group, although the differences were statistically insignificant. The SPPB scores and mean HGS for the dominant hand were similar in both groups. Occupational physical activity should not substitute other forms of physical activity. Regardless of the type of work performed before retirement, the men obtained similar results in terms of their physical activity.

Handgrip Strength Cut-Off Values for the Undernutrition Risk Screening among Elderly Men and Women in Bosnia and Herzegovina

OBJECTIVES

To determine the optimal cut-off points of handgrip strength (HGS) to identify the undernutrition risk among individuals older than 65 years of age in Bosnia and Herzegovina.

DESIGN

Cross-sectional study.

SETTING

Towns of Sarajevo, Foca, Rogatica, and Pale in Bosnia and Herzegovina.

PARTICIPANTS

300 community-dwelling older adults and 146 nursing home residents. Comprehensive Geriatric multidimensional assessment (CGA) was carried out to evaluate general health, functional, and cognitive capabilities. Nutritional status and undernutrition risk were assessed by Mini Nutritional Assessment (MNA) and Seniors in the Community: risk evaluation for eating and nutrition, version II (SCREEN II). HGS was measured with a Smedley dynamometer.

RESULTS

According to the classification of nutritional status by MNA, 42% of community-dwelling men and 39% of community-dwelling women were at undernutrition risk. The undernutrition risk was significantly higher among nursing home residing men (89%) and women (78%) (p < 0.001). When nutritional status was assessed by SCREEN II, 100% on nursing home residents, 86% of community-dwelling men and 80% of women were identified as having a high risk for undernutrition. Per MNA, HGS cut-off thresholds were 23.50 kgF (65-74 years) and 19.50 kgF (≥75 years) for men; 15.50 kgF (65-74 years) and 13.50 kgF (≥75 years) for women. Per SCREEN II, cut-points were 28.50 kgF (65-74 years) and 24.50 kgF (≥75 years) for men; 24.50 kgF (65-74 years), 19.50 kgF (≥75 years for women).

CONCLUSION

HGS can be a useful instrument to identify undernutrition risk among the elderly patients. This study provides threshold for men and women older than 65 years of age in Bosnia and Herzegovina.

Associations between grip strength and generalized anxiety disorder in older adults: Results from the Irish longitudinal study on ageing

BACKGROUND

Associations between grip strength and mental health disorders have been established; however, associations between grip strength and Generalized Anxiety Disorder (GAD) remain unstudied. Therefore, this study investigates associations between grip strength and prevalent and incident GAD.

METHODS

A prospective cohort design was utilized. At baseline, participants aged ≥50 years (N = 3,952) completed a hand grip strength assessment and abbreviated Penn State Worry Questionnaire (PSWQ) and were divided into sex-specific tertiles based on strength. A score of ≥23 on the PSWQ defined caseness of GAD. At two-year follow-up, GAD was assessed with the Composite International Diagnostic Interview-Short Form.

RESULTS

Prevalence and incidence of GAD were 18.2% (N = 718) and 0.9% (N = 29), respectively. Adjusting for age, sex, waist circumference, social class, smoking status, and physical activity, a one-standard-deviation (1-SD) increase in strength was associated (OR, 95%CI) with 12.1% (OR = 0.88, 0.80-0.96; p < 0.01) lower odds of prevalent GAD, and middle and high strength tertiles were associated with 27.3% (OR = 0.73, 0.59-0.89; p < 0.01) and 23.1% (OR = 0.77, 0.62-0.95; p < 0.05) lower odds, respectively. A 1-SD increase in strength was non-significantly associated with 24.2% (OR = 0.76, 0.50-1.14) lower odds of incident GAD, and middle and high strength tertiles were non-significantly associated with 31.4% (OR = 0.69, 0.30-1.58) and 66.5% (OR = 0.34, 0.11-1.00) lower odds, respectively (all p > 0.05). There was no significant interaction between strength tertiles and sex.

LIMITATIONS

The observational nature of the study limits inferring causality.

CONCLUSIONS

Increased hand grip strength may be associated with lower odds of developing GAD in older adults. Larger investigations of prospective associations are needed.

Is muscle mechanical function altered in polycystic ovary syndrome?

PURPOSE

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women of reproductive age. The aim of the current study was to assess muscle mechanical function in PCOS and its relationship with hormonal and metabolic features of the syndrome.

METHODS

The study included 44 women with PCOS, all having clinical or biochemical hyperandrogenism, chronic oligo-anovulation and PCOM, and 32 age- and BMI-matched healthy women. Anthropometric, hormonal and biochemical measurements were performed. Muscle mechanical function including lower limb explosive strength and average power (AvP) was measured using isokinetic dynamometry, a valid and reliable instrument for measuring muscle strength.

RESULTS

The mean age and BMI of the women with PCOS and controls were 21.8 ± 3.2 versus 22.8 ± 3 years and 26.1 ± 5.4 versus 25.5 ± 5.7 kg/m², respectively (p = NS for both). PCOS patients had higher androgen levels, whereas total and regional fat and lean body mass and insulin resistance parameters were similar between the groups. The peak muscle force output defined as the peak torque of knee extensor and flexor muscles was higher in normal weight women compared to overweight and obese (p < 0.05 for both) but did not differ in patients and controls. AvP determined by the time-averaged integrated area under the curve at 60°/s angular velocity was higher in the PCOS group for extension and flexion (50.3 ± 21.2 vs 42.1 ± 11.6 and 35.3 ± 27 vs 22.2 ± 11.1, respectively, p < 0.05 for both). These measurements were correlated with bioavailable testosterone (r = 0.29, p = 0.012, r = 0.36, p = 0.001, respectively).

CONCLUSION

Muscle mechanical function is altered in PCOS. Women with PCOS have increased average lower limb power that is associated with hyperandrogenism.

Multidomain Geriatric Screen and Physical Fitness Assessment Identify Prefrailty/Frailty and Potentially Modifiable Risk Factors in Community-Dwelling Older Adults

Introduction: Frailty begins in middle life and manifests as a decline in functional fitness. We described a model for community frailty screening and factors associated with prefrailty and frailty and fitness measures to distinguish prefrail/frail from robust older adults. We also compared the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale against Fried frailty phenotype and Frailty Index (FI). Materials and Methods: Community-dwelling adults >55 years old were designated robust, prefrail or frail using FRAIL. The multidomain geriatric screen included social profiling and cognitive, psychological and nutritional assessments. Physical fitness assessments included flexibility, grip strength, upper limb dexterity, lower body strength and power, tandem and dynamic balance and cardiorespiratory endurance. Results: In 135 subjects, 99 (73.3%) were robust, 34 (25.2%) were prefrail and 2 (1.5%) were frail. After adjusting for age and sex, depression (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.05-7.90; P = 0.040) and malnutrition (OR, 6.07; 95% CI, 2.52-14.64; P<0.001) were independently associated with prefrailty/frailty. Prefrail/frail participants had significantly poorer performance in upper limb dexterity (P = 0.030), lower limb power (P = 0.003), tandem and dynamic balance (P = 0.031) and endurance (P = 0.006). Except for balance and flexibility, all fitness measures differentiated prefrail/frail from robust women. In men, only lower body strength was significantly associated with frailty. Area under receiver operating characteristic curves for FRAIL against FI and Fried were 0.808 (0.688-0.927, P <0.001) and 0.645 (0.546-0.744, P = 0.005), respectively. Conclusion: Mood and nutrition are targets in frailty prevention. Physical fitness declines early in frailty and manifests differentially in both genders. Key words: Elderly, Frail, Function

VALIDITY OF HAND-HELD DYNAMOMETRY IN MEASURING QUADRICEPS STRENGTH AND RATE OF TORQUE DEVELOPMENT

BACKGROUND

A hand-held dynamometer (HHD) offers a reliable and valid method to quantify quadriceps strength in a clinical environment. While measures of peak strength provide functional insights, most daily activities are performed quickly and do not require maximum strength. Rate of torque development (RTD) measures better reflect both the demands of daily activity and athletic movements. The capacity to obtain RTD measures in clinical settings is possible with an HHD, but the validity of RTD measures has not been quantified.

HYPOTHESIS/PURPOSE

To determine the validity of an HHD to measure quadriceps isometric strength metrics compared to isometric strength measures obtained on an isokinetic dynamometer. It was hypothesized that the HHD would be a valid measure of peak torque and RTD at all time intervals when compared to the isokinetic dynamometer.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Twenty healthy participants (12 male, 8 female) (age = 23.7 ± 2.9 years, height = 174.6 ± 10.1 cm, mass = 76.4 ± 15.9 kg, and Tegner = 6.7 ± 1.2) performed maximum isometric quadriceps contractions on an isokinetic dynamometer and with an HHD. Outcome measures included quadriceps peak torque and RTD at three intervals (0-100, 0-250 ms, and average). Pearson product-moment correlation coefficients and Spearman's rank correlation coefficient were used to determine relationships between devices. Bland-Altman Plots with Limits of Agreement (LOA) calculations were used to quantify systematic bias between measurement techniques.

RESULTS

There was a significant correlation between the isokinetic dynamometer and the HHD for peak torque (p<.001, r = .894) and all RTD measurements (p<.002, r = .807; ρ = .502-.604). Bland-Altman plot LOA indicated the HHD overestimated peak torque values (19.4 ± 53.2 Nm) and underestimated all RTD measurements (-55.2 ± 190.7 Nm/s to -265.2 ± 402.6 Nm/s).

CONCLUSION

These results show it is possible to obtain valid measures of quadriceps peak torque and late RTD using an HHD. Measures of early RTD and RTDAvg obtained with an HHD were more variable and should be viewed with caution.

LEVEL OF EVIDENCE

Diagnostic, Level 3.

Comparison of computed tomographic attenuation values for epaxial muscles in old and young dogs

OBJECTIVE To determine whether the degree of CT attenuation of muscle would differ between healthy old and young dogs. ANIMALS 10 healthy old (> 8 years old) and 9 healthy young (1 to 5 years old) Labrador Retrievers with a body condition score of 5 or 6 on a 9-point scale. PROCEDURES CT was performed with the dogs mildly sedated. A freehand closed polygon tool was used to define the outer margin of the left epaxial muscles on each transverse image obtained from the cranial to caudal endplates of T13. The CT attenuation values from every voxel from within these regions of interest were exported from DICOM software as a single dataset in an extensible markup language file. From these data, mean CT attenuation values were calculated for each dog and these mean values were compared between age groups. RESULTS Mean CT attenuation values for the epaxial muscles were significantly lower in old dogs than in young dogs. A significant negative correlation (r = -0.74) was identified between mean CT attenuation values and dog age. CONCLUSIONS AND CLINICAL RELEVANCE In addition to loss of skeletal muscle mass, low muscle CT attenuation values suggested that the old dogs in this study also had greater muscle fat content than did young dogs. Additional studies are warranted to evaluate qualitative and quantitative muscle changes in old dogs.

The Influence of Upper and Lower Extremity Strength on Performance-Based Sarcopenia Assessment Tests

The optimal management of sarcopenia requires appropriate endpoint measures to determine intervention efficacy. While hand grip strength is a predictor of morbidity and mortality, lower extremity strength may be better associated with functional activities in comparison to hand grip strength. The purpose of our study was to examine the comparative association of upper and lower extremity strength with common measures of physical performance in older adults. Thirty community-dwelling men, aged 62.5 ± 9.2 years, completed body composition analysis, quantitative strength testing, and performance-based tests of functional status. Hand grip force values were not significantly associated with knee extensor or flexor torque values (p > 0.05). Hand grip force was only associated with fast gait speed, while knee extensor torque at 60°/s was the only variable significantly associated across all functional outcome measures: customary gait speed, fast gait speed, sit to stand time, and the Physical Performance Test (p < 0.02). Hand grip strength was not a proxy measure of lower extremity strength as assessed in this study. Overall, lower extremity muscle strength values had the strongest associations with participant functional performance. Lower extremity strength testing may provide additional value as an endpoint measure in the assessment and clinical management of sarcopenia.

Handgrip Strength and Its Associated Factors among Community-dwelling Elderly in Sri Lanka: A Cross-sectional Study

PURPOSE

Low muscle strength is central to geriatric physical disabilities and mortality. The purpose of the present study was to examine handgrip strength (HGS) and its associated factors among community-dwelling older people in Sri Lanka.

METHODS

A cross-sectional study was conducted in the Kandy district using multistage sampling. A total of 999 older people were recruited, with a female preponderance. Data were collected using interviewer-administered questionnaires on demographic characteristics, depression, and physical activity. Anthropometric measurements including weight, height, mid-upper arm circumference, calf circumference, and HGS were recorded. Complex sample general linear model was used to examine the association between HGS and its associated factors.

RESULTS

The mean highest HGS of the study group was 12.56 kg (95% confidence interval: 11.94-13.19). Male older people had a higher HGS (17.02, 95% confidence interval: 15.55-18.49 kg) than females (10.59, 95% confidence interval: 10.12-11.06 kg). For both men and women, older age was associated with lower HGS, while mid-upper arm circumference was associated with better HGS. Diabetes mellitus, vegetarian diet, and alcohol consumption were associated with HGS for women only.

CONCLUSION

Men had a higher HGS compared with women. Age, mid-upper arm circumference, diabetes mellitus, vegetarian diet, and alcohol consumption were factors associated with HGS among community-dwelling older people in Kandy district, Sri Lanka. HGS can be used as a feasible strategy to improve health status of older people by community health nurses.

Handgrip Strength Cannot Be Assumed a Proxy for Overall Muscle Strength

OBJECTIVES

Dynapenia, low muscle strength, is predictive for negative health outcomes and is usually expressed as handgrip strength (HGS). Whether HGS can be a proxy for overall muscle strength and whether this depends on age and health status is controversial. This study assessed the agreement between HGS and knee extension strength (KES) in populations differing in age and health status.

DESIGN

Data were retrieved from 5 cohorts.

SETTING AND PARTICIPANTS

Community, geriatric outpatient clinics, and a hospital. Five cohorts (960 individuals, 49.8% male) encompassing healthy young and older individuals, geriatric outpatients, and older individuals post hip fracture were included.

MEASURES

HGS and KES were measured according to the protocol of each cohort. Pearson correlation was performed to analyze the association between HGS and KES, stratified by sex. HGS and KES were standardized into sex-specific z scores. The agreement between standardized HGS and standardized KES at population level and individual level were assessed by intraclass correlation coefficients (ICC) and Bland-Altman analysis.

RESULTS

Pearson correlation coefficients were low in healthy young (male: 0.36 to 0.45, female: 0.45) and healthy older individuals (male: 0.35 to 0.37, female: 0.44), and moderate in geriatric outpatients (male and female: 0.54) and older individuals post hip fracture (male: 0.44, female: 0.57) (P < .05, except for male older individuals post hip fracture [P = .07]). Intraclass correlation coefficient values were poor to moderate in all populations (ie, healthy young individuals [0.41, 0.45], healthy older individuals [0.37, 0.41, 0.44], geriatric outpatients [0.54], and older individuals post hip fracture [0.54]). Bland-Altman analysis showed that within the same population of age and health status, agreement between HGS and KES varied on individual level.

CONCLUSIONS

At both population and individual level, HGS and KES showed a low to moderate agreement independently of age and health status. HGS alone should not be assumed a proxy for overall muscle strength.

Knee extension strength measurements should be considered as part of the comprehensive geriatric assessment

BACKGROUND

Comprehensive geriatric assessment (CGA) generally includes handgrip strength (HGS) as a measure of overall muscle strength that is associated with various health characteristics in geriatric outpatients. Whether this is also true for knee extension strength (KES) is yet unknown. This study aims to compare the associations between health characteristics from the CGA with both HGS and KES in geriatric outpatients.

METHODS

Data were retrieved from a cross-sectional study. A total of 163 community-dwelling older adults referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Health characteristics included physical, nutritional, social, psychological, diseases, cognitive, and behavioural factors. HGS and KES were assessed three times for each limb and the best performance was used for analysis. Sex-specific z-scores of HGS and KES were used to allow comparison of effect estimates. Associations between health characteristics with standardized HGS and KES were analysed with linear regression adjusted for age, sex and further adjustment for standardized KES (for model of HGS) or standardized HGS (for model of KES).

RESULTS

Physical, nutritional and psychological health characteristics were positively associated with both HGS and KES after adjustment for age and sex, with overall stronger associations with KES compared to HGS. All significant associations with HGS were lost after further adjustment for KES; significant associations with KES remained after further adjustment for HGS, except for nutritional characteristics.

CONCLUSIONS

Stronger associations of health characteristics with KES compared to HGS indicate its additional value and therefore inclusion of KES in the CGA is recommended.

Association between handgrip strength, balance, and knee flexion/extension strength in older adults

The objective of the study was to examine the association between handgrip strength (HGS), knee flexion and extension strength, and static and dynamic balance in older women. One hundred and ten women with a mean age of 67.4±5.9 years were assessed for dynamic postural balance using the Time Up & Go Test (TUG) with and without cognitive tasks. Semi-static balance was assessed by means of a force platform; knee flexor and extensor muscle strength was calculated using an isokinetic dynamometer; and HGS using a hand held dynamometer. Weaker HGS was significantly correlated with worse performance in dynamic postural balance, as well as performance with TUG with and without cognitive tasks; however, there was no correlation between HGS and static balance. There was a moderate positive correlation between knee flexion/extension strength and HGS. This suggests that HGS could be used as a proxy indicator of overall strength capacity for clinical screening among older women.

Diagnostic Criteria and Clinical Outcomes in Sarcopenia Research: A Literature Review

By the sixth decade of life, nearly one quarter of the population has substantial muscle atrophy, or sarcopenia. Despite the creation of a standardized definition of sarcopenia by the European Working Group on Sarcopenia in Older People, variability may exist in the diagnostic criteria utilized for clinical sarcopenia research. The primary objectives of this review were to characterize diagnostic criteria used for measurement of sarcopenia in original studies, and to describe associations between sarcopenia and important clinical outcomes. We performed a literature review of the term “sarcopenia” in PubMed. Inclusion criteria were English language, original data, a clear and specific definition for diagnosing sarcopenia, and the analysis of sarcopenia’s effect on a clinical outcome. A total of 283 studies met inclusion criteria. More than half of the included sarcopenia investigations were level IV studies (54.1%), while 43.1% provided level II evidence. Under one third (27.6%) of studies examined sarcopenia with regard to surgical outcomes. In terms of diagnostic criteria for sarcopenia, 264 (93.3%) studies used measures of skeletal muscle mass, with dual energy X-ray absorptiometry (DEXA) being the most common modality (43.6%). Sarcopenia was found to be a consistent predictor of chronic disease progression, all-cause mortality, poorer functional outcomes, and postoperative complications. In conclusion, there is substantial evidence that sarcopenia impacts both medical and surgical outcomes. However, current research has utilized heterogeneous diagnostic criteria for sarcopenia. Further efforts to standardize the modalities used to diagnose sarcopenia in clinical research and practice will help strengthen our ability to study this important phenomenon.

Prevalence of clinically relevant muscle weakness and its association with vitamin D status among older adults in Ecuador

BACKGROUND

Muscle weakness and 25-hydroxyvitamin D (25(OH)D) deficiency have been associated with adverse outcomes among older adults. However, little is known about the relationship between clinically relevant muscle weakness and 25(OH)D levels in Ecuador.

AIMS

To examine the prevalence of muscle weakness and its association with 25(OH)D status among subjects aged 60 years and older in Ecuador.

METHODS

The present study was based on data from 2205 participants in the first National Survey of Health, Wellbeing, and Aging. The Foundation for the National Institute of Health Sarcopenia Project criteria was used to examine muscle weakness prevalence rates. Gender-specific general linear and logistic regression models adjusted for potential confounders were created to compare mean 25(OH)D concentrations and 25(OH)D deficiency across muscle strength categories, respectively.

RESULTS

An estimated 32.2% of women and 33.4% of men had evidence of clinically relevant muscle weakness in Ecuador. In general, increased muscle weakness prevalence rates were present among Indigenous, residents in the rural Andes Mountains, underweight subjects, and those with a sedentary lifestyle. Muscle strength was significantly and directly correlated with mean 25(OH)D levels. After controlling for potential confounders, 25(OH)D deficiency prevalence rates were 31 and 43% higher among men and women with muscle weakness than those with normal strength, respectively.

CONCLUSIONS

One-third of older adults nationwide had evidence of muscle weakness. While the present study found a significant correlation between muscle strength and 25(OH)D concentrations, further research is needed to examine whether optimizing 25(OH)D levels may improve muscle weakness among older adults.

Instrumented Assessment of Physical Activity Is Associated With Muscle Function but Not With Muscle Mass in a General Population

OBJECTIVES

Self-reported physical activity has shown to affect muscle-related parameters. As self-report is likely biased, this study aimed to assess the association between instrumented assessment of physical activity (I-PA) and muscle-related parameters in a general population.

METHOD

Included were 156 young-to-middle-aged and 80 older community-dwelling adults. Seven days of trunk accelerometry (DynaPort MoveMonitor, McRoberts B.V.) quantified daily physical activity (i.e., active/inactive duration, number and mean duration of active/inactive periods, and number of steps per day). Muscle-related parameters included muscle mass, handgrip strength, and gait speed.

RESULTS

I-PA was associated with handgrip strength in young-to-middle-aged adults and with gait speed in older adults. I-PA was not associated with muscle mass in either age group.

DISCUSSION

The association between I-PA and muscle-related parameters was age dependent. The lack of an association between I-PA and muscle mass indicates the relevance of muscle function rather than muscle mass.

Handgrip strength is associated with, but poorly predicts, disability in older women with acute low back pain: A 12-month follow-up study

BACKGROUND

Older women with low back pain (LBP) constitute a special subpopulation at risk of severe and permanent disability. It is important to identify factors limiting functionality in this population in order to reduce costs and improve both prevention and intervention. Handgrip strength (HGS) is a biomarker of aging associated with several adverse health outcomes, but long-term associations with disability in older patients with LBP are not known.

OBJECTIVE

To examine whether HGS predicts disability in older women with acute low back pain (LBP).

METHODS

Longitudinal analyses were conducted with a sample of 135 older women from the international multicenter study Back Complaints in the Elders (BACE-Brazil). Women aged 60 years and over with a new episode of acute LBP were included. HGS was assessed with Jamar^® dynamometer, and disability was assessed using the Roland Morris questionnaire and gait speed test. Variables were assessed at baseline and at 12-month follow-up. Linear regression models explored associations between HGS and disability measures.

RESULTS

Significant association was found between HGS at baseline and gait speed at 12-month follow-up (r=-0.24; p=0.004). A multivariable-adjusted model showed that this association was independent of age, body mass index, and pain intensity (adjusted R²=0.13; p<0.001). A final prediction model showed an incremental difference of only 2.1% in gait speed after inclusion of HGS as an independent variable. No association was found between HGS and score on the Roland Morris questionnaire.

CONCLUSION

Caution is needed regarding the use of HGS as a predictive measure of disability in older women with acute LBP. Changes in gait speed were very small and unlikely to be of clinical relevance.

Subtypes of physical frailty: Latent class analysis and associations with clinical characteristics and outcomes

Frailty is a well-recognized geriatric syndrome with various definitions and conceptual frameworks. This study aimed to use latent class analysis to discover potential subtypes of pre-frail and frail older people. Data from the I-Lan Longitudinal Aging Study (ILAS), a community-based cohort study was used for analysis. Latent class analysis was applied to characterize classes or subgroups with different frailty phenotypes among ILAS participants targeting older adults aged 65 and above, capable of completing a 6-meter walk, without severe major or life threatening diseases, and not institutionalized. Latent class analysis identified three distinct subgroups with different frailty phenotypes: non-mobility-type (weight loss and exhaustion), mobility-type frailty (slowness and weakness), and low physical activity. Comparing these groups with the robust group, people with mobility-type frailty had poorer body composition, worse bone health, poorer cognitive function, lower survival (hazard ratio: 6.82, p = 0.019), and poorer overall health outcomes (hazard ratio: 1.67, p = 0.040). People in the non-mobility-type group had poorer bone health and more metabolic serum abnormalities. In conclusion, mobility-type frailty was a better predictor of adverse outcomes. However, further investigation is needed to evaluate how these phenotypic subgroups may help in predicting prognosis or in developing interventions.

Standardized Method to Measure Muscle Force at the Bedside in Hemodialysis Patients

OBJECTIVES

In hemodialysis, diminution of muscle strength constitutes a major prognostic factor of mortality. Currently, measurement of quadriceps isometric maximal voluntary force (MVF) represents the reference method to investigate muscle strength. However, reduction of MVF is rarely detected in these patients due to the absence of portative bedside tools in clinical practice. The purposes of this study were therefore to assess the agreement of a belt-stabilized handheld dynamometer (HHD) with the dynamometer chair (reference method) and to determine intratester and intertester reliability of the quadriceps MVF measurements using belt-stabilized HHD in healthy subjects and in hemodialysis patients.

DESIGN

Repeated-measures cross-sectional study.

SETTING

Clinical and academic hospital.

PARTICIPANTS

Fifty-three healthy adult subjects (23 males, 36.5 + 12.5 y.o.) and 21 hemodialysis patients (14 males, 72.4 + 13.3 y.o., dialysis vintage 30 + 75.1 months).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURE

MVF measurements were assessed with belt-stabilized HHD and dynamometer chair, by two independent investigators. The agreement between the two devices would be quantified using the Bland-Altman 95% limits of agreement (LOA) method and the Spearman correlation.

RESULTS

For healthy subjects and hemodialysis patients, Spearman coefficients between belt-stabilized HHD and dynamometer chair were 0.63 and 0.75, respectively (P < .05). In hemodialysis group, reliability was excellent for both the intratester and intertester reliability R² = 0.85 (P < .01) and R² = 0.90 (P < .01), respectively. In all individuals, the mean difference between the dynamometer chair and the belt-stabilized HHD was -13.07 ± 21.77 N.m. (P < .001). The LOA for the upper and the lower was 29.59 and -55.73 N.m., respectively.

CONCLUSION

In healthy subjects and in hemodialysis patients, the belt-stabilized HHD dynamometer appears as a valid and reliable method to measure in clinical practice isometric MVF of quadriceps in hemodialysis patients. Therefore, the belt-stabilized HHD appears as a suitable and a relevant diagnostic tool for the identification of muscle dysfunction in hemodialysis patients.

Effects of short-term Nordic walking training on sarcopenia-related parameters in women with low bone mass: a preliminary study

Background

Several studies have demonstrated the positive effects of physical activity on skeletal muscle mass and muscle strength in women with osteoporosis. However, the impact of Nordic walking training on sarcopenia-related parameters in women with low bone mass remains unknown. Therefore, the purpose of this study was to evaluate the impact of 12 weeks of Nordic walking training on skeletal muscle index, muscle strength, functional mobility, and functional performance in women with low bone mass.

Materials and methods

The participants were 45 women, aged 63–79 years, with osteopenia or osteoporosis. The subjects were randomly assigned either to an experimental group (12 weeks of Nordic walking training, three times a week) or to a control group. Skeletal muscle mass and other body composition factors were measured with octapolar bioimpedance InBody 720 analyser. Knee extensor and flexor isometric muscle strength were measured using Biodex System 4 Pro™ dynamometers. This study also used a SAEHAN Digital Hand Dynamometer to measure handgrip muscle strength. The timed up-and-go test was used to measure functional mobility, and the 6-minute walk test was used to measure functional performance.

Results

Short-term Nordic walking training induced a significant increase in skeletal muscle mass (P=0.007), skeletal muscle index (P=0.007), strength index of the knee extensor (P=0.016), flexor (P<0.001), functional mobility (P<0.001), and functional performance (P<0.001) and a significant decrease in body mass (P=0<006), body mass index (P<0.001), and percent body fat (P<0.001) in participants. Regarding handgrip muscle strength, no improvement was registered (P=0.315). No significant changes in any of the analyzed parameters were observed in the control group.

Conclusion

Overall, short-term Nordic walking training induces positive changes in knee muscle strength and functional performance in women with low bone mass. This finding could be applied in clinical practice for intervention programs in women with osteopenia and osteoporosis.

Effect of Sarcopenia on Postoperative Morbidity and Mortality After Thoracolumbar Spine Surgery

Sarcopenia is the loss of muscle mass associated with aging and advanced disease. This study retrospectively examined patients older than 55 years (N=46) who underwent thoracolumbar spine surgery between 2003 and 2015. Each patient's comorbidity burden was determined using the Charlson Comorbidity Index, and the Mirza Surgical Invasiveness Index was used to measure procedural complexity. Sarcopenia was diagnosed by measuring the total cross-sectional area of the psoas muscle at the L4 vertebrae using perioperative computed tomography scans. Of the 46 patients assessed, 16 were in the lowest third for L4 total psoas area (sarcopenic). Average follow-up time was 5.2 years (range, 6 days to 12.7 years). The cohort of patients with sarcopenia was significantly older than the cohort without sarcopenia (mean age, 76.4 vs 69.9 years; P=.01) but did not have a significantly different mean Charlson Comorbidity Index (3.3 vs 2.0; P=.32) or mean Mirza Surgical Invasiveness Index (7.1 vs 7.0; P=.49). Patients with sarcopenia had a hospital length of stay 1.7-fold longer than those without sarcopenia (8.1 vs 4.7 days; P=.02) and a 3-fold increase in postoperative in-hospital complications (1.2 vs 0.4; P=.02), and they were more likely to require discharge to a rehabilitation or nursing facility (81.2% vs 43.3%; P=.006). Patients with sarcopenia had a significantly lower cumulative survival (log rank=0.007). All 4 deaths occurred among patients with sarcopenia. Patients with sarcopenia have a significantly increased risk of in-hospital complications, longer length of stay, increased rates of discharge to rehabilitation facilities, and increased mortality following thoracolumbar spinal surgery, making sarcopenia a useful perioperative risk stratification tool. [Orthopedics. 2016; 39(6):e1159-e1164.].