Reference values for hand grip strength in Japanese community-dwelling elderly: a meta-analysis

Relationship Between Malunion and Short-Term Outcomes of Nonsurgical Treatment of Distal Radius Fractures in the Elderly: Differences Between Early- and Late-Geriatric Patients

PURPOSE

Previous studies have suggested little association between radiographic malalignment and long-term functional outcomes of nonsurgical treatment of distal radius fractures in geriatric patients. However, no report has stratified the elderly by age and focused on short-term outcomes. The purpose of this study was to determine how the relationship between malunion and patient outcomes differs between early- and late-geriatric patients in the short and long terms after injury, thereby informing explanations and decision-making on treatment options for geriatric patients with distal radius fractures.

METHODS

One hundred patients treated nonsurgically for distal radius fractures were evaluated retrospectively; 52 were defined as early-geriatric patients (aged 60-72 years) and 48 as late-geriatric (aged >77 years). Malunion (dorsal tilt > 10°, ulnar variance > 3 mm, or intra-articular displacement or step-off > 2 mm), range of motion, and grip strength were investigated at 3 months. Multiple regression analysis was performed for each age group using Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores at 3 months as the dependent variable. QuickDASH scores over 1 year after injury were analyzed in the same way.

RESULTS

The early-geriatric patients included 33 acceptable unions and 19 malunions. The late-geriatric patients included 12 acceptable unions and 26 malunions. The significant predictors of QuickDASH scores at 3 months were malunion for the early-geriatric group and grip strength for the late-geriatric group (standardized coefficient β, 0.31 and -0.49, respectively). No factor significantly predicted the QuickDASH scores after at least 1 year in either group.

CONCLUSIONS

Malunion was associated with worse QuickDASH scores at 3 months after injury in the early-geriatric patients but not in the late-geriatric patients and did not predict the QuickDASH scores at 1 year after injury in either age group.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Reference values for Jamar+ digital dynamometer hand grip strength in healthy adults and in adults with non-communicable diseases or osteoarthritis: the Norwegian Tromsø study 2015-2016

Hand grip strength (HGS) is a key indicator of intrinsic capacity and has shown good predictive ability for morbidity and mortality. Reference values from normative populations are valuable, and such data from the Norwegian population are scarce. Normative values for the digital Jamar+ dynamometer are largely lacking.HGS was assessed in the Norwegian Tromsø study, survey 7 in 2015-2016 for 7824 participants (9324 invited) aged 40+ using a Jamar+ digital dynamometer, and three measurements for each hand were performed following the Southampton protocol. To account for non-response, full Tromsø population data, by age, education and sex, were collected from registry data from microdata.no, a service from Statistics Norway, and were then used as post-stratification weights, to provide standardized HGS values. HGS was higher in men than in women and inversely associated with age. Men and women with a history of non-communicable diseases had lower HGS than those without these conditions, while osteoarthritis was associated with lower HGS only among men. Lower height was associated with lower HGS, especially at younger ages in men. This article provides up-to-date references values for HGS in the community-dwelling population aged 40+ with or without osteoarthritis or non-communicable diseases, in Tromsø, Norway. These reference values will guide clinicians and researchers.

Assessment of handgrip strength in healthy african subjects: Establishing age and gender stratified reference values

Background

The handgrip strength assesses hand function in traumatic and non-traumatic upper extremity conditions. It is also a surrogate marker for other systemic diseases unrelated to the upper limb. Various reference values have been established in different world regions, with few studies in our population.

Aim

To determine the average handgrip strength by gender and age categories among healthy subjects in Nigeria.

Materials and Methods

It was a cross-sectional study assessing handgrip strength by age category (ten-year bin width), gender, and handedness in 210 healthy persons aged 10 to 79 in Nigeria. Its relationship with age, height, weight, mid-arm circumference, triceps skinfold thickness, and mid-arm muscle area was evaluated using multiple linear regression.

Results

The mean handgrip strength in the dominant and non-dominant hands was 31.09 kg and 28.45 kg, respectively, P < 0.001. Males have higher values than females in all age categories. The grip strength peaked in the 30-39-year age group in both genders and declined afterward. Age exhibited a nonlinear pattern but had an overall negative relationship, while height was positively related to grip strength in both genders. In contrast, mid-arm circumference and mid-arm muscle area predicted handgrip strength only in males. Triceps skinfold thickness was excluded from the model because of multicollinearity with the mid-arm muscle area, while weight did not predict grip strength in either gender.

Conclusion

The handgrip strength in this study is less than that in western literature. Hence, test interpretation should reference the values from this study.

Population-based reference values for tongue pressure in Japanese older adults: A pooled analysis of over 5,000 participants

PURPOSE

To establish age- and sex-specific population reference values for tongue pressure (TP) in community-dwelling Japanese older adults.

METHODS

For this analysis, we pooled four population-based studies on community-dwelling adults aged ≥65 years that measured TP using a JMS tongue pressure measuring device. We calculated the means and deciles of TP per 5-year age group for each sex. We also estimated age trends in TP for men and women.

RESULTS

In total, 5,083 individuals (2,150 men and 2,933 women, with a mean [standard deviation] age of 75.2 [6.5] years) were included in the present analysis. In male participants, the mean (standard deviation) TPs for ages 65-69, 70-74, 75-79, 80-84, and ≥85 years were 34.0 (8.4), 32.2 (8.1), 30.8 (8.3), 28.4 (8.9), and 24.4 (8.2) kPa, respectively. In female participants, the corresponding values were 31.5 (7.1), 30.5 (7.5), 29.6 (7.3), 28.4 (8.0), and 26.4 (7.6) kPa, respectively. For both sexes, there were significant declining trends in TP with advanced age. In addition, the interaction between age and sex had a significant effect on TP (regression coefficient [95% confidence interval] = -0.18 [-0.25 to -0.11] when age was modeled as a continuous variable and sex was modeled as a categorical variable [coded as 0=women, 1=men]).

CONCLUSIONS

This study determined age- and sex-specific reference values for TP, presented as means and deciles, in community-dwelling Japanese older adults aged ≥65 years. This study also demonstrated sex differences in age-related declines in TP.

Factors Affecting Functional Recovery After Volar Locking Plate Fixation for Distal Radius Fractures

BACKGROUND

There is still no certainty about factors delaying functional recovery after surgery, although volar locking plate (VLP) fixation is the mainstay of treatment for distal radius fractures (DRFs), and several good postoperative recoveries have been reported. The purpose of this study was to investigate factors affecting functional recovery after VLP fixation for DRF.

METHODS

The subjects included 104 patients (84 females, 20 males, mean age: 63.2 ± 13.8 years) treated with VLP fixation for DRF, who could be followed for 1 year. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and range of motion of the wrist joint were measured at 3, 6, and 12 months postoperatively, and the primary outcome was the QuickDASH score. A multiple regression analysis adjusted for age and sex was used to analyze factors affecting functional recovery at 12 months.

RESULTS

A multiple regression analysis showed that the factors that significantly influenced the QuickDASH score at 1 year postoperatively were the grip strength ratio to the uninjured side, dominancy of the injured hand, and postoperative ulnar variance, in descending order of involvement. Trauma energy, history of diabetes, fracture type, complications, and range of motion were not included in the model.

CONCLUSIONS

Smaller grip strength, dominant-hand injury, and larger postoperative ulnar variance significantly worsened the QuickDASH score at 1 year postoperatively. In order to achieve satisfactory functional recovery at 1 year after surgery, we confirmed that it is important to surgically achieve smaller postoperative ulnar variance and increase grip strength.

Physical performance reference values for Japanese oldest old: a SONIC study

Background

The oldest old, defined as those aged 90 or over, is now the fastest-growing population sector. This study aimed to determine reference values for several physical performance measures (PPMs) among 90-year-olds using internationally standardized measurements and to clarify the characteristics of these indices by comparing their results for 90-year-olds with those for older people 70 and 80.

Methods

We used the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study data from 2010 to 2018. The study subjects were 70, 80, and 90-year-olds in the target area eligible to participate in the venue. Excluding those certified for long-term care, the final number of eligible persons is 70s cohort 1000 (2010), 80s cohort 973 (2011), and 90s cohort 690. 90s cohort only consisted of three survey waves: 2012, 2015, and 2018. We used hand grip strength and score on the Short Physical Performance Battery (SPPB) for our physical performance measurements. In addition, we statistically analyzed sex and age differences.

Result

The simple mean ± standard deviation (SD) for the 90-year-old respondents were in men, 24.1 ± 5.4 kg in hand grip strength, 0.80 ± 0.22 m/s in usual gait speed, 17.2 ± 6.73 s in 5times chair stand, 5.89 ± 4.42 s in tandem balance, and 8.3 ± 2.2 in SPPB respectively and in women, 14.4 ± 4.0 kg in hand grip strength, 0.72 ± 0.20 m/s in usual gait speed, 17.8 ± 7.89 s in 5times chair stand, 4.72 ± 4.35 s in tandem balance, and 7.5 ± 2.4 in SPPB, respectively. For all PPMs, the age 90 cohort was statistically significantly different from the age 70 and 80 cohorts (all trends P <  0.001). Hand grip strength decreased with a similar gradient with age cohort increase of 10 years for both sexes. In contrast, SPPB lower limb score showed a larger drop between the age 80 and 90 cohorts than between the age 70 and 80 cohorts. We also constructed sex-specific appraisal standards according to quintiles.

Conclusions

Our study yielded inclusive sex-specific reference values and appraisal standards for major physical performance measures not certified as requiring long-term care, community-dwelling, oldest old Japanese. The characteristics of age-related decline in physical performance differed between the upper and lower extremity assessments.

Investigation of presenteeism, physical function, and exercise habits in workers with CKD: three case reports with literature review

Management of presenteeism in the context of chronic kidney disease (CKD) is essential for disease management, ensuring the workforce's availability, and reducing health-related costs. The purpose of this case study was to investigate presenteeism, physical function, and exercise habits in three working patients with CKD and discuss their effects. Case 1 was a 71-year-old male security guard; Case 2 was a 72-year-old male agricultural worker; and Case 3 was an 83-year-old male civil engineering employee. Presenteeism was measured using the work functioning impairment scale (WFun), and physical function was measured using grip strength, skeletal muscle mass index, 10 m walk test, short physical performance battery, and exercise habits. The WFun assessment showed that only Case 3 had moderate presenteeism, and the barrier to employment was fatigue. Each value of physical function was higher than the reference value, but Case 3 had the lowest physical function values. All three patients had no exercise habits and were in the interest stage of behavior change. This case report indicates the existence of workers with CKD who need care for presenteeism, even if they have no problems with physical function or activities of daily living. To ensure work productivity in workers with CKD, clinicians may need to evaluate presenteeism, physical function, and exercise habits in addition to popular treatment and care.

Association of circulating calciprotein particle levels with skeletal muscle mass and strength in middle-aged and older adults

Calciprotein particles (CPPs) are tiny mineral-protein aggregates consisting of calcium-phosphate and fetuin-A. Recent studies have suggested that CPPs may contribute to the pathogenesis of chronic inflammation and arteriosclerosis. Reduced skeletal muscle mass and strength reportedly contribute independently to increased serum phosphate levels. This finding suggests that reduced skeletal muscle mass and strength can endogenously induce an increase in circulating CPP levels. Therefore, we investigated the potential association between circulating CPP levels and skeletal muscle mass and strength in middle-aged and older adults. One hundred eighty-two middle-aged and older adults (age, 46-83 years) were included in this cross-sectional study (UMIN000034741). Circulating CPP levels were measured using the gel filtration method. Appendicular skeletal muscle mass was assessed using multifrequency bioelectrical impedance analysis with a tetrapolar eight-point tactile electrode system. The skeletal muscle mass index was calculated from appendicular skeletal muscle mass and height. Handgrip and knee extension strengths were used as measures of skeletal muscle strength. The skeletal muscle mass index was negatively correlated with circulating CPP levels (r = -0.31; P < 0.05). This association remained significant after adjustment for potential covariates (β = -0.34; P < 0.05). In contrast, skeletal muscle strength, represented by handgrip strength and knee extension strength, was not significantly associated with circulating CPP levels. In middle-aged and older adults, a lower skeletal muscle mass index was independently associated with higher circulating CPP levels. The present results suggest that maintaining skeletal muscle mass may prevent an increase in circulating CPP levels.

Impairment in Physical Function and Mental Status in a Survivor of Severe COVID-19 at Discharge from an Acute Care a Hospital: A Case Report

BACKGROUND

Early mobilization and rehabilitation interventions should be provided to patients who survived severe COVID-19 to improve their physical function and activities of daily living (ADL). However, their physical and mental status at discharge has not been well described in Japan. We report the intervention provided for a survivor of severe COVID-19 and his physical and mental status at discharge from an acute care hospital.

CASE REPORT

A 62-year-old man was admitted to our emergency department with a diagnosis of COVID-19 with severe acute respiratory dysfunction. He had complicated intensive care unit-acquired weakness (ICU-AW) and delirium during mechanical ventilation therapy. Rehabilitation intervention was initiated on the seventh day post-admission and was gradually performed according to his respiratory and hemodynamic status. As a result of the rehabilitation intervention, ICU-AW and cognitive function gradually improved. On hospital day 37, he independently performed basic ADL and was discharged. However, he lost approximately 9% of his body weight at discharge. In addition, his hand grip strength and six-minute walking distance were lower and shorter than the reference values, respectively. His mental component summary of the Short Form-8™ was lower than the national standard deviation for the Japanese population.

CONCLUSION

Although survivors of severe COVID-19 who undergo early rehabilitation can be discharged from an acute care hospital, they may have several impairments in their physical and mental status, including muscle function, diffusion capacity, exercise tolerance, and health-related quality of life.

Physical Activity, Sedentary Behavior, and Skeletal Muscle Strength in Patients With Chronic Kidney Disease: An Isotemporal Substitution Approach

OBJECTIVE

Insufficient physical activity and excessive sedentary behavior can contribute to decreased skeletal muscle strength, which is strongly associated with increased mortality in patients with chronic kidney disease (CKD). However, the potential impact of replacing sedentary behavior with physical activity on skeletal muscle strength remains unclear in these individuals. The purpose of this study was to examine the associations of physical activity, sedentary behavior, and skeletal muscle strength in patients with CKD using an isotemporal substitution model to estimate the associations on replacing time from one behavior to another while keeping the total time and other behaviors fixed.

METHODS

A total of 108 patients with CKD (mean age = 65 [SD = 9] y; mean estimated glomerular filtration rate = 57 [SD = 22] mL/min/1.73 m2) participated in this cross-sectional analysis study. The time spent in sedentary behavior, light-intensity physical activity, and moderate- to vigorous-intensity physical activity (MVPA) was assessed using a triaxial accelerometer. Handgrip strength, isometric knee extension strength, and 30-second chair stand test were used to measure skeletal muscle strength.

RESULTS

In multivariate analyses (single-factor and partition models), the time spent in MVPA was beneficially associated with both isometric knee extension strength and 30-second chair stand test. Furthermore, the isotemporal substitution model found that replacing 10 min/d of sedentary behavior or light-intensity physical activity with equivalent MVPA time was beneficially associated with both isometric knee extension strength and 30-second chair stand test.

CONCLUSION

These cross-sectional findings indicate that MVPA time is beneficially associated with lower extremity muscle strength and that a slight increase in the MVPA time may contribute to maintaining skeletal muscle strength in patients with CKD.

IMPACT

Increasing the time spent in MVPA (10 min/d) may be a feasible strategy in patients with CKD who have a high prevalence of impaired physical function.

Association between hand grip strength and stroke in China: a prospective cohort study

OBJECTIVES

The association between weak hand grip strength (HGS) and stroke recovery has been studied; however, few studies focused on the association of HGS with stroke prevalence and incidence.

METHODS

A prospective cohort baseline study of a nationally representative sample in Chinese adults aged 45 years and older in 2011 was followed up in 2015. 8871 participants without stroke at baseline were followed. The associations of HGS and its changes with stroke prevalence and incidence were investigated using logistic regression models and Cox proportional hazards regression models.

RESULTS

Association of HGS and stroke prevalence was significant. HGS weakness significantly increased risk of stroke incidence, with 89.3% higher risk when compared to normal HGS. During 35,263 person-years of follow-up, 112 stroke patients occurred. The four-year incidence rate ratio of stroke for participants with a HGS weakness was 2.15, compared to normal HGS participants. HGS changes in weakness/weakness from 2011 to 2015(D-HGS) and normal/weakness D-HGS had higher risks of stroke incidence when compared with those who had normal/normal D-HGS.

CONCLUSIONS

HGS weakness and decline of HGS were associated with stroke incidence for adults aged 45 years and older in China.

Association between serum sodium level within normal range and handgrip strength in relation to hypertension status: a cross-sectional study

Serum sodium concentration within the normal range could act as an indicator of age-related changes such as decrease in muscle strength and impairment of capillary function. Since endothelial injury stimulates endothelial repair by enhancing CD34-positive cell production, the level of serum sodium may be inversely associated with that of circulating CD34-positive cells, thus indicating the degree of age-related endothelial injury. We conducted a cross-sectional study of 246 elderly Japanese men aged 60–69 years. Subjects were stratified by hypertension status because hypertension should act as a strong confounding factor for the analyses performed in this study. Serum sodium concentration was positively associated with handgrip strength in non-hypertensive subjects [standardized parameter estimate (β) = 0.29; p = 0.003], but not for hypertensive subjects (β = 0.01; p = 0.878), while it was inversely associated with circulating CD34-positive cell levels in non-hypertensive subjects [simple correlation coefficient (r) = − 0.28; p = 0.002] but not for hypertensive subjects (r = − 0.07; p = 0.454). For non-hypertensive elderly subjects, serum sodium concentration within the normal range is positively associated with handgrip strength and inversely associated with CD34-positive cells, thus partly indicating the degree of age-related endothelium injury. These associations could prove to be an efficient tool for clarifying the background mechanism governing the decrease in age-related muscle strength.

Walking-friendly built environments and objectively measured physical function in older adults

BACKGROUND

Few studies have examined the associations between urban design attributes and older adults' physical function. Especially, it is not well known how built-environment attributes may influence physical function in Asian cities. The aim of this study was to examine associations between objectively measured environmental attributes of walkability and objectively assessed physical function in a sample of Japanese older adults.

METHODS

Cross-sectional data collected in 2013 from 314 older residents (aged 65-84 years) living in Japan were used. Physical function was estimated from objectively measured upper- and lower-body function, mobility, and balance by a trained research team member. A comprehensive list of built-environment attributes, including population density, availability of destinations, intersection density, and distance to the nearest public transport station, were objectively calculated. Walk Score as a composite measure of neighborhood walkability was also obtained.

RESULTS

Among men, higher population density, availability of destinations, and intersection density were significantly associated with better physical function performance (1-legged stance with eyes open). Higher Walk Score was also marginally associated with better physical function performance (1-legged stance with eyes open). None of the environmental attributes were associated with physical function in elderly women.

CONCLUSION

Our findings indicate that environmental attributes of walkability are associated with the physical function of elderly men in the context of Asia. Walking-friendly neighborhoods can not only promote older adults' active behaviors but can also support their physical function.

Age-stratified differences of physical capacity in rural community-dwelling Taiwanese older women: A cross-sectional study

OBJECTIVES

Physical capacity decline may precede physical disability. We explored age-related physical capacity decline among rural community-dwelling Taiwanese older women to provide reference values and to identify indicators of early-onset decline in physical capacity.

METHODS

Older women aged 65-96 were recruited from rural community centers. Physical capacity was measured by handgrip strength (HS), gait speed (GS), five-times-sit-to-stand (5xSTS), timed up and go (TUG), and the Berg balance scale (BBS). Participants were stratified into four age groups: 65-69, 70-74, 75-79, and ≥80 years.

RESULTS

Of 137 participants, 61 % exhibited poor 5xSTS, 34-49 % showed low HS, poor TUG and BBS, and 26 % had slow GS. The mean values in GS, HS, 5xSTS, TUG, and BBS were 1.02 m/s, 17.8 kg, 14.5 s, 12.6 s, and 50 points, respectively. Abnormal mean values were first noted at age 70-74 years for 5xSTS, age 75-79 years for HS, TUG, and BBS, and age ≥80 years for GS. Also, more than half the participants exhibited the first poor 5xSTS at age 70-74 years; the first poor HS and TUG at age 75-79 years; and lastly, the first poor BBS and GS at age ≥80 years. At age 65-69 years, 14-41 % of participants reported poor performance in all measures except for GS.

CONCLUSIONS

Low HS and poor 5xSTS and TUG performance were more common and had earlier onset than slow GS. More attention should be directed toward the 5xSTS, TUG, and HS in rural community-dwelling Taiwanese older women.

Comparison between grip strength and grip strength divided by body weight in their relationship with metabolic syndrome and quality of life in the elderly

Strength measures should be normalized by body mass; however, the definition of sarcopenia includes only simple grip strength. Thus, we compared the relationship of grip strength and grip strength divided by body weight or body mass index to two major consequences of sarcopenia, namely metabolic syndrome and poor quality of life. Data from the participants (aged 60 years or older) of the Sixth Korea National Health and Nutrition Examination were analyzed. Metabolic syndrome was defined according to the Adult Treatment Panel III guidelines with some modifications appropriate for Koreans. Quality of life was assessed using the EuroQoL Five-dimension questionnaire. Multiple logistic regression models were used to evaluate the association of grip strength and grip strength divided by body weight with metabolic syndrome and quality of life. A total of 1273 men and 1436 women were included in the analyses. Grip strength was not related to metabolic syndrome, whereas grip strength divided by body weight and grip strength normalized by body mass index revealed a dense dose-response relationship. All measures showed a similar correlation with quality of life. Grip strength divided by body weight can be superior to simple grip strength and grip strength normalized by body mass index in representing the metabolic aspects of sarcopenia.

Muscular grip strength normative values for a Korean population from the Korea National Health and Nutrition Examination Survey, 2014-2015

Introduction

Muscle weakness is linked to a range of adverse health outcomes across the lifespan including mortality, morbidity, and disability. Because lifestyles and body composition are quite different between Western and Asian countries, there is an urgent need to establish normative grip strength values for individuals of Asian descent. This study presents normative data for hand grip strength in a Korean population-representative sample.

Methods

A sample of 11,073 individuals (age 10–80 years) was included from the Sixth Korea National Health and Nutrition Examination Survey, 2014–2015. Isometric grip strength was assessed using a handheld dynamometer. Relative grip strength was calculated as the maximum absolute grip strength divided by body mass index. Means, standard error, and quintiles for grip strength and relative grip strength were analyzed per 5-year age group for each sex. To create growth charts for grip strength and relative grip strength, parametric quantile regression was used.

Results

In males, absolute grip strength increased quickly starting from 10 years of age until approximately 20 years of age. In females, there was gradual growth until approximately 15 years of age. Grip strength continued to increase until a peak between ages 30 and 39 years, and then declined from midlife onwards in both sexes. Our data showed that the prevalence of weak grip strength increased rapidly in late adult life based on a T-score of -2 standard deviations below the sex-specific peak mean (equivalent to 33 kg in males and 20 kg in females). Approximately 20% of subjects had weak grip strength at age 65–69 years.

Conclusion

This was the first study to establish normative reference values for grip strength across the lifespan in a Korean population aged 10–80 years. Percentiles of grip strength will inform clinical assessments and will help identify thresholds for the identification of muscle weakness.

Hand grip strength measurement in different epidemiologic studies using various methods for diagnosis of sarcopenia: a systematic review

BACKGROUND

The purpose of this systematic review was to compare various methods for measuring hand grip strength to provide data for the development of a standardized protocol for such a measurement based on epidemiologic studies of sarcopenia in older population.

METHODS

Systematic review and meta-analysis were performed using 34 available epidemiologic studies.

RESULTS

The choice of hand dynamometer and measurement protocols for measuring hand grip strength was not consistent among studies. Mean values of hand grip strength in older population were also different by study area (Europe, America, and Asia) and gender.

CONCLUSION

This systematic review demonstrated that various grip strength measurement methods were used in different epidemiologic studies. A standardized method is needed to enable more consistent measurement of grip strength and better assessment of sarcopenia.

Hand grip strength as a predictor of postoperative complications in esophageal cancer patients undergoing esophagectomy

BACKGROUND

Radical esophagectomy remains the primary treatment option for resectable esophageal cancer. However, it sometimes induces postoperative complications due to its invasive nature. Recently, the impact of loss of muscle mass on postoperative complications and survival among cancer patients has been highlighted. This study aimed to identify the impact of low hand grip strength (HGS) on postoperative complications after esophagectomy.

METHODS

A total of 188 patients (male: 166, female: 22) who underwent radical esophagectomy with gastric tube reconstruction between 2008 and 2014 were included. The correlation between HGS and age was analyzed using Pearson's correlation coefficient. Due to the small patient numbers, only male patients were stratified into two groups according to age (<70 years: non-elderly group, ≥70 years: elderly group). Receiver operating characteristic curve analysis was performed for each group using postoperative complication occurrence as the endpoint to determine an optimal HGS cutoff value.

RESULTS

Postoperative complications occurred in 60.9% of the elderly group and 47.4% of the non-elderly group. When the cutoff values were set at 30.5 and 37 kg for the elderly and non-elderly group, respectively, low HGS was an independent predictive factor of postoperative complications on multivariate analysis only in the elderly group (p = 0.008). In the elderly group, the incidence of postoperative pneumonia was 39.5% among patients with low HGS vs. 3.8% among patients with high HGS.

CONCLUSION

Preoperative HGS is an independent predictive factor of postoperative complications, especially postoperative pneumonia, for elderly male patients with esophageal cancer treated with radical esophagectomy.

Associations of sedentary behavior and physical activity with older adults' physical function: an isotemporal substitution approach

Backgrounds

The purpose of this study was to examine, in a sample of Japanese older adults, the associations of objectively-assessed sedentary behavior (SB) and physical activity (PA) with performance-based physical function. The isotemporal substitution (IS) approach was used to model simultaneously the effects of the specific activity being performed and the activity being displaced, in an equal time-exchange manner.

Methods

Among 287 older adults (65–84 years), we used accelerometers to identify the daily average time spent on SB (≤1.5 METs); light-intensity PA (LIPA) (>1.5 to <3.0 METs); and moderate- to vigorous-intensity PA (MVPA) (≥3.0 METs). Physical function was assessed using five performance-based measures: hand grip strength, usual and maximum gait speeds, timed up and go, and one-legged stance with eyes open. We employed three linear regression models – a single-activity model, a partition model, and an IS model – to assess the associations of SB, LIPA, and MVPA with each of the five measures of physical function.

Results

There were significant positive associations in the single-activity and partition models between MVPA and the measures of physical function (with the exception of hand grip strength). The IS models found that replacing SB or LIPA with MVPA was significantly and favorably associated with physical function measures.

Conclusions

These findings indicate that replacing small amounts of SB and LIPA with MVPA (such as 10 min) may contribute to improvements in older adults’ physical function.

Laterality and grip strength influence hand bone micro-architecture in modern humans, an HRpQCT study

It is widely hypothesized that mechanical loading, specifically repetitive low-intensity tasks, influences the inner structure of cancellous bone. As such, there is likely a relationship between handedness and bone morphology. The aim of this study is to determine patterns in trabecular bone between dominant and non-dominant hands in modern humans. Seventeen healthy patients between 22 and 32 years old were included in the study. Radial carpal bones (lunate, capitate, scaphoid, trapezium, trapezoid, 1st, 2nd and 3rd metacarpals) were analyzed with high-resolution micro-computed tomography. Additionally, crush and pinch grip were recorded. Factorial analysis indicated that bone volume ratio, trabeculae number (Tb.N), bone surface to volume ratio (BS.BV), body weight, stature and crush grip were all positively correlated with principal components 1 and 2 explaining 78.7% of the variance. Volumetric and trabecular endostructural parameters (BV/TV, BS/BV or Tb.Th, Tb.N) explain the observed inter-individual variability better than anthropometric or clinical parameters. Factors analysis regressions showed correlations between these parameters and the dominant side for crush strength for the lunate (r² = 0.640, P < 0.0001), trapezium (r² = 0.836, P < 0.0001) and third metacarpal (r² = 0.763). However, despite a significant lateralization in grip strength for all patients, the endostructural variability between dominant and non-dominant sides was limited in perspective to inter-individual differences. In conclusion, handedness is unlikely to generate trabecular patterns of asymmetry. It appears, however, that crush strength can be considered for endostructural analysis in the modern human wrist.

Strong or Weak Handgrip? Normative Reference Values for the German Population across the Life Course Stratified by Sex, Age, and Body Height

Handgrip strength is an important biomarker of healthy ageing and a powerful predictor of future morbidity and mortality both in younger and older populations. Therefore, the measurement of handgrip strength is increasingly used as a simple but efficient screening tool for health vulnerability. This study presents normative reference values for handgrip strength in Germany for use in research and clinical practice. It is the first study to provide normative data across the life course that is stratified by sex, age, and body height. The study used a nationally representative sample of test participants ages 17–90. It was based on pooled data from five waves of the German Socio-Economic Panel (2006–2014) and involved a total of 11,790 persons living in Germany (providing 25,285 observations). Handgrip strength was measured with a Smedley dynamometer. Results showed that peak mean values of handgrip strength are reached in men’s and women’s 30s and 40s after which handgrip strength declines in linear fashion with age. Following published recommendations, the study used a cut-off at 2 SD below the sex-specific peak mean value across the life course to define a ‘weak grip’. Less than 10% of women and men aged 65–69 were classified as weak according to this definition, shares increasing to about half of the population aged 80–90. Based on survival analysis that linked handgrip strength to a relevant outcome, however, a ‘critically weak grip’ that warrants further examination was estimated to commence already at 1 SD below the group-specific mean value.