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Qi KJ, Li Q, Lu GL, Zhang MJ, Zhang MZ, Yan JM, He QQ. The combined effect of handgrip strength and obesity phenotype on the risk of stroke in Chinese middle-aged and elderly: A cohort study. Arch Gerontol Geriatr 2024; 124:105481. [PMID: 38733920 DOI: 10.1016/j.archger.2024.105481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the combined effect of handgrip strength (HGS) and obesity phenotype on the risk of stroke in Chinese middle-aged and elderly people. METHODS The data was used from the China Health and Retirement Longitudinal Study (CHARLS). Middle-aged and older adults who participated in surveys between 2011 and 2018 were included in the study. They were divided into 4 different types of obesity phenotypes based on obesity and metabolic status: metabolically healthy non-overweight/obesity (MHNO), metabolically healthy overweight/obesity (MHO), metabolically abnormal non-overweight/obesity (MANO), and metabolically abnormal overweight/obesity (MAO). The HGS level was divided into low and high groups according to the median values. Cox proportional risk regression model was used to analyze the joint effect of HGS and obesity phenotype on the risk of stroke among participants. RESULTS A total of 7904 participants aged 58.89±9.08 years were included in this study. After adjusting for potential confounders, high HGS&MHO (HR=1.86, 95 % CI=1.12-3.09), high HGS&MANO (HR=2.01, 95 %CI=1.42-2.86), high HGS&MAO (HR=2.01, 95 % CI=1.37-2.93), low HGS&MHNO (HR=1.57, 95 % CI=1.00-2.46), low HGS&MHO (HR=2.09, 95 % CI=1.29-3.38), low HGS&MANO (HR=2.02, 95 % CI=1.35-3.03), and low HGS&MAO (HR=2.48, 95 % CI=1.72-3.58) group had significantly higher risks of stroke than the high HGS&MHNO group. CONCLUSION The coexistence of metabolically unhealthy and low HGS can synergistically increase the risk of stroke in Chinese middle-aged and elderly people.
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Affiliation(s)
- Kai-Jie Qi
- School of public health, Wuhan University, Wuhan, China
| | - Qiang Li
- School of health and nursing, Wuchang University of Technology, Wuhan, China
| | - Gao-Lei Lu
- School of public health, Wuhan University, Wuhan, China
| | - Min-Jie Zhang
- School of public health, Wuhan University, Wuhan, China
| | - Min-Zhe Zhang
- School of public health, Wuhan University, Wuhan, China
| | - Jia-Min Yan
- Department of Laboratory Medicine, Wuhan Children's Hospital, Wuhan, China.
| | - Qi-Qiang He
- School of public health, Wuhan University, Wuhan, China; Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, China.
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Knoll K, Rhee Y, Fillmore N, Jurivich DA, Lang JJ, McGrath BM, Tomkinson GR, McGrath R. Weakness Status is Differentially Associated with Time to Diabetes in Americans. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 6:e240004. [PMID: 39119102 PMCID: PMC11308643 DOI: 10.20900/agmr20240004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Background The purpose of this study was to evaluate the associations of (1) individual absolute and body size normalized weakness cut-points, and (2) the collective weakness classifications on time to diabetes in Americans. Methods We analyzed data from 9577 adults aged at least 50-years from the Health and Retirement Study. Diabetes diagnosis was self-reported. A handgrip dynamometer measured handgrip strength (HGS). Males with HGS <35.5 kg (absolute), <0.45 kg/kg (normalized to body weight), or <1.05 kg/kg/m2 (normalized to BMI) were categorized as weak. Females were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg/kg/m2. Compounding weakness included falling below 1, 2, or all 3 cut-points. Results Persons below the body weight normalized weakness cut-points had a 1.29 (95% confidence interval (CI): 1.15-1.47) higher hazard for incident diabetes, while those below the BMI normalized cut-points had a 1.30 (CI: 1.13-1.51) higher hazard. The association between absolute weakness and incident diabetes was insignificant (hazard ratio: 1.06; CI: 0.91-1.24). Americans below 1, 2, or all 3 collective weakness categories had a 1.28 (CI: 1.10-1.50), 1.29 (CI: 1.08-1.52), and 1.33 (CI: 1.09-1.63) higher hazard for the incidence of diabetes, respectively. Conclusions Our findings indicate that while absolute weakness, which is confounded by body size, was not associated with time to diabetes, adjusting for the influence of body size by normalizing HGS to body weight and BMI was significantly associated with time to diabetes. This suggests that muscle strength, not body size, may be driving such associations with time to diabetes.
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Affiliation(s)
- Kelly Knoll
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA
- Healthy Aging North Dakota, North Dakota State University, Fargo, ND 58102, USA
| | - Yeong Rhee
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - Natasha Fillmore
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58108, USA
| | - Donald A. Jurivich
- Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
| | - Justin J. Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | | | - Grant R. Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA
- Healthy Aging North Dakota, North Dakota State University, Fargo, ND 58102, USA
- Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
- Fargo VA Healthcare System, Fargo, ND 58102, USA
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Xu Y, Qiu S, Ye J, Chen D, Wang D, Zhou X, Sun Z. Performance of different machine learning algorithms in identifying undiagnosed diabetes based on nonlaboratory parameters and the influence of muscle strength: A cross-sectional study. J Diabetes Investig 2024; 15:743-750. [PMID: 38439210 PMCID: PMC11143412 DOI: 10.1111/jdi.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/21/2024] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS/INTRODUCTION Machine learning algorithms based on the artificial neural network (ANN), support vector machine, naive Bayesian or logistic regression model are commonly used to identify diabetes. This study investigated which approach performed the best and whether muscle strength provided any incremental benefit in identifying undiagnosed diabetes in Chinese adults. METHODS This cross-sectional study enrolled 4,482 eligible participants from eight provinces in China, who were randomly divided into the training dataset (n = 3,586) and the testing dataset (n = 896). Muscle strength was assessed by handgrip strength and the number of chair stands in the 30-s chair stand test. An oral glucose tolerance test was used to ascertain undiagnosed diabetes. The areas under the curve (AUCs) were calculated accordingly and compared with each other. RESULTS Of the included participants, 233 had newly diagnosed diabetes. All the four machine learning algorithms, which were developed based on nonlaboratory parameters, showed acceptable discriminative ability in identifying undiagnosed diabetes (all AUCs >0.70), with the ANN approach performing the best (AUC 0.806). Adding handgrip strength or the 30-s chair stand test to this approach did not increase the AUC further (P = 0.39 and 0.26, respectively). Furthermore, compared with the New Chinese Diabetes Risk Score, the ANN approach showed a larger AUC in identifying undiagnosed diabetes (Pcomparison < 0.01), regardless of the addition of handgrip strength or the 30-s chair stand test. CONCLUSIONS The ANN approach performed the best in identifying undiagnosed diabetes in Chinese adults; however, the addition of muscle strength might not improve its efficacy.
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Affiliation(s)
- Ying Xu
- Department of Endocrine Metabolism, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Shanhu Qiu
- Department of General Practice, School of Medicine, Institute of Diabetes, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jinli Ye
- School of Mathematics and Statistics, Yunnan University, Kunming, China
| | - Dan Chen
- School of Mathematics and Statistics, Yunnan University, Kunming, China
| | - Donglei Wang
- Department of Endocrinology, School of Medicine, Institute of Diabetes, Zhongda Hospital, Southeast University, Nanjing, China
| | - Xiaoying Zhou
- Department of Endocrinology, School of Medicine, Institute of Diabetes, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, School of Medicine, Institute of Diabetes, Zhongda Hospital, Southeast University, Nanjing, China
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Zhong P, Yang S, Liu R, Zhu Z, Zhang Y, Cheng W, Wang W. Handgrip strength and risks of diabetic vascular complications: Evidence from Guangzhou Diabetic Eye Study and UK cohorts. Br J Ophthalmol 2024:bjo-2023-324893. [PMID: 38816182 DOI: 10.1136/bjo-2023-324893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The purpose is to investigate the association between handgrip strength (HGS) and the risk of future diabetic complications in multicountry cohorts. METHODS The association between HGS and diabetic complications was evaluated using cox models among 84 453 patients with pre-diabetes and diabetes from the UK Biobank with a 12-year follow-up. The association between HGS and longitudinal microcirculatory damage rates was assessed among 819 patients with diabetes from the Guangzhou Diabetic Eye Study (GDES) with a 3-year follow-up. Participants were divided into three age groups (<56, 56-65 and ≥65 years), and each group was further subdivided into three HGS tertiles. RESULTS A 5 kg reduction in HGS was associated with increased risk for all-cause mortality (women, HR=1.10, 95% CI: 1.05 to 1.14; p<0.001; men, HR=1.13, 95% CI: 1.11 to 1.15; p<0.001). Women and men in the lowest HGS group exhibited 1.6-times and 1.3-1.5-times higher risk of myocardial infarction and stroke compared with the highest HGS group. In men, there was a higher risk of developing end-stage renal disease (HR=1.83, 95% CI: 1.30 to 2.57; p=0.001), while this was not observed in women. Both sexes in the lowest HGS group had a 1.3-times higher risk of diabetic retinopathy compared with the highest HGS group. In the GDES group, individuals with the lowest HGS showed accelerated microcirculatory damage in retina (all p<0.05). CONCLUSIONS Reduced HGS is significantly associated with a higher risk of diabetic complications and accelerated microvascular damage. HGS could serve as a practical indicator of vascular health in patients with pre-diabetes and diabetes.
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Affiliation(s)
- Pingting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Riqian Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ziyu Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yongjie Zhang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan Province, China
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Liu D, Li N, Zhou Y, Wang M, Song P, Yuan C, Shi Q, Chen H, Zhou K, Wang H, Li T, Pan XF, Tian H, Li S. Sex-specific associations between skeletal muscle mass and incident diabetes: A population-based cohort study. Diabetes Obes Metab 2024; 26:820-828. [PMID: 37997500 DOI: 10.1111/dom.15373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023]
Abstract
AIMS To investigate the sex-specific associations between predicted skeletal muscle mass index (pSMI) and incident type 2 diabetes in a retrospective longitudinal cohort of Chinese men and women. MATERIALS AND METHODS We enrolled Chinese adults without diabetes at baseline from WATCH (West chinA adulT health CoHort), a large health check-up-based database. We calculated pSMI to estimate skeletal muscular mass, and measured blood glucose variables and assessed self-reported history to identify new-onset diabetes. The nonlinear association between pSMI and incident type 2 diabetes was modelled using the penalized spline method. The piecewise association was estimated using segmented linear splines in weighted Cox proportional hazards regression models. RESULTS Of 47 885 adults (53.2% women) with a median age of 40 years, 1836 developed type 2 diabetes after a 5-year median follow-up. In women, higher pSMI was associated with a lower risk of incident type 2 diabetes (Pnonlinearity = 0.09, hazard ratio [HR] per standard deviation increment in pSMI: 0.79 [95% confidence interval {CI} 0.68, 0.91]). A nonlinear association of pSMI with incident type 2 diabetes was detected in men (Pnonlinearity < 0.001). In men with pSMI lower than 8.1, higher pSMI was associated with a lower risk of incident type 2 diabetes (HR 0.58 [95% CI 0.40, 0.84]), whereas pSMI was not significantly associated with incident diabetes in men with pSMI equal to or greater than 8.1 (HR 1.08 [95% CI 0.93, 1.25]). CONCLUSIONS In females, a larger muscular mass is associated with a lower risk of type 2 diabetes. For males, this association is significant only among those with diminished muscle mass.
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Affiliation(s)
- Dan Liu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Nan Li
- Department of Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Yiling Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Miye Wang
- Department of Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Peige Song
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Qingyang Shi
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Chen
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Kaixin Zhou
- College of Life Sciences, University of the Chinese Academy of Sciences, Beijing, China
- College of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Huan Wang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Tao Li
- Department of Anesthesiology, Laboratory of Mitochondria and Metabolism, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiong-Fei Pan
- Section of Epidemiology and Population Health, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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Dlamini M, Khathi A. Prediabetes-Associated Changes in Skeletal Muscle Function and Their Possible Links with Diabetes: A Literature Review. Int J Mol Sci 2023; 25:469. [PMID: 38203642 PMCID: PMC10778616 DOI: 10.3390/ijms25010469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
The skeletal muscle plays a critical role in regulating systemic blood glucose homeostasis. Impaired skeletal muscle glucose homeostasis associated with type 2 diabetes mellitus (T2DM) has been observed to significantly affect the whole-body glucose homeostasis, thereby resulting in other diabetic complications. T2DM does not only affect skeletal muscle glucose homeostasis, but it also affects skeletal muscle structure and functional capacity. Given that T2DM is a global health burden, there is an urgent need to develop therapeutic medical therapies that will aid in the management of T2DM. Prediabetes (PreDM) is a prominent risk factor of T2DM that usually goes unnoticed in many individuals as it is an asymptomatic condition. Hence, research on PreDM is essential because establishing diabetic biomarkers during the prediabetic state would aid in preventing the development of T2DM, as PreDM is a reversible condition if it is detected in the early stages. The literature predominantly documents the changes in skeletal muscle during T2DM, but the changes in skeletal muscle during prediabetes are not well elucidated. In this review, we seek to review the existing literature on PreDM- and T2DM-associated changes in skeletal muscle function.
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Affiliation(s)
| | - Andile Khathi
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban X54001, South Africa;
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Chen R, Chen Q, Lu G, Zhang M, Zhang M, Yang H, Qi K, Yu H, Zheng M, He Q. Sleep duration and depressive symptoms in Chinese middle-aged and older adults: The moderating effects of grip strength. J Affect Disord 2023; 339:348-354. [PMID: 37451435 DOI: 10.1016/j.jad.2023.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Evidence on the combined effect of sleep duration and grip strength on depressive symptoms is scarce. This study aimed to explore the moderating effect of grip strength on the association between sleep duration and depressive symptoms in a large cohort of middle-aged and older adults. METHOD Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 wave. Grip strength and sleep duration were assessed by dynamometer and self-report, respectively. Depressive symptoms were determined by the Centre for Epidemiological Studies Depression scale (CESD-10). Multivariable cox regression model was used to explore the associations between sleep duration, and depressive symptoms, and assess moderation by grip strength. RESULTS A total of 4337 participants aged 57.0 ± 8.1 years (45.1 % females) were included in this study. During the 7-year follow up period, 1508 participants developed depressive symptoms. Short sleep duration (<6 h/d) was significantly associated with an increased risk of depressive symptoms [Hazard ratio (HR):1.24, 95 % confidence interval (CI):1.09, 1.40)]. This association remained in individuals with the low (HR:1.22, 95%CI:1.00, 1.49) and middle grip strength (HR:1.32, 95%CI: 1.07, 1.63), but attenuated in individuals with high grip strength (HR:1.11, 95%CI: 0.86, 1.43). CONCLUSIONS High grip strength mitigated the association between short sleep duration and higher risk of depressive symptoms. Thus, improving sleep duration and strengthening muscle strength are recommended to prevent depressive symptoms in middle-aged and older adults.
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Affiliation(s)
- Rui Chen
- School of Public Health, Wuhan University, Wuhan, China
| | - Qiutong Chen
- College of Language Intelligence, Sichuan International Studies University, Chongqing, China
| | - Gaolei Lu
- School of Public Health, Wuhan University, Wuhan, China
| | - Minjie Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | - Minzhe Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Kaijie Qi
- School of Public Health, Wuhan University, Wuhan, China
| | - Hongjie Yu
- School of Public Health, Wuhan University, Wuhan, China
| | - Miaobing Zheng
- School of Nutrition and Exercise, Deakin University, Melbourne, Australia.
| | - Qiqiang He
- School of Public Health, Wuhan University, Wuhan, China; Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, China.
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Qiu S, Cai X, Liang Y, Chen W, Wang D, Sun Z, Xie B, Wu T. Cumulative muscle strength and risk of diabetes: A prospective cohort study with mediation analysis. Diabetes Res Clin Pract 2023; 197:110562. [PMID: 36738835 DOI: 10.1016/j.diabres.2023.110562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
AIMS Previous studies assessing the association of muscle strength with risk of diabetes have seldomly accounted for the cumulative exposure over time. This study examined the association of 4-year cumulative muscle strength with risk of diabetes in middle-aged and older adults. METHODS We included participants without diabetes, who had 3 repeated measurements of muscle strength, which was assessed by grip strength (normalized by body-weight) and chair-rising time, over 4 years. Cumulative muscle strength was calculated based on trapezoid rule. Logistic regression analysis and mediation analysis for cumulative blood pressure were performed. RESULTS We included 3731 and 3799 participants with data on cumulative grip strength and cumulative chair-rising time, respectively. The odds of diabetes were gradually reduced with increments in cumulative grip strength or decrements in cumulative chair-rising time, with the corresponding odds ratio being 0.79 and 0.89 per 1 standard deviation change after multivariable-adjustment. Cumulative systolic blood pressure mediated 10.8% and 14.2% of the associations of diabetes with cumulative grip strength and cumulative chair-rising time, respectively. Cumulative grip strength also correlated inversely with blood pressure, glycemia, and inflammation. CONCLUSIONS Higher cumulative muscle strength was associated with lower risk of diabetes and better cardiometabolic health in middle-aged and older Chinese adults.
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Affiliation(s)
- Shanhu Qiu
- Department of General Practice, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China; Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Xue Cai
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yan Liang
- Department of General Practice, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China; Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wenji Chen
- Department of General Practice, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China; Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
| | - Bo Xie
- Department of General Practice, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China; Research and Education Centre of General Practice, Zhongda Hospital, Southeast University, Nanjing, China.
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Mediation of 10-Year Cardiovascular Disease Risk between Inflammatory Diet and Handgrip Strength: Base on NHANES 2011-2014. Nutrients 2023; 15:nu15040918. [PMID: 36839276 PMCID: PMC9962519 DOI: 10.3390/nu15040918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Dietary inflammatory index (DII) and handgrip strength (HGS) were correlated, and both were associated with cardiovascular disease (CVD). However, the role of the 10-year CVD risk in the relationship between DII and grip strength remains uncertain. METHODS This study involved 5691 adults from the National Health and Nutrition Examination Survey (NHANES) in 2011-2014. Dietary inflammation, 10-year CVD risk and relative grip strength were assessed by the Dietary Inflammation Index, the Framingham Risk Score (FRS) and handgrip strength adjusted BMI. Linear regression analyses and mediation analysis were used to explore these associations. RESULTS Both DII and 10-year CVD risk were negatively associated with relative handgrip strength, and DII was positively associated with 10-year CVD risk. Additionally, 10-year CVD risk partially mediated the association between DII and relative handgrip strength by a 11.8% proportion. Specifically, the mediating effect of the 10-year risk of CVD varied by gender and age. CONCLUSIONS Reducing the 10-year risk of CVD attenuates the effect of an inflammatory diet on relative grip strength impairment. Therefore, we recommend reducing the effect of inflammatory diet on grip strength impairment by controlling any of the FRS parameters, such as lowering blood pressure and smoking cessation, especially with targeted measures for different populations.
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Peterson MD, Collins S, Meier HC, Brahmsteadt A, Faul JD. Grip strength is inversely associated with DNA methylation age acceleration. J Cachexia Sarcopenia Muscle 2023; 14:108-115. [PMID: 36353822 PMCID: PMC9891916 DOI: 10.1002/jcsm.13110] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a large body of evidence linking muscular weakness, as determined by low grip strength, to a host of negative ageing-related health outcomes. Given these links, grip strength has been labelled a 'biomarker of aging'; and yet, the pathways connecting grip strength to negative health consequences are unclear. The objective of this study was to determine whether grip strength was associated with measures of DNA methylation (DNAm) age acceleration. METHODS Middle age and older adults from the 2006 to 2008 waves of the Health and Retirement Study with 8-10 years of follow-up were included. Cross-sectional and longitudinal regression modelling was performed to examine the association between normalized grip strength (NGS) and three measures of DNAm age acceleration, adjusting for cell composition, sociodemographic variables and smoking. Longitudinal modelling was also completed to examine the association between change in absolute grip strength and DNAm age acceleration. The three DNAm clocks used for estimating age acceleration include the established DunedinPoAm, PhenoAge and GrimAge clocks. RESULTS There was a robust and independent cross-sectional association between NGS and DNAm age acceleration for men using the DunedinPoAm (β: -0.36; P < 0.001), PhenoAge (β: -8.27; P = 0.01) and GrimAge (β: -4.56; P = 0.01) clocks and for women using the DunedinPoAm (β: -0.36; P < 0.001) and GrimAge (β: -4.46; P = 0.01) clocks. There was also an independent longitudinal association between baseline NGS and DNAm age acceleration for men (β: -0.26; P < 0.001) and women (β: -0.36; P < 0.001) using the DunedinPoAm clock and for women only using the PhenoAge (β: -8.20; P < 0.001) and GrimAge (β: -5.91; P < 0.001) clocks. Longitudinal modelling revealed a robust association between change in grip strength from wave 1 to wave 3 was independently associated with PhenoAgeAA (β: -0.13; 95% CI: -0.23, -0.03) and GrimAgeAA (β: -0.07; 95% CI: -0.14, -0.01) in men only (both P < 0.05). CONCLUSIONS Our findings provide some initial evidence of age acceleration among men and women with lower NGS and loss of strength over time. Future research is needed to understand the extent to which DNAm age mediates the association between grip strength and chronic disease, disability and mortality.
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Affiliation(s)
- Mark D. Peterson
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMIUSA
- Michigan Institute for Health Policy and Innovation (IHPI)Ann ArborMIUSA
- Michigan Center on the Demography of Aging (MiCDA)Ann ArborMIUSA
| | - Stacey Collins
- Survey Research Center, Institute for Social ResearchUniversity of MichiganAnn ArborMIUSA
| | - Helen C.S. Meier
- Michigan Center on the Demography of Aging (MiCDA)Ann ArborMIUSA
- Survey Research Center, Institute for Social ResearchUniversity of MichiganAnn ArborMIUSA
| | - Alexander Brahmsteadt
- Department of Physical Medicine and RehabilitationUniversity of MichiganAnn ArborMIUSA
| | - Jessica D. Faul
- Michigan Center on the Demography of Aging (MiCDA)Ann ArborMIUSA
- Survey Research Center, Institute for Social ResearchUniversity of MichiganAnn ArborMIUSA
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11
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Jiang G, Wu X. Effects of resistance training combined with balance training on physical function among older adults: a protocol for a randomised controlled trial. BMJ Open 2022; 12:e062486. [PMID: 36198467 PMCID: PMC9535182 DOI: 10.1136/bmjopen-2022-062486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The world's population is ageing. Age-related declines in physical function negatively affect the quality of life but may be ameliorated by certain types of exercise. The purpose of this study is to investigate the effects of combining resistance training (RT) with balance training on physical function in older community-dwelling adults to provide a reference for this type of exercise compared with other exercises and to provide a theoretical basis for optimising exercise plans to improve physical function among older adults. METHODS This single-blind randomised controlled trial will recruit 66 community dwelling adults 60-89 years of age with normal cognition. Participants will be randomly assigned to one of three groups: RT, RT combined with balance training or a control group with usual daily activities. Exercise interventions will be conducted in three 45 min sessions per week for 24 weeks. Primary physical function outcomes will be assessed using the timed up and go test, usual walking speed, maximal walking speed, 30 s chair stand and 30 s arm curl. Secondary assessments will be conducted using the 2 min step test, back scratch test and chair sit-and-reach test. All physical function assessments will be performed at baseline and after 12 and 24 weeks of exercise interventions. Exercise intensity will be monitored to maintain moderate intensity by heart rate, ratings of perceived exertion and OMNI-Resistance Exercise Scale. Data that conform to a normal distribution will be expressed as means±SD, otherwise as medians and interquartile intervals. Pretest, mid-test and post-test outcomes will be analysed for within-group and between-group comparisons using two-way repeated measures analyses of variance. ETHICS AND DISSEMINATION This proposal was reviewed and approved by the Shanghai University of Sport Research Ethics Committee (102772021RT067). The results will be disseminated to the trial participants and as a peer-reviewed publication. TRIAL REGISTRATION NUMBER ChiCTR2200056090.
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Affiliation(s)
- Guiping Jiang
- School of Physical Education, Shanghai University of Sport, Shanghai, China
- School of Physical Education, Harbin University, Harbin, China
| | - Xueping Wu
- School of Physical Education, Shanghai University of Sport, Shanghai, China
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12
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Zhao M, Banhos Danneskiold-Samsøe N, Ulicna L, Nguyen Q, Voilquin L, Lee DE, White JP, Jiang Z, Cuthbert N, Paramasivam S, Bielczyk-Maczynska E, Van Rechem C, Svensson KJ. Phosphoproteomic mapping reveals distinct signaling actions and activation of muscle protein synthesis by Isthmin-1. eLife 2022; 11:e80014. [PMID: 36169399 PMCID: PMC9592085 DOI: 10.7554/elife.80014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
The secreted protein isthmin-1 (Ism1) mitigates diabetes by increasing adipocyte and skeletal muscle glucose uptake by activating the PI3K-Akt pathway. However, while both Ism1 and insulin converge on these common targets, Ism1 has distinct cellular actions suggesting divergence in downstream intracellular signaling pathways. To understand the biological complexity of Ism1 signaling, we performed phosphoproteomic analysis after acute exposure, revealing overlapping and distinct pathways of Ism1 and insulin. We identify a 53% overlap between Ism1 and insulin signaling and Ism1-mediated phosphoproteome-wide alterations in ~450 proteins that are not shared with insulin. Interestingly, we find several unknown phosphorylation sites on proteins related to protein translation, mTOR pathway, and, unexpectedly, muscle function in the Ism1 signaling network. Physiologically, Ism1 ablation in mice results in altered proteostasis, including lower muscle protein levels under fed and fasted conditions, reduced amino acid incorporation into proteins, and reduced phosphorylation of the key protein synthesis effectors Akt and downstream mTORC1 targets. As metabolic disorders such as diabetes are associated with accelerated loss of skeletal muscle protein content, these studies define a non-canonical mechanism by which this antidiabetic circulating protein controls muscle biology.
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Affiliation(s)
- Meng Zhao
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
- Stanford Diabetes Research Center, Stanford University School of MedicineStanfordUnited States
- Stanford Cardiovascular Institute, Stanford University School of MedicineStanfordUnited States
| | | | - Livia Ulicna
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
| | - Quennie Nguyen
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
| | - Laetitia Voilquin
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
- Stanford Diabetes Research Center, Stanford University School of MedicineStanfordUnited States
- Stanford Cardiovascular Institute, Stanford University School of MedicineStanfordUnited States
| | - David E Lee
- Duke Molecular Physiology Institute, Duke University School of MedicineDurhamUnited States
- Department of Medicine, Duke University School of MedicineDurhamUnited States
| | - James P White
- Duke Molecular Physiology Institute, Duke University School of MedicineDurhamUnited States
- Department of Medicine, Duke University School of MedicineDurhamUnited States
- Duke Center for the Study of Aging and Human Development, Duke University School of MedicineDurhamUnited States
| | - Zewen Jiang
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
- Department of Laboratory Medicine, University of California, San FranciscoSan FranciscoUnited States
- Diabetes Center, University of California, San FranciscoSan FranciscoUnited States
| | - Nickeisha Cuthbert
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
| | - Shrika Paramasivam
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
| | - Ewa Bielczyk-Maczynska
- Stanford Diabetes Research Center, Stanford University School of MedicineStanfordUnited States
- Stanford Cardiovascular Institute, Stanford University School of MedicineStanfordUnited States
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of MedicineStanfordUnited States
| | - Capucine Van Rechem
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
| | - Katrin J Svensson
- Department of Pathology, Stanford University School of MedicineStanfordUnited States
- Stanford Diabetes Research Center, Stanford University School of MedicineStanfordUnited States
- Stanford Cardiovascular Institute, Stanford University School of MedicineStanfordUnited States
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13
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Haapala HJ, Schmidt M, Lin P, Kamdar N, Mahmoudi E, Peterson MD. Musculoskeletal Morbidity Among Adults Living With Spina Bifida and Cerebral Palsy. Top Spinal Cord Inj Rehabil 2022; 28:73-84. [PMID: 36017121 DOI: 10.46292/sci21-00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Individuals living with cerebral palsy (CP) or spina bifida (SB) are at heightened risk for chronic health conditions that may develop or be influenced by the impairment and/or the process of aging. Objectives The objective of this study was to compare the incidence of and adjusted hazards for musculoskeletal (MSK) morbidities among adults living with and without CP or SB. Methods A retrospective, longitudinal cohort study was conducted among adults living with (n = 15,302) CP or SB and without (n = 1,935,480) CP or SB. Incidence estimates of common MSK morbidities were compared at 4 years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident MSK morbidities. The analyses were performed in 2019 to 2020. Results Adults living with CP or SB had a higher 4-year incidence of any MSK morbidity (55.3% vs. 39.0%) as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with CP or SB had a greater hazard for all MSK disorders; this ranged from hazard ratio (HR) 1.40 (95% CI, 1.33 to 1.48) for myalgia to HR 3.23 (95% CI, 3.09 to 3.38) for sarcopenia and weakness. Conclusion Adults with CP or SB have a significantly higher incidence of and risk for common MSK morbidities as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of MSK disease onset/progression in these higher risk populations.
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Affiliation(s)
- Heidi J Haapala
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mary Schmidt
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Elham Mahmoudi
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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14
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Association of Handgrip Strength with Diabetes Mellitus in Korean Adults According to Sex. Diagnostics (Basel) 2022; 12:diagnostics12081874. [PMID: 36010223 PMCID: PMC9406341 DOI: 10.3390/diagnostics12081874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetes mellitus (DM) is known to lead to many diseases such as cardiovascular disease and chronic kidney diseases. Therefore, it is essential to find diagnostic tools to prevent DM. This study aimed to find the association between handgrip strength and the prevalence of diabetes mellitus (DM) in Korean adults with respect to sex and menopause. A total of 26,536 participants (12,247 men, 6977 premenopausal women, and 7312 postmenopausal women) aged >19 years were recruited. The study population was divided into quartiles of relative handgrip strength. Logistic regression was used to analyse the association between relative handgrip strength and the prevalence of DM. Compared with the lowest quartile, the odds ratio (95% confidence interval (CI)) the prevalence of DM for the fourth quartile (Q4) was 0.57 (0.43−0.75) after adjusting for confounding factors in men; 0.33 (0.14−0.75), premenopausal women; and 0.82 (0.63−1.07), postmenopausal women. The prevalence of DM decreased as relative handgrip strength increased. This inverse association was more significant in men and premenopausal women than that in postmenopausal women.
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15
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Tatangelo T, Muollo V, Ghiotto L, Schena F, Rossi AP. Exploring the association between handgrip, lower limb muscle strength, and physical function in older adults: A narrative review. Exp Gerontol 2022; 167:111902. [PMID: 35878867 DOI: 10.1016/j.exger.2022.111902] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/23/2022] [Accepted: 07/17/2022] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Toni Tatangelo
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | - Laura Ghiotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Andrea P Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, Treviso, Italy; Healthy Aging Center, Department of Medicine, Division of Geriatric, University of Verona, 37126 Verona, Italy.
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16
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Dritsas E, Trigka M. Data-Driven Machine-Learning Methods for Diabetes Risk Prediction. SENSORS 2022; 22:s22145304. [PMID: 35890983 PMCID: PMC9318204 DOI: 10.3390/s22145304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023]
Abstract
Diabetes mellitus is a chronic condition characterized by a disturbance in the metabolism of carbohydrates, fats and proteins. The most characteristic disorder in all forms of diabetes is hyperglycemia, i.e., elevated blood sugar levels. The modern way of life has significantly increased the incidence of diabetes. Therefore, early diagnosis of the disease is a necessity. Machine Learning (ML) has gained great popularity among healthcare providers and physicians due to its high potential in developing efficient tools for risk prediction, prognosis, treatment and the management of various conditions. In this study, a supervised learning methodology is described that aims to create risk prediction tools with high efficiency for type 2 diabetes occurrence. A features analysis is conducted to evaluate their importance and explore their association with diabetes. These features are the most common symptoms that often develop slowly with diabetes, and they are utilized to train and test several ML models. Various ML models are evaluated in terms of the Precision, Recall, F-Measure, Accuracy and AUC metrics and compared under 10-fold cross-validation and data splitting. Both validation methods highlighted Random Forest and K-NN as the best performing models in comparison to the other models.
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17
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Esmaeilzadeh S, Kumpulainen S, Pesola AJ. Strength-Cognitive Training: A Systemic Review in Adults and Older Adults, and Guidelines to Promote "Strength Exergaming" Innovations. Front Psychol 2022; 13:855703. [PMID: 35712202 PMCID: PMC9197110 DOI: 10.3389/fpsyg.2022.855703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite functional and cognitive benefits, few adults and older adults do strength training twice per week with sufficient intensity. Exercise-based active video games (exergaming) may amplify the cognitive benefits of exercise and increase adherence and motivation toward training. However, the benefits of a well-defined and monitored dose of strength training, executed simultaneously or sequentially with a cognitive element, has received little attention. In this study we have two aims: First, to systematically gather the available evidence; second, to suggest possible ways to promote strength exergaming innovations. Methods We systematically reviewed randomized controlled trials using simultaneous or sequent combined strength and cognitive training or strength exergaming to improve cognitive or functional outcomes in adults and older adults. Results After screening 1,785 studies (Google Scholar, ACM Digital Library, IEEE Xplore Library, PsycARTICLES, Scopus, Cochrane Library and PubMed) we found three eligible studies. Of the two studies using sequent strength and cognitive training, one showed improved functionality, but the other showed negative effects on cognition. The third study using simultaneous intervention, reported a positive influence on both cognition and function, when compared with either strength training alone or a control group. Moderate level of evidence was showed on GRADE analysis. Conclusion The existing little evidence suggests that strength and cognitive training improves cognition and function in adults and older adults. The following suggestions may help to promote further innovation: (1) ensure minimal dosage of strength training (30-60 min, 2 × /week), (2) use machine-based strength training devices to control volume and intensity (to prevent cognitive components from interfering with strength training), (3) include power training by using cognitive tasks requiring rapid reactions, and (4) add cognitive memory tasks (to extend the cognitive benefits of strength training per se), and (5) include motivational exergame elements to increase adherence.
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Affiliation(s)
- Samad Esmaeilzadeh
- Active Life Lab, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
| | - Susanne Kumpulainen
- Active Life Lab, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
| | - Arto J Pesola
- Active Life Lab, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
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18
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Qiu S, Cai X, Xie B, Yuan Y, Sun Z, Wu T. Normalized Creatinine-to-Cystatin C Ratio and Risk of Diabetes in Middle-Aged and Older Adults: The China Health and Retirement Longitudinal Study. Diabetes Metab J 2022; 46:476-485. [PMID: 35249274 PMCID: PMC9171165 DOI: 10.4093/dmj.2021.0074] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/13/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Creatinine-to-cystatin C ratio is recently suggested to be a surrogate marker for sarcopenia. However, little is known about its association with diabetes. This study aimed to fill in this gap based on a large-scale prospective cohort. METHODS A population-based representative sample of 5,055 participants aged ≥45 years from the China Health and Retirement Longitudinal Study was enrolled between 2011 and 2012 and followed at least once during the subsequent surveys at 2013, 2015, or 2018. Creatinine-to-cystatin C ratio was calculated and normalized by body weight. Incident diabetes was ascertained by plasma glucose, glycosylated hemoglobin, self-reported history, or use of anti-diabetic drugs. Logistic regression analysis and mediation analysis were employed. RESULTS During follow-up, 634 participants developed diabetes. The risk of diabetes was gradually and significantly decreased with increased normalized creatinine-cystatin C ratio. The multivariable-adjusted odds ratio for diabetes was 0.91 (95% confidence interval, 0.83 to 0.99) per 1 standard deviation higher of normalized creatinine-to-cystatin C ratio, and this relationship remained significant after controlling for muscle strength. The risk reduction in diabetes was significantly larger in participants with normal-weight and high normalized creatinine-to-cystatin C ratio compared with those with overweight/obesity and high normalized creatinine-to-cystatin C ratio (Pinteraction=0.01). Insulin resistance and inflammation appeared to be key mediators accounting for the observed relationship between normalized creatinine-to-cystatin C ratio and risk of diabetes, with their mediating effect being 93.1% and 22.0%, respectively. CONCLUSION High normalized creatinine-to-cystatin C ratio is associated with reduced risk of diabetes in middle-aged and older adults.
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Affiliation(s)
- Shanhu Qiu
- Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Endocrinology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xue Cai
- Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bo Xie
- Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Yuan
- Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zilin Sun
- Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, China
- Corresponding author: Zilin Sun https://orcid.org/0000-0001-7936-0196 Institute of Diabetes, Zhongda Hospital, School of Medicine, Southeast University, Dingjiaqiao No. 87, Nanjing 210009, China E-mail:
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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19
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Qiu S, Cai X, Yuan Y, Xie B, Sun Z, Wang D, Wu T. Muscle strength and prediabetes progression and regression in middle-aged and older adults: a prospective cohort study. J Cachexia Sarcopenia Muscle 2022; 13:909-918. [PMID: 35068089 PMCID: PMC8978008 DOI: 10.1002/jcsm.12905] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Prediabetes progression is associated with increased mortality while its regression decreases it. It is unclear whether muscle strength is related to prediabetes progression or regression. This study investigated the associations of muscle strength, assessed by grip strength and chair-rising time, with prediabetes progression and regression based on the China Health and Retirement Longitudinal Study (CHARLS) enrolling middle-aged and older adults. METHODS We included 2623 participants with prediabetes from CHARLS, who were followed up 4 years later with blood samples collected for measuring fasting plasma glucose and haemoglobin A1c. Grip strength (normalized by body weight) and chair-rising time were assessed at baseline and categorized into tertiles (low, middle, and high groups). Prediabetes at baseline and follow-up was defined primarily using the American Diabetes Association (ADA) criteria and secondarily using the World Health Organization (WHO) and International Expert Committee (IEC) criteria. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The mean age of included participants was 59.0 ± 8.6 years, and 46.6% of them were males. During follow-up, 1646 participants remained as prediabetes, 379 progressed to diabetes, and 598 regressed to normoglycaemia based on ADA criteria. Participants who progressed to diabetes had lower normalized grip strength than those who remained as prediabetes (0.49 ± 0.15 vs. 0.53 ± 0.15, P < 0.001), but participants who regressed to normoglycaemia showed the opposite (0.55 ± 0.16 vs. 0.53 ± 0.15, P = 0.003). However, chair-rising time was comparable across different groups (Poverall = 0.17). Compared with participants in low normalized grip strength or high chair-rising time group, those in high normalized grip strength or low chair-rising time group had decreased odds of progression to diabetes (OR 0.62, 95% CI 0.44 to 0.87; and OR 0.69, 95% CI 0.51 to 0.93, respectively) after multivariable adjustment. However, both were unrelated to the odds of regression to normoglycaemia (OR 0.94, 95% CI 0.71 to 1.25; and OR 0.84, 95% CI 0.65 to 1.07, respectively). These outcomes remained generally comparable when prediabetes was defined by WHO or IEC criteria. Higher normalized grip strength but not lower chair-rising time was prospectively associated with lower blood pressure, better glycaemic condition, and lower inflammation (all P ≤ 0.04). CONCLUSIONS High muscle strength is associated with reduced odds of progression to diabetes but does not predict regression to normoglycaemia in prediabetes. Future studies are warranted to assess whether increases in muscle strength promote prediabetes regression.
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Affiliation(s)
- Shanhu Qiu
- Department of General Practice, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.,Department of Endocrinology, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University), Shenzhen, China
| | - Xue Cai
- Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Yuan
- Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.,Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bo Xie
- Department of General Practice, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Zilin Sun
- Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.,Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia
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20
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Rodrigo-Mallorca D, Loaiza-Betancur AF, Monteagudo P, Blasco-Lafarga C, Chulvi-Medrano I. Resistance Training with Blood Flow Restriction Compared to Traditional Resistance Training on Strength and Muscle Mass in Non-Active Older Adults: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111441. [PMID: 34769957 PMCID: PMC8583588 DOI: 10.3390/ijerph182111441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
Low-intensity training with blood flow restriction (LI-BFR) has been suggested as an alternative to high-intensity resistance training for the improvement of strength and muscle mass, becoming advisable for individuals who cannot assume such a load. The systematic review aimed to determine the effectiveness of the LI-BFR compared to dynamic high-intensity resistance training on strength and muscle mass in non-active older adults. A systematic review was conducted according to the Cochrane Handbook and reportedly followed the PRISMA statement. MEDLINE, EMBASE, Web of Science Core Collection, and Scopus databases were searched between September and October 2020. Two reviewers independently selected the studies, extracted data, assessed the risk of bias and the quality of evidence using the GRADE approach. Twelve studies were included in the qualitative synthesis. Meta-analysis pointed out significant differences in maximal voluntary contraction (MVC): SMD 0.61, 95% CI [0.10, 1.11], p = 0.02, I2 71% p < 0.0001; but not in the repetition maximum (RM): SMD 0.07, 95% CI [−0.25, 0.40], p = 0.66, I2 0% p < 0.53; neither in the muscle mass: SMD 0.62, 95% CI [−0.09, 1.34], p = 0.09, I2 59% p = 0.05. Despite important limitations such as scarce literature regarding LI-BFR in older adults, the small sample size in most studies, the still differences in methodology and poor quality in many of them, this systematic review and meta-analysis revealed a positive benefit in non-active older adults. LI- BFR may induce increased muscular strength and muscle mass, at least at a similar extent to that in the traditional high-intensity resistance training.
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Affiliation(s)
- Darío Rodrigo-Mallorca
- UIRFIDE (Sport Performance and Physical Fitness Research Group), Department of Physical and Sports Education, Faculty of Physical Activity and Sports Science, University of Valencia, 46010 Valencia, Spain; (D.R.-M.); (P.M.); (I.C.-M.)
| | - Andrés Felipe Loaiza-Betancur
- Department of Physical Education and Sports, Institute of Physical Education, University of Antioquia, Medellín 050010, Colombia;
| | - Pablo Monteagudo
- UIRFIDE (Sport Performance and Physical Fitness Research Group), Department of Physical and Sports Education, Faculty of Physical Activity and Sports Science, University of Valencia, 46010 Valencia, Spain; (D.R.-M.); (P.M.); (I.C.-M.)
- Department of Education and Specific Didactics, Jaume I University, 12071 Castellon, Spain
| | - Cristina Blasco-Lafarga
- UIRFIDE (Sport Performance and Physical Fitness Research Group), Department of Physical and Sports Education, Faculty of Physical Activity and Sports Science, University of Valencia, 46010 Valencia, Spain; (D.R.-M.); (P.M.); (I.C.-M.)
- Correspondence:
| | - Iván Chulvi-Medrano
- UIRFIDE (Sport Performance and Physical Fitness Research Group), Department of Physical and Sports Education, Faculty of Physical Activity and Sports Science, University of Valencia, 46010 Valencia, Spain; (D.R.-M.); (P.M.); (I.C.-M.)
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21
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Tiainen K, Raitanen J, Strandberg T, Koskinen S, Stenholm S. Type 2 Diabetes as a Predictor of Muscle Strength Decline over 11 years among Men and Women Aged 55 Years and Older. Gerontology 2021; 68:635-643. [PMID: 34818235 DOI: 10.1159/000518268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Long-term associations between type 2 diabetes, prediabetes, and muscle strength are obscure in older adults. The aim of this study was to examine type 2 diabetes as a predictor of handgrip strength decline during an 11-year follow-up among men and women aged 55 years. METHODS We used Finnish population-based Health 2000 Survey and its follow-up measurements in 2011. The study population consisted of 1,200 individuals, aged 55-86 years at baseline. Baseline fasting glucose level or use of diabetes medication was used to categorize the participants into diabetes (≥7.0 mmol/L), prediabetes (≥6.1 mmol/L but <7.0 mmol/L), and nondiabetes (<6.1 mmol/L) groups. Handgrip strength was measured at baseline and during 11-year follow-up. RESULTS Mean handgrip strength at baseline did not differ between diabetes groups in men or women. Among men during the 11-year follow-up, decline in muscle strength was significantly greater among diabetes group (-131.5 Newtons [N], 95% confidence interval (CI) -182.7 to -80.4) than nondiabetes group (-98.9 N, 95% CI -139.5 to -58.3) after adjusting for age, education, lifestyle factors, chronic conditions, and diabetes status at follow-up. Among women, muscle strength decline did not differ between diabetes, prediabetes, or nondiabetes groups after adjusting for all potential covariates, the results being -45.0 N (95% CI -73.2 to -16.7), -29.4 N (95% CI -59.7 to 0.9), and -42.3 N (95% CI -70.5 to -14.1), respectively. CONCLUSIONS The presence of type 2 diabetes was associated with greater muscle strength decline among older men but not among older women.
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Affiliation(s)
- Kristina Tiainen
- Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, Tampere University, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, Tampere University, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
| | - Timo Strandberg
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Clinicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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22
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Peterson MD, Casten K, Collins S, Hassan H, García-Hermoso A, Faul J. Muscle weakness is a prognostic indicator of disability and chronic disease multimorbidity. Exp Gerontol 2021; 152:111462. [PMID: 34224846 DOI: 10.1016/j.exger.2021.111462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to use nationally-representative data on Americans greater than 50 years of age to determine the association between grip strength and inflammation as independent predictors of incident disability, chronic multimorbidity and dementia. METHODS Middle age and older adults (n = 12,618) from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Longitudinal modeling was performed to examine the association between baseline grip strength (normalized to body mass: NGS) and high sensitivity C-reactive protein (hs-CRP) (≥3.0 mg/L) with incident physical disabilities (i.e., ≥2 limitations to activities of daily living), chronic multimorbidity (≥2 of chronic conditions), and dementia. RESULTS The odds of incident disability were 1.25 (95% CI: 1.20-1.30) and 1.31 (95% CI: 1.26-1.36) for men and women respectively, for each 0.05-unit lower NGS. The odds of incident chronic multimorbidity were 1.14 (95% CI: 1.08-1.20) and 1.14 (95% CI: 1.07-1.21) for men and women respectively for each 0.05-unit lower NGS. The odds of incident dementia were 1.10 for men (95% CI: 1.02-1.20) for each 0.05-unit lower NGS, but there was no significant association for women. Elevated hs-CRP was only associated with chronic multimorbidity among men (OR = 1.29; 95% CI: 1.00-1.73) and women (OR = 1.60; 95% CI: 1.26-2.02). CONCLUSIONS Our findings indicate a robust inverse association between NGS and disability and chronic, multimorbidity in older men and women, and dementia in men. Elevated hs-CRP was only associated with chronic multimorbidity in men and women. Healthcare providers should implement measures of grip strength in routine health assessments and discuss the potential dangers of weakness as well as interventions to improve strength with their patients.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine & Rehabilitation, University of Michigan, United States of America; Michigan Center on the Demography of Aging (MiCDA), United States of America; Michigan Institute for Health Policy and Innovation (IHPI), United States of America.
| | - Kimberly Casten
- Department of Physical Medicine & Rehabilitation, University of Michigan, United States of America
| | - Stacey Collins
- Institute for Social Research, University of Michigan, United States of America
| | - Halimah Hassan
- Institute for Social Research, University of Michigan, United States of America
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - Jessica Faul
- Institute for Social Research, University of Michigan, United States of America
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23
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Lee J, Park W, Sung E, Kim B, Kim N, Park S, Shin C, Park J. The effect of oral glucose tolerance testing on changes in arterial stiffness and blood pressure in elderly women with hypertension and relationships between the stage of diabetes and physical fitness levels. Phys Act Nutr 2021; 24:34-43. [PMID: 33539693 PMCID: PMC7934524 DOI: 10.20463/pan.2020.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022] Open
Abstract
[Purpose] The purpose of this study was to assess changes in blood glucose level, blood pressure, and arterial stiffness after a 75 g oral glucose tolerance test (OGTT) in elderly women aged over 65 years with hypertension and either normal glycemic control, impaired fasting glucose tolerance, or diabetes mellitus. We also wished to investigate the relationship between stages of diabetes and physical fitness. [Methods] A total of 24 elderly women with hypertension were assigned to a control group (CON; n=7), impaired fasting glucose group (IFG; n=9), and diabetes mellitus group (DM; n=8). In each group, blood glucose level, brachial ankle pulse wave velocity (PWV), and blood pressure were measured at baseline as well as 60 and 120 minutes after a 75 g OGTT. Physical fitness factors such as hand grip strength, balance test, 4 m gait speed test, chair stand test, short physical performance battery, and 6-minute walking test were subsequently assessed. [Results] In all three groups, blood glucose levels were significantly increased at 60 and 120 minutes after a 75 g OGTT. In the DM group, blood glucose levels were significantly higher before and after a 75 g OGTT than in the CON group. In the CON group, PWV was significantly increased at 60 minutes after a 75 g OGTT; however, there were no changes in other groups after glucose ingestion. In the CON group, systolic and diastolic blood pressures were significantly decreased at 60 and 120 minutes after a 75 g OGTT compared to baseline. However, there was no change in blood pressure after ingestion in the DM group. The IFG group had greater grip strength than the CON group; however, there were no differences in other variables between the groups. [Conclusion] After a 75 g OGTT, elderly women with hypertension and diabetes maintain higher blood glucose levels compared to those with hypertension alone. Unlike elderly women with hypertension alone, those with hypertension and diabetes did not show changes in arterial stiffness and blood pressure after a 75 g OGTT. Therefore, elderly women with hypertension and diabetes may not be able to control their blood vessels following a 75 g OGTT due to impaired vascular endothelial function. Moreover, there was no association between diabetes stage and physical fitness in elderly women with hypertension.
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Affiliation(s)
- Jaesong Lee
- Department of Physical Education, Korea University, Seoul, Republic of Korea
| | - Wonil Park
- Department of Physical Education, Korea University, Seoul, Republic of Korea
| | - Eunsook Sung
- Department of Physical Education, Korea University, Seoul, Republic of Korea
| | - Bokbeom Kim
- Department of Physical Education, Korea University, Seoul, Republic of Korea
| | - Nahyun Kim
- Department of Physical Education, Korea University, Seoul, Republic of Korea
| | - Saejong Park
- Department of Sports Science, Korea Institute of Sport Science, Seoul, Republic of Korea
| | - Chulho Shin
- Department of Health Care, Namseoul University, Cheonan, Republic of Korea
| | - Jonghoon Park
- Department of Physical Education, Korea University, Seoul, Republic of Korea
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24
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Al-Ozairi E, Alsaeed D, Alroudhan D, Voase N, Hasan A, Gill JMR, Sattar N, Welsh P, Gray CM, Boonpor J, Celis-Morales C, Gray SR. Skeletal Muscle and Metabolic Health: How Do We Increase Muscle Mass and Function in People with Type 2 Diabetes? J Clin Endocrinol Metab 2021; 106:309-317. [PMID: 33336682 DOI: 10.1210/clinem/dgaa835] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Whilst skeletal muscles' primary role is allowing movement, it has important metabolic roles, including in glycemic control. Indeed, evidence indicates that low muscle mass and function are associated with an increased risk of type 2 diabetes, highlighting its importance in the development of metabolic disease. METHODS In this mini-review, we detail the evidence highlighting the importance of muscle in type 2 diabetes and the efficacy of resistance exercise in improving glycemic control alongside our approach to increase uptake of such exercise in people with type 2 diabetes. This summary is based in the authors' knowledge of the filed supplemented by a Pubmed search using the terms "muscle," "glycemic control," "HbA1c," "type 2 diabetes," and "resistance exercise." RESULTS The main strategy to increases muscle mass is to perform resistance exercise and, although the quality of evidence is low, such exercise appears effective in reducing Glycated Haemoglobin (HbA1c) in people with type 2 diabetes. However, to increase participation we need to improve our understanding of barriers and facilitators to such exercise. Current data indicate that barriers are similar to those reported for aerobic exercise, with additional resistance exercise specific barriers of looking to muscular, increase risk of cardiovascular event, having access to specialized equipment and knowledge of how to use it. CONCLUSIONS The development of simple resistance exercises that can be performed anywhere, that use little or no equipment and are effective in reducing HbA1c will be, in our opinion, key to increasing the number of people with type 2 diabetes performing resistance exercise.
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Affiliation(s)
- Ebaa Al-Ozairi
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabirya, Kuwait
| | - Dalal Alsaeed
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
- Ministry of Health, Kuwait City, Kuwait
| | - Dherar Alroudhan
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
| | - Nia Voase
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
| | - Amal Hasan
- Department of Immunology and Microbiology, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Cindy M Gray
- Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Jirapitcha Boonpor
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
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25
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Lombardo M, Padua E, Campoli F, Panzarino M, Mîndrescu V, Annino G, Iellamo F, Bellia A. Relative handgrip strength is inversely associated with the presence of type 2 diabetes in overweight elderly women with varying nutritional status. Acta Diabetol 2021; 58:25-32. [PMID: 32797286 DOI: 10.1007/s00592-020-01588-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS To describe cross-sectional associations of BMI-adjusted handgrip strength with the presence of diabetes and hypertension in a community setting. METHODS AND RESULTS Between 2016 and 2018, 601 consecutive elderly active women (70.7 ± 6.9 years) were enrolled. Nutritional status was evaluated by the Mini Nutritional Assessment (MNA) score. Muscle strength and level of fitness were assessed by standardized physical functional tests and handgrip strength (HGS). The majority of participants were overweight or obese (80% with BMI > 25). Prevalence of diabetes and hypertension was 13 and 60%, respectively. Participants in the lowest quartile of BMI-adjusted HGS (RHGS) had significantly higher prevalence of diabetes and hypertension compared with those in the top quartile (20.7 vs 5.3% and 49.3 vs 39.3%, respectively, p < 0.01 for both), without significant differences in nutritional status. Association with the presence of diabetes was significantly weaker in women with higher vs lower RHGS values (OR 0.77; 0.59-0.86 CI95%; p = 0.002), independent of age, abdominal adiposity, and presence of hypertension. RHGS was positively correlated with most of the physical functional tests performed. CONCLUSION RHGS is an easy-to-obtain measure of muscular strength, independently associated with the presence of diabetes in overweight active elderly women. Prospective studies are required to assess its predictive value to identify adults at risk of developing diabetes.
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Affiliation(s)
- Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166, Rome, Italy.
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166, Rome, Italy
- School of Human Movement Science, University of Rome "Tor Vergata", Rome, Italy
| | - Francesca Campoli
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166, Rome, Italy
- School of Human Movement Science, University of Rome "Tor Vergata", Rome, Italy
| | - Michele Panzarino
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166, Rome, Italy
- School of Human Movement Science, University of Rome "Tor Vergata", Rome, Italy
| | - Veronica Mîndrescu
- Faculty of Physical Education and Mountain Sports, Department of Motric Performance, Transilvania University of Brasov, Brasov, Romania
| | - Giuseppe Annino
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166, Rome, Italy
- School of Human Movement Science, University of Rome "Tor Vergata", Rome, Italy
| | - Ferdinando Iellamo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- School of Human Movement Science, University of Rome "Tor Vergata", Rome, Italy
| | - Alfonso Bellia
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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26
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Lee JC, Song BS, Kang YM, Kim YR, Kang YE, Lee JH, Shong M, Yi HS. Effect of Thyroid-Stimulating Hormone Suppression on Muscle Function After Total Thyroidectomy in Patients With Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:769074. [PMID: 34858341 PMCID: PMC8631429 DOI: 10.3389/fendo.2021.769074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/22/2021] [Indexed: 12/30/2022] Open
Abstract
CONTEXT Thyroid-stimulating hormone (TSH) suppression is recommended to reduce tumor recurrence following surgery for differentiated thyroid cancer (DTC). However, prolonged subclinical hyperthyroidism caused by levothyroxine treatment has deleterious effects on various organs. OBJECTIVE To evaluate the relationships of TSH concentration with muscle mass, muscle strength, and physical performance related to sarcopenia in patients with DTC undergoing TSH suppression following surgery. METHODS We studied 134 patients of >60 years who were undergoing TSH suppression therapy following surgery for DTC. We evaluated muscle mass and muscle function-related parameters and diagnosed sarcopenia using the threshold for Asian people. RESULTS The participants were 68.3 ± 7.2 years old and 36/134 (26.9%) were diagnosed with sarcopenia. They were allocated to high-TSH and low-TSH groups using a threshold concentration of 0.40 μU/mL, and grip strength was significantly lower in the low-TSH group. The data were further analyzed according to age and sex, and in the low-TSH group, male participants and those of <70 years were found to have significantly lower grip strength. CONCLUSIONS Low-TSH concentrations is associated with low grip strength, and this is most pronounced in individuals of <70 years of age. Therefore, muscle function should be considered an adverse effect of TSH suppression in patients with DTC who undergo TSH suppression therapy, especially in men of <70 years.
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Affiliation(s)
- Jun Choul Lee
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Byong-Sop Song
- Department of Core Laboratory of Translational Research, Biomedical Convergence Research Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Young Mi Kang
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yu-Ri Kim
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yea Eun Kang
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Ju Hee Lee
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Minho Shong
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyon-Seung Yi
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
- Department of Core Laboratory of Translational Research, Biomedical Convergence Research Center, Chungnam National University Hospital, Daejeon, South Korea
- *Correspondence: Hyon-Seung Yi,
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Association of metabolic phenotypes, grip strength and diabetes risk: The 15-year follow-up of The North West Adelaide Health Study, Australia. Obes Res Clin Pract 2020; 14:536-541. [PMID: 33041220 DOI: 10.1016/j.orcp.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/11/2020] [Accepted: 09/12/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The association of diabetes risk in the long-term, metabolic phenotypes (MP) and muscle strength is unclear. We aimed to investigate the association between strictly defined MP, grip strength (GS) and diabetes. MATERIAL AND METHODS MP were defined according to BMI and presence of any individual metabolic abnormality for ≥18 years, in participants of the North West Adelaide Health Study (Australia) free of diabetes at baseline. The association of MP and dominant hand GS with incident diabetes over 15-years follow-up and the moderation effect of GS on the association between diabetes and MP were investigated by logistic regression models. RESULTS Of 3039 participants followed over 13.3 years (SD 2.6), 236 (7.8%) developed diabetes. Compared to the metabolically healthy (MH) normal weight phenotype, the metabolically unhealthy (MU) overweight (OR 6.15, 95%CI 2.43-15.59) and obese (OR 12.32, 95%CI 4.97-30.52) phenotypes were associated with a high risk of diabetes, but not the MU normal weight (OR 1.73, 95%CI 0.57-5.25), MH overweight (OR 1.15, 95%CI 0.31-4.31) or MH obese phenotypes (OR 0.77, 0.07-8.89). GS was inversely associated with diabetes (OR 0.97, 95% CI 0.95-0.99) and attenuated the risk associated with MU overweight (beta = -0.296, p = 0.039) and MU normal weight (beta = -0.773; p for interaction = 0.009). CONCLUSION Strictly defined MP (rather than based on metabolic syndrome criteria) and GS, a proxy of muscle strength, might be useful for stratifying the risk of diabetes in the long-term. Improving muscle strength might be an important strategy to reduce diabetes risk.
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28
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Shen C, Lu J, Xu Z, Xu Y, Yang Y. Association between handgrip strength and the risk of new-onset metabolic syndrome: a population-based cohort study. BMJ Open 2020; 10:e041384. [PMID: 33020107 PMCID: PMC7537454 DOI: 10.1136/bmjopen-2020-041384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES A lower relative handgrip strength (HGS) may disrupt metabolic homeostasis and then lead to metabolic syndrome (MetS). There is a paucity of longitudinal studies to examine whether relative HGS at baseline is linked to incident MetS. Thus, the purpose of the present study was to explore the association between relative HGS and new-onset MetS. DESIGN This is an observational and longitudinal research.A nationally representative sample of population in China. PARTICIPANTS A total of 3350 subjects without MetS were selected for analysis in the present study. Data are from the China Health and Retirement Longitudinal Study (2011-2015). OUTCOME MEASURES We calculated the relative HGS by dividing the HGS by body weight. Participants were divided into gender-specific quartiles. We estimated HRs for MetS and its components using Cox proportional hazard models according to the relative HGS categories. RESULTS After multiple adjustment, the risk of MetS increased with the lower quartile of relative HGS in both sexes. Using the highest quartile (Q4) as a reference, the HR for quartile Q3-1 was 1.49 (0.95, 2.34), 1.67 (1.08, 2.59) and 1.76 (1.12, 2.78), respectively, in men, and 1.14 (0.82, 1.58), 1.30 (1.02, 1.57) and 1.28 (1.03, 1.55), respectively, in women. Additionally, we observed that relative HGS was negatively or inversely associated with the risk of abdominal obesity in both sexes. CONCLUSIONS The current study demonstrated that relative HGS was inversely and independently associated with an increased risk of MetS and abdominal obesity, suggesting a possible role of relative HGS as a useful and simple index for muscle strength in the prediction of occurrence of MetS.
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Affiliation(s)
- Chao Shen
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Jiangting Lu
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Zhijie Xu
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yuanyuan Xu
- Department of General Practice, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Ying Yang
- Department of Cardiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
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Brown EC, Buchan DS, Madi SA, Gordon BN, Drignei D. Grip Strength Cut Points for Diabetes Risk Among Apparently Healthy U.S. Adults. Am J Prev Med 2020; 58:757-765. [PMID: 32273132 DOI: 10.1016/j.amepre.2020.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Early detection screening tools are needed to aid in preventing vascular complications associated with type 2 diabetes. As low muscular strength is linked to increased diabetes risk, the purpose of this study is to establish muscular strength cut points for determining diabetes risk using a large, nationally representative U.S. METHODS Using the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey data, 5,108 participants aged 20-80 years (68.6% aged 20-50 years; young male participants, n=1,813, mean age=33.43 years; young female participants, n=1,692, mean age=33.39 years; older male participants, n=813, mean age=59.92 years; older female participants, n=790, mean age=60.45 years) and free of common diabetes comorbidities were included. Muscular strength was assessed using a handgrip dynamometer and normalized by adjusting for body weight. A logistic regression for survey data controlling for covariates was used to determine normalized grip strength cut points. Diabetes risk was determined using American Diabetes Association diagnostic criteria. Analyses were conducted in the summer of 2019. RESULTS Normalized grip strength significantly predicted diabetes (p=0.0332), and the cut points for detecting diabetes risk included 0.78 (young male participants), 0.57 (young female participants), 0.68 (older male participants), and 0.49 (older female participants). The risk percentages for diabetes and estimated rates reported for all subgroups were comparable, and the risk percentages included 6.84 (95% CI=5.32, 8.36; younger male participants), 7.49 (95% CI=5.87, 9.10; younger female participants), 5.76 (95% CI=2.34, 9.19, older male participants), and 4.27 (95% CI=2.44, 6.10; older female participants). CONCLUSIONS Normalized grip strength using the cut points proposed in this paper may be a useful screening tool for diabetes risk in apparently healthy, normotensive adults.
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Affiliation(s)
- Elise C Brown
- Department of Public and Environmental Wellness, Oakland University, Rochester, Michigan.
| | - Duncan S Buchan
- Division of Sport and Exercise, Institute for Clinical Exercise and Health Sciences, University of the West of Scotland, Lanarkshire, Scotland
| | - Samar A Madi
- Department of Mathematics and Statistics, Oakland University, Rochester, Michigan
| | - Breanne N Gordon
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan
| | - Dorin Drignei
- Department of Mathematics and Statistics, Oakland University, Rochester, Michigan
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Duchowny K. Do Nationally Representative Cutpoints for Clinical Muscle Weakness Predict Mortality? Results From 9 Years of Follow-up in the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2020; 74:1070-1075. [PMID: 30052779 DOI: 10.1093/gerona/gly169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Muscle weakness, as measured by handgrip strength, is associated with cardiovascular and all-cause mortality; however, there are wide inconsistencies in the magnitude of these effects due to divergent definitions used to define muscle weakness across studies. Therefore, the objective of this study was to examine the relationship between previously defined sex- and race-specific cutpoints of clinical muscle weakness and early mortality. METHODS Data come from the 2006-2014 Health and Retirement Study. Time-varying clinical muscle weakness, as defined by handgrip strength cutpoints, was the primary exposure. Time to death, ascertained from the National Death Index, was the outcome of interest. The association between time-varying clinical muscle weakness and early mortality across a 9-year observation period was determined using Kaplan-Meier methods and extended Cox regression. RESULTS Out of the 8,326 individuals in the study, 1,799 deaths (21%) occurred during the observation period. Median follow-up time was 8.3 years (SD ±1.9 years). Weak individuals had a steeper decline in their survival trajectory, compared to non-weak individuals (Log-Rank test, p < .001). After adjusting for sociodemographic factors and time-varying smoking history, weak individuals were over 50% more likely to die earlier than non-weak individuals (hazard ratio [HR] = 1.52, 95% confidence interval [CI] = 1.15, 1.47). CONCLUSIONS This is the first study to use muscle weakness cutpoints derived in a nationally representative sample to identify those individuals who may be at greatest risk for premature mortality. Results underscore the importance of muscle weakness, as defined by handgrip strength, as a key risk factor for premature mortality in older Americans.
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Affiliation(s)
- Kate Duchowny
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor
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McGrath RP, Ottenbacher KJ, Vincent BM, Kraemer WJ, Peterson MD. Muscle weakness and functional limitations in an ethnically diverse sample of older adults. ETHNICITY & HEALTH 2020; 25:342-353. [PMID: 29278920 DOI: 10.1080/13557858.2017.1418301] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/06/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Muscle weakness is often linked to functional limitations in older adults. However, certain demographic characteristics, such as ethnicity, may differentially impact the association between weakness and functional limitations. This investigation sought to (1) identify sex- and ethnically-specific muscle weakness thresholds associated with functional limitations among older adults, and (2) determine the odds of functional limitations for each ethnicity by sex after identifying older adults below the weakness thresholds.Design: Persons aged ≥60 years from the 2011-2012 to 2013-2014 waves of the National Health and Nutrition Examination Survey identifying as non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic Asian were included. Handgrip strength was normalized to each participant's body weight (normalized grip strength (NGS)). Participants responded to 19-items asking them about their ability to perform certain activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility functions, and general physical activities. Receiver operating characteristic curves identified the optimal NGS thresholds associated with functional limitations. Covariate-adjusted multiple logistic regression models were performed to determine the odds of functional limitations for weak vs. not-weak participants.Results: Of the 3,027 participants, the highest NGS thresholds for functional limitations were in non-Hispanic Asian males (0.41; p < 0.001) and Hispanic females (0.36; p < 0.001); whereas, the lowest NGS thresholds were in Hispanic males (0.25; p < 0.001) and non-Hispanic black females (0.23; p < 0.001). Weak non-Hispanic Asian males (odds ratio (OR): 10.42; 95% confidence interval (CI): 10.24, 10.61) and females (OR: 11.95; CI: 11.71, 12.19) had the highest odds for functional limitations compared to their non-weak counterparts.Conclusion: Preserving muscle strength, especially for certain older adult populations, may help reduce the odds of developing functional limitations. Interventions designed to increase muscle strength to preserve or improve function should consider the role of ethnicity when designing such interventions and identifying at risk populations.
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Affiliation(s)
- Ryan P McGrath
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Brenda M Vincent
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Fragala MS, Cadore EL, Dorgo S, Izquierdo M, Kraemer WJ, Peterson MD, Ryan ED. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. J Strength Cond Res 2019; 33:2019-2052. [PMID: 31343601 DOI: 10.1519/jsc.0000000000003230] [Citation(s) in RCA: 523] [Impact Index Per Article: 104.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.
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Affiliation(s)
| | - Eduardo L Cadore
- School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandor Dorgo
- Department of Kinesiology, University of Texas at El Paso, El Paso, Texas
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarre, CIBER of Frailty and Healthy Aging (CIBERFES), Navarrabiomed, Pamplona, Navarre, Spain
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan-Medicine, Ann Arbor, Michigan
| | - Eric D Ryan
- Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Winett RA, Ogletree AM. Evidence-Based, High-Intensity Exercise and Physical Activity for Compressing Morbidity in Older Adults: A Narrative Review. Innov Aging 2019; 3:igz020. [PMID: 31380470 PMCID: PMC6658199 DOI: 10.1093/geroni/igz020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Indexed: 12/12/2022] Open
Abstract
Recent research in exercise science has important applications for middle-aged and older adults and points to how the programming of individual and multicomponent interventions including theory-based health behavior change strategies may be improved to compress morbidity by delaying or reducing the disabling process. High-intensity interval training and sprint interval training until recently were seen as only applicable to athletes. But recent lab-based research has adapted these interventions for even older adults and demonstrated their safety with beneficial outcomes on cardiometabolic risk factors comparable to or surpassing the usual lower- to moderate-intensity endurance training, and their potential translatability by showing the efficacy of much lower duration and frequency of training, even by systematic stair climbing. Moreover, people report positive affect while engaged in such training. For a century, resistance training was conceived as weightlifting with heavy weights required. Recent research has shown that using a higher degree of effort with lighter to moderate resistance in simple, time efficient protocols result in gains in strength and muscle mass similar to heavy resistance, as well as improvement of cardiometabolic risk factors, strength, body composition, and cognitive, affective, and functional abilities. More effort-based resistance training with moderate resistance may make resistance training more appealing and accessible to older adults. A key potential translational finding is that with correct technique and a high degree of effort, training with inexpensive, portable elastic bands, useable virtually anywhere, can provide appreciable benefits. More emphasis should be placed on long-term, translational interventions, resources, and programs that integrate interval and resistance trainings. This work may improve public health programs for middle-aged and older adults and reflects an emerging evidence base.
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Affiliation(s)
| | - Aaron M Ogletree
- Health Research and Evaluation, American Institutes for Research, Washington, District of Columbia
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Hu S, Gu Y, Lu Z, Zhang Q, Liu L, Meng G, Yao Z, Wu H, Bao X, Chi VTQ, Zhang S, Liu M, Wang Y, Wang L, Zheng L, Wang X, Tian C, Fu J, Sun S, Zhou M, Jia Q, Song K, Sun Z, Niu K. Relationship Between Grip Strength and Prediabetes in a Large-Scale Adult Population. Am J Prev Med 2019; 56:844-851. [PMID: 31003803 DOI: 10.1016/j.amepre.2019.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Prediabetes has been a growing health problem in China, and it is a high-risk state for developing diabetes and cardiovascular disease. In previous studies, low grip strength has been associated with diabetes. However, few population-based studies have examined the relationship between grip strength and prediabetes. Thus, the purpose of this study was to investigate whether grip strength is related to prediabetes in a large-scale adult population. METHODS A total of 27,295 participants aged 20 to 90 years were included from the 2013-2016 Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. Grip strength was assessed using an electronic hand-grip dynamometer and the greatest force was normalized to body weight. Prediabetes was diagnosed based on the American Diabetes Association criteria. Multiple logistic regression analysis was conducted in 2018 to assess the relationship of grip strength to the prevalence of prediabetes, while controlling for age, BMI, smoking, drinking, physical activities, dietary patterns, and other confounders. RESULTS Of the 27,295 participants, 28.5% (7,783) had prediabetes. After adjusting for potential confounders, a one unit increase in grip strength per body weight was associated with 52% lower odds of having prediabetes for men (OR=0.48, 95% CI=0.30, 0.74, p<0.01) and 62% lower odds of having prediabetes for women (OR=0.38, 95% CI=0.20, 0.70, p<0.01). CONCLUSIONS Increased grip strength is independently associated with lower prevalence of prediabetes in Chinese adults, suggesting that grip strength may be a useful marker for screening individuals at risk of prediabetes.
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Affiliation(s)
- Shan Hu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yeqing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zuolin Lu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhanxin Yao
- Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - Hongmei Wu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xue Bao
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Vu Thi Quynh Chi
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shunming Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Mingyue Liu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanyan Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Liu Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lixiao Zheng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaona Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chunling Tian
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jingzhu Fu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shaomei Sun
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Zhou
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiyu Jia
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Kun Song
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhong Sun
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
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Wu H, Liu M, Chi VTQ, Wang J, Zhang Q, Liu L, Meng G, Yao Z, Bao X, Gu Y, Zhang S, Sun S, Zhou M, Jia Q, Song K, Huang J, Huo J, Zhang B, Ding G, Niu K. Handgrip strength is inversely associated with metabolic syndrome and its separate components in middle aged and older adults: a large-scale population-based study. Metabolism 2019; 93:61-67. [PMID: 30690038 DOI: 10.1016/j.metabol.2019.01.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Muscle weakness is followed by insulin resistance which is associated with metabolic disorders leading to metabolic syndrome (MetS). Therefore, muscle strength decline may be associated with MetS. The aim of this study was to investigate the relationships between muscle strength and MetS and its separate components. METHODS A cross-sectional study was performed in 17,703 participants aged 40 years and older living in Tianjin, China. Handgrip strength was measured using a handheld digital dynamometer. MetS was defined in accordance with the criteria of the American Heart Association scientific statements of 2009. Multiple logistic regression analyses were used to assess the association between handgrip strength and MetS and its separate components. RESULTS The overall prevalence of MetS was 33.6%. The prevalence of MetS was significantly higher in men than in women (41.6% vs 22.9%, P < 0.0001). After adjustment for potential confounding factors (including sociodemographic variables, lifestyle factors, total energy intake, and family history of disease), the odds ratios (95% confidence interval) of MetS across decreasing handgrip strength quartiles were: 1.00 (reference), 1.87 (1.66, 2.11), 2.40 (2.13, 2.71), and 3.36 (2.97, 3.80) in men and 1.00 (reference), 1.80 (1.48, 2.21), 2.77 (2.29, 3.36), and 3.89 (3.22, 4.71) in women, respectively (P for all trend <0.0001). Similarly, handgrip strength was also observed to be negatively associated with separate components of MetS both in men and women. CONCLUSIONS Muscle strength is inversely associated with MetS and its separate components. Further prospective studies are needed to confirm this issue.
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Affiliation(s)
- Hongmei Wu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health; Center for International Collaborative Research on Environment, Nutrition and Public Health
| | - Mingyue Liu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Vu Thi Quynh Chi
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Qing Zhang
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health; Center for International Collaborative Research on Environment, Nutrition and Public Health
| | - Zhanxin Yao
- Tianjin Institute of Environmental & Operational Medicine, Tianjin, China
| | - Xue Bao
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yeqing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shunming Zhang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shaomei Sun
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Zhou
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiyu Jia
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Kun Song
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Huang
- Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Junsheng Huo
- Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Bing Zhang
- Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Gangqiang Ding
- Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China; Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health; Center for International Collaborative Research on Environment, Nutrition and Public Health.
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Whitney DG, Peterson MD. The Association Between Differing Grip Strength Measures and Mortality and Cerebrovascular Event in Older Adults: National Health and Aging Trends Study. Front Physiol 2019; 9:1871. [PMID: 30666214 PMCID: PMC6330303 DOI: 10.3389/fphys.2018.01871] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/11/2018] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to compare the predictive capacity of different post-processing methods of hand grip strength (GS) for mortality and incident cerebrovascular events in older adults. A sample of 4,143 participants aged 65 years and older was included from the National Health and Aging Trends Study (NHATS) and followed for 6 years. GS measures included baseline (i.e., round 1) (1) absolute GS, (2) GS divided by body mass (NGSmass), and (3) GS divided by body mass index (NGSBMI), as well as (4) change in absolute GS from round 1 to round 2 (GS1-2). Cox proportional hazards regression models were used to examine the association between sex- and age group-specific tertiles of GS measures (weak, moderate-strength, strong) with mortality (n = 641) and incident cerebrovascular events (n = 329). Absolute GS (hazard ratio [HR] = 1.83; 95% confidence interval [CI] = 1.51–2.22), NGSmass (HR = 1.46; 95% CI = 1.21–1.76), and NGSBMI (HR = 1.50; 95% CI = 1.24–1.82) were each associated with mortality among weak participants, but not GS1-2 (HR = 1.10; 95% CI = 0.99–1.46). NGSmass (HR = 1.54; 95% CI = 1.19–2.01) and NGSBMI (HR = 1.37; 95% CI = 1.06–1.79) were both associated with incident cerebrovascular event among weak participants, but not absolute GS (HR = 1.12; 95% CI = 0.86–1.47) or GS1-2 (HR = 1.11; 95% CI = 0.85–1.44). Absolute GS, NGSmass, and NGSBMI were each associated with mortality, whereas only NGSmass and NGSBMI were associated with cerebrovascular event. These findings suggest that different post-processing methods of GS may have differing predictive capacity in the elderly depending on the outcome of interest; however, since NGS measures were associated with both mortality and cerebrovascular events, they may be considered advantageous for screening in older adults.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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Kim BJ, Lee SH, Isales CM, Hamrick MW, Kwak MK, Koh JM. Association of Serum TSH With Handgrip Strength in Community-Dwelling Euthyroid Elderly. J Clin Endocrinol Metab 2018; 103:3986-3992. [PMID: 30137405 DOI: 10.1210/jc.2018-01095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/14/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Despite apparent muscle weakness in overt or even subclinical hyperthyroidism, the effects of thyroid function in the reference range on muscle strength are unknown. OBJECTIVE To investigate the association of serum TSH and free T4 with handgrip strength (HGS) in euthyroid elderly. DESIGN AND SETTING A nationally representative population-based, cross-sectional study from the Korea National Health and Nutrition Examination Surveys. PARTICIPANTS A total of 650 men aged ≥50 years and 533 postmenopausal women. MAIN OUTCOME MEASURES HGS was measured using a digital grip strength dynamometer, and low muscle strength was defined based on the Korean specific cutoff point of HGS (28.9 and 16.8 kg in men and women, respectively). RESULTS After adjustment for confounders, lower serum TSH but not free T4 was associated with lower HGS in men (P = 0.032). Compared with men with high-normal TSH, those with low-normal TSH consistently showed 5.0% lower HGS (P = 0.027), with a linear decrease in HGS across decreasing serum TSH quartiles (P for trend = 0.018). Men with low muscle strength had 22.0% lower serum TSH than those without (P = 0.015), and the odds for the risk of low muscle strength was 3.76 times higher among men with low-normal TSH than it was among those with high-normal TSH (P = 0.021). However, these associations were not observed in postmenopausal women. CONCLUSIONS These results suggest that serum TSH level at the lower end of reference range may be associated with low muscle strength, especially in older men.
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Affiliation(s)
- Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Carlos M Isales
- Departments of Orthopaedic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Mark W Hamrick
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Suwa M, Imoto T, Kida A, Yokochi T, Iwase M, Kozawa K. Poor toe flexor strength, but not handgrip strength, is associated with the prevalence of diabetes mellitus in middle-aged males. Endocr J 2018; 65:611-620. [PMID: 29593144 DOI: 10.1507/endocrj.ej17-0517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Previous studies suggested that reduced muscular strength was one of the potential predictor of prevalence of diabetes mellitus. The purpose of this study was to investigate the association between toe flexor strength (TFS) and handgrip strength (HGS) and the prevalence of diabetes mellitus. Cross-sectional analysis was conducted using data from 1,390 Japanese males (35-59 years). TFS and HGS were measured and medical examinations undertaken. The prevalence of diabetes mellitus was defined as fasting blood glucose ≥126 mg/dL, glycated hemoglobin ≥6.5% (48 mmol/mol), and/or current use of anti-diabetes mellitus drugs. A total of 114 participants had diabetes mellitus. TFS in participants with diabetes mellitus was significantly lower than that in persons not suffering from diabetes mellitus but HGS was not. Odds ratio (OR) and 95% confidence interval (CI) per 1-standard deviation-increase in muscular strength measurements for the prevalence of diabetes mellitus were obtained using a multiple logistic regression model. Prevalence of diabetes mellitus was inversely related to TFS (OR 0.769, 95% CI 0.614-0.963), TFS/body mass (BM) (0.696, 0.545-0.889) and TFS/body mass index (BMI) (0.690, 0.539-0.882) after adjustment of covariates. Such associations were not observed in HGS (OR 0.976, 95% CI 0.773-1.232), HGS/BM (0.868, 0.666-1.133) or HGS/BMI (0.826, 0.642-1.062). These results suggested that poor TFS was associated with an increased prevalence of diabetes mellitus independent of visceral fat accumulation, but HGS was not, in middle-aged males. TFS may be a better marker for the prevalence of diabetes mellitus than HGS.
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Affiliation(s)
- Masataka Suwa
- Health Support Center WELPO, Toyota Motor Corporation, Toyota, Aichi, 444-2225, Japan
| | - Takayuki Imoto
- Health Support Center WELPO, Toyota Motor Corporation, Toyota, Aichi, 444-2225, Japan
| | - Akira Kida
- Health Support Center WELPO, Toyota Motor Corporation, Toyota, Aichi, 444-2225, Japan
| | - Takashi Yokochi
- Health Support Center WELPO, Toyota Motor Corporation, Toyota, Aichi, 444-2225, Japan
- Midtown Clinic Meieki, Nagoya, Aichi, 450-6305, Japan
| | | | - Kenji Kozawa
- Health Support Center WELPO, Toyota Motor Corporation, Toyota, Aichi, 444-2225, Japan
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Lee MR, Jung SM, Bang H, Kim HS, Kim YB. Association between muscle strength and type 2 diabetes mellitus in adults in Korea: Data from the Korea national health and nutrition examination survey (KNHANES) VI. Medicine (Baltimore) 2018; 97:e10984. [PMID: 29879054 PMCID: PMC5999476 DOI: 10.1097/md.0000000000010984] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Diabetes mellitus (DM) is a significant chronic disease, and health burden from DM is increasing. Recently, studies on the relationship between handgrip strength, which is a measuring tool for muscle strength, and type 2 DM were published. However, the results have been conflicting. In addition, few studies that used data from adults in Korea have been conducted. Thus, this study aimed to identify the association between handgrip strength as well as type 2 DM and insulin resistance in adults using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014 to 2015. Inflammation is a condition affecting the muscle strength of individuals with type 2 DM; therefore, its mediating effects were also examined.We included 8208 participants aged between 19 and 80 years who had undergone a handgrip test and had received information about type 2 DM. General linear and binary logistic regression models were used to examine the association between handgrip strength and type 2 DM variables. In addition, mediation analysis was conducted to estimate the role of inflammation in the relationship between handgrip strength and type 2 DM.After adjusting for age, sex, education, alcohol consumption, lifetime smoking, obesity, and aerobic physical activity, handgrip strength was inversely associated with fasting glucose, HbA1c, and fasting insulin levels as well as the homeostasis model assessment of insulin resistance (HOMA-IR) score. Multivariable logistic regression analyses showed that handgrip strength was significantly inversely associated with type 2 DM and insulin resistance. The high-sensitivity C-reactive protein (hs-CRP), an inflammation-related biomarker, mediated approximately 10% of the association between handgrip strength and type 2 DM.Using large, well-defined, nationally representative cross-sectional data on adults in Korea, we found that handgrip strength, which is an indicator of muscle strength, was associated with type 2 DM.
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Affiliation(s)
- Mee-Ri Lee
- Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Soonchunhyang University College of Medicine, Chungcheongnam-do
| | - Sung Min Jung
- Department of Surgery, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea
| | - Hyuk Bang
- Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Soonchunhyang University College of Medicine, Chungcheongnam-do
| | - Hwa Sung Kim
- Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Soonchunhyang University College of Medicine, Chungcheongnam-do
| | - Yong Bae Kim
- Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Soonchunhyang University College of Medicine, Chungcheongnam-do
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Peterson MD, Belakovskiy A, McGrath R, Yarrow JF. Testosterone Deficiency, Weakness, and Multimorbidity in Men. Sci Rep 2018; 8:5897. [PMID: 29651127 PMCID: PMC5897450 DOI: 10.1038/s41598-018-24347-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/28/2018] [Indexed: 01/03/2023] Open
Abstract
The purposes of this study were to evaluate the association between total testosterone (TT) deficiency and weakness on multimorbidity in men. Analyses were performed to examine the prevalence of multimobidity among young, middle-aged, and older men, with and without testosterone deficiency. Multivariate logistic models were also used to determine the association between age-specific TT tertiles and multimorbidity, adjusting for key sociodemographic variables, as well as a secondary analysis adjusted for grip strength. Multimorbidity was more prevalent among men with testosterone deficiency, compared to normal TT in the entire group (36.6% vs 55.2%; p < 0.001); however, differences were only seen within young (testosterone deficiency: 36.4%; normal TT: 13.5%; p < 0.001) and older men (testosterone deficiency: 75.0%; normal TT: 61.5%; p < 0.001). Robust associations were found between the age-specific low-TT (OR: 2.87; 95%CI: 2.14–3.83) and moderate-TT (OR: 1.67; 95%CI: 1.27–2.20) tertiles (reference high-TT) and multimorbidity. Secondary analysis demonstrated that both low TT (OR: 1.82; 95%CI: 1.29–2.55) and moderate-TT (OR: 1.31; 95%CI: 1.01–1.69) were associated with multimorbidity, even after adjusting for obesity (OR: 1.75; 95%CI: 1.07–2.87) and NGS (OR: 1.21 per 0.05 unit lower NGS). Low TT and weakness in men were independently associated with multimorbidity at all ages; however, multimorbidity was more prevalent among young and older men with testosterone deficiency.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, USA.
| | - Aleksandr Belakovskiy
- Department of Family Medicine, Michigan Medicine, University of Michigan Research Service, Ann Arbor, USA
| | - Ryan McGrath
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Joshua F Yarrow
- Malcom Randall Department of Veterans Affairs Medical Center, North Florida/South Georgia Veterans Health System, Gainesville, USA.,Division of Endocrinology, Diabetes, and Metabolism, University of Florida College of Medicine, Gainesville, USA
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Giglio BM, Mota JF, Wall BT, Pimentel GD. Low Handgrip Strength Is Not Associated with Type 2 Diabetes Mellitus and Hyperglycemia: a Population-Based Study. Clin Nutr Res 2018; 7:112-116. [PMID: 29713619 PMCID: PMC5921328 DOI: 10.7762/cnr.2018.7.2.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/08/2018] [Accepted: 03/11/2018] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes mellitus (DM) is commonly linked to muscle weakness and metabolic abnormalities which increase healthcare costs. The study was undertaken to investigate if low handgrip strength, as a marker of muscle weakness, is associated with hyperglycemia and/or DM in Brazilian subjects. In a cross-sectional design, 415 individuals of both sexes (46.7% male) were interviewed by a questionnaire and the DM diagnostic was self-reported. Anthropometric measurements, such as weight, height, body mass index (BMI), arm circumference, mid-arm and calf circumference and handgrip strength, were obtained by trained nutritionists. Blood glucose concentrations were determined by portable monitor analysis. Student's t-test was applied to compare DM cases with non-diabetic individuals, and logistic regression analysis was performed to verify the odds for becoming diabetic or having altered glycemia and p < 0.05 was considered as significant. From 415 subjects, 9.2% (n = 35) were classified as DM. DM patients had significantly higher age, BMI, casual glycemia and lower handgrip strength and normalized (to body weight) handgrip strength (NHS) when compared with non-diabetic patients. Individuals with low NHS have 2.7 odds ratio to DM without adjustment for covariate (crude model, p = 0.006) and have 2.7 times higher the likelihood of DM than individuals with high NHS after adjusting for age (model 1, p = 0.006); however, this association disappeared after further adjusting for sex. In conclusion, low handgrip strength normalized or not to body weight, was not associated with hyperglycemia and DM diagnosis.
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Affiliation(s)
- Bruna M Giglio
- Clinical and Sports Nutrition Research Laboratory, Faculty of Nutrition, Federal University of Goiás, Goiânia, GO 74605-080, Brazil
| | - João F Mota
- Clinical and Sports Nutrition Research Laboratory, Faculty of Nutrition, Federal University of Goiás, Goiânia, GO 74605-080, Brazil
| | - Benjamin T Wall
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4SB, UK
| | - Gustavo Duarte Pimentel
- Clinical and Sports Nutrition Research Laboratory, Faculty of Nutrition, Federal University of Goiás, Goiânia, GO 74605-080, Brazil
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Duchowny KA, Clarke PJ, Peterson MD. Muscle Weakness and Physical Disability in Older Americans: Longitudinal Findings from the U.S. Health and Retirement Study. J Nutr Health Aging 2018; 22:501-507. [PMID: 29582889 PMCID: PMC6472265 DOI: 10.1007/s12603-017-0951-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. OBJECTIVE To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. DESIGN We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. SETTING General community, nationally representative sample of older Americans. PARTICIPANTS Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. RESULTS In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001). CONCLUSIONS This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes.
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Affiliation(s)
- K A Duchowny
- Kate Duchowny, MPH, University of Michigan School of Public Health, Department of Epidemiology, Center for Social Epidemiology and Population health, 1415 Washington Heights, 3rd Flower Tower, Ann Arbor, Michigan 48109, Phone: (734) 615-9209,
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Peterson MD, Duchowny K, Meng Q, Wang Y, Chen X, Zhao Y. Low Normalized Grip Strength is a Biomarker for Cardiometabolic Disease and Physical Disabilities Among U.S. and Chinese Adults. J Gerontol A Biol Sci Med Sci 2017; 72:1525-1531. [PMID: 28329157 PMCID: PMC5861974 DOI: 10.1093/gerona/glx031] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/15/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Evidence highlights the importance of muscular strength as a protective factor for health and function across aging populations. The purpose of this study was to examine the extent to which low normalized grip strength (NGS) serves as a biomarker for both cardiometabolic disease and physical disability in U.S. and Chinese adults. METHODS Middle aged and older adults from the U.S. National Health and Nutrition Examination Survey 2011-2012 and 2013-2014 combined surveys (n = 4,544), and the 2011 wave of the China Health and Retirement Longitudinal Study (n = 6,030) were included. Strength was assessed using a handgrip dynamometer, and was normalized to body mass. Weighted logistic regression models were used to assess the association between NGS and diabetes, hyperglycemia, hypertriglyceridemia, low HDL-cholesterol, hypertension, and physical disability status, while controlling for age, sex, and sociodemographic characteristics. RESULTS Every 0.05 lower NGS was independently associated with a 1.49 (95% confidence interval [CI]: 1.42-1.56) and 1.17 (95% CI: 1.11-1.23) odds for diabetes; a 1.46 (95% CI: 1.39-1.53) and 1.11 (95% CI: 1.07-1.15) odds of hyperglycemia; a 1.15 (95% CI: 1.07-1.25) and 1.11 (95% CI: 1.08-1.14) odds of hypertriglyceridemia; a 1.22 (95% CI: 1.17-1.27) and 1.15 (95% CI: 1.12-1.18) odds of low HDL-cholesterol; a 1.19 (95% CI: 1.14-1.24) and 1.10 (95% CI: 1.07-1.14) odds of hypertension; and a 1.36 (95% CI: 1.29-1.42) and 1.10 (95% CI: 1.05-1.15) odds for physical disability status in U.S. and Chinese adults, respectively. CONCLUSIONS NGS was robustly associated with both cardiometabolic disease risk and physical disabilities in U.S. and Chinese aging adults.
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Affiliation(s)
- Mark D Peterson
- Department of Physical Medicine & Rehabilitation, University of Michigan Health System, Ann Arbor
- Global REACH, University of Michigan Medical School, Ann Arbor
| | - Kate Duchowny
- School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor
| | | | | | | | - Yaohui Zhao
- National School of Development, Peking University, Beijing, China
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Julian V, Blondel R, Pereira B, Thivel D, Boirie Y, Duclos M. Body Composition Is Altered in Pre-Diabetic Patients With Impaired Fasting Glucose Tolerance: Results From the NHANES Survey. J Clin Med Res 2017; 9:917-925. [PMID: 29038669 PMCID: PMC5633092 DOI: 10.14740/jocmr3142w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/21/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Previous studies suggest that type 2 diabetes mellitus (T2DM) is associated with a loss of muscle mass but the impact of fasting blood glucose (FBG) on body composition remains underappreciated in pre-diabetic subjects. The aim of this study was to determine the influence of FBG on lean mass (LM), fat mass (FM) and their distribution (trunk vs. appendicular), separately in middle-aged men and women. METHODS One thousand nine hundred and eleven (1,911) men (63.9 ± 11.7 years) and 1,977 women (63.7 ± 12.1 years) from the National Health and Nutrition Examination Survey (1999 - 2004) were divided into four groups: normal glucose tolerance (NGT), low impaired fasting glucose (IFG), high IFG and T2DM. Body composition was obtained from dual X-ray absorptiometry (DXA). RESULTS Of the patients, 68.7% had NGT, 16.1% low IFG, 9.4% high IFG and 5.8% T2DM. After adjustment for age, body mass index, ethnicity, smoking, alcohol and physical activity (PA), no change in appendicular LM was observed between groups, but significant increases in trunk FM (in both gender) and trunk LM (in women) were found with increased glucose intolerance (T2DM > IFG > NGT), as well as significant decreases in trunk and total LM/FM ratios (T2DM < IFG < NGT) and a significant increase in trunk/appendicular FM ratio (T2DM > IFG > NGT). CONCLUSIONS Elevated FBG within the normal range is not associated with a significant loss of appendicular LM, but modifications in LM and FM trunk and total distribution with IFG suggest that nutritional and physical lifestyle strategies should be implemented in the pre-diabetic state.
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Affiliation(s)
- Valerie Julian
- Service Medecine du Sport et Explorations Fonctionnelles, CHU Clermont-Ferrand, INRA, Universite Clermont Auvergne, Clermont-Ferrand, France.,Unite de Nutrition Humaine, CHU Clermont-Ferrand, INRA, Universite Clermont Auvergne, Clermont-Ferrand, France
| | - Romain Blondel
- Service Medecine du Sport et Explorations Fonctionnelles, CHU Clermont-Ferrand, INRA, Universite Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Service de Biostatistique, CHU Clermont-Ferrand, Universite Clermont Auvergne, Clermont-Ferrand, France
| | - David Thivel
- Laboratoire AME2P, Universite Clermont Auvergne, Aubiere, France
| | - Yves Boirie
- Unite de Nutrition Humaine, CHU Clermont-Ferrand, INRA, Universite Clermont Auvergne, Clermont-Ferrand, France.,Service de Nutrition Clinique CHU Clermont-Ferrand, INRA, Universite Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Service Medecine du Sport et Explorations Fonctionnelles, CHU Clermont-Ferrand, INRA, Universite Clermont Auvergne, Clermont-Ferrand, France.,Unite de Nutrition Humaine, CHU Clermont-Ferrand, INRA, Universite Clermont Auvergne, Clermont-Ferrand, France
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Marques-Vidal P, Vollenweider P, Waeber G, Jornayvaz FR. Grip strength is not associated with incident type 2 diabetes mellitus in healthy adults: The CoLaus study. Diabetes Res Clin Pract 2017; 132:144-148. [PMID: 28863331 DOI: 10.1016/j.diabres.2017.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/05/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022]
Abstract
AIMS We examined the association of grip strength with incident type 2 diabetes mellitus (T2DM) in healthy subjects initially aged 50 to 75years after a follow-up of 5.5years and 10.7years. METHODS This was a prospective, population-based study derived from the CoLaus (Cohorte Lausannoise) study including 2318 participants (aged 60.2y; 1354 women) free from T2DM at baseline. Grip strength was assessed using a handheld dynamometer. The effect of grip strength on the incidence of T2DM was analyzed by logistic regression. RESULTS After a follow-up of 5.5years, 190 (8.2%) T2DM cases were identified. In bivariate analysis, participants who developed T2DM had a higher absolute grip strength (35.3±10.6 versus 33.2±10.7kg, P=0.013). Analysis between grip strength expressed in 5kg increment and incident TD2M showed a negative association when adjusted for age and sex [ORs (95% CI): 0.88 (0.79, 0.98)], or for age, sex and body mass index (BMI) [ORs (95% CI): 0.87 (0.78, 097)]. After a follow-up of 10.7years, 131 supplemental (7.3%) T2DM cases were identified, but there was no association between grip strength and incident T2DM in bivariate and multivariable analysis, potentially due to a lack of statistical power. CONCLUSIONS In non elderly healthy adults, the risk of incident T2DM is overall not associated with grip strength over a maximum follow-up of 10.7years. Future studies are warranted to better assess the association between grip strength and incident T2DM in bigger and even younger cohorts.
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Affiliation(s)
- Pedro Marques-Vidal
- Service of Internal Medicine, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Peter Vollenweider
- Service of Internal Medicine, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Gérard Waeber
- Service of Internal Medicine, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - François R Jornayvaz
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
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Sinclair AJ, Abdelhafiz AH, Rodríguez-Mañas L. Frailty and sarcopenia - newly emerging and high impact complications of diabetes. J Diabetes Complications 2017; 31:1465-1473. [PMID: 28669464 DOI: 10.1016/j.jdiacomp.2017.05.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 12/14/2022]
Abstract
Diabetes increases the risk of physical dysfunction and disability. Diabetes-related complications and coexisting morbidities partially explain the deterioration in physical function. The decline in muscle mass, strength and function associated with diabetes leads to sarcopenia, frailty and eventually disability. Frailty acts as a mediator in the pathogenesis of disability in older people with diabetes and its measurement in routine daily practice is recommended. Frailty is a dynamic process which progresses from a robust condition to a pre-frail stage then frailty and eventually disability. Therefore, a multimodal intervention which includes adequate nutrition, exercise training, good glycaemic control and the use of appropriate hypoglycemic medications may help delay or prevent the progression to disability.
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Affiliation(s)
- Alan J Sinclair
- University of Aston and Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, WR9 0QH, UK.
| | - Ahmed H Abdelhafiz
- Department of Elderly Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, UK
| | - Leocadio Rodríguez-Mañas
- Hospital Universitario de Getafe, Department of Geriatrics and School of Health Sciences, Universidad Europea de Madrid, Spain
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McGrath RP, Vincent BM, Snih SA, Markides KS, Dieter BP, Bailey RR, Peterson MD. The Association Between Handgrip Strength and Diabetes on Activities of Daily Living Disability in Older Mexican Americans. J Aging Health 2017. [PMID: 28627325 DOI: 10.1177/0898264317715544] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this study is to determine the independent and joint effects of muscle weakness and diabetes on incident activities of daily living (ADL) disability in older Mexican Americans. METHOD A subsample of 2,270 Mexican Americans aged at least 65 years at baseline were followed for 19 years. Handgrip strength was normalized to body weight (normalized grip strength [NGS]). Weakness was defined as NGS ≤0.46 in males and ≤0.30 in females. Diabetes and ADL disability were self-reported. RESULTS Compared with participants that were not weak and did not have diabetes, those that had diabetes only, were weak only, and were both weak and had diabetes experienced a 1.94 (95% confidence interval [CI] = [1.89, 1.98]), 1.17 (CI = [1.16, 1.19]), and 2.12 (CI = [2.08, 2.16]) higher rate for ADL disability, respectively. DISCUSSION Muscle weakness and diabetes were independently and jointly associated with higher rates for ADL disability in older Mexican Americans.
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Affiliation(s)
| | | | - Soham Al Snih
- 3 University of Texas Medical Branch, Galveston, USA
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McGrath R, Vincent BM, Al Snih S, Markides KS, Peterson MD. The Association Between Muscle Weakness and Incident Diabetes in Older Mexican Americans. J Am Med Dir Assoc 2017; 18:452.e7-452.e12. [PMID: 28330635 PMCID: PMC5401795 DOI: 10.1016/j.jamda.2017.01.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES A natural decline of muscle strength occurs during the aging process; however, preserving muscle strength may lower the rate of many preventable diseases such as diabetes, especially in higher risk populations. The purpose of this study was to examine the sex-specific association between muscle weakness and incident diabetes in older Mexican Americans. DESIGN Observational, longitudinal study. SETTING Urban and rural households in the Southwestern United States. PARTICIPANTS A subsample of 1903 Mexican Americans aged at least 65 years without diabetes at baseline were followed for 19 years. MEASUREMENTS Muscle weakness was assessed with a hand-held dynamometer and was normalized to body weight (normalized grip strength). Male and female participants were categorized as weak if their normalized grip strength was ≤0.46 and ≤0.30, respectively. Sex-stratified Cox proportional hazard regression models were used to determine the association between muscle weakness and incident diabetes (self-reported) when using age as an entry variable and after adjusting for education, employment status, instrumental activities of daily living disability, interview language, marital status, and obesity. A sensitivity analysis was performed to account for influential outliers for the outcome variable (incident diabetes) and the model was re-run. RESULTS The hazard ratio for incident diabetes was 1.05 (95% confidence interval: 1.02-1.09; P < .001) in weak vs not-weak male participants and 1.38 (95% confidence interval: 1.35-1.41; P < .001) in weak vs not-weak female participants, after adjusting for relevant covariates. CONCLUSIONS Muscle weakness was associated with an increased rate of diabetes in older male and female Mexican Americans. Health professionals should encourage activities that preserve muscle strength, thereby preventing the incidence of diabetes in older Mexican Americans.
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Affiliation(s)
- Ryan McGrath
- Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, Ann Arbor, MI
| | - Brenda M. Vincent
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Soham Al Snih
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - Kyriakos S. Markides
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, Ann Arbor, MI
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Ferreira JP, Sartor CD, Leal ÂMO, Sacco ICN, Sato TO, Ribeiro IL, Soares AS, Cunha JE, Salvini TF. The effect of peripheral neuropathy on lower limb muscle strength in diabetic individuals. Clin Biomech (Bristol, Avon) 2017; 43:67-73. [PMID: 28213167 DOI: 10.1016/j.clinbiomech.2017.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/29/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skeletal muscle strength is poorly described and understood in diabetic participants with diabetic peripheral neuropathy. This study aimed to investigate the extensor and flexor torque of the knee and ankle during concentric, eccentric, and isometric contractions in men with diabetes mellitus type 2 with and without diabetic peripheral neuropathy. METHODS Three groups of adult men (n=92), similar in age, body mass index, and testosterone levels, were analyzed: 33 non-diabetic controls, 31 with type 2 diabetes mellitus, and 28 with diabetic peripheral neuropathy. The peak torques in the concentric, eccentric, and isometric contractions were evaluated using an isokinetic dynamometer during knee and ankle flexion and extension. FINDINGS Individuals with diabetes and diabetic peripheral neuropathy presented similar low concentric and isometric knee and ankle torques that were also lower than the controls. However, the eccentric torque was similar among the groups, the contractions, and the joints. INTERPRETATION Regardless of the presence of peripheral neuropathy, differences in skeletal muscle function were found. The muscle involvement does not follow the same pattern of sensorial losses, since there are no distal-to-proximal impairments. Both knee and ankle were affected, but the effect sizes of the concentric and isometric torques were found to be greater in the participants' knees than in their ankles. The eccentric function did not reveal differences between the healthy control group and the two diabetic groups, raising questions about the involvement of the passive muscle components.
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Affiliation(s)
- Jean P Ferreira
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Cristina D Sartor
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ângela M O Leal
- Department of Medicine, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Tatiana O Sato
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Ivana L Ribeiro
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Alice S Soares
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Jonathan E Cunha
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil
| | - Tania F Salvini
- Laboratory of Skeletal Muscle Plasticity, Department of Physical Therapy, Federal University of São Carlos, SP, Brazil.
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Resist diabetes: A randomized clinical trial for resistance training maintenance in adults with prediabetes. PLoS One 2017; 12:e0172610. [PMID: 28231265 PMCID: PMC5322950 DOI: 10.1371/journal.pone.0172610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/06/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To determine whether a social cognitive theory (SCT)-based intervention improves resistance training (RT) maintenance and strength, and reduces prediabetes prevalence. Research design and methods Sedentary, overweight/obese (BMI: 25–39.9 kg/m2) adults aged 50–69 (N = 170) with prediabetes participated in the 15-month trial. Participants completed a supervised 3-month RT (2×/wk) phase and were randomly assigned (N = 159) to one of two 6-month maintenance conditions: SCT or standard care. Participants continued RT at a self-selected facility. The final 6-month period involved no contact. Assessments occurred at baseline and months 3, 9, and 15. The SCT faded-contact intervention consisted of nine tailored transition (i.e., supervised training to training alone) and nine follow-up sessions. Standard care involved six generic follow-up sessions. Primary outcomes were prevalence of normoglycemia and muscular strength. Results The retention rate was 76%. Four serious adverse events were reported. After 3 months of RT, 34% of participants were no longer prediabetic. This prevalence of normoglycemia was maintained through month 15 (30%), with no group difference. There was an 18% increase in the odds of being normoglycemic for each % increase in fat-free mass. Increases in muscular strength were evident at month 3 and maintained through month 15 (P<0.001), which represented improvements of 21% and 14% for chest and leg press, respectively. Results did not demonstrate a greater reduction in prediabetes prevalence in the SCT condition. Conclusions Resistance training is an effective, maintainable strategy for reducing prediabetes prevalence and increasing muscular strength. Future research which promotes RT initiation and maintenance in clinical and community settings is warranted. Trial Registration ClinicalTrials.gov NCT01112709.
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