Handgrip strength asymmetry is associated with future falls in older Americans

Association of handgrip strength asymmetry and weakness with depression among middle-aged and older population in China: A cohort study

BACKGROUND

Handgrip strength (HGS) weakness and asymmetry were recently reported to be associated with age-related health conditions. However, little is known about their combined effects on depression. We aimed to explore the joint association of HGS asymmetry and weakness with depressive symptoms in Chinese middle and older aged population.

METHODS

8700 participants aged ≥45 years were enrolled from China Health and Retirement Longitudinal Study (2015-2018). HGS weakness was determined as maximal HGS < 28 kg in males and <18 kg in females. HGS asymmetry was measured by HGS ratio and was defined using two different rules. Specifically, HGS ratio < 0.90 or >1.10 (10 % rule) and <0.80 or >1.20 (20 % rule) were considered as asymmetry. Participants were classified into four groups: normal and symmetric HGS, asymmetry only, weakness only, and both weakness and asymmetry. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale, with scores ≥12 defined as depression. The logistic regression and multiple linear regression models were conducted to estimate the associations between HGS status and depressive symptoms.

RESULTS

The three-year incidence of depression was 19.2 %. After adjusting for covariates, compared to normal and symmetric HGS, participants with both HGS asymmetry and weakness showed the greatest risk of incident depression (10 % rule: OR 1.55, 95 % CI 1.19-2.02; 20 % rule: OR 1.71, 95 % CI 1.16-2.50). The coexistence of asymmetry and weakness was related to a significant increase in depression score (10 % rule: β 0.96, 95 % CI 0.38-1.54; 20 % rule: β 0.94, 95 % CI 0.08-1.81). The complete case analysis supported the results, and the associations were not modified by age, sex, and hand dominance.

LIMITATIONS

Depressive assessment was based on self-reported screening instrument.

CONCLUSIONS

The presence of both HGS asymmetry and weakness was associated with a higher risk of depression. Examining HGS asymmetry along with weakness may aid in identifying individuals at risk of depression to enable early interventions.

Low handgrip strength with asymmetry is associated with elevated all-cause mortality risk in older Chinese adults with abdominal obesity

BACKGROUND AND OBJECTIVES

Low handgrip strength (HGS) and abdominal obesity (AO) have been reported to be linked to an increased all-cause mortality risk in older adults. However, the combined impact of AO with low HGS and/or HGS asymmetry on mortality risk remains unclear. Therefore, this study aimed to investigate the synergistic effects of AO and abnormal HGS on mortality risk among Chinese older adults.

METHODS

Baseline data of the China Health and Retirement Longitudinal Study in 2011, along with mortality outcomes obtained in 2018 were used for the analysis. Low HGS was identified as HGS <18 kg in women or <28 kg in men, while HGS asymmetry is defined as an HGS of either hand > 10% stronger than the other. AO was characterized by a waist circumference ≥90 cm in men and ≥85 cm in women. Logistic regression analysis was used to evaluate the relationship between AO, abnormal HGS and mortality risk.

RESULTS

A total of 5186 subjects aged 60 years or older were enrolled, 50.6% of whom were male. The proportions of participants with only AO, only low HGS, only HGS asymmetry, low HGS with asymmetry, both AO and low HGS, both AO and asymmetric HGS, and AO with both low HGS and asymmetry were 20.0%, 6.1%, 16.6%, 8.3%, 3.2%, 13.4%, and 3.9%, respectively. Over the course of a 7-year follow-up interval, 970 of these individuals died, with 13.4%, 12.4%, 13.6%, 15.5%, 4.1%, 10.1% and 6.9% of deaths in the above groups, respectively. The adjusted logistic regression analysis model confirmed that only low HGS (OR = 1.897, 95%CI: 1.386-2.596, p<0.001), low HGS with asymmetry (OR = 1.680, 95%CI: 1.265-2.231, p<0.001), and AO combined with both low HGS and asymmetry (OR = 2.029, 95%CI: 1.381-2.981, p<0.001) were associated with a higher risk of mortality.

CONCLUSIONS

Low HGS, with or without asymmetry, is associated with increased mortality risk in older Chinese adults without AO, and the combination of low HGS and HGS asymmetry further elevates mortality risk in those with AO.

The relationship between low and asymmetric handgrip strength and low muscle mass: results of a cross-sectional study on health and aging trends in western China

OBJECTIVE

The aim was to determine the relationship between low handgrip strength (HGS) only, asymmetric HGS only, and low HGS combined with asymmetric HGS and low muscle mass in the West China Health and Aging Trends Study (WCHAT) data.

STUDY DESIGN

Individuals aged at least 50 years old were included in this cross-sectional study using WCHAT data. Demographic characteristics, such as age, marital status, education level, ethnicity, and drinking and smoking history, as well as chronic diseases, were recorded for all participants. The HGS of both hands was tested three times using a grip dynanometer with the participant in a standing position with arms extended, before recording the maximum value for both hands. The maximum value referred to values < 28 kg and < 18 kg for males and females, respectively. HGS ratios (non-dominant HGS/dominant HGS) of < 0.90 or > 1.10 suggest asymmetric HGS. The subjects were then allocated to the low HGS, asymmetrical HGS, and combined low and asymmetrical HGS (BOTH group) groups, and those with neither low nor asymmetric HGS (the normal group). The InBody 770 instrument was used for the analysis of muscle mass, with low muscle mass defined as a skeletal muscle mass index (SMI) of < 7.0 kg/m2 or < 5.7 kg/m2 for males and females, respectively. The associations between the different HGS groups and low muscle mass were assessed by logistic regression analysis.

RESULTS

The study included 1748 subjects, of whom 1272 (72.77%) were over the age of 60 years. The numbers of Han, Tibetan, and Qiang were 885 (50.63%), 217 (12.41%), and 579 (33.12%), respectively. A total of 465 individuals (26.60%) were classified as having low muscle mass, while 228 (13.04%), 536 (30.66%), and 125 (7.15%) participants were allocated to the low HGS, asymmetric HGS, and BOTH groups, respectively. The average SMI differed significantly between the normal group and the other groups (normal group vs. asymmetric HGS group vs. low HGS group vs. BOTH group: 6.627 kg/m2 vs. 6.633 kg/m2 vs. 6.492 kg/m2 vs. 5.995 kg/m2, respectively, P < 0.05). In addition, the prevalence of low muscle mass in the normal, asymmetric HGS, low HGS, and BOTH groups increased sequentially, with significant differences (normal group vs. asymmetric HGS group vs. low HGS group vs. BOTH group: 21.5% vs. 22.4% vs. 39.5% vs. 56%, respectively, P = 0.001). Further logistic regression analysis showed that the presence of low HGS (OR = 1.7, 95%CI: 1.203-2.402) and both low and asymmetric HGS (OR = 3.378, 95%CI: 2.173-5.252) were predictive of low muscle mass, with the chance being higher for the latter condition.

CONCLUSION

The findings suggest that although asymmetrical HGS itself does not increase the chances of low muscle mass. When low HGS and a combination of both features (low HGS combined with asymmetric HGS) is present in subjects, the chance of low muscle mass increases.

The relationship between asymmetrical grip strength criteria and fall incidence among middle-aged and older Chinese adults

PURPOSE

Current handgrip strength (HGS) protocols employ a variety of criteria, affecting the assessment of asymmetric HGS. The impact of these different criteria on fall prediction is understudied. This study was devised to compare the relative performance of average and maximum HGS asymmetry criteria as tools to predict fall incidence among middle-aged or older adults in China.

METHODS

9627 Chinese adults 50 + years of age who were participants in the China Health and Retirement Longitudinal Study (2013-2015 waves) were evaluated. The measurement of HGS was achieved based on either the maximum recorded value (HGSmax) or the average (HGSave), and these values were employed for the calculation of HGS asymmetry. Fall incidence over a 2-year period was evaluated based on self-reported data. Logistic regression analyses were utilized to determine the predictive performance of HGSmax asymmetry or HGSave asymmetry when gaging 2-year fall risk.

RESULTS

Significant differences in overall rates of HGS asymmetry and the rates of subdivisions thereof were observed when comparing the HGSmax and HGSave criteria, with moderate consistency (kappa = 0.599, p < 0.001). Over the 2-year follow-up period, 1743 fall incidents were recorded. Adjusted logistic regression models indicated that only HGSmax asymmetry > 30.0% was significantly related to fall risk (p = 0.034, odds ratio = 1.36, 95% confidence interval: 1.02-1.81).

CONCLUSION

These findings highlight the importance of HGS criteria in detecting HGS asymmetry, and suggest that HGSmax is a more robust criterion for predicting fall risk among Chinese adults 50 + years of age.

Age- and sex-related changes in motor functions: a comprehensive assessment and component analysis

Age-related motor impairments often cause caregiver dependency or even hospitalization. However, comprehensive investigations of the different motor abilities and the changes thereof across the adult lifespan remain sparse. We, therefore, extensively assessed essential basic and complex motor functions in 444 healthy adults covering a wide age range (range 21 to 88 years). Basic motor functions, here defined as simple isolated single or repetitive movements in one direction, were assessed by means of maximum grip strength (GS) and maximum finger-tapping frequency (FTF). Complex motor functions, comprising composite sequential movements involving both proximal and distal joints/muscle groups, were evaluated with the Action Research Arm Test (ARAT), the Jebsen-Taylor Hand Function Test (JTT), and the Purdue Pegboard Test. Men achieved higher scores than women concerning GS and FTF, whereas women stacked more pins per time than men during the Purdue Pegboard Test. There was no significant sex effect regarding JTT. We observed a significant but task-specific reduction of basic and complex motor performance scores across the adult lifespan. Linear regression analyses significantly predicted the participants' ages based on motor performance scores (R2 = 0.502). Of note, the ratio between the left- and right-hand performance remained stable across ages for all tests. Principal Component Analysis (PCA) revealed three motor components across all tests that represented dexterity, force, and speed. These components were consistently present in young (21-40 years), middle-aged (41-60 years), and older (61-88 years) adults, as well as in women and men. Based on the three motor components, K-means clustering analysis differentiated high- and low-performing participants across the adult life span. The rich motor data set of 444 healthy participants revealed age- and sex-dependent changes in essential basic and complex motor functions. Notably, the comprehensive assessment allowed for generating robust motor components across the adult lifespan. Our data may serve as a reference for future studies of healthy subjects and patients with motor deficits. Moreover, these findings emphasize the importance of comprehensively assessing different motor functions, including dexterity, force, and speed, to characterize human motor abilities and their age-related decline.

Association of Handgrip Strength with Hip Fracture and Falls in Community-dwelling Middle-aged and Older Adults: A 4-Year Longitudinal Study

OBJECTIVE

Hip fracture and falls are significant health concerns. Handgrip strength (HGS) is closely associated with overall muscle strength and physical health. However, the longitudinal relationship between HGS and the risk of hip fractures and falls remains unclear, particularly regarding gender differences. This longitudinal study aimed to investigate the association between HGS and the risk of hip fracture and falls in individuals aged 45 years and above, considering gender-specific differences over a 4-year period.

METHODS

This study included 10,092 participants (4471 men and 5621 women) aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS). Incidents of hip fractures and falls were recorded during a 4-year follow-up, along with various demographic and clinical factors. Participants were categorized into five groups based on their HGS quintiles. Logistic regression models were employed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationship between HGS and hip fracture/fall risk.

RESULTS

During the 4-year follow-up period, 223 cases of hip fracture (2.2%) and 1831 cases of falls (18.1%) were documented. Notably, higher HGS demonstrated a strong inverse association with the risk of hip fracture in both males and females (p < 0.05). In comparison to the lowest HGS quintile, the adjusted odds ratios (ORs) for hip fracture were 0.46 (0.27-0.78) for the total population, 0.4 (0.19-0.81) for males and 0.48 (0.23-0.98) for females in the highest HGS quintile. Furthermore, a profound and statistically significant negative correlation between HGS and falls was detected (p < 0.05). The adjusted ORs for falls in the highest HGS quintile, compared to the lowest quintile, were 0.62 (0.51-0.76) in the overall population, 0.59 (0.44-0.78) in males, and 0.78 (0.62-0.99) in females.

CONCLUSION

Our findings highlight the significant inverse association between HGS and the risk of hip fracture and falls in both males and females aged 45 years and above. Assessing handgrip strength may serve as a valuable tool for predicting fracture and fall risk.

Association of diet quality with hand grip strength weakness and asymmetry in a multi-ethnic Asian cohort

Hand grip strength (HGS) is an important diagnostic tool for sarcopenia and a reliable predictor for age-related chronic diseases and mortality. Interventions in nutrition have been shown as a low-cost strategy to maintain muscular strength and mass. However, there are limited data on the effect of diet on HGS in Southeast Asian populations. This study aims to investigate the association of diet quality with HGS weakness and asymmetry in a multi-ethnic population in Singapore. This cross-sectional study used data from the Singapore Multi-Ethnic Cohort (n = 1547). Dietary data were collected using a validated semi-quantitative FFQ and summarised as the Dietary Quality Index - International (DQI-I). HGS was calculated as the maximum value of six measurements from both hands. HGS weakness and asymmetry were defined using well-recognised criteria. Multivariable linear regression and logistic regression were utilised for continuous and binary outcomes, respectively, adjusting for age, sex, ethnicity, physical activity and smoking status. It was found that the highest quartile of DQI-I was significantly associated with higher HGS (β = 1·11; 95 % CI 0·41, 1·82; Pfor trend < 0·001) and lower odds of HGS asymmetry (OR = 0·71; 95 % CI 0·53, 0·94; Pfor trend = 0·035) and both HGS weakness and asymmetry (OR = 0·50; 95 % CI 0·32, 0·76; Pfor trend = 0·004). Among the different components of DQI-I, only dietary adequacy was significantly associated with higher HGS (Pfor trend < 0·001) and lower odds for both HGS weakness and asymmetry (Pfor trend = 0·006). Our findings support that DQI-I, an indicator of overall diet quality, can be used to provide dietary guidelines for prevention and management of muscle wasting, sarcopenia and frailty.

Risk factors associated with weak and asymmetric handgrip strength in older Chinese adults

OBJECTIVES

This study sought to investigate the potential risk factors associated with weak and asymmetric handgrip strength (HGS) in older Chinese adults.

METHODS

A total of 2702 participants aged ≥65 years from the two waves of data (2011 and 2013) from the China Health and Retirement Longitudinal Study were analyzed. The highest recorded HGS values (Method A) or the average HGS values (Method B) for the dominant hand were used to compute the HGS asymmetry (nondominant HGS/dominant HGS out of 0.9-1.1) and HGS weakness (male <28 kg, female <18 kg). Risk factors associated with the weak and asymmetric HGS were identified by logistic regression analysis.

RESULTS

Risk factors associated with weak and asymmetric HGS of varying severity differed between the two methods. Both methods identified age and illiteracy as risk factors for weak HGS with 10%-20% asymmetry. Method A also identified speech impediment, stroke, and sleep duration as additional risk factors. Similarly, both methods identified age, illiteracy, primary school education and below, diabetes, and stroke as risk factors for weak HGS and asymmetry over 30.1%. Method B additionally identified a history of falls as a risk factor. However, apart from age, the risk factors for weak HGS with 20.1%-30% asymmetry differed between the two methods-Method A identified kidney disease, while Method B identified illiteracy and asthma.

CONCLUSIONS

The results revealed that risk factors associated with the abnormal HGS in older adults varied based on the methods used to define these conditions.

The accuracy of different calculation methods when identifying handgrip strength asymmetry among middle-aged and older Chinese adults

At present, there is no uniform standard mean of identifying handgrip strength (HGS) asymmetry based on maximum or average HGS values. Therefore, this study aimed to explore the accuracy of different calculation methods in the evaluation of HGS asymmetry. Using the maximum reading of two trials from both hands (Method A) as the reference standard, the accuracy of the HGS asymmetry identified by the average value of two trials of both hands (Method B) was determined by using various indicators, including specificity, sensitivity, the area under the receiver operating characteristic curve (AUC), positive, and negative predictive values. Overall, 12,163 individuals were included in this study, of whom 47.61% (5791/12,163) were male. The percentages of individuals with HGS asymmetry differed as a function of age and sex when using these two different methods. When employing Method A, 38.52%, 41.57%, and 44.57% of males 45 ≤ age<60, 60 ≤ age<80, and ≥ 80 years of age exhibited HGS asymmetry as compared to 40.78%, 39%, and 39.63% of females. Using Method B, the corresponding proportions were 41.69%, 42.5%, and 40% in males and 42.01%, 41.18%, and 40.55% in females, respectively. When compared to Method A, Method B was found to be effective in identifying HGS asymmetry, with AUC values ranging from 0.844 to 0.877. However, there was only moderate agreement between the two methods in assessing HGS asymmetry. Specifically, the Kappa values for the two Methods were 0.692, 0.694, and 0.766 in males aged 45 to 60, 60 to 80, and 80 years and above, respectively. For females, the Kappa values were 0.674, 0.661, and 0.751, respectively. These results demonstrated that the maximal or average HGS values from two trials using both hands has a significant impact on the consequent identification of HGS asymmetry.

Handgrip strength asymmetry and cognitive impairment risk: Insights from a seven-year prospective cohort study

OBJECTIVES

This study aimed to explore the links of handgrip strength and asymmetry with cognitive impairment.

DESIGN

This was a seven-year prospective cohort study.

SETTING AND PARTICIPANTS

We used data from wave 3 (2015-2017) to wave 5 (2019-2022) from the ongoing Taiwan Initiative of Geriatric Epidemiological Research (TIGER), with wave 3 as the baseline (n = 446). The study included community-dwelling participants aged 65 years or older.

MEASUREMENTS

Handgrip strength was measured, and abnormalities were determined based on handgrip strength weakness and asymmetry. Handgrip strength asymmetry was categorized into three groups at baseline based on the handgrip strength ratio (left handgrip strength/right handgrip strength). Cognitive tests evaluating global and specific cognitive domains were conducted at baseline and two biennial follow-ups. Generalized linear mixed models were utilized to assess the associations of abnormal handgrip strength with global cognition and multiple cognitive domain progression over time.

RESULTS

This study included 392 dementia-free participants, with an average age of 75.8 years and 179 (45.7%) males. Mild handgrip strength asymmetry was present in 88 participants (22.4%), while 53 (13.5%) exhibited moderate asymmetry. In men, the coexistence of low handgrip strength and handgrip strength asymmetry was linked to cognitive impairment over time. These associations were observed in global cognition (β^ = -1.76, 95% CI: -2.79 to -0.74), memory (immediate free recall: β^ = -0.67, 95% CI: -1.17 to -0.17), executive function (Trail Making Test-A: β^ = -0.54, 95% CI: -0.94 to -0.13), and attention (Digit span-forward: β^ = -1.00, 95% CI: -1.46 to -0.54).

CONCLUSIONS

This study found that individuals with reduced handgrip strength and handgrip strength asymmetry had an increased risk of cognitive impairment across various domains. Moreover, this association appears to be more pronounced among men than women. Incorporating these simple assessments into regular clinical practice improves the allocation of limited screening resources and timely clinical interventions in older adults.

Biological ageing and the risk of decreased handgrip strength among community-dwelling older adult Indians: a cross-sectional study

BACKGROUND

Evidence from the literature demonstrates that the risk of decreased handgrip strength is associated with various health issues, particularly in older persons. To make judgments regarding their general health condition that are well-informed for longevity, it is crucial to assess the risk level of decreased handgrip strength among community-dwelling older adult Indians. However, no study has examined the relationship between biological aging and the risk of decreased handgrip strength in Indian men and women aged 60 and older. The goal of the current study was to fill this gap in the literature.

METHODS

In this cross-sectional study, we included 31,464 (15,098 men and 16,366 women) community-dwelling older adult Indians aged 60 years and older using data from the Longitudinal Aging Study in India (LASI). The LASI is the world's most extensive and India's first multidisciplinary, internationally harmonized, longitudinal aging study. It has enrolled 72,250 individuals aged 45 and above across all 28 states and 8 union territories of India. Secondary analysis of biological ageing was performed by stratifying for age groups (60-64, 65-69, 70-74, 75-79, 80-84, and 85 + years) for both genders. The dominant right and nondominant left handgrip strength was assessed using the portable Smedley's Hand Dynamometer. All individuals had a dominant right hand. The adjusted logistic regression analysis assessed the association between biological ageing and the risk of decreased handgrip strength for both genders.

RESULTS

Compared to those between the ages of 60-64, those at age 65 and those aged 85 and above had 1-fold and 12-fold odds of decreasing handgrip strength, respectively. Men 85 years or older had a 12-fold higher chance than women in the same age group of having decreased handgrip strength.

CONCLUSIONS

The results indicate that community-dwelling older adult Indians aged 65 years and older are significantly associated with a higher risk of decreased handgrip strength, especially among older men. The results of this study can help assess and implement handgrip strength measurement in medicine for older Indians as part of regular admission assessment, particularly for older men.

The relationship between low handgrip strength with or without asymmetry and fall risk among middle-aged and older males in China: evidence from the China Health and Retirement Longitudinal Study

PURPOSE

This study sought to explore the potential correlation between low handgrip strength (HGS) with or without asymmetry and fall risk in middle-aged and older Chinese adults.

METHODS

Baseline characteristic data from participants 45+ years of age and data regarding fall events collected from two rounds (2011-2013) of the China Health and Retirement Longitudinal Study were utilized for the present analyses. HGS and HGS asymmetry was defined according to the updated American Society of Hand Therapist. Fall events were identified through self- or proxy-reported details. Logistic regression analyses were employed to gauge the potential relationship between abnormal HGS and fall risk.

RESULTS

In total, 10 563 participants were enrolled in this analysis, of whom 47.49% (5016/10 563) were male. The proportions of low HGS alone, HGS asymmetry alone, and low HGS with asymmetry were 22.23%, 18.34%, and 22.75%, respectively, in males, but just 3.64%, 35.12%, and 6.62% in females. A total of 693 and 1019 fall events were recorded for male (13.82%) and female (18.37%) participants over the 2-year follow-up period, respectively. Significant differences in fall event incidence among different HGS groups were only observed among males. An adjusted logistic regression analysis model confirmed that low HGS with dominant asymmetry was closely related to fall risk among middle-aged and older males [P = 0.014, odds ratio = 1.332, 95% confidence interval: 1.059-1.676).

CONCLUSION

These results demonstrated that low HGS with dominant asymmetry is a risk factor linked to increased fall risk among middle-aged and older Chinese males. What is already known on this topic Low HGS or HGS asymmetry is been reported to be linked to an increased risk of falls in middle-aged and older adults; however, little is known about the association between fall risk and low HGS and/or HGS asymmetry. Main messages The prevalence of low HGS alone and low HGS asymmetry in men was significantly higher than in women, while HGS alone asymmetry was more common in women than men. The risk factor for the increased risk of falls in Chinese middle-aged and older men is low and asymmetric HGS, rather than low or asymmetric HGS alone. Low HGS with dominant asymmetry rather than nondominant asymmetry is associated with future fall risk among middle-aged and older Chinese males. Current research questions What is the mechanism for the significant difference in the proportion of abnormal HGS components between the sexes? If female subjects with low HGS and asymmetric HGS were added, would an association be observed between low HGS and asymmetric HGS falls? Is there an association between the severity of asymmetric HGS with weakness and falls?

Tracking handgrip strength asymmetry from childhood to mid-life

AIM

Determine if asymmetric handgrip strength exists in childhood and adulthood and quantify the degree of tracking of handgrip strength asymmetry over time.

METHODS

Participants from the Childhood Determinants of Adult Health Study had their right and left handgrip strength measured using handgrip dynamometry in childhood (1985: 9-15 y), young adulthood (2004-06: 26-36 y) and/or mid-adulthood (2014-19: 36-49 y). Handgrip strength asymmetry was calculated as: strongest handgrip strength/strongest handgrip strength on the other hand. Participants were categorised based on the degree of their asymmetry (0.0%-10.0%, 10.1%-20.0%, 20.1%-30.0%, >30.0%). Tracking was quantified using Spearman's correlations and log binomial regression.

RESULTS

Handgrip strength asymmetry was present in childhood and adulthood (>30.0% asymmetry: childhood = 6%, young adulthood = 3%, mid-adulthood = 4%). Handgrip strength asymmetry did not track between childhood and young- (r = 0.06, 95% CI = -0.02, 0.12) and mid-adulthood (r = 0.01, 95% CI = -0.09, 0.10). Tracking was more apparent between young- and mid-adulthood (r = 0.16, 95% CI = 0.09, 0.22). Participants with >30.0% asymmetry were at greater risk to maintain this status between childhood and young- (RR = 3.53, 95% CI = 1.15, 10.87) and mid-adulthood (RR = 2.14, 95% CI = 0.45, 10.20).

CONCLUSION

Although handgrip strength asymmetry tracked relatively poorly, asymmetric handgrip strength was apparent in children and adults. Handgrip strength asymmetry does not exclusively affect older adults and should be considered in protocols to better understand its role across the life course.

Handgrip strength asymmetry as a new biomarker for sarcopenia and individual sarcopenia signatures

BACKGROUND

Although handgrip strength (HGS) asymmetry has clinical screening utility, its relevance to sarcopenia is unknown. This study examined the relationship between HGS asymmetry and sarcopenia signatures, and explored the relevance of circulating neural/neuromuscular markers.

METHODS

9403 individuals aged 18-92 years participated in this study. Maximal HGS and skeletal muscle index (SMI) were determined using hand dynamometry and DXA. Sarcopenia was diagnosed upon the presence of low HGS and low SMI, according to cohort-specific thresholds. Plasma biomarkers were measured by ELISA in a sub-group of 269 participants aged 50-83 years. Asymmetry was determined as the highest recorded HGS divided by the highest recorded HGS of the opposite hand. Individuals with a ratio > 1.10 were classified as having asymmetrical HGS.

RESULTS

Subjects with asymmetrical HGS had significantly lower SMI (7.67 kg/m2 vs 7.71 kg/m2, p = 0.004) and lower HGS (37.82 kg vs 38.91 kg, p < 0.001) than those with symmetrical HGS. In those aged ≥ 50 years asymmetrical HGS was associated with 2.67 higher odds for sarcopenia [95% confidence interval: (CI) = 1.557-4.561, p < 0.001], 1.83 higher odds for low HGS only (CI 1.427-2.342, p < 0.001), and 1.79 higher odds for low SMI only (CI 1.257-2.554, p = 0.001). HGS asymmetry demonstrated acceptable diagnostic accuracy for sarcopenia (AUC = 0.727, CI 0.658-0.796, p < 0.001). Plasma neural cell adhesion molecule concentrations were 19.6% higher in individuals with asymmetrical HGS (185.40 ng/mL vs 155.00 ng/mL, p < 0.001) than those with symmetrical HGS.

DISCUSSION

Our findings demonstrate the utility of HGS asymmetry as a screening tool that may complement existing strategies seeking to combat sarcopenia. Biomarker analyses suggest that heightened denervation may be an important aetiological factor underpinning HGS asymmetry.

Criterion-Referenced Standards of Handgrip Strength for Identifying the Presence of Hypertension in Croatian Older Adults

BACKGROUND

It is well known that muscular fitness has been associated with hypertension. However, it is less known which cut-off values of muscular fitness may predict the presence of hypertension. The main purpose of this study was to establish criterion-referenced standards of muscular fitness to define the presence of hypertension in Croatian older adults.

METHODS

In this cross-sectional study, we recruited men and women over 60 years of age. Muscular fitness was assessed by handgrip strength and normalized by height squared. Hypertension was defined as having systolic blood pressure ≥130 mm/Hg or diastolic blood pressure ≥80 mm/Hg.

RESULTS

In older men, the optimal cut-point of muscular fitness in defining hypertension was 15.4 kg/m2. The area under the curve (AUC) was 0.85 (96% CI 0.77 to 0.92, p < 0.001). In older women, the optimal cut-point was 11.8 kg/m2, with an AUC of 0.84 (95% CI 0.80 to 0.89, p < 0.001). Men and women with cut-points of < 15.4 kg/m2 and < 11.8 kg/m2 were 11.8 (OR = 11.8, 95% CI 4.3 to 32.4, p < 0.001) and 10.6 (OR = 10.6, 95% CI 5.7 to 19.7, p < 0.001) times more likely to be diagnosed with hypertension.

CONCLUSIONS

Our newly developed cut-points of muscular fitness assessed by the handgrip strength and normalized by height squared have satisfactory predictive validity properties in detecting men and women aged 60-81 years with hypertension.

Short sleeping duration is associated with a higher risk of asymmetric handgrip strength among older Chinese males: a cross-sectional study evidence from the China health and retirement longitudinal study

Objective

This study aimed to explore the potential correlation between sleeping duration and the risk of handgrip strength (HGS) asymmetry in older Chinese adults.

Methods

The data of participants (65+ years of age) were obtained from the first Wave 1 (2011) of the China Health and Retirement Longitudinal Study (CHARLS). Information on sleeping duration during the previous month was collected from self-reports and was divided into three groups: long (>8 h), normal (6-8 h), and short (< 6 h). HGS was computed as the average of two tests per hand and asymmetric HGS was diagnosed when the ratio of average non-dominant to average dominant HGS was greater than 1.1 or less than 0.9. Logistic regression analyses were employed to gauge the relationship between sleeping duration and asymmetric HGS risk.

Results

In total, 3,174 participants were enrolled in this analysis, of whom 51.54% (1,636/3,174) were male. The proportions of asymmetric HGS were 42.18% in males and 41.87% in females. The sleeping duration (hours) in the asymmetric and non-asymmetric HGS groups were 6 h (5,8) and 7 h (5,8) in males with a significant difference between them (p = 0.015), and 6 h (5,8) and 6 h (5,8) in females with no significant difference (p = 0.415). Compared with non-asymmetric HGS individuals, the proportions of normal, short, and long sleeping duration were 40.4, 47.3, and 37.7% in males with a significant difference (p = 0.023), and 42.4, 40.3, and 43.8% in females with no significant differences (p = 0.685). An adjusted logistic regression analysis model confirmed that short sleeping duration was significantly associated with asymmetric HGS risk among older males (p = 0.048, OR = 1.252, 95%CI:1.002-1.565).

Conclusion

The results demonstrated that short sleeping duration (<6 h) was a risk factor for increased HGS asymmetry among older Chinese males.

Low handgrip strength with or without asymmetry is associated with elevated all-cause mortality risk in older Chinese males

AIM

This study aimed to examine the link between handgrip strength (HGS) asymmetry and mortality risk among older Chinese adults.

METHODS

These analyses were conducted using data from adults aged 60 years and older from the 2011-2013 waves of the China Health and Retirement Longitudinal Study, using baseline participant data collected in 2011. Proxy-reported information was used to assess the mortality outcomes of the participants over a 2-year follow-up. The highest recorded HGS values for each hand were used to compute the HGS asymmetry ratio (non-dominant HGS/dominant HGS) and HGS weakness (Male<26 kg, Female<16 kg). Covariate-adjusted Cox models were employed to gauge the relationship between abnormal HGS and mortality risk.

RESULTS

Overall, 5083 adults were enrolled in this study, of whom 50.15% (2549/5083) were male. The proportions of low HGS alone, HGS asymmetry alone, and asymmetric and low HGS were 6.43%, 30.95%, and 9.22%, respectively, in males, and 4.81%, 35.87%, and 9.55%, respectively, in females. A total of 96 and 78 deaths were recorded for male (3.77%) and female (3.08%) participants, respectively, over the 2-year follow-up period. Significant differences in mortality were observed between the different HGS groups for both sexes. An adjusted Cox regression analysis model confirmed that only low HGS (P = 0.047, hazard ratio [HR] = 1.949, 95% confidence interval [95% CI]: 1.008-3.768) and low HGS with asymmetry (P = 0.007, HR = 2.152, 95% CI: 1.231-3.764) were significantly associated with mortality risk in older males.

CONCLUSIONS

The results revealed that low HGS with or without asymmetry was associated with a higher risk of death over a 2-year follow-up interval in older Chinese males. Geriatr Gerontol Int 2023; 23: 692-699.

Handgrip Strength Is Associated with Specific Aspects of Vascular Function in Individuals with Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS) is a disorder associated with an increased risk for the development of diabetes mellitus and its complications. Lower isometric handgrip strength (HGS) is associated with an increased risk of cardiometabolic diseases. However, the association between HGS and arterial stiffness parameters, which are considered the predictors of morbidity and mortality in individuals with MetS, is not well defined.

OBJECTIVE

To determine the association between HGS and HGS asymmetry on components of vascular function in adults with MetS.

METHODS

We measured handgrip strength normalized to bodyweight (HGS/kg), HGS asymmetry, body composition, blood glucose, lipid profile, blood pressure, pulse wave velocity (PWV), reflection coefficient (RC), augmentation index @75 bpm (AIx@75) and peripheral vascular resistance (PVR) in 55 adults with a diagnosis of MetS between 25 and 54 years old.

RESULTS

Mean age was 43.1 ± 7.0 years, 56.3% were females. HGS/kg was negatively correlated with AIx@75 (r = -0.440), p < 0.05, but these associations were not significant after adjusting for age and sex. However, when interaction effects between sex, HGS/kg and age were examined, we observed an inverse relationship between HGS/kg and AIx@75 in the older adults in the sample, whereas in the younger adults, a weak direct association was found. We also found a significant association between HGS asymmetry and PVR (beta = 30, 95% CI = 7.02; 54.2; p <0.012).

CONCLUSIONS

Our findings suggest that in people with MetS, maintaining muscle strength may have an increasingly important role in older age in the attenuation of age-related increases in AIx@75-a marker of vascular stiffness-and that a higher HGS asymmetry could be associated with a greater vascular resistance.

Prevalence and Trends of Handgrip Strength Asymmetry in the United States

Background

Strength asymmetries are a type of muscle function impairment that is associated with several health conditions. However, the prevalence of these asymmetries among adults from the United States remains unknown. We sought to estimate the prevalence and trends of handgrip strength (HGS) asymmetry in American adults.

Methods

The unweighted analytic sample included 23,056 persons aged at least 50-years with information on HGS for both hands from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS, with the highest recorded values for each hand used to calculate asymmetry. Persons were categorized into the following asymmetry severity categories: (1) >10%, (2) >20.0%, and (3) >30.0%. Survey weights were used to generate nationally-representative asymmetry estimates.

Results

Overall, there were no statistically significant trends in HGS asymmetry categories over time. The prevalence of HGS asymmetry in the 2014-2016 wave was 53.4% (CI: 52.2-54.4), 26.0% (CI: 25.0-26.9), and 11.7% (CI: 10.9-12.3) for asymmetry at >10%, >20%, and >30%, respectively. HGS asymmetry was generally higher in older Americans compared to middle-aged adults at each wave. In the 2014-2016 wave, >30% asymmetry prevalence was 13.7% (CI: 12.7-14.6) in females and 9.3% (CI: 8.4-10.2) in males. Some differences in asymmetry prevalence by race and ethnicity were observed.

Conclusions

The prevalence of asymmetry was generally high, especially in women and older adults. Ongoing surveillance of strength asymmetry will help monitor trends in muscle dysfunction, guide screening for disablement, identify subpopulations at risk for asymmetry, and inform relevant interventions.

Association of Handgrip Strength Weakness and Asymmetry With Incidence of Motoric Cognitive Risk Syndrome in the China Health and Retirement Longitudinal Study

BACKGROUND AND OBJECTIVES

Motoric cognitive risk (MCR) syndrome is a type of pre-dementia. It is defined as the co-occurrence of subjective cognitive complaints and a slow gait speed. A recent study found that handgrip strength (HGS) asymmetry is associated with an increased risk of neurodegenerative disorders. We aimed to investigate the associations of HGS weakness and asymmetry separately and together with MCR incidence among older Chinese adults.

METHODS

Data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study were used. HGS values <28 kg for male participants and <18 kg for female participants were considered HGS weaknesses. HGS asymmetry was assessed by the ratio of nondominant to dominant HGS. We used 3 different cutoff values of HGS ratio to define asymmetry, including 10%, 20%, and 30%. Specifically, HGS ratios <0.90 or >1.10 (10%), <0.80 or >1.20 (20%), and <0.70 or >1.30 (30%) were classified as asymmetry. The participants were classified into 4 groups: neither weakness nor asymmetry (neither), asymmetry only, weakness only, and weakness and asymmetry (both). The association between baseline HGS status and 4-year incidence of MCR was examined using logistic regression analyses.

RESULTS

A total of 3,777 participants 60 years and older were included in the baseline analysis. The prevalence of MCR at the baseline was 12.8%. Participants with asymmetry only, weakness only, and both showed significantly increased risk of MCR. After excluding participants with MCR at baseline, 2,328 participants were included in the longitudinal analysis. There were 111 MCR cases (4.77%) over the 4-year follow-up period. Participants with HGS weakness and asymmetry together at baseline had increased odds of incident MCR (HGS ratio at 10%: odds ratio [OR] 4.48, p < 0.001; HGS ratio at 20%: OR 5.43, p < 0.001; HGS ratio at 30%: OR 6.02, p < 0.001).

DISCUSSION

These results show that the presence of both HGS asymmetry and weakness is associated with MCR incidence. The early recognition of HGS asymmetry and weakness may be helpful in the prevention and treatment of cognitive dysfunction.

Handgrip strength asymmetry cut points to identify slow gait speed in six low- and middle-income countries: A cross-sectional analysis with 12,669 older adults

BACKGROUND

Handgrip strength (HGS) asymmetry is associated with slow gait speed. Both mark muscle dysfunction, potential risk of falls, and adverse health outcomes. This association was found in older adults from high-income countries, but not yet studied in low- and middle-income countries. Moreover, there is no HGS asymmetry referential to identify the disabling process. Thus, our study aims to verify the association of HGS asymmetry with slowness in older adults from six low- and middle-income countries and to propose cut points to slowness.

METHODS

A cross-sectional study with data from 12,669 older adults (≥60 years) of the Study on Global Aging and Adult Health (SAGE) conducted in six low- and middle-income countries were analyzed. Based in the difference between upper body sides HGS (asymmetry), participants were categorized in groups as 0.0-10.0% (reference group), 10.1-20.1%, 20.1-30.0% or >30.0%. Slow gait speed was established as <0.59 (men) and <0.51 (women) m/s. Associations of HGS asymmetry with gait speed were ascertained with logistic regression. HGS asymmetry index "[(HGS asymmetry*HGS)/(BMI*Age)]*100" cut points to identify slowness were generated with the ROC curve and Youden index (α = 5%).

RESULTS

Compared to HGS reference group, those with HGS asymmetry of 10.1-20%, 20.1-30.0% and >30.0% had a superior odds for slowness [1.18(CI:1.02,1.42); 1.17(CI: 0.97; 1.44); and 1.21(CI:1.03;1.43), respectively]. HGS asymmetry index cut points to identify slowness were ≤1.14 (women) and ≤1.77 (men).

CONCLUSIONS

HGS asymmetry association with slowness is present in economically disadvantaged countries. We proposed a new index for impaired muscle function with acceptable sensibility and specificity.

Upper Extremity Skeletal Muscle Mass Asymmetry Exacerbated by Shoulder Imbalance in Lenke1A Adolescent Idiopathic Scoliosis

Limb muscle strength asymmetry affects many physical abilities. The present study (1) quantified limb muscle asymmetry in patients with adolescent idiopathic scoliosis (AIS); (2) compared AIS patients with major thoracolumbar/lumbar (TL/L) or major thoracic (MT) curves; (3) examined correlations between limb muscle asymmetry and radiographic parameters. Patients with AIS with major TL/L curves (Lenke type 5C) and MT curves (Lenke Type 1A) who underwent posterior spinal fusion at our university hospitals were included. Patients with left hand dominance were excluded. Body composition was measured using whole-body dual-energy X-ray absorptiometry and asymmetry of left and right side skeletal muscles were evaluated. Upper extremity skeletal muscles on the dominant side were significantly larger than those on the nondominant side in both Lenke1A and 5C groups. The asymmetry of upper extremity skeletal muscles was significantly greater in the Lenke1A group than in the Lenke5C group. Additionally, the size of the asymmetry did not correlate with the magnitude of the major curve and rotational deformation but did correlate with a right shoulder imbalance in the Lenke1A group. These results suggest that in AIS with a constructive thoracic curve, right shoulder imbalance is an independent risk factor for upper extremity skeletal muscle asymmetry.

Relationship between Asymmetries and Functional Autonomy in Older Chilean Adults

The objectives of this study were: (a) to determine asymmetries, both lower limb (LL) and upper limb (UL), in Chilean older adults, and (b) to relate asymmetries to FA in both LL and UL. Forty-one older adults voluntarily participated in this study (mean ± standard deviation [SD]: age 72.0 ± 8.0 years, LL asymmetries 13.78 ± 14.87%, UL asymmetries 10.70 ± 8.85%, FA 40.35 ± 16.26 points). The variables were: (1) asymmetries of LL and UL, assessed through a force platform and handgrip, respectively; (2) FA, assessed through the Latin American Group for Maturity (GDLAM) and the GDLAM index of autonomy (GI) protocol. The relationship between the variables was performed through Spearman's correlation. The analysis showed that 39% of the participants presented asymmetries above 15% in the LL. Likewise, this 39% of older adults presented a lower FA than their peers with asymmetries below 15% in the LL (≤15%: 35.64 ± 12.26 points vs. >15%: 47.69 ± 19.23 points, p = 0.003). The analysis showed a small correlation between LL and GI asymmetries (r = 0.27, p = 0.07) and a small but negative correlation between UL and GI (r = -0.21). The mean values of asymmetries of both LL and UL are within 'normal' parameters. However, several older adults were identified as being at risk. In parallel, older adults who presented a higher level of asymmetries in LL showed a lower level of FA.

WHO working definition of vitality capacity for healthy longevity monitoring

Intrinsic capacity, a crucial concept in healthy ageing, is defined by WHO as "the composite of all the physical and mental capacities that an individual can draw on at any point in time". Vitality capacity is considered the underlying physiological determinant of intrinsic capacity. To advance the measurement and monitoring of vitality capacity, a working group of WHO staff members and twenty experts representing six WHO regions was convened to discuss and clarify the attributes of vitality capacity and to develop a clear working definition of the concept. Potential biomarkers to measure vitality capacity were identified, and the following consensual working definition was developed: vitality capacity is a physiological state (due to normal or accelerated biological ageing processes) resulting from the interaction between multiple physiological systems, reflected in (the level of) energy and metabolism, neuromuscular function, and immune and stress response functions of the body.

Handgrip strength weakness and asymmetry together are associated with cardiovascular outcomes in older outpatients: A prospective cohort study

Aim

The evaluations of handgrip strength (HGS) weakness and asymmetry have implications for the comprehensive geriatric assessment. The aim of this study was to investigate the association of HGS weakness and asymmetry on cardiovascular outcomes in older outpatients.

Methods

This was a prospective observational cohort study of 364 Geriatrics outpatients aged ≥60 years, in which all participants carried out HGS tests at baseline. Patients with HGS <28 kg for men and <18 kg for women were diagnosed as HGS weakness, and HGS ratio <0.90 or >1.10 were diagnosed as HGS asymmetry. Primary outcomes defined as the major adverse cardiovascular event and composite end‐points were assessed during a 21‐month median follow‐up.

Results

Among 364 participants, 155 (42.6%) showed HGS weakness, and 160 (44.0%) showed HGS asymmetry. HGS weakness was associated with major adverse cardiovascular events (HR 2.76, 95% CI 1.22–6.27) and composite end‐points (HR 2.84, 95% CI 1.40–5.77). However, no significant correlation between HGS asymmetry and cardiovascular outcomes was observed. Compared with the normal and symmetric HGS group, older adults with HGS weakness and asymmetry together had a higher risk of major adverse cardiovascular events (HR 5.23, 95% CI 1.56–17.54) and composite end‐points (HR 4.00, 95% CI 1.56–10.28).

Conclusions

HGS weakness and asymmetry together might increase the risk of cardiovascular outcomes in older outpatients. HGS asymmetry offers complementary information to HGS weakness when making a comprehensive assessment of HGS. Geriatr Gerontol Int 2022; 22: 759–765.

The Association Between Handgrip Strength Asymmetry Severity and Future Morbidity Accumulation: Results from the Health and Retirement Study

Analyzing the severity of handgrip strength (HGS) asymmetry in aging populations may help to screen for morbidities and add utility to handgrip dynamometer testing. Our study sought to determine the relationships between HGS asymmetry severity and future accumulating morbidities in older Americans. Secondary analyses from the 2006-2016 waves of the Health and Retirement Study included 18,506 adults ≥ 50 years old. The highest recorded HGS values from each hand were used to calculate HGS asymmetry ratio (non-dominant HGS/dominant HGS). If the HGS asymmetry ratio < 1.0, it was inversed to make all asymmetry ratios ≥ 1.0. Participants were categorized into groups based on the severity of their HGS asymmetry ratio: 1) 0.0% - 10.0%, 2) 10.1% - 20.0%, 3) 20.1% - 30.0%, and 4) > 30.0%. Healthcare provider-diagnosed morbidities (hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems) were self-reported. Covariate-adjusted ordinal generalized estimating equations evaluated the relationships between HGS asymmetry severity on future accumulating morbidities. Results showed 8,936 (48.3%) participants had HGS asymmetry 0.0%-10.0%, 6,105 (33.0%) participants had HGS asymmetry 10.1%-20.0%, 2,411 (13.0%) participants had HGS asymmetry 20.1%-30.0%, and 1,054 (5.7%) participants had HGS asymmetry > 30.0%. Overall, every 10% increase in HGS asymmetry was associated with a 1.17 (CI: 1.05, 1.32) greater odds of future morbidity accumulation. Additionally, asymmetry between 10.1% - 20.0%, 20.1% - 30.0%, and > 30.0% was associated with a 1.10 (CI: 1.05, 1.15), 1.11 (CI: 1.04, 1.18), and 1.20 (CI: 1.09, 1.33) greater odds for morbidity accumulation during aging. These findings suggest that severe functional asymmetries may elevate the odds for accumulating morbidities.

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

BACKGROUND

Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up.

METHODS

This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated.

DISCUSSION

This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes.

TRIAL REGISTRATION

NCT04911179 02/06/2021.

Associations of Handgrip Asymmetry With Impaired Health-Related Quality of Life Among Older Adults in South Korea: A Cross-Sectional Study Using National Survey Data

This study aimed to examine the associations of handgrip strength (HGS) and asymmetry with health-related quality of life among South Korean older adults. We enrolled 7395 older adults from the Korea National Health and Nutrition Examination Survey. Health-related quality of life was measured using the EuroQol-5 Dimension. Weakness was defined as a HGS of <26 kg for men and <18 kg for women. Handgrip strength symmetry was defined as an HGS ratio of 0.9:1.1, and HGS asymmetry was defined as a ratio outside that range. Data were analyzed using the Rao-Scott χ², F test, and multivariate logistic regression. Compared with those in the "symmetric HGS and not weak" group, those in the "asymmetric HGS and weak" group had impaired health-related quality of life for all variables among men (odds ratios [ORs] = 1.67-3.75, 95% confidence interval [CI] [1.14, 6.27]). A greater risk of impaired self-care (SC; odds ratio [OR] = 2.33, 95% CI [1.67, 3.25]) and anxiety/depression (AD; OR = 1.40, 95% CI [1.04, 1.88]) was observed among women in the "asymmetric HGS and weak" group. Handgrip weakness and asymmetry are associated with impaired health-related quality of life. Handgrip asymmetry can be a clinical marker of health-related quality of life in older adults and must be measured alongside HGS.

Asymmetrical Handgrip Strength Is Associated with Lower Cognitive Performance in the Elderly

(1) Background: Several studies have reported that handgrip strength (HGS) may be a sign of lower cognitive performance. However, studies supporting an association between asymmetrical HGS and cognitive function are lacking. This study aimed to determine the association between asymmetrical HGS and cognitive performance among the elderly. (2) Methods: The study sample included 2729 individuals aged ≥60 years-old who participated in the 2011-2014 National Health and Nutrition Examination Survey. The cognitive tests consisted of the word learning and recall modules from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Animal Fluency Test, and Digit Symbol Substitution Test (DSST). HGS was measured using a handgrip dynamometer, and asymmetrical HGS was used to calculate HGS. (3) Results: Of the 2729 participants, 53.0% were aged 60 to 69 years-old, and 47.0% were aged 70 years and older. All cognitive performance scores were significantly correlated with asymmetrical HGS in both age groups. After adjusting for confounders, there was a significant association between DSST and HGS asymmetry in both age groups. Contrastingly, a significant association was only observed for the relationship between the CERAD test and HGS asymmetry in the ≥70 year-old group. (4) Conclusions: We found that low cognitive function was associated with asymmetrical HGS in elderly participants in the United States. Thus, asymmetrical HGS may be an important predictor of cognitive deficits. However, further research is required to confirm our results and to establish possible mechanisms.

Independent factors that attenuate the effectiveness of fracture rehabilitation in improving activities of daily living in female patients aged 80 years and above

BACKGROUND

Some factors, such as cognitive impairment, can attenuate the effectiveness of rehabilitation. We hypothesized that handgrip strength (HGS) might be one of the independent factors affecting the activities of daily living (ADL) improvements in patients with fractures.

AIMS

This study aimed to evaluate the relationship between HGS and improvement in ADL during rehabilitation, and to assess the factors affecting ADL improvement among older patients ≥ 80 years with fractures.

METHODS

This longitudinal study was conducted at a rehabilitation hospital among 427 females aged ≥ 80 years, who underwent fracture rehabilitation. Patients were divided into two groups based on their HGS. Analysis of comparison between the two groups and multivariate linear regression analyses were performed with respect to functional independence measure (FIM) gain during rehabilitation.

RESULTS

FIM gain was significantly lower in the weak HGS group (31.5 [20.0-41.0]) than in the strong HGS group (35.0 [27.5-47.0], p = 0.011). In multivariate linear regression analyses, HGS was significantly associated with FIM gain (coefficient: 0.683, 95% confidence intervals 0.302-1.064, p < 0.001). In addition, Mini-Mental State Examination, necessity of assistance in ADL before injury, length of hospital stays for rehabilitation, and period of rehabilitation per day were significantly associated with FIM gain.

CONCLUSIONS

Weak HGS, cognitive impairment, and necessity of assistance in ADL before injury could be independent factors that attenuate the effectiveness of fracture rehabilitation to improve ADL in old female patients. We encourage such patients to undertake more rehabilitation for improving their ADL, and not refrain from rehabilitation due to old age and fracture.

Influence of handgrip strength on pharyngeal transit time in individuals with chronic obstructive pulmonary disease

OBJECTIVE

To investigate the relationship between Handgrip Strength (HGS), dysphagia classification, nutritional aspects, and Pharyngeal Transit Time (PTT) in subjects with Chronic Obstructive Pulmonary Disease (COPD).

METHODS

Study based on the analysis of secondary data from a database. The sample comprised 15 COPD patients of both sexes and a mean age of 65.7 years. We collected information on HGS, videofluoroscopic swallowing study, Volume-Viscosity Swallow Test (V-VST), and Body Mass Index (BMI). We applied correlation, effect size, and logistic regression tests at the 5% significance level.

RESULTS

Most individuals had severe COPD (66.7%), mean dominant HGS of 28.2, and non-dominant HGS of 25.3. Five subjects were malnourished, five were well-nourished, and five were obese. Most of them had normal swallowing (40%), normal V-VST results (60%), and PTT of 0.89 s (liquid) and 0.81 s (pudding-thick). There was no significant correlation between the swallowing classification and the other variables. We obtained a significant correlation (p = 0.015), though weak (r = -0.611), between non-dominant HGS and PTT. Regarding the binary logistic regression, HGS variables and HGS asymmetry were not enough to be considered a risk to clinically abnormal swallowing (V-VST).

CONCLUSION

Subjects with COPD in this study had a longer PTT than reported in the literature for normal subjects and a weak correlation between PTT and non-dominant HGS. The variables related to muscle condition were not considered predictors for abnormal swallowing.

LEVEL OF EVIDENCE: 3

Handgrip strength as a surrogate marker of lean mass and risk of malnutrition in paediatric patients

BACKGROUND & AIMS

The use of handgrip strength (HGS) as a proxy of nutritional status in sick children has not been studied. This study created HGS centile charts in healthy children and explored the utility of HGS z-scores as markers of body composition and screening of malnutrition risk in sick children.

METHODS

Data from 535 healthy children aged 5-16 years were used for the development of HGS centiles adjusted either for age or height. In 595 sick children, relationships between HGS z-scores with body composition, malnutrition risk (Paediatric Yorkhill Malnutrition Score-PYMS), length of hospital stay (LOS) and biomarkers of disease severity were explored. The use of HGS z-score to identify sick children in need of further dietetic assessment was investigated.

RESULTS

Children scoring at high malnutrition risk with PYMS had lower HGS z-scores for age (by 0.51 SD, p < 0.001) and height (by 0.46 SD, p = 0.001) than those who scored low. A HGS z-score at cut-offs of -0.81 SD and -1.2 SD for age and height, respectively, was predictive of need for dietetic intervention in sick children with sensitivity of 79% and 70% and specificity of 56% and 69%, respectively. HGS z-scores were predictive of fat free mass (FFM) in sick and healthy (all p < 0.001) children, while fat mass was not. HGS z-scores were inversely related with plasma CRP (rho, age: -0.21; height: -0.23, both p = 0.001). HGS was not predictive of LOS.

CONCLUSION

HGS is predictive of FFM, could compliment assessment of malnutrition risk, and may help identify children for further dietetic intervention on admission to hospital.

Association between handgrip strength asymmetry and falls in elderly Koreans: A nationwide population-based cross-sectional study

PURPOSE

This study aimed to investigate the association between handgrip strength (HGS) asymmetry and fall risk in elderly Koreans.

METHODS

This study used data from the 2016-2018 Korea National Health and Nutrition Examination Survey. A total of 3407 participants aged ≥ 65 years were included. HGS asymmetry was defined as an HGS asymmetry ratio (nondominant HGS/dominant HGS) of ≥ 1.2 or ≤ 0.8. The presence of a fall was defined as a self-reported fall event that needed treatment at a hospital or emergency department in the previous year. Multivariate logistic regression analysis was performed to analyze the association between HGS asymmetry and fall risk.

RESULTS

The odds ratio for falls was 1.89 times higher in the group with HGS asymmetry than in the group without HGS asymmetry after adjusting for age, sex, multimorbidity, obesity, current smoking, alcohol drinking, and physical exercise (95% confidence interval, 1.03-3.49; P < 0.05).

CONCLUSIONS

This study revealed that HGS asymmetry is significantly associated with an increased risk of falls in the Korean elderly population. Therefore, early identification and treatment of HGS asymmetry in the elderly could reduce the incidence of falls and be a potential preventive strategy.

Body Composition Symmetry in Long-Term Active Middle-Aged and Older Individuals

This study aimed to analyze body composition and strength symmetry in a sample of 165 middle-aged and elderly Italian volunteers, which included 97 active (67 men and 30 women; 61.17 ± 7.56 years) individuals regularly engaged in Tai Chi Chuan, tennis, or running, and a control group of 59 age-matched sedentary (27 men and 32 women) individuals. Anthropometric and bioelectrical measurements and hand grip strength of both sides were collected. Segmental body composition was analyzed through specific bioelectrical impedance vector analysis. The body composition of the right and left limbs was similar among active individuals (arms: T² = 6.3, n.s.; legs: T² = 5.0, n.s.), with a similar pattern in the three different disciplines. By contrast, the control group showed bilateral asymmetry (arms: T² = 6.8, p < 0.001; legs: T² = 8.8, p < 0.001), mainly because of the higher values of specific reactance (t = 2.4; p = 0.018) and phase angle (t = 2.0; p = 0.054) in the dominant arm, and the higher specific vector length (t = −3.0; p = 0.027) in the left leg. All of the groups showed a higher hand grip strength in the dominant arm (active: t = 7.0, p < 0.001; control: t = 2.9; p < 0.01). In conclusion, the active individuals showed stronger body composition symmetry than the controls, thus indicating a previously undetected positive effect of sport in middle-aged and older adults.

The Associations of Handgrip Strength and Leg Extension Power Asymmetry on Incident Recurrent Falls and Fractures in Older Men

BACKGROUND

Evaluating asymmetries in muscle function could provide important insights for fall risk assessments. We sought to determine the associations of 1) handgrip strength (HGS) asymmetry, and 2) leg extension power (LEP) asymmetry on risk of incident recurrent falls and fractures in older men.

METHODS

There were 5,730 men with HGS asymmetry data and 5,347 men with LEP asymmetry data from the Osteoporotic Fractures in Men (MrOS) study. A handgrip dynamometer measured HGS and a Nottingham Power Rig ascertained LEP. Percent difference in maximal HGS between hands was calculated, and asymmetric HGS was defined as men in the highest quartile of dissimilarity for HGS between hands. The same approach was used to determine asymmetric LEP. Participants self-reported falls every four-months after the baseline exam, and persons with ≥2 falls in the first year were considered recurrent fallers. Fractures and their dates of occurrence were self-reported and confirmed with radiographic reports.

RESULTS

Older men in the highest HGS asymmetry quartile had a 1.20 (95% confidence interval (CI): 1.01-1.43) relative risk for incident recurrent falls. Likewise, men in the highest HGS asymmetry quartile had a higher risk for incident fractures: 1.41 (CI: 1.02-1.96) for hip, 1.28 (CI: 1.04-1.58) for major osteoporotic, and 1.24 (CI: 1.06-1.45) for non-spine. There were no significant associations between LEP asymmetry and recurrent falls or fractures.

CONCLUSIONS

Asymmetric HGS could be a novel risk factor for falls and fractures that is more feasible to measure than LEP. Fall risk assessments should consider evaluating muscle function, including HGS asymmetry.