Handgrip Strength in Old and Very Old Adults: Mood, Cognition, Function, and Mortality

The relationship between muscle strength and epicardial fat in healthy adults

BACKGROUND

Muscular strength and muscle mass are considered key factors for healthy ageing. Modification of body composition and redistribution of adipose tissue has been described in advanced age. Muscle strength has an important predictive role for health outcomes. However, little is known regarding the relationship between muscle strength and epicardial fat.

METHODS AND MATERIALS

In a cohort of healthy adults following physical capacity evaluations, anthropometric measurements, handgrip strength (HGS), echocardiography and bioimpedance analysis (BIA) were performed. Kruskal-Wallis test, Spearman's correlation and regression analysis adjusted for confounders were applied.

RESULTS

A total population of 226 adults, age range 18-83 years, were included. Epicardial fat thickness resulted significantly associated with age p < 0.001, HGS (p < 0.001). Regression analysis adjusted for confounders revealed an independent relationship between handgrip strength and epicardial fat thickness: regression coefficient: -1.34; R2 = 0.27 and p = 0.044.

CONCLUSIONS

The relationship between epicardial fat and muscle strength is inverse and independent. Implementation of HGS measurement may be useful for the identification of subjects with excessive epicardial fat and cardiovascular risk. Measurement of epicardial fat could be helpful in the early detection of physical decline associated to ageing.

The offsetting relationship between hand grip strength and hypertension: A cross-sectional study from physically disabled over 50 years old in China

OBJECTIVES

To explore the relationship between hand grip strength (HGS) and blood pressure in physically disabled individuals over 50 years old.

METHODS

The research adopts a cross-sectional survey, and the data comes from the "2022-2023 Physical Health Monitoring and Scientific and Technological Services for Physical Disabilities" jointly carried out by Beijing Sport University and China Disabled Sports Management Center. Select physically disabled individuals over 50 years old and collect physical fitness measurement data. HGS was measured and adjusted based on body weight and waist circumference, with standard normal conversion. The relationship between HGS and blood pressure was analyzed using multiple linear regression, and further logistic regression was used to analyze the relationship between standard HGS and the risk of abnormal blood pressure.

RESULTS

695 disabled individuals participated in the experiment, including 402 males (57.84%) and 293 females (42.16%). Multiple linear regression analysis found that for each standard deviation increase in the standardized Z-value of relative HGS, the systolic and diastolic blood pressure of male individuals decreased by 2.391 mmHg (P = 0.008) and 1.229 mmHg (P = 0.025); decreased by 2.336 mmHg (P = 0.026) and 1.585 mmHg (P = 0.008), respectively, for female. The increase in HGS reduced the risk of hypertension in physical disabilities in males [OR = 0.820 95%CIs (0.670, 0.952)] (P = 0.003) and females [OR = 0.735 95%CIs (0.472, 0.986)] (P = 0.007).

CONCLUSION

The HGS of middle-aged and elderly physically disabled individuals negatively correlates with blood pressure, indicating the importance of increasing muscle strength (HGS) in preventing blood pressure.

Plasma proteomic signature of human longevity

The identification of protein targets that exhibit anti-aging clinical potential could inform interventions to lengthen the human health span. Most previous proteomics research has been focused on chronological age instead of longevity. We leveraged two large population-based prospective cohorts with long follow-ups to evaluate the proteomic signature of longevity defined by survival to 90 years of age. Plasma proteomics was measured using a SOMAscan assay in 3067 participants from the Cardiovascular Health Study (discovery cohort) and 4690 participants from the Age Gene/Environment Susceptibility-Reykjavik Study (replication cohort). Logistic regression identified 211 significant proteins in the CHS cohort using a Bonferroni-adjusted threshold, of which 168 were available in the replication cohort and 105 were replicated (corrected p value <0.05). The most significant proteins were GDF-15 and N-terminal pro-BNP in both cohorts. A parsimonious protein-based prediction model was built using 33 proteins selected by LASSO with 10-fold cross-validation and validated using 27 available proteins in the validation cohort. This protein model outperformed a basic model using traditional factors (demographics, height, weight, and smoking) by improving the AUC from 0.658 to 0.748 in the discovery cohort and from 0.755 to 0.802 in the validation cohort. We also found that the associations of 169 out of 211 proteins were partially mediated by physical and/or cognitive function. These findings could contribute to the identification of biomarkers and pathways of aging and potential therapeutic targets to delay aging and age-related diseases.

Low grip strength and gait speed as markers of dependence regarding basic activities of daily living: the FIBRA study

OBJECTIVE

Marincolo et al. showed that older adults without limitations in basic activities of daily living at baseline presented with an 11.7% concomitant presence of functional dependence, slow gait speed, and low muscle strength at follow-up. Slow gait speed remains a predictor of dependence in basic activities of daily living. To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults.

METHODS

A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson's χ2 test with a 5% significance level and logistic regression analysis.

RESULTS

Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41).

CONCLUSION

Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.

Correlation between low handgrip strength and metabolic syndrome in older adults: a systematic review

Muscle weakness has been associated to insulin resistance and metabolic syndrome in the general population. However, it is still unclear whether this association is maintained in older adults. This study investigated correlations between low handgrip strength (HGS) and metabolic syndrome, or some of its components, in older adults through a systematic review of the literature. Searches were conducted in the Virtual Health Library Regional Portal, Scopus, Cochrane, Embase, MEDLINE/ PubMed, SciELO, and Web of Science databases for relevant studiesinvestigating muscle weakness (measured by hand dynamometer) and metabolic syndrome or its components in older adult populations, published up to September 2023. From the 2050 references initially identified, 20 studies, comprising a total of 31,264 older adults of both genders, completely met the inclusion/exclusion criteria. Eighteen studies showed that lower HGS was associated with metabolic syndrome or some of its risk factors, such as abdominal obesity, hyperglycemia, insulin resistance, dyslipidemia, or high blood pressure. Two studies found that older men with high blood pressure had increased HGS. Most studies included in this systematic review revealed a significant correlation between reduced HGS and metabolic syndrome or some of its components, especially abdominal obesity and insulin resistance. We conclude that below-average HGS can be associated with metabolic syndrome in older adults.

Frailty and Survivability of Polish Caucasian Nonagenarians and Centenarians

Frailty is a major geriatric problem leading to an increased risk of disability and death. Prevention, identification, and treatment of frailty are important challenges in gerontology and public health. The study aimed to estimate the prevalence of the frailty phenotype (FP) among the oldest-old Polish Caucasians and investigate the relationship between the FP and mortality. Baseline data were collected from 289 long-lived individuals, including 87 centenarians and 202 subjects aged 94-99. Mortality was obtained from population registers over the following 5 years. Sixty percent of subjects were classified as frail, 33% as prefrail, and 7% as robust. Frailty was more common in women than men and among centenarians than nonagenarians. During the 5-year observation period, 92.6% of the frail women and all frail men died, while mortality rates were lower among prefrail, 78.8% and 66.7%, and robust individuals, 60% and 54.5%, respectively. In the survival analysis, frailty was the strongest negative risk factor: HR = 0.328 (95% CI: 0.200-0.539). The inability to perform handgrip strength measurement was an additional predictor of short survival. In conclusion, the FP is prevalent in nonagenarians and centenarians and correlates with lower survivability. Future studies should address differences between unavoidable age-associated frailty and reversible disability in long-lived individuals.

[Mortality associated with neurocognitive disorder and dependence in people over 55 years of age. Systematic review]

INTRODUCTION

The increasing aging of the population brings with it an increase in the incidence of neurocognitive disorder (NCD) as well as various situations that generate dependence.

OBJECTIVE

To analyze by means of a systematic review the relationship between NCD and dependence with the risk of mortality in the elderly.

METHODS

A bibliographic search of longitudinal studies published in Pubmed and Scopus addressing the relationship between NCI, dependence for basic activities of daily living (ADL) and mortality published between 1995 and 2021 was performed. Of the 1040 articles found, 10 studies were selected.

RESULTS

It was observed that cohorts of elderly people with NCI presented mortality risk associated with ABVD impairment (Barthel test) and Mini-Mental State Examination scores following a significant linear trend. Other factors associated with mortality risk were low levels of education, living alone, and frailty.

CONCLUSIONS

The results underline the importance of performing assessments of cognitive and functional status using validated scales, since both areas are associated with mortality. The link between the three terms used in the search for this work is clear, but it is noteworthy that there are few longitudinal studies that analyze them together. The assessment of dependence and cognitive function in older adults should be considered in both research and clinical practice as it would provide information on their possible relationship with mortality.

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.

Longitudinal Relationship Between Handgrip Strength and Cognitive Function in a European Multicentric Population Older Than 50 Years

OBJECTIVE

The aim of this study was to analyze the bidirectional association between handgrip strength (HGS) and cognitive performance in different cognitive functions in a European population and to evaluate the predictive validity of HGS for the risk of future cognitive impairment in aging individuals.

METHODS

This was a prospective cohort study conducted using data on individuals over 50 years of age from the Survey of Health, Aging and Retirement in Europe (SHARE). HGS measures and scores in numeracy, recall, and verbal fluency were repeated and analyzed biannually for 4 years and were used in generalized estimating equations to test the bidirectional association, categorized by sex.

RESULTS

Of the 8236 individuals included, 55.73% were women with a mean age of 67.55 (standard deviation [SD] = 8.4) years and 44.27% were men with a mean age of 68.42 (SD = 7.7) years. HGS predicted cognitive decline in both sexes, except for numeracy in men, even after adjustments. The strongest association with HGS in women was in verbal fluency (β = .094; 95% CI = 0.039 to 0.151), whereas the strongest association with HGS in men was in delayed verbal recall (β = .095; 95% CI = 0.039 to 0.151). Conversely, the greatest cognitive predictor of HGS decline was verbal fluency in men (β = .796; 95% CI = 0.464 to 1.128), and in women (β = .801; 95% CI= 0.567 to 1.109).

CONCLUSION

There is a significant and bidirectional association between HGS and different cognitive functions in a European multicentric population. This bidirectional association differed between sexes.

IMPACT

Both men and women who presented with cognitive decline also showed early changes in their HGS measures, and vice versa, but there still were differences between the sexes. These findings reinforce that HGS may be a simple and inexpensive method to identify early signs of cognitive decline, and that studies and rehabilitation strategies should be more sex specific.

Prospective associations between hand grip strength and subsequent depressive symptoms in men and women aged 50 years and older: insights from the Survey of Health, Aging, and Retirement in Europe

Introduction

In previous cross-sectional and longitudinal studies, depressive symptoms have been associated with lower hand grip strength (HGS), which is a convenient measure of overall muscular strength and serves as a marker of poor health. Most studies have considered low sample sizes or highly selective patient cohorts.

Methods

We studied the association between depressive symptoms (EURO-D) and HGS in three waves from the cross-national panel dataset Survey of Health, Aging, and Retirement in Europe (SHARE). Linear regressions and Generalized Estimating Equations (GEE) were conducted to determine factors associated with depressive symptoms and investigate whether HGS predicts future depressive symptoms.

Results

Cross-sectional HGS explained 7.0% (Wave 4), 5.7% (Wave 5), and 6.4% (Wave 6) of the EURO-D variance. In the GEE, we analyzed people without depression in Wave 4 (N = 39,572). HGS predicted future EURO-D (B = -0.21, OR = 0.979, 95%CI (0.979, 0.980), p < 0.001) and remained a significant predictor of future depressive symptoms after adjustment for age, sex, psychosocial and physical covariates.

Discussion

Muscle strength is a known marker for physical health, but a relation with mental health has also been proposed previously. This study confirmed the link between HGS and depressive symptoms in men and women aged ≥50 years in a large longitudinal dataset. Further research is required to understand the mechanisms behind this link to determine whether HGS can serve as a specific marker of depressive symptomology, or whether they coexist due to common underlying disease processes.

Association between Locomotive Syndrome and Hearing Loss in Community-Dwelling Adults

The relationship between hearing and motor function as a function of aging is unclear. Therefore, we aimed to clarify the relationship between age-related hearing loss and locomotive syndrome. In total, 240 participants aged ≥40 years, whose hearing acuity and motor function had been measured, were included in this study. Patients with a hearing acuity of <35 dB and ≥35 dB were categorized into normal and low hearing acuity groups, respectively. Motor function was compared according to sex between the groups. Among men, those in the low hearing acuity group (51/100) were older, had a significantly slower walking speed, and had a higher prevalence of locomotive syndrome than those in the normal group. Among women, those in the low hearing group (14/140) were older and had a significantly slower gait speed than those in the normal group. The multivariate analysis showed that, in the low hearing acuity group, age and gait speed were risk factors in men, while age was the only risk factor in women. In conclusion, hearing loss was associated with walking speed. The association between hearing loss and locomotive syndrome was observed only in men. In the multivariate analysis, hearing loss was associated with walking speed only in men.

Association of absolute and relative hand grip strength with all-cause mortality among middle-aged and old-aged people

OBJECTIVES

This study aimed to examine the association of absolute and relative hand grip strength (HGS) with the risk of all-cause mortality among middle-aged and old-aged people in South Korea. Considering that both absolute HGS and relative HGS could be effective measures, an in-depth investigation is necessary to compare the effects of both measures on mortality.

METHODS

Data of 9,102 participants, derived from the Korean Longitudinal Study of Aging from 2006 to 2018, were examined. HGS was divided into two categories: absolute HGS and relative HGS (defined as HGS divided by body mass index). The risk of all-cause mortality was the dependent variable. Cox proportional hazard regression was used to analyze the association between HGS and all-cause mortality.

RESULTS

The average of absolute and relative HGS were 25.6 ± 8.7 kg and 1.1 ± 0.4 kg/BMI, respectively. The all-cause mortality rate decreased by 3.2% as absolute HGS increased by 1 kg (adjusted hazard ratio [HR] = 0.968, 95% CI = 0.958-0.978). An increase in relative HGS by 1 kg/BMI was associated with a 22% reduction in risk of all-cause mortality (adjusted HR = 0.780, 95% CI = 0.634-0.960). Individuals with more than two chronic diseases, there was a decrease in all-cause mortality as absolute HGS increased by 1 kg and relative HGS by 1 kg/BMI (absolute HGS; adjusted HR = 0.97, 95% CI = 0.959-0.982, relative HGS; adjusted HR = 0.483, 95% CI = 0.325-0.718).

CONCLUSIONS

Our study findings showed that both absolute and relative HGS were inversely associated with the risk of all-cause mortality; a higher absolute/relative HGS was associated with a lower risk of all-cause mortality. Moreover, these findings highlight the importance of improving HGS to alleviate the burden of adverse health problems.

Nativity differences in the relationship between handgrip strength and cognitive impairment in older Mexican Americans over 20 years of follow-up

PURPOSE

To examine nativity differences in the relationship between handgrip strength (HGS) and cognitive impairment among Mexican Americans aged ≥ 65 years with normal or high cognitive function at baseline over a 20-year period.

METHODS

Prospective cohort study of 2,155 non-institutionalized Mexican Americans aged ≥ 65 years from the Hispanic Established Population for the Epidemiological Study of the Elderly) who scored ≥ 21 in the Mini Mental State Examination (MMSE) at baseline. Measures included socio-demographics, body mass index, medical conditions, depressive symptoms, physical function, disability, HGS quartiles (sex-adjusted), and MMSE. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of cognitive impairment (MMSE < 21) as a function of HGS quartile by nativity and adjusted for covariates.

RESULTS

US-born and foreign-born participants in the 4th quartile (highest) of HGS at baseline had lower odds of cognitive impairment over time compared with those in the 1st (lowest) HGS quartile (OR=0.95, 95% CI=0.90-0.99 and OR=0.93, 95% CI=0.89-0.98, respectively), after controlling for all covariates. When we analyzed HGS quartiles as time-varying, we found that US-born participants in the 3rd and 4th HGS quartile had 25% and 30% lower odds of cognitive impairment, respectively, while foreign-born participants in the 3rd and 4th HGS quartile had 27% and 49% lower odds of cognitive impairment over time, respectively, after controlling for all covariates.

CONCLUSION

Foreign-born older Mexican Americans who performed high in HGS experienced 7% lower odds of cognitive impairment over time compared with US-born older Mexican Americans.

Comparison of the Relationship between Visual Acuity and Motor Function in Non-Elderly and Elderly Adults

This study aimed to clarify the relationship between visual acuity and motor function in younger and elderly participants and to compare differences between non-elderly and elderly participants. In total, 295 participants who underwent visual and motor functional examinations were included; participants with visual acuity ≥0.7 were assigned to the normal group (N group) and those with visual acuity ≤0.7 were assigned to the low-visual-acuity group (L group). Motor function was compared between the N and L groups; the analysis was performed by grouping participants into those aged >65 years (elderly) and those aged <65 years (non-elderly). The non-elderly group (average age, 55.6 ± 6.7 years) had 105 and 35 participants in the N and L groups, respectively. Back muscle strength was significantly lower in the L group than in the N group. The elderly group (average age, 71.1 ± 5.1 years) had 102 and 53 participants in the N and L groups, respectively. Gait speed was significantly lower in the L group than in the N group. These results reveal differences in the relationship between vision and motor function in non-elderly and elderly adults and indicate that poor vision is associated with lower back-muscle strength and walking speed in younger and elderly participants, respectively.

The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS90)

The AHFS⁹⁰ was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS⁹⁰ has a good accuracy and in most risk categories a good calibration. In our study population, the AHFS⁹⁰ yielded a maximum prediction of early mortality of 64.5%.

PURPOSE

Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS⁹⁰).

METHODS

Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS⁹⁰, which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks.

RESULTS

One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS⁹⁰ includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS⁹⁰ had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS⁹⁰ overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS⁹⁰ had a maximal prediction of early mortality of 64.5% in this study population.

CONCLUSION

The AHFS⁹⁰ accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS⁹⁰ yielded a maximum prediction of early mortality of 64.5%.

Relationship between Strength and Professional Quality of Life of Nurses Working Hospital Emergency Departments

Optimal quality of professional life can allow coping with stressful situations and avoiding fatigue. This is instrumental in jobs undergoing very demanding situations, such as nurses working in Emergency Departments. In this study, we investigated the relationship between functional and physiological indicators and the quality of professional life in nurses of Emergency Departments of two public hospitals. Fifty-nine professionals participated in the study. Cortisol (an indicator of stress) and post-test lactate (an indicator of fatigue) were analyzed in saliva and in the blood, respectively, at the beginning and at the end of the morning shift. The CVP-35 survey (Spanish version of the QPL-35 questionnaire) was used to assess the quality of professional life. Post-dynamometry circulating lactate levels increased significantly; meanwhile, salivary cortisol decreased in participants at the end of the working shift. Regarding dynamometry, no significant changes were observed. CVP-35/QPL-35 scores did not show significant changes in participants from both hospitals in all dimensions analyzed. In conclusion, nurses participating in the study displayed adaptation to stress accompanied by an acceptable level of professional quality of life. However, certain fatigue appears at the end of the working day. Altogether, results suggest that a better organization must be implemented at work, improving ergonomic, safe, and healthy conditions.

Influencing factors of weak grip strength and fall: a study based on the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Fall is a major cause of mortality and cause a significant burden on the healthcare system and economic system. Weak grip strength signifies impaired function. Older people with weak grip strength are at a higher risk of death. China has the largest ageing population in the world today. This study aims to analyze the factors contributing to weak grip strength and fall among Chinese.

METHODS

This study analyzed data from the 2011 baseline and 2015 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). To identify the risk factors of fall and weak grip strength, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) regression model.

RESULTS

In the LASSO regression model, all the risk factors were not shrunken. In the stepwise logistic regression model, adjusted for gender, age, grip strength, depression, and chronic disease, we found that female (aOR = 1.376, 95% CI = 1.243-1.523; P < 0.001), history of ischemic stroke (aOR = 1.786, 95% CI = 1.263-2.524; P = 0.001), depression (aOR = 1.559, 95% CI = 1.396-1.742; P < 0.001), weak grip strength (aOR = 1.285, 95% CI = 1.105-1.494; P = 0.001), older age (aOR = 1.227, 95% CI = 1.163-1.294; P < 0.001), rheumatoid arthritis (aOR = 1.410, 95% CI = 1.270-1.560; P < 0.001), history of kidney disease (aOR = 1.383, 95% CI = 1.136-1.682; P = 0.001) were factors associated with fall significantly. After further adjusting, we found the risk factors of weak grip strength included symptomatic knee osteoarthritis (aOR = 1.755, 95% CI 1.158-2.661; P = 0.008), living in rural area (aOR = 2.056, 95% CI 1.290-3.277; P = 0.002), depression (aOR = 1.523, 95% CI 1.116-2.078; P = 0.008), older age (aOR = 2.116, 95% CI 1.801-2.486; P < 0.001).

CONCLUSION

From the study, we found that older age and depression were risk factors of weak grip strength and fall. Weak grip strength was a risk factor of fall. Female, ischemic stroke, kidney disease, rheumatoid arthritis were risk factors of fall; living in rural area and symptomatic knee osteoarthritis were risk factors of weak grip strength.

Handgrip Strength and Cognitive Performance in a Multiethnic Cohort in Singapore

BACKGROUND

Handgrip strength (HGS) is an important marker of frailty but there is limited research on lifestyle and vascular determinants of HGS and its relationship with cognitive impairment.

OBJECTIVE

To identify determinants of HGS and the association of HGS with cognitive impairment in a multiethnic cohort from Singapore.

METHODS

This study (n = 2,109, median [Q1, Q3] age: 53 [48, 60] years, 59.6% women) was based on cross-sectional data from Singapore Multi-Ethnic Cohort. HGS was collected using hand-held Electronic Dynamometer. The potential determinants of HGS included age, sex, ethnicity, smoking, physical activity, serum cholesterol and history of hypertension, diabetes, and stroke. Cognition, assessed with the Mini-Mental State Examination (MMSE), was analyzed as both continuous and binary outcome (cognitively impaired [scores < 26] and cognitively normal [scores≥26]).

RESULTS

In total, 239 (11.3%) participants were cognitively impaired. Older age, female sex, Malay or Indian compared with Chinese ethnicity, and diabetes history were associated with decreased HGS, whereas higher education, higher body mass index, and more physical activity were associated with higher HGS. Higher HGS was associated with higher MMSE scores (β: 0.34, 95% CI: 0.20, 0.49) and 37% lower odds of cognitive impairment (OR: 0.63, 95% CI: 0.49-0.82). These associations were significantly stronger in participants who were older (50-90 years), female, of Malay and Indian ethnicity (compared with Chinese), and less educated.

CONCLUSION

In this multi-ethnic Asian population, demographics, vascular risk factors, and lifestyle behaviors were associated with HGS. Additionally, higher HGS was associated with substantially better cognitive function, which association was modified by age, sex, ethnicity, and education level.

Plasma proteomic signature of decline in gait speed and grip strength

The biological mechanisms underlying decline in physical function with age remain unclear. We examined the plasma proteomic profile associated with longitudinal changes in physical function measured by gait speed and grip strength in community-dwelling adults. We applied an aptamer-based platform to assay 1154 plasma proteins on 2854 participants (60% women, aged 76 years) in the Cardiovascular Health Study (CHS) in 1992-1993 and 1130 participants (55% women, aged 54 years) in the Framingham Offspring Study (FOS) in 1991-1995. Gait speed and grip strength were measured annually for 7 years in CHS and at cycles 7 (1998-2001) and 8 (2005-2008) in FOS. The associations of individual protein levels (log-transformed and standardized) with longitudinal changes in gait speed and grip strength in two populations were examined separately by linear mixed-effects models. Meta-analyses were implemented using random-effects models and corrected for multiple testing. We found that plasma levels of 14 and 18 proteins were associated with changes in gait speed and grip strength, respectively (corrected p < 0.05). The proteins most strongly associated with gait speed decline were GDF-15 (Meta-analytic p = 1.58 × 10^-15 ), pleiotrophin (1.23 × 10^-9 ), and TIMP-1 (5.97 × 10^-8 ). For grip strength decline, the strongest associations were for carbonic anhydrase III (1.09 × 10^-7 ), CDON (2.38 × 10^-7 ), and SMOC1 (7.47 × 10^-7 ). Several statistically significant proteins are involved in the inflammatory responses or antagonism of activin by follistatin pathway. These novel proteomic biomarkers and pathways should be further explored as future mechanisms and targets for age-related functional decline.

Thresholds of handgrip strength for all-cause, cancer, and cardiovascular mortality: A systematic review with dose-response meta-analysis

BACKGROUND

While handgrip strength is associated with all-cause and cause-specific mortality, whether such associations are dose-dependent is largely unknown. Therefore, we conducted a systematic review on the dose-response relationship of handgrip strength with all-cause mortality, cancer, and cardiovascular mortality.

METHODS

The data source included three electronic databases (PubMed/MEDLINE, Web of Science and Scopus) from inception to 8 February 2022. Prospective cohort studies of healthy adults with objective measures of handgrip strength were included. Two researchers independently screened studies, extracted data, and assessed risk of bias. We used estimates regarding handgrip strength categories to conduct a random forest model, and a two-stage random-effects hierarchical meta-regression model pooling study-specific estimates for dose-response relationship. Outcomes included all-cause, cancer, and cardiovascular mortality.

REULTS

Forty-eight studies comprising 3,135,473 participants (49.6% women, age range 35-85 years) were included. Random forest models showed a significant inverse association between handgrip strength and all-cause and cause-specific mortality. Dose-response meta-analyses showed that higher levels of handgrip strength significantly reduced the risk of all-cause mortality within 26-50 kg (Higgin´s I² =45.7%) in a close-to-linear inverse fashion. Cancer and cardiovascular mortality displayed a trend towards a U-shaped association with a significant risk reduction between 16 and 33 kg (Higgin´s I² =77.4%), and a close-to-linear inverse shaped and significant risk reduction ranging from 24 to 40 kg (Higgin´s I² =79.7%) respectively.

CONCLUSION

There is strong evidence for an association between lower handgrip strength with higher all-cause, cancer, and cardiovascular mortality risk. The dose-response relationship of handgrip strength substantially varies depending on the cause of mortality.

Associations between HIV infection and frailty status and its individual components: Are frailty components disproportionally affected?

OBJECTIVE

We aimed to examine whether HIV infection was independently associated with frailty status and its individual components.

METHODS

This cross-sectional investigation included people living with HIV (PLWH) and HIV-negative individuals from the baseline survey of the Comparative HIV and Aging Research in Taizhou (CHART) cohort, China. Frailty phenotype was based on five components: weight loss, low physical activity, exhaustion, weak grip strength and slow gait speed. Frailty was defined as the presence of at least three components, and prefrailty was defined as one or two components. Logistic regression models were used to analyse the factors associated with frailty and its components.

RESULTS

In all, 2475 people living with HIV (age 45.5 ± 14.9 years; 76.2% male) and 4948 HIV-negative individuals (age 45.5 ± 14.8 years; 76.3% male) were included. Among PLWH, median CD4 count was 395 cells/μL and 78% were currently on antiretroviral therapy (ART). Frailty and prefrailty were significantly more prevalent in PLWH (3.2% vs 1.9% and 32.9% vs 27.9%) overall and at ages 18-39 (1.4% vs 0.2% and 22.7% vs 19.0%), 40-59 (2.5% vs 0.9% and 30.9% vs 27.9%) and 60-90 years (8.4% vs 7.4% and 57.1% vs 45.8%). HIV infection was associated with frailty and prefrailty [adjusted odds ratio (aOR) = 1.48, 95% confidence interval (CI): 1.06-2.08; and aOR = 1.18, 95% CI: 1.05-1.33, respectively] after adjusting for confounding variables, but were strengthened with further adjustment for multimorbidity (aOR = 1.62, 95% CI: 1.14-2.28; and aOR = 1.22, 95% CI: 1.09-1.37), and were no longer significant with further adjustment for depressive symptoms and sleep disorders (aOR = 1.02, 95% CI: 0.71-1.46; and aOR = 1.06, 95% CI: 0.94-1.20). Among individual components, HIV infection was positively associated with weak grip strength and slow gait speed, but negatively associated with low physical activity and exhaustion in all the adjusted models described.

CONCLUSIONS

Frailty and prefrailty occur more often and earlier in PLWH. However, grip strength and gait speed are affected to a greater extent, highlighting their potential as screening and intervention targets to prevent or slow frailty among PLWH.

The association between physical performance and subjective wellbeing in Chinese older adults: A cross-sectional study

Purpose

This study aimed to investigate the association between physical performance and subjective wellbeing among Chinese older adults.

Methods

Data on the Chinese population were gathered from the Study on Global Aging and Adult Health Survey (SAGE). This survey used a stratified multistage cluster sample design based on geographical location and economic status. Chinese older adults aged 65 years old or above from eight provinces (Guangdong, Hubei, Jilin, Shaanxi, Shandong, Shanghai, Yunnan, and Zhejiang) were included in this cross-sectional study. Physical performance was measured using relative handgrip strength and normal gait speed. Subjective wellbeing was measured using quality-of-life (QOL), happiness, and mood through interviews with participants. Logistic regressions were used to examine the associations between physical performance and each of the three wellbeing variables (QOL, happiness, and mood).

Results

Data of 5,421 Chinese older adults (mean age: 72.93 ± 5.89 years old, 47.1% men) were analyzed. In this sample, individuals with a higher level of relative handgrip strength (rHGS) had better mood compared to those with a lower level of rHGS (p < 0.05), and persons with lower gait speed had poorer QOL, happiness, and mood compared to those with faster gait speed (p < 0.05).

Conclusion

Our findings suggest that a higher level of relative handgrip strength predicted better mood and lower gait speed predicted poor QOL, happiness, and mood in Chinese older adults.

Muscle strength and incidence of depression and anxiety: findings from the UK Biobank prospective cohort study

BACKGROUND

Depression and anxiety are the leading mental health problems worldwide; depression is ranked as the leading cause of global disability with anxiety disorders ranked sixth. Preventive strategies based on the identification of modifiable factors merit exploration. The aim of the present study was to investigate the associations of handgrip strength (HGS) with incident depression and anxiety and to explore how these associations differ by socio-demographic, lifestyle, and health-related factors.

METHODS

The analytic sample comprised 162 167 participants (55% women), aged 38-70 years, from the UK Biobank prospective cohort study. HGS was assessed at baseline using dynamometry. Depression and anxiety were extracted from primary care and hospital admission records. Cox proportional models were applied, with a 2 year landmark analysis, to investigate the associations between HGS and incident depression and anxiety.

RESULTS

Of the 162 167 participants included, 5462 (3.4%) developed depression and 6614 (4.1%) anxiety, over a median follow-up period of 10.0 years (inter-quartile range: 9.3-10.8) for depression and 9.9 (inter-quartile range: 9.0-10.8) for anxiety. In the fully adjusted model, a 5 kg lower HGS was associated with a 7% (HR: 1.07 [95% CI: 1.05, 1.10]; P < 0.001) and 8% (HR: 1.08 [95% CI: 1.06, 1.10]; P < 0.001) higher risk of depression and anxiety, respectively. Compared with participants in the sex and age-specific highest tertiles of HGS, those in the medium and lowest tertiles had an 11% (HR: 1.11 [95% CI: 1.04, 1.19]; P = 0.002) and 24% (HR: 1.24 [95% CI: 1.16, 1.33]; P < 0.001) higher risk of depression and 13% (HR: 1.13 [95% CI: 1.06, 1.20]; P < 0.001) and 27% (HR: 1.27 [95% CI: 1.19, 1.35]; P < 0.001) higher risk of anxiety, respectively. The association of HGS with depression was stronger among participants with average or brisk walking pace (vs. slow walking pace; P_interaction  < 0.001). The association with anxiety was stronger in those participants aged ≥58 years (vs. ≤58 years; P_interaction  = 0.002) and those living in more affluent areas (vs. deprived; P_interaction  = 0.001).

CONCLUSIONS

Handgrip strength was inversely associated with incident depression and anxiety. Because HGS is a simple, non-invasive, and inexpensive measure, it could be easily used in clinical practice to stratify patients and identify those at elevated risk of mental health problems. However, future research should assess if resistance training aimed at increasing HGS can prevent the occurrence of mental health conditions.

Objective Physical Activity Levels, Sedentary Time, and Muscle Mass, Strength, and Function: Impact on Physical and Mental Health-Related Quality of Life in Older Adults

Limited physical activity, sedentary behavior, and reduction in muscle mass, strength, and function are accompanied by negative outcomes. The relationship between these factors and physical and mental health-related quality of life (HRQoL) has yet to be elucidated in continuing care retirement community (CCRC) residents. The current study investigated the relationships among physical activity, sedentary behavior, and muscle mass, strength, and function to physical and mental HRQoL. A sample of 105 CCRC residents participated in this cross-sectional correlational study. Findings demonstrated that low physical activity and muscle function were significantly associated with low physical HRQoL and explained 38% of the variance in physical HRQoL. Handgrip strength was significantly associated with low mental HRQoL and explained 8% of the variance in mental HRQoL. Older adults living in CCRCs may benefit from interventions targeting physical activity and the distinct muscle components of sarcopenia that have the potential to improve physical and mental HRQoL. [Research in Gerontological Nursing, 15(3), 131-139.].

Handgrip strength and risk of cognitive outcomes: new prospective study and meta-analysis of 16 observational cohort studies

Handgrip strength (HGS), a measure of muscular strength, might be a risk indicator for cognitive functioning, but the evidence is not consistent. Using a new prospective study and meta-analysis of published observational cohort studies, we aimed to evaluate the prospective associations of HGS with poor cognitive outcomes including cognitive impairment, dementia and Alzheimer's disease (AD). Handgrip strength, measured using a Martin-Balloon-Vigorimeter, was assessed at baseline in a population-based sample of 852 men and women with good cognitive function in the Kuopio Ischemic Heart Disease cohort. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for cognitive outcomes. Relevant published studies were sought in MEDLINE, Embase and Web of Science from inception until October 2021 and pooled using random effects meta-analysis. During a median follow-up of 16.6 years, 229 dementia cases were recorded. Comparing extreme tertiles of HGS, the multivariable adjusted HR (95% CI) for dementia, AD and vascular dementia was 0.77 (0.55-1.07), 0.75 (0.52-1.10) and 0.49 (0.16-1.48), respectively. In a meta-analysis of 16 population-based prospective cohort studies (including the current study) comprising 180,920 participants, the pooled multivariable adjusted relative risks (95% CIs) comparing the top vs bottom thirds of HGS levels were as follows: 0.58 (0.52-0.65) for cognitive impairment; 0.37 (0.07-1.85) for cognitive decline; 0.73 (0.62-0.86) for dementia; 0.68 (0.53-0.87) for AD; and 0.48 (0.32-0.73) for vascular dementia. GRADE quality of evidence ranged from low to very low. Meta-analysis of aggregate prospective data suggests that HGS may be a risk indicator for poor cognitive outcomes such as cognitive impairment, dementia and AD. Systematic review registration: PROSPERO 2021: CRD42021237750.

Clarifying the relationship between sarcopenia and depression in geriatric outpatients

OBJECTIVE

We investigate the relationship between sarcopenia components and depression in geriatric outpatients, considering the effects of potential confounding factors.

METHODS

Adults ≥60 years of age were selected from outpatient clinics. Muscle strength was assessed using handgrip strength (HGS) measured using a hydraulic hand dynamometer and chair stand test (CSST). Physical performance was evaluated by usual gait speed (UGS), nutritional status, and frailty were screened by mini-nutritional assessment (MNA) questionnaire and FRAIL scale. Depression was diagnosed through a psychiatric interview and the administration of the Geriatric Depression Scale (GDS).

RESULTS

Participants with depression were similar to participants without depression regarding age (p = .055), education (p = .095), frailty (p = .857), and HGS scores (p = .053). The group with depression had longer CSST duration (p = .023), slower UGS (p =  .027), and more malnutrition (p = .001). Multivariate regression analysis revealed that only the malnutrition was independently associated factor with depression after adjusting for confounding factors.

CONCLUSIONS

Depression is associated with malnutrition and some components of sarcopenia in geriatric outpatients. Our results revealed that sarcopenia might be associated with depression through malnutrition. If malnutrition lasts for a long time, sarcopenia may become evident in the later stages of depression.

Exploring the bidirectional associations between handgrip strength and depression in middle and older Americans

OBJECTIVE

Current evidence on the relationship between decreased handgrip strength and depression risk is controversial, and there is limited study focus on the potential bidirectional associations between them. We aim to explore their bidirectional relationships.

METHODS

This study used panel data from the Health and Retirement Study involving 17,713 aging Americans (≥50 years old) who participated in at least 2 waves. Smedley spring-type hand-held dynamometer was used to assess the handgrip strength. Depression was evaluated by the 8-item Center for Epidemiologic Studies-Depression (CESD) scale. Time-lagged general estimating equations (GEE) were used to assess the bidirectional association between handgrip strength and the depression risk.

RESULTS

In the fully adjusted model, every 5 kg decreased handgrip strength was associated with a 6% (95%CI: 3%-9%) increased risk of depression. Compared with non-weakness participants, those with weakness had a higher depression risk (OR = 1.22, 95%CI: 1.09-1.36). Conversely, depression might associate with a 0.33 kg (95% CI: 0.09-0.56) decrease in handgrip strength and increased the risk of weakness by 18% (95% CI: 6%-33%). In addition, the results remained stable in the stratified analyses by gender and sex. Interestingly, the above-mentioned associations were also observed in overweight and obese participants.

CONCLUSIONS

The present study found bidirectional associations between handgrip strength and depression risk. Our results indicated early interventions for depression and handgrip strength might achieve reciprocal benefits over time.

Gait speed and 6-minute walking distance are useful for identifying difficulties in activities of daily living in patients with cardiovascular disease

BACKGROUND

Difficulty in activities of daily living (ADL) is common in patients with cardiovascular disease (CVD) and is associated with mortality.

OBJECTIVES

The relationship between gait speed/6-minute walking distance (6MWD) and difficulties in ADL in patients with CVD was explored.

METHODS

The study population consisted of 447 patients with CVD for whom data on gait speed, 6MWD, and difficulty in ADL during outpatient rehabilitation were available. Relationships of gait speed/6MWD and difficulty in ADL were examined using propensity-adjusted logistic regression analysis.

RESULTS

Both gait speed and 6MWD were significantly related to difficulty in ADL, and the areas under the curves were large. The cutoff values ranged from 0.93 to 1.30 m/s for gait speed and 370 to 500 m for 6MWD, from basic ADL to vigorous activities.

CONCLUSIONS

Both gait speed and 6MWD were used for the estimation of difficulty in ADL in patients with CVD. Gait speed can be measured easily and therefore could be incorporated in busy clinical practice to identify patients at risk for functional decline.

Association of Vitamin D Supplementation in Cardiorespiratory Fitness and Muscle Strength in Adult Twins: A Randomized Controlled Trial

Although vitamin D is related to cardiorespiratory fitness and muscle strength, there is no evidence in the literature about the genetic influence of the response to vitamin D supplementation and improvements in these parameters. Therefore, we evaluate the effect of longitudinal supplementation of vitamin D on parameters of physical fitness in monozygotic twins. In total, 74 participants were included, with a mean age of 25 years, divided into two groups, one group received supplementation with cholecalciferol for 60 days and the other group did not. Cardiorespiratory fitness and muscle strength were measured before and after supplementation through maximal treadmill tests and dynamometry, respectively. Wilcoxon tests were used to compare intragroup results and the Mann-Whitney test to examine intergroup differences. There was an increase in the serum concentration of vitamin D in participants who ingested the supplementation. Cardiorespiratory fitness improved after supplementation through increases in the values of maximum oxygen consumption of 28% (p < .001). Muscle strength in left hand grip increased 18% in participants who received the supplement (p = .007). Sixty days of cholecalciferol supplementation improved cardiorespiratory fitness and upper limb muscle strength.

Synergistic associations of visual and self-reported hearing acuity with low handgrip strength in older adults: a population-based cross-sectional study

BACKGROUND

It is unclear whether visual and hearing acuity are independently or synergistically associated with muscle strength. We aimed to examine the associations of visual and self-reported hearing acuity with low handgrip strength and the additive interaction between visual and hearing acuity on low handgrip strength in people over 60 years.

METHOD

Data of 3,075 individuals aged over 60 years from the 2017 and 2018 Korea National Health and Nutrition Examination Survey were used for this cross-sectional study. Low handgrip strength was defined based on the 20th percentile of the study population (< 30.4 kg for male and < 17.7 kg for female). Visual and self-reported hearing acuity were each divided into three categories: good, moderate, and impaired. Multiple logistic regression and relative excess risk due to interaction (RERI) were performed.

RESULTS

Of the 3,075 participants, 993 (32.3 %) demonstrated low handgrip strength. Low handgrip strength was more prevalent in participants with moderate (adjusted odds ratio [AOR] = 1.54, 95 % confidence interval [CI] = 1.12-2.12) and impaired visual acuity (AOR = 2.00, 95 % CI = 1.34-2.96). Both moderate and impaired self-reported hearing acuity were significantly associated with low handgrip strength (moderate: AOR = 1.25, 95 % CI = 1.01-1.55; impaired: AOR = 1.66, 95 % CI = 1.15-2.38). The more severe the sensory function decline, the higher the association with muscle weakness. Moreover, combined sensory impairments were associated with deteriorating low handgrip strength (AOR = 8.38), with significantly strong additive interactions (RERI = 2.61, 95 % CI = 2.52-2.70).

CONCLUSIONS

Awareness is needed regarding the risk of reduced muscle strength in individuals with moderate and impaired sensory function. Older people with sensory function decline in clinical settings may benefit from programs such as exercise prescription to prevent muscle weakness.

Hand grip strength and health-related quality of life in postmenopausal women: a national population-based study

OBJECTIVE

Muscle strength progressively decreases after menopause. Hand grip strength (HGS) reflects overall muscle strength and may be associated with health-related quality of life (HRQoL). We aimed to assess the association between HGS and HRQoL in postmenopausal women.

METHODS

We used nationally representative data on 6,059 postmenopausal women from the Korea National Health and Nutrition Examination Survey (2014-2018). HGS was determined as the maximum value in kilograms (kg) achieved using either hand. HRQoL was estimated using the European Quality of Life Questionnaire-Five Dimensions (EQ-5D) questionnaire. The prevalence ratios of having moderate/severe problems on the EQ-5D were evaluated with adjustment for covariates using complex survey analysis.

RESULTS

The prevalence of having a problem in at least one of the HRQoL dimensions among postmenopausal women was 43.6%. Compared with participants with the lowest quintile of HGS, women in the highest quintile had a significantly lower prevalence of moderate/severe problems in most dimensions (fully adjusted prevalence ratios [95% confidence intervals]; 0.73 [0.60-0.89], 0.45 [0.28-0.72], 0.52 [0.38-0.71], 0.74 [0.63-0.87], and 0.91 [0.70-1.18] for mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, respectively). The associations between HGS and EQ-5D index were stronger among the participants who were older (65-79 y), had a higher body mass index (≥ 25.0 kg/m2), had low physical activity, had a longer duration since menopause (≥ 10 y), and had a chronic disease.

CONCLUSIONS

Higher HGS was associated with a lower prevalence of moderate/severe problems in each dimension of the EQ-5D in postmenopausal women. These associations were more apparent in individuals who were older, had higher body mass index, or had a chronic disease.

Bidirectional Associations between Handgrip Strength and Depressive Symptoms: A Longitudinal Cohort Study

OBJECTIVES

This study aimed to examine the bidirectional associations between handgrip strength and depressive symptoms in a nationally representative sample.

DESIGN

Cohort study with a 4-year follow-up.

SETTING AND PARTICIPANTS

A total of 13,208 participants from the China Health and Retirement Longitudinal Study were included in the analyses.

METHODS

Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies-Depression Scale. Separate generalized estimating equations were used to analyze the cross-sectional and longitudinal associations between handgrip strength and depressive symptoms. Restricted cubic spline models were performed to explore the shape of the dose-response relationship.

RESULTS

Decreased handgrip strength was related to subsequent increased risk of depressive symptoms, such that participants in the lowest quartile of handgrip strength were found to have an approximately 36% increased in their risk of depressive symptoms compared with those in the highest quartile [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.17, 1.58]. There was a linear dose-response relationship between handgrip strength and risk of depressive symptoms (P_nonlinearity = .25), in that a 5-unit increment in handgrip strength may lead to an 11% decrease in the risk of depressive symptoms (OR 0.89, 95% CI 0.85, 0.92). Conversely, depressive symptoms were prospectively associated with subsequent decreased handgrip strength (β = -0.84, 95% CI -1.13, -0.55). An approximatively L-shaped dose-response pattern was found for the association between depressive symptoms level and handgrip strength (P_nonlinearity = .02).

CONCLUSIONS AND IMPLICATIONS

The present study identified bidirectional associations between handgrip strength and depressive symptoms, and the associations were found to have a dose-response pattern. It provides important insights into integrated mental and physical health intervention strategies that simultaneously promote handgrip strength and depressive symptoms.

A Narrative Review of Handgrip Strength and Cognitive Functioning: Bringing a New Characteristic to Muscle Memory

BACKGROUND

Measures of handgrip strength have not only emerged as a clinically viable screening tool for determining risk for morbidity, functional disability, and early mortality, but also for helping to identify cognitive deficits. However, the phenomena that links low handgrip strength with cognitive decline remains unclear. The role of the muscular and neural systems, and their adaptations to muscle strengthening activities over the life course, may provide important information for how age-related changes to muscle mass, strength, and neural capacity influence cognition. Moreover, disentangling how handgrip strength and cognitive function are associated may help to inform healthcare providers working with aging adults and guide targeted interventions aiming to preserve muscle and cognitive functioning.

OBJECTIVE

To 1) highlight and summarize evidence examining the associations of handgrip strength and cognitive functioning, and 2) provide directions for future research in this area.

METHODS

Articles from the PubMed database were searched from November 2018-May 2019. The search term algorithm, inclusion and exclusion criteria were pre-specified by investigators.

RESULTS

Several cross-sectional and longitudinal studies have revealed that measures of handgrip strength were associated with cognitive declines regardless of age demographics and the presence of comorbidities.

CONCLUSION

Handgrip strength can be used in clinical and epidemiological settings for helping to determine the onset and progression of cognitive impairment. Future research should continue to examine how handgrip strength and cognitive function are linked.

Correlation between Handgrip Strength and Depression in Older Adults-A Systematic Review and a Meta-Analysis

Background: Depression remains an important health problem among older adults and it may be correlated with the deterioration of physical fitness, whose chief indicator is hand grip strength (HGS). The aim of the study was to investigate the relationship between depression and HGS among older populations using the available literature. Methods: PubMed, Web of Science and Science Direct databases were searched. The inclusion criteria were as follows: written in English and published after 2009, subject age: ≥60 years, HGS measured using a hand dynamometer, assessment of the depressive symptoms using a validated tool. The following articles were excluded: studies conducted among institutionalized subjects and/or populations with a specific disease. Results: The total combined effect of 33 results presented in 16 studies included in the meta-analysis, converted to the correlation coefficient, was OEr = −0.148 (SE = 0.030, 95%CI: −0.206–−0.091), indicating a weak, negative correlation between HGS and depressive symptoms. Conclusions: The review of the literature and the meta-analysis demonstrated a relationship between low muscle strength and intensified depressive symptoms in older populations. Bearing in mind that depression is often unrecognized or underdiagnosed among older patients, lowered muscle strength should be an important sign for physicians and an incentive to screen them for depression.

Comparison of Prevalence of Hyperlipidemia, Medical Expenses, Inpatient, Emergency and Outpatient According to the Level of Physical Activity of Korean Adults: A Cross-Sectional Study of 2018 Korea Medical Panel

OBJECTIVES The purpose of this study is to compare the difference in the prevalence of hyperlipidemia according to the level of physical activity in adults, and to compare the difference between annual personal medical expenses, hospitalization, emergency and outpatient use depending on the level of physical activity for hyperlipidemia patients.METHODS The 2018 Korea medical panel data was used (14,489 adults and 2,559 Hyperlipidemia). Physical activity was measured with short form of IPAQ and converted to MET-minutes per week. The days of hospitalization, and personal medical expenses were compared, and frequency analysis, logistic regression, ANOVA and chi-square were performed.RESULTS The prevalence of hyperlipidemia based on the inactive group were decreased both minimally active group (OR = 0.94) and the active group (OR = 0.74, p<0.01). Annual personal medical expenses I (p<.01) and II (p<.01) with hyperlipidemia were all showed significant differences depending on the level of physical activity. On active group basis, medical expenses showed slight differences of 3.0 to 3.2% with the minimally activity group, but that of the inactive group were 19.3 ~ 21.7% higher. The annual days of hospitalization were 6.8 ± 7.2 days in activity group, minimally activity group 7.1 ± 7.2 days, inactive group 11.7 ± 26.0 days. There was no significant difference in the annual days of hospitalization and emergency between the three groups. In particular, the annual days of outpatient increased sharply at the inactive group. Participation in physical activity has been shown to have a significant effect on hospitalization and decreasing use of emergency rooms.CONCLUSIONS Hyperlipidemia prevalence was similar to inactive groups and minimally activity groups, and that of activity groups was 0.74. On medical expenses of hyperlipidemia, the activity and minimally activity group was similar, the inactivity group was 19.3 to 21.7% higher. Physical activity was found to have a positive effect on hospitalization and emergency use reduction.

Test-retest reliability of the functional reach test and the hand grip strength test in older adults using nursing home services

OBJECTIVE

This study aimed to determine the absolute and relative test-retest reliability of the functional reach test (FRT) and the handgrip strength test (HGST) in older adults using nursing homes.

METHODS

Participants (≥ 65 years old), living in nursing homes or using their day care services, were distributed into a group without cognitive impairment (GWCI, n = 43) and a group with mild cognitive impairment (GCI; n = 22). A 1-week test-retest was performed for the FRT and the HGST. Relative reliability was measured by the intraclass correlation coefficient (ICC_3.1), and absolute reliability by the standard error of measurement (SEM), minimal detectable change (MDC₉₅), and Bland-Altman plots.

RESULTS

The ICC showed high reliability for the FRT (GWCI, ICC = 0.83; GCI, ICC = 0.87) and the HGST (ICC ≥ 0.95 in both hands and participant groups). The absolute reliability was good: FRT, SEM = 2.96/2.29, MDC₉₅ = 8.20/6.35 for the GWCI and the GCI, respectively; HGST dominant hand SEM = 1.26/0.82, MDC₉₅ = 3.50/2.29, and HGST non-dominant hand SEM = 1.05/0.80, MDC₉₅ = 2.90/2.21, for the GWCI and the GCI, respectively. Bland-Altman showed that there was not a systematic bias for the tests in both groups.

DISCUSSION

Findings show that the FRT and the HGST are reliable, have acceptable measurement error, and may be used for research and clinical purposes to assess functional balance and strength of the hands in older adults using nursing homes.

Current Status of Sarcopenia in the Disabled Elderly of Chinese Communities in Shanghai: Based on the Updated EWGSOP Consensus for Sarcopenia

Our study aimed to investigate the prevalence and associated factors of sarcopenia in the disabled elderly in communities in Shanghai, China. A cross-sectional study was conducted in 2018. Five hundred and seventy two participants (≥60 years) were recruited through cluster sampling from Putuo District of Shanghai. Sarcopenia was defined according to the updated consensus of the European Sarcoma Working Group in 2019. The sarcopenia, depression, and nutrition status were assessed by using SARC-F, the Short Version of the Center for Epidemiological Studies Depression Scale (CES-D-10), and the Mini Nutritional Assessment-Short form (MNA-SF), respectively Physical activity was also assessed. Our results showed the prevalence of sarcopenia was 0.5%, but the prevalence of low handgrip strength was 37.2% (male, 5.5%; female, 39.1%). The modified Poisson regression model was used to evaluate the relationship among related variables and low handgrip strength. The risk for low handgrip strength was higher in the physically disabled subjects than in the visually disabled ones (aPR: 1.69, 95% CI: 1.88-2.42). Depressive symptoms (aPR: 1.31, 95% CI: 1.04-1.62) and PASE score (aPR: 0.99, 95% CI: 0.99-1.00) were independently associated with low handgrip strength. In summary, the prevalence of EWGSOP2-defined sarcopenia is low and the prevalence of declined muscle strength is high in the disabled elderly. The elderly participants with a physical disability had a higher prevalence of low hand handgrip strength than those with a visual disability. More studies with a larger sample size and longitudinal follow-up are needed to confirm our findings.

The Association of Multiple Gene Variants with Ageing Skeletal Muscle Phenotypes in Elderly Women

There is a scarcity of studies that have investigated the role of multiple single nucleotide polymorphisms (SNPs) on a range of muscle phenotypes in an elderly population. The present study investigated the possible association of 24 SNPs with skeletal muscle phenotypes in 307 elderly Caucasian women (aged 60–91 years, 66.3 ± 11.3 kg). Skeletal muscle phenotypes included biceps brachii thickness, vastus lateralis cross-sectional areas, maximal hand grip strength, isometric knee extension and elbow flexion torque. Genotyping for 24 SNPs, chosen on their skeletal muscle structural or functional links, was conducted on DNA extracted from blood or saliva. Of the 24 SNPs, 10 were associated with at least one skeletal muscle phenotype. HIF1A rs11549465 was associated with three skeletal muscle phenotypes and PTK2 rs7460 and ACVR1B rs10783485 were each associated with two phenotypes. PTK2 rs7843014, COL1A1 rs1800012, CNTF rs1800169, NOS3 rs1799983, MSTN rs1805086, TRHR rs7832552 and FTO rs9939609 were each associated with one. Elderly women possessing favourable genotypes were 3.6–13.2% stronger and had 4.6–14.7% larger muscle than those with less favourable genotypes. These associations, together with future work involving a broader range of SNPs, may help identify individuals at particular risk of an age-associated loss of independence.

Handgrip strength, tumor necrosis factor-α, interlukin-6, and visfatin levels in oldest elderly patients with cognitive impairment

INTRODUCTION

Handgrip strength is associated with mild cognitive impairment. Tumor necrosis factor [TNF]-α and interleukin [IL]-6 were pro-inflammatory cytokines influencing the severity of initial neurological deficit. Visfatin is a novel adipokine and has a strong correlation with inflammation. The relationships of TNF-α, IL-6 and visfatin are not consistent, and no study has investigated them in the elderly patients with cognitive impairment.

METHODS

This study included patients aged ≥75 years at the emergency department from August 2018 to February 2019. All patients underwent comprehensive geriatric assessment and blood tests for fasting plasma TNF-α, IL-6 and visfatin levels.

RESULTS

We enrolled 106 elderly patients with a mean age of 87.3 years, including 62 (58.4%) patients in cognitive impairment group (Mini-Mental State Examination [MMSE] < 24) and 44 (41.5%) patients in the non-cognitive impairment group. Compared to the non-cognitive impairment group, the cognitive impairment group had significantly lower handgrip strength, and significantly higher TNF-α, IL-6 and visfatin levels. TNF-α positively correlated with IL-6. Both TNF-α and IL-6 negatively correlated with Barthel index and MMSE. Handgrip strength negatively correlated with TNF-α but positively correlated with Barthel index and MMSE scores. Backward and stepwise multiple logistic regression analyses showed that the independent predictor for cognitive impairment was handgrip strength and age.

CONCLUSION

The cognitive impairment group had significantly higher serum TNF-α, IL-6, and visfatin levels. The independent predictors of cognitive impairment were handgrip strength and age. Handgrip strength negatively correlated with TNF-α and IL-6 but positively with Barthel index and MMSE scores.

Grip Strength and Depression Symptoms Among Middle-Age and Older Adults

OBJECTIVE

To analyze the relationship between grip strength and symptoms of depression, considering sex and age, in adults from 18 countries.

METHODS

Cross-sectional data for adults 50 years and older from the Survey of Health, Aging, and Retirement in Europe wave 6 (collected in 2015) were analyzed. Grip strength was measured twice on each hand using a handgrip dynamometer. The EURO-D 12-item scale was used to measure depression symptoms. Multivariable logistic regression analysis was conducted. Data analyses were conducted between November 5, 2019, and February 7, 2020.

RESULTS

Men and women who were in quartiles 2, 3, and 4 of grip strength were less likely to have depression symptoms than those in the first quartile of grip strength. Having more grip strength decreased the odds of depression symptoms by 30% (odds ratio 0.70; 95% CI, 0.65 to 0.77) and 47% (odds ratio, 0.53; 95% CI, 0.49 to 0.57) for adults aged 50 to 64 years and 65 years and older, respectively, when compared with those with the lowest grip strength. The negative relationship between strong grip strength and depression symptoms was observed among men and women younger and older than 65 years.

CONCLUSION

There was an association between grip strength and depression symptoms. For clinical practice and geriatric health professionals, assessing adults' grip strength can be used as a signal to screen for physical and mental health.

Effectiveness of SaBang-DolGi Walking Exercise Program on Physical and Mental Health of Menopausal Women

Objective: We investigated the effectiveness of a 12-week SaBang-DolGi walking exercise program on the physical and mental health of menopausal women and aimed to provide the basic data needed to develop health promotion programs for the active and healthy aging of menopausal women. Materials and methods: The participants comprised 40 women aged 50–65 years who were divided into two randomly selected groups in training sessions (exercising group, n = 21 and control group, n = 19). A physical (grip, muscle and endurance) test and mental health test (simple mental health test II) were conducted using questionnaires with the aim of examining subjects’ physical and mental health before and after exercise. Results: After the intervention, the participants experienced positive changes in the physical dimension, with significant enhancements particularly in mental well-being and menopause-related health and subdomains. Controlled and regular exercise for 12 weeks was significantly correlated with a positive change in vitality and mental health. Conclusions: We found that the SaBang-DolGi walking exercise program helps to promote the physical and mental health of menopausal women who are exposed to the various stresses and depressions that accompany physical deterioration; the program was found to encourage active and healthy aging.

The Relationship between Muscular Strength and Depression in Older Adults with Chronic Disease Comorbidity

Older adults with disease and disability are particularly vulnerable to experiencing more severe consequences of depression. The purpose of the present study is to investigate the relationship between disease comorbidities (number of disease: ND0, 1 disease: ND1 and 2 or more diseases: ND ≥ 2), hand grip strength (low HGS and high HGS), and the prevalence of depression in Korean older adults. Data from the living profiles of older people survey that was conducted by the ministry of health and welfare in Korea were utilized. Data for 6107 females and 4347 males were appropriate for statistical tests. The results demonstrated that depression was more prevalent as ND increased (p < 0.01). In addition, HGS appeared lower as ND increased in both male (p < 0.01) and female subjects (p < 0.01). Furthermore, relative to ND0 and low HGS, ND0 and high HGS showed a ~65% reduction in the prevalence of depression (p < 0.01). After adjusting for age, the prevalence of depression was reduced by ~60% in the subgroup with ND0 and high HGS relative to ND0 and low HGS (p < 0.01). These data demonstrate that muscular strength indices such as HGS may be useful when assessing depression in older adults. Further research in this area is warranted.

The Effect of Muscular Strength on Depression Symptoms in Adults: A Systematic Review and Meta-Analysis

The aim was to systematically review the relationship between muscular strength (MS) and depression symptoms (DS) among adults, and conduct a meta-analysis to determine the pooled odds ratio (OR) for the relationship between MS and DS. The strategies employed in this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies published up to December 2019 were systematically identified by searching in the PubMed, Scopus, and Web of Science electronic databases. Inclusion criteria were: (1) cross-sectional, longitudinal and intervention studies; (2) outcomes included depression or DS; (3) participants were adults and older adults; and (4) the articles were published in English, French, Portuguese, or Spanish. A total of 21 studies were included in the review, totalling 87,508 adults aged ≥18 years, from 26 countries. The systematic review findings suggest that MS has a positive effect on reducing DS. Meta-analysis findings indicate that MS is inversely and significantly related to DS 0.85 (95% CI: 0.80, 0.89). Interventions aiming to improve MS have the potential to promote mental health and prevent depression. Thus, public health professionals could use MS assessment and improvement as a strategy to promote mental health and prevent depression.

Association of phase angle with sarcopenia and its components in physically active older women

OBJECTIVE

The aim of the present study was to associate phase angle (PhA) with sarcopenia and its components in physically active older women.

METHODS

A cross-sectional study was performed with 94 physically active older women. PhA and muscle mass were assessed by bioelectrical impedance. Muscle strength was measured by handgrip strength (HGS) and functional capacity was evaluated by 4-meter walk test. Sarcopenia was diagnosed according to the European Consensus on Definition and Diagnosis of Sarcopenia (2010). Participants were evaluated according to the PhA tercile. The individuals were divided into two groups: 1st vs. 2nd and 3rd terciles. The individuals in the first tercile were considered having low PhA (< 5.7º).

RESULTS

Low PhA was not associated with sarcopenia (OR = 1.50 (0.520-4.319)), low muscle mass index (OR = 1.50 (0.520-4.319)), low HGS (OR = 3.15 (0.954-10.401)) and low walk speed (OR = 1.46 (0.384-5.534)). In addition, PhA had a weak correlation with walk speed (r = 0.24, p = 0.023) and walk speed was able to predict the PhA variations by 3.9%.

CONCLUSION

PhA was not associated with sarcopenia and its components in physically active older women. Although PhA was correlated with walk speed, the biological meaning of this association is questionable, since the power of the prediction was low.

Muscle strength is related to mental and physical quality of life in the oldest old

PURPOSE OF THE STUDY

Quality of life represents the principal outcome of health interventions for the oldest old. However, little is known about the determinants of quality of life in this population stratum. We evaluated the association between health-related quality of life (HRQoL) and handgrip strength in a cohort of 331 participants aged 90+ with a living in the Mugello area (Tuscany, Italy).

DESIGN AND METHODS

HRQoL was assessed using the Medical Outcomes Study Short Form 12 (SF12), considering the Physical Composite Score (PCS) and the Mental Composite Score (MCS) of the SF-12. Muscle strength was tested by hand grip dynamometry.

RESULTS

The median MCS was 46.9, while the median PCS was 43.0. According to logistic regression, muscle strength was associated with increased probability of better PCS (OR = 1.05; 95 % CI = 1.01-1.10, P = .042), and better MCS (OR = 1.05; 95 % CI = 1.01-1.10, P = .036), after adjusting.

IMPLICATION

Muscle strength is associated with both physical and mental HRQoL among nonagenarians. Further studies are needed to explore the subsystems involved in this association, and whether improving muscle performance might improve global mental and physical quality of life in the most advanced age.

Distribution and trajectory of handgrip strength in Chinese non-institutionalized middle-aged and older adults: A longitudinal descriptive analysis

Using a national sample, we explored the distribution of and longitudinal trajectory of handgrip strength (HGS) in Chinese non-institutionalized middle-aged and older adults. We included a total of 12292 participants in the cross-sectional distribution analysis and a total of 7193 in the longitudinal trajectory analysis. The mean HGS was significantly higher (P < 0.001) in males (38.88 kg) than in females (26.52 kg). The HGS centiles and mean HGS in both males and females decreased as age increased. HGS declined with time in a nonlinear manner. HGS declined faster in males than in females.

Associations Between Aging-Related Changes in Grip Strength and Cognitive Function in Older Adults: A Systematic Review

OBJECTIVES

Grip strength and cognitive function reflect upper body muscle strength and mental capacities. Cross-sectional research has suggested that in old age these two processes are moderately to highly associated, and that an underlying common cause drives this association. Our aim was to synthesize and evaluate longitudinal research addressing whether changes in grip strength are associated with changes in cognitive function in healthy older adults.

METHODS

We systematically reviewed English-language research investigating the longitudinal association between repeated measures of grip strength and of cognitive function in community-dwelling older adults to evaluate the extent to which the two indices decline concurrently. We used four search engines: Embase, PsychINFO, PubMed, and Web of Science.

RESULTS

Of 459 unique citations, 6 met our full criteria: 4 studies reported a longitudinal association between rates of change in grip strength and cognitive function in older adults, 2 of which reported the magnitudes of these associations as ranging from low to moderate; 2 studies reported significant cross-sectional but not longitudinal associations among rates of change. All studies concluded that cognitive function and grip strength declined, on average, with increasing age, although with little to no evidence for longitudinal associations among rates of change.

CONCLUSIONS

Future research is urged to expand the study of physical and cognitive associations in old age using a within-person and multi-study integrative approach to evaluate the reliability of longitudinal results with greater emphasis on the magnitude of this association.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42016038544.