Isometric hand grip strength measured by the Nintendo Wii Balance Board - a reliable new method

Interrater Reliability and Precision of a Novel Hand Strength Assessment and Treatment Device: The GripAble

IMPORTANCE

Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings.

OBJECTIVE

To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials).

DESIGN

Measurement study.

SETTING

Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis.

PARTICIPANTS

Thirty volunteers, age ≥18 yr, without any hand problems.

OUTCOMES AND MEASURES

Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision.

RESULTS

GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults.

CONCLUSIONS AND RELEVANCE

GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming. Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future.

Reliability of two devices for shoulder strength assessment: Wii Fit Balance Board and hand-held dynamometer

Background

The aim of this study was to compare the reliability and agreement between two devices - Wii Fit Balance Board (WBB) versus Hand-Held Dynamometer (HHD) to measure isometric strength during the athletic shoulder (ASH) test in healthy amateur rugby players.

Methods

Fifteen males (23.73 ± 2.8 years) completed two testing sessions. Maximal isometric contractions using the dominant arm (D) and non-dominant arm (ND) against a WBB and HHD were assessed at three angles of abduction (180°, 'I'; 135°, 'Y' and 90°, 'T'), in a prone lying position.

Results

The results indicate a very large correlation between the HHD and the WBB. WBB provides acceptable reliability at I-Test D (CV = 9.97%, ICC = 0.88) and HHD in the I-Test D (CV = 8.90%, ICC = 0.94), I-Test ND (CV = 8.60%, ICC = 0.95) in peak strength values. The HHD is most reliable in D ASH I-Y-T (CV = 10.94%) and WBB (CV = 11.05%). In the ND ASH I-Y-T test, the HHD is the most reliable (CV = 12.5%) compared to the WBB (CV = 14.43%).

Conclusions

These results suggest that WBB is a reliable device to assess strength in the ASH test with a very large correlation with the HHD. WBB and HHD are two affordable devices to assess isometric shoulder strength.

Measures of attributes of locomotor capacity in older people: a systematic literature review following the COSMIN methodology

BACKGROUND

Locomotor capacity (LC) is an important domain of intrinsic capacity and key determinant of functional ability and well-being in older age. The United Nations Decade of Healthy Ageing (2021-2030) calls for strengthening data and research on healthy ageing, including the measurement of older persons' LC. To advance the measurement and monitoring of LC, there is pressing need to identify valid and reliable measures.

OBJECTIVE

To identify all the available tools that were validated for measurement of LC or of its specific attributes in older people and to assess the methodological quality of the studies and measurement properties of the tools.

DESIGN

Systematic review.

SETTING

Anywhere (Community-dwelling; long-term care facility; etc.).

SUBJECTS

Older people.

METHODS

We used highly sensitive search strategies to search the following databases: Medline, Embase, Scopus, CINAHL and PsycINFO. The study was conducted following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of outcome measurement instruments.

RESULTS

A total of 125 studies were included, which assessed tools for balance (n = 84), muscle power (n = 12), muscle strength (n = 32, including four studies about tools for balance and muscle power) and endurance (n = 1). No studies on tools for muscle function, joint function, or locomotor capacity overall, were retrieved. We identified 69 clinician-report or objective assessment tools for balance, 30 for muscle strength, 12 for muscle power and 1 endurance assessment tool. The GRADE assessment of quality of evidence showed that only a few tools have high quality evidence for both sufficient validity and reliability: The Balance Evaluation Systems Test (BESTest), the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test.

CONCLUSIONS

A few tools with high quality evidence for sufficient validity and reliability are currently available for balance assessment in older people that may be recommended for use in clinical and research settings. Further validation studies are required for muscle strength, muscle power and endurance assessment tools.

Effect of a home-based isometric handgrip training programme on systolic blood pressure in adults: A randomised assessor-blinded trial

OBJECTIVES

To evaluate the effects of 20 weeks of home-based isometric handgrip training (IHT) compared with usual care on systolic blood pressure (SBP) in adults.

DESIGN AND PARTICIPANTS

This was a randomised, controlled, assessor-blinded trial. Participants were randomised to either IHT (intervention group) or usual care (control group).

INTERVENTIONS

Participants randomised to the intervention group performed a session of 16 min of effective workout home-based IHT three times per week for 20 weeks. Participants randomised to the control group were asked to continue their daily activities as usual.

OUTCOMES

The primary outcome was the difference in SBP between groups over 20 weeks. Secondary outcomes were diastolic blood pressure, heart rate, handgrip strength, and self-administered home blood pressure measures.

RESULTS

Forty-eight adults (mean [SD] age, 64 [8] years) were included in this trial. The adjusted between-group mean difference in SBP was 8.12 mmHg (95% CI 0.24 to 16.01, p = 0.04) - favouring the usual care group. No differences between groups were found in any of the home blood pressure measurements.

CONCLUSIONS

This trial showed that 20 weeks of home-based isometric handgrip training was not superior compared to the usual care in lowering SBP.

Force/moment tracking performance during constant-pose, force-varying, bilaterally symmetric, hand-wrist tasks

Bilateral movement is widely used for calibration of myoelectric prosthesis controllers, and is also relevant as rehabilitation therapy for patients with motor impairment and for athletic training. Target tracking and/or force matching tasks can be used to elicit such bilateral movement. Limited descriptive accuracy data exist in able-bodied subjects for bilateral target tracking or dominant vs non-dominant dynamic force matching tasks requiring more than one degree of freedom (DoF). We examined dynamic trajectory (0.75 Hz band-limited, white, uniform random) constant-posture, hand open-close, wrist pronation-supination target tracking and matching tasks. Tasks were normalized to maximum voluntary contraction (MVC), spanning a ± 30% MVC force range, in four 1-DoF and 2-DoF tasks: (1, 2) unilateral dominant limb tracking with/without visual feedback, and (3, 4) bilateral dominant/non-dominant limb tracking with mirror visual feedback. In 12 able-bodied subjects, unilateral tracking error with visual feedback averaged 10-15 %MVC, but up to 30 %MVC without visual feedback. Bilateral matching error averaged ∼10 %MVC and was affected little by visual feedback type, so long as feedback was provided. In 1-DoF bilateral tracking, the dominant side had statistically lower error than the non-dominant side. In 2-DoF bilateral tracking, the side providing mirror visual feedback exhibited lower error than the opposite side. In 2-DoF tasks (assumed to be more challenging than their constituent 1-DoF tracking tasks), hand grip force errors grew disproportionately larger than those of each wrist DoF. In unilateral 1-DoF tasks, both hand vs target and wrist vs target latency averaged 250-350 ms. In unilateral 2-DoF tasks, wrist vs target latency also averaged 250-350 ms, while hand vs target latency averaged > 500 ms. These results provide guidance on bilateral 2-DoF hand-wrist performance in target tracking, and dominant vs non-dominant force matching tasks.

Remote collection of physical performance measures for older people: a systematic review

Remotely collected physical performance measures could improve inclusion of under-served groups in clinical research as well as enabling continuation of research in pandemic conditions. It is unclear whether remote collection is feasible and acceptable to older patients, or whether results are comparable to face-to-face measures. We conducted a systematic review according to a prespecified protocol. We included studies with mean participant age ≥ 60 years, with no language restriction. Studies examining the gait speed, Short Physical Performance Battery, distance walk tests, grip strength, Tinetti score, Berg balance test, sit-to-stand test and timed up and go were included. Reports of feasibility, acceptability, correlation between remote and face-to-face assessments and absolute differences between remote and face-to-face assessments were sought. Data were synthesised using Synthesis Without Meta-analysis methodology; 30 analyses from 17 publications were included. Study size ranged from 10 to 300 participants, with a mean age ranging from 61 to >80 years. Studies included a broad range of participants and conditions. Most studies had a moderate or high risk of bias. Only two studies undertook assessment of acceptability or feasibility, reporting good results. Correlation between face-to-face and remote measures was variable across studies, with no measure showing consistently good correlation. Only nine studies examined the accuracy of remote measures; in six studies, accuracy was rated as good (<5% mean difference between face-to-face and remote measures). There is a lack of robust evidence that remote collection of physical performance measures is acceptable to patients, feasible or provides comparable results to face-to-face measures.

Test-Retest of a Novel Wii Board-Based Device to Assess Eccentric Knee Flexor Strength During the Nordic Hamstring Exercise

This study aimed to assess the test-retest reliability of a Wii board-based device to assess the eccentric knee strength. Healthy participants (n = 20, 22.7 [3.4] y, 1.71 [0.09] m, 69 [13] kg) performed 2 assessments-days 1 and 2-of the Nordic hamstring exercise (3 trials per day, 3 min of rest between trials, and 48 h between trials) on a padded board with an attached Wii Balance Board (WBB). A ratchet inelastic strap made the contact between the participant's distal aspect of both legs and the inverted upper surface of the WBB. The means among 3 trials were used to extract the absolute strength and the left and the right limb strengths. No between-session differences were found (P range = .691-.981). The intraclass correlation coefficient range showed excellent results (.905-.926), as the Cronbach α test (above .94). The correlation was high (r > .91; .820 < r2 < .862). The Bland-Altman analysis returned high levels of agreement. The standard error of measurement ranged from 5.56 to 11.07 N and the minimal detectable change from 15.42 to 30.68 N. The percentage of standard error of measurement values were 2.95%, 3.74%, 2.88%, respectively, for absolute strength, right limb strength, and left limb strength. The adapted system showed an excellent cost-benefit relationship with optimal test-retest reliability. The findings suggest that the adapted system, using the WBB, is a reliable method for measuring the eccentric knee strength.

Metacarpal squeezing reduces grip strength

Unduly tight plaster hand casts may narrow the metacarpal joint space, hindering rehabilitation. This study investigated how metacarpal narrowing affects grip strength. Forty-two adult volunteers with no other pathology were included. Dominant and non-dominant hand grip strength was measured with a digital hand dynamometer (Jamar plus, China). Metacarpal width was measured with a metal caliper, and the caliper was then fixed at 10% narrowing of the joint space, and a second measurement of grip strength was taken. The measurements were thus taken twice each in the dominant and non-dominant hand, and the average of the two was recorded. A total 336 measurements were taken in the dominant and non-dominant hands of 42 individuals at two time points. There was no significant difference in grip strength between dominant and non-dominant hands (p = 0.183). After 10% narrowing, both the dominant and the non-dominant hand showed a mean 33.4% reduction in grip strength: i.e., squeezing the metacarpus with a caliper significantly reduced grip strength in both dominant and non-dominant hands (p = 0.01). The study thus showed that grip strength will decrease significantly when the metacarpus is squeezed by a tight cast. Although the patient does not feel the 10% narrowing of the metacarpus, it is clear that hand muscle mass may be adversely affected in the long term.

Development of a multivariable prognostic PREdiction model for 1-year risk of FALLing in a cohort of community-dwelling older adults aged 75 years and above (PREFALL)

Background

Falls are the leading cause of fatal and non-fatal injuries in older adults, and attention to falls prevention is imperative. Prognostic models identifying high-risk individuals could guide fall-preventive interventions in the rapidly growing older population. We aimed to develop a prognostic prediction model on falls rate in community-dwelling older adults.

Methods

Design: prospective cohort study with 12 months follow-up and participants recruited from June 14, 2018, to July 18, 2019.

Setting: general population.

Subjects: community-dwelling older adults aged 75+ years, without dementia or acute illness, and able to stand unsupported for one minute.

Outcome: fall rate for 12 months.

Statistical methods: candidate predictors were physical and cognitive tests along with self-report questionnaires. We developed a Poisson model using least absolute shrinkage and selection operator penalization, leave-one-out cross-validation, and bootstrap resampling with 1000 iterations.

Results

Sample size at study start and end was 241 and 198 (82%), respectively. The number of fallers was 87 (36%), and the fall rate was 0.94 falls per person-year. Predictors included in the final model were educational level, dizziness, alcohol consumption, prior falls, self-perceived falls risk, disability, and depressive symptoms. Mean absolute error (95% CI) was 0.88 falls (0.71–1.16).

Conclusion

We developed a falls prediction model for community-dwelling older adults in a general population setting. The model was developed by selecting predictors from among physical and cognitive tests along with self-report questionnaires. The final model included only the questionnaire-based predictors, and its predictions had an average imprecision of less than one fall, thereby making it appropriate for clinical practice. Future external validation is needed.

Trial registration

Clinicaltrials.gov (NCT03608709).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02346-z.

Short-Term Immobilization Promotes a Rapid Loss of Motor Evoked Potentials and Strength That Is Not Rescued by rTMS Treatment

Short-term limb immobilization results in skeletal muscle decline, but the underlying mechanisms are incompletely understood. This study aimed to determine the neurophysiologic basis of immobilization-induced skeletal muscle decline, and whether repetitive Transcranial Magnetic Stimulation (rTMS) could prevent any decline. Twenty-four healthy young males (20 ± 0.5 years) underwent unilateral limb immobilization for 72 h. Subjects were randomized between daily rTMS (n = 12) using six 20 Hz pulse trains of 1.5 s duration with a 60 s inter-train-interval delivered at 90% resting Motor Threshold (rMT), or Sham rTMS (n = 12) throughout immobilization. Maximal grip strength, EMG activity, arm volume, and composition were determined at 0 and 72 h. Motor Evoked Potentials (MEPs) were determined daily throughout immobilization to index motor excitability. Immobilization induced a significant reduction in motor excitability across time (−30% at 72 h; p < 0.05). The rTMS intervention increased motor excitability at 0 h (+13%, p < 0.05). Despite daily rTMS treatment, there was still a significant reduction in motor excitability (−33% at 72 h, p < 0.05), loss in EMG activity (−23.5% at 72 h; p < 0.05), and a loss of maximal grip strength (−22%, p < 0.001) after immobilization. Interestingly, the increase in biceps (Sham vs. rTMS) (+0.8 vs. +0.1 mm, p < 0.01) and posterior forearm (+0.3 vs. +0.0 mm, p < 0.05) skinfold thickness with immobilization in Sham treatment was not observed following rTMS treatment. Reduced MEPs drive the loss of strength with immobilization. Repetitive Transcranial Magnetic Stimulation cannot prevent this loss of strength but further investigation and optimization of neuroplasticity protocols may have therapeutic benefit.

Reference data on hand grip and lower limb strength using the Nintendo Wii balance board: a cross-sectional study of 354 subjects from 20 to 99 years of age

Background

Accurate assessment of isometric hand grip strength (HGS) and isometric lower limb strength (LS) are often limited to specialized clinics due to high costs and need for specialized equipment and personnel. A mobile and user-friendly device would facilitate a wider use of these measures in the clinical setting. The Nintendo Wii Balance Board (WBB) is a novel and pragmatic tool that has been validated for measuring muscle strength and other clinically relevant physiological variables. However, reference data for HGS and LS are lacking. The purpose of the current study is to establish reference data for HGS and LS in individuals ≥20 years of age using the WBB method, and to characterize the effects of age in these measurements.

Method

Healthy participants were recruited at various locations and their HGS and LS were tested by six assessors using the WBB. Reference data were analysed and presented in age-groups, while the age-related change in HGS and LS was tested and characterized with linear regression models.

Results

Three hundred and fifty-four participants between 20 and 99 years of age were tested. Data are presented separately according to gender and the following age categories: 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80+, and presented in absolute values as well as percentiles. The main findings were; (1) Significantly higher HGS and LS among males compared to females and for the dominant limb compared to the non-dominant limb, (2) a significant decline in strength with increasing age, and (3) the rate of decline increased significantly (i.e. it was non-linear) with age for HGS, but not for LS.

Conclusion

This study reported reference data with percentiles for a novel method for assessing HGS and LS. Data were consistent with previously known effects of age and gender on HGS and LS. The presented data may supplement future trials using the WBB in research or in the clinical setting.

A Brief Review of Handgrip Strength and Sport Performance

Cronin, J, Lawton, T, Harris, N, Kilding, A, and McMaster, DT. A brief review of handgrip strength and sport performance. J Strength Cond Res 31(11): 3187-3217, 2017-Tests of handgrip strength (HGS) and handgrip force (HGF) are commonly used across a number of sporting populations. Measures of HGS and HGF have also been used by practitioners and researchers to evaluate links with sports performance. This article first evaluates the validity and reliability of various handgrip dynamometers (HGD) and HGF sensors, providing recommendations for procedures to ensure that precise and reliable data are collected as part of an athlete's testing battery. Second, the differences in HGS between elite and subelite athletes and the relationships between HGS, HGF, and sports performance are discussed.

Handgrip force steadiness in young and older adults: a reproducibility study

Background

Force steadiness is a quantitative measure of the ability to control muscle tonus. It is an independent predictor of functional performance and has shown to correlate well with different degrees of motor impairment following stroke. Despite being clinically relevant, few studies have assessed the validity of measuring force steadiness. The aim of this study was to explore the reproducibility of handgrip force steadiness, and to assess age difference in steadiness.

Method

Intrarater reproducibility (the degree to which a rating gives consistent result on separate occasions) was investigated in a test-retest design with seven days between sessions. Ten young and thirty older adults were recruited and handgrip steadiness was tested at 5%, 10% and 25% of maximum voluntary contraction (MVC) using Nintendo Wii Balance Board (WBB). Coefficients of variation were calculated from the mean force produced (CVM) and the target force (CVT). Area between the force curve and the target force line (Area) was also calculated. For the older adults we explored reliability using intraclass correlation coefficient (ICC) and agreement using standard error of measurement (SEM), limits of agreement (LOA) and smallest real difference (SRD).

Results

A systematic improvement in handgrip steadiness was found between sessions for all measures (CVM, CVT, Area). CVM and CVT at 5% of MVC showed good to high reliability, while Area had poor reliability for all percentages of MVC. Averaged ICC for CVM, CVT and Area was 0.815, 0.806 and 0.464, respectively. Averaged ICC on 5%, 10%, and 25% of MVC was 0.751, 0.667 and 0.668, respectively. Measures of agreement showed similar trends with better results for CVM and CVT than for Area. Young adults had better handgrip steadiness than older adults across all measures.

Conclusion

The CVM and CVT measures demonstrated good reproducibility at lower percentages of MVC using the WBB, and could become relevant measures in the clinical setting. The Area measure had poor reproducibility. Young adults have better handgrip steadiness than old adults.

Twenty weeks of isometric handgrip home training to lower blood pressure in hypertensive older adults: a study protocol for a randomized controlled trial

BACKGROUND

Hypertension markedly increases the risk of cardiovascular diseases and overall mortality. Lifestyle modifications, such as increased levels of physical activity, are recommended as the first line of anti-hypertensive treatment. A recent systematic review showed that isometric handgrip (IHG) training was superior to traditional endurance and strength training in lowering resting systolic blood pressure (SBP). The average length of previous IHG training studies is approximately 7.5 weeks with the longest being 10 weeks. Therefore, presently it is unknown if it is possible to further lower blood pressure levels beyond the 10-week mark. Recently, we developed a novel method for monitoring handgrip intensity using a standard Nintendo Wii Board (Wii). The primary aim of this study is to explore the effects of a 20-week IHG home training facilitated by a Wii in hypertensive older adults (50 + years of age) on lowering SBP compared to usual care. Secondary aims are to explore if/when a leveling-off effect on SBP will occur during the 20-week intervention period in the training group and to explore adherence and potential harms related to the IHG home training.

METHODS/DESIGN

Based on previous evidence, we calculated that 50 hypertensive (SBP between 140 and 179 mmHg), older adults (50 + years of age) are needed to achieve a power of 80% or more. Participants will be randomly assigned to either an intervention >group (IHG home training + hypertension guidelines on lifestyle changes) or to a control group (hypertension guidelines on lifestyle changes). Participants in the intervention group will perform IHG home training (30% of maximum grip strength for a total of 8 min per day per hand) three times a week for 20 weeks. Resting blood pressure and maximal handgrip strength will be obtained by a blinded outcome assessor in both groups at specific time points (baseline, follow-up at 5, 10, 15, and 20 weeks) throughout the study.

DISCUSSION

This assessor-blinded, randomized controlled trial will explore the effect of a 20-week IHG home training intervention on resting blood pressure in hypertensive older adults. In addition, the trial will report adherence and potential harms related to the IHG home training.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03069443 . Registered on 3 March 2017.

Reference data on reaction time and aging using the Nintendo Wii Balance Board: A cross-sectional study of 354 subjects from 20 to 99 years of age

Background

Falls among older adults is one of the major public health challenges facing the rapidly changing demography. The valid assessment of reaction time (RT) and other well-documented risk factors for falls are mainly restricted to specialized clinics due to the equipment needed. The Nintendo Wii Balance Board has the potential to be a multi-modal test and intervention instrument for these risk factors, however, reference data are lacking.

Objective

To provide RT reference data and to characterize the age-related changes in RT measured by the Nintendo Wii Balance Board.

Method

Healthy participants were recruited at various locations and their RT in hands and feet were tested by six assessors using the Nintendo Wii Balance Board. Reference data were analysed and presented in age-groups, while the age-related change in RT was tested and characterized with linear regression models.

Results

354 participants between 20 and 99 years of age were tested. For both hands and feet, mean RT and its variation increased with age. There was a statistically significant non-linear increase in RT with age. The averaged difference between male and female was significant, with males being faster than females for both hands and feet. The averaged difference between dominant and non-dominant side was non-significant.

Conclusion

This study reported reference data with percentiles for a new promising method for reliably testing RT. The RT data were consistent with previously known effects of age and gender on RT.

Unilateral lower limb strength assessed using the Nintendo Wii Balance Board: a simple and reliable method

BACKGROUND

Lower limb weakness is an important risk factor for fall accidents and a predictor for all-cause mortality among older adults. Unilateral whole-lower limb strength may be a better measure of fall risk than the bilateral measure. In addition, a number of clinical conditions affect only one leg, and thus this type of assessment is relevant in clinical settings.

AIM

To explore the intra-rater reproducibility of the Nintendo Wii Balance Board (WBB) to measure unilateral whole-lower limb strength and to compare the method with stationary isometric muscle apparatus (SID).

METHOD

Intra-rater test-retest design with 1 week between sessions. Thirty community-dwelling older adults (69 ± 4.2 years) were enrolled and examined for maximum lower limb strength in their dominant and non-dominant leg. Intraclass correlation coefficient (ICC) was calculated to describe relative reproducibility, while standard error of measurement (SEM), limits of agreement (LOA) and smallest real difference (SRD) were calculated to describe absolute reproducibility between test sessions. Concurrent validity with the SID was explored using the Pearson product-moment correlation coefficient (PCC).

RESULTS

No systematic difference was observed between test sessions. ICC was 0.919-0.950 and SEM, LOA and SRD was 2.9-4.1 kg, 24.1-28.3 kg and 7.6-11.3 kg, respectively. Further, the PCC was 0.755 and 0.730 for the dominant limb and the non-dominant limb, respectively.

CONCLUSION

A high relative and an acceptable absolute reproducibility was seen when using the Nintendo Wii Balance Board for testing unilateral lower limb strength in community-dwelling older adults. The WBB correlated strongly with the SID.

Hand-grip strength among older adults in Singapore: a comparison with international norms and associative factors

BACKGROUND

Hand-grip strength (HGS) serves as a proxy measure for muscle function and physical health. Studies have shown that low HGS is associated with common age-related disorders including frailty and sarcopenia. The aim of the present study was to establish the normative values of HGS among older adults in Singapore and to compare it with data from Western and other Asian countries. The study also aimed to explore the sociodemographic and anthropometric correlates of HGS.

METHODS

Data were collected from 2043 men and women aged 60 years and above who took part in the Well-being of the Singapore Elderly study in 2013. HGS was obtained using a Jamar Plus + digital hand dynamometer. Normative data were stratified by; 5-year age groups, sex and ethnicity. Relationships between the HGS with various sociodemographic and anthropometric correlates were examined using multiple linear regression analysis.

RESULTS

The mean HGS demonstrate a decreasing trend with increased age across all ethnic groups and sexes. HGS among Singapore older adults were relatively low compared to Western and other Asian countries. Males in the youngest age group (60-64) and of Chinese ethnicity attained greater HGS values than their counterparts. When the regression analysis was stratified for sex, significant associations were found between height, upper arm circumference with HGS in the males sample, and between height, weight, waist circumference and HGS in the females sample.

CONCLUSIONS

Older adults in Singapore have a relatively weak HGS compared to other countries. Greater height and weight, and smaller waist circumference are independently associated with greater HGS in females but not males. These results facilitate the interpretation of HGS conducting using Jamar digital-type dynamometers among the older adults in Singapore.