Grip Strength: An Indispensable Biomarker For Older Adults

Quantitative evaluation of hindlimb grip strength in mice as a measure of neuromuscular function

Muscle strength is a crucial metric for assessing motor function, with significant diagnostic and prognostic value. It is widely used in clinical and preclinical studies as a phenotypic indicator. In mouse models of neuromuscular disorders, grip strength provides a direct, repeatable measure of motor function changes throughout disease progression. Hindlimbs are critical evaluative targets in research due to their relevancy to rodent motor functions, but assessing their strength remains a challenge. Existing methods, such as the wire-hanging test, in vivo quadriceps contractility measurements, and isolated muscle or myofiber tests, each have limitations. The wire-hanging test, though repeatable, does not explicitly isolate hindlimbs, while in vivo contractility testing requires deep anesthesia, potentially compromising accuracy. Isolated muscle tests offer precise measurements but necessitate animal sacrifice, preventing longitudinal measurements. This study introduces an optimized method for assessing hindlimb grip strength that improves consistency and accessibility.•It can be applied to measure both hindlimbs simultaneously, allowing for repeatable pre- and post-treatment comparisons.•It enables single-hindlimb evaluation, supporting self-comparisons.•This method is sensitive, user-friendly, and suitable for researchers of all expertise levels. It offers a robust tool for future research on neuromuscular interventions.

Association of intrinsic capacity with incident type 2 diabetes mellitus in older Chinese: Guangzhou Biobank Cohort Study

BACKGROUND

The World Health Organization introduced intrinsic capacity (IC) as a metric for healthy aging. However, we found no report on the association between IC and type 2 diabetes mellitus (T2DM). We investigated the association between IC and incident T2DM in older Chinese from the Guangzhou Biobank Cohort Study.

METHODS

IC was assessed across five domains equally: locomotion, vitality, cognition, psychological and sensory. Composite IC scores (0-10) were classified into three groups: poor (0-5.9), fair (6.0-8.9), and high (9.0-10), with higher scores representing greater IC. Multivariable linear regression and cox regression was used to analyze the association between IC with glycemia and T2DM, respectively.

RESULTS

Of 3582 participants with a mean age of 59.1 years (standard deviation (SD)=7.13) without baseline diabetes, during an average follow-up of 3.3 years (SD=0.86), 497 (13.87%) developed T2DM. After adjustments for potential confounders, those with baseline poor IC, versus high, had higher fasting glucose, 2-hour post-load glucose and glycosylated hemoglobin A1c at follow-up, and a higher risk of incident T2DM (HR (95%CI): 1.80 (1.20, 2.72)). Among IC domains, only vitality impairment was associated with an increased risk of T2DM (P for trend < 0.001).

CONCLUSION

We first reported the prospective associations of poor IC and vitality with higher glycemia and incident T2DM risk. Enhancing muscle strength to improve functional ability may be a possible intervention for reducing future risk of T2DM in older populations.

Hand grip strength and quality of life among adults aged 50-90 years from South West Poland

With advancing age, progressive loss of muscle strength, as assessed by hand grip strength, may result in a poorer health-related quality of life. The aim of this study is to determine the associations of hand grip strength with quality of life among people aged 50-90 years from South West Poland. The study group comprised 1 446 people, including 351 men and 1 095 women, aged between 50 and 90 years. The WHOQoL-BREF questionnaire was used to assess quality of life. Hand grip strength of the dominant hand was measured. The general assessment of quality of life shows a significant relationship with hand grip strength. Two domains of quality of life: social and environmental also significantly differentiate hand grip strength. As the number of points in given domains increases, the hand grip strength increases. Among men, the relationship between the environmental domain and hand grip strength is significantly stronger compared to women. Hand grip strength is related to the quality of life among older adults, especially in the social and environmental domains. The results of our study suggest that measures need to be taken to improve the strength of skeletal muscles in adults, which might improve their quality of life.

Role of Medical Nutrition Therapy as Treatment of Sarcopenia in Older People with Type 2 Diabetes

BACKGROUND

Globally, the progressive increase in the aging population has led to social and health problems associated with age-related chronic diseases, such as type 2 diabetes mellitus (T2DM) and sarcopenia. Recent studies have highlighted that sarcopenia and diabetes have a bidirectional relationship. Nutritional therapy is a key element in the treatment of both sarcopenia and diabetes. To date, there are no nutritional guidelines for the management of sarcopenia in T2DM. The aim of this study was to evaluate the efficacy of a muscle-targeted nutritional intervention in older people with sarcopenia and type 2 diabetes based on the Italian nutrition guidelines.

METHODS

A total of 211 subjects (117 M and 94 F) affected by T2DM with a mean age of 74 ± 6.0 years were screened for sarcopenia, using EWGSOP2 diagnosis criteria, and enrolled to receive personalized dietary plans with two main targets: a daily energy intake of 25-30 kcal/kg body weight and a daily protein intake of at least 1.1-1.2 g/kg body weight.

RESULTS

In total, 34 subjects (24 M and 10 F) were sarcopenic with a prevalence of 16%, which was higher in men. After six months of treatment, handgrip strength increased by 0.83 kg (19.57 ± 5.70 kg vs. 20.40 ± 6.10 kg, p = 0.649), protein intake improved (0.91 ± 0.28 g/kg body weight vs. 1.03 ± 0.40 g/kg body weight, p = 0.115), and the glycated hemoglobin decreased (7.39 ± 0.49% to 6.82 ± 0.98%, p = 0.010). Seven younger subjects had an improvement of sarcopenia with a decrease in HbA1c (7.50 ± 0.59% vs. 6.91 ± 0.79, p = 0.19). The difference over time in the consumption of saturated fatty acids (OR 0.6, 95% CI 0.33-1.09, p = 0.096) and simple sugars (OR 0.91, 95% CI 0.80-1.01, p = 0.090) appeared to be associated with an improvement of sarcopenia status. A total of 177 subjects did not meet the criteria for a diagnosis of sarcopenia, and 148 subjects were assessed. The handgrip strength (26.22 ± 9.36 vs. 26.18 ± 9.24 kg, p0.974) and the glycated hemoglobin (7.21 ± 1.07 vs. 7.27 ± 0.98%, p = 0.735) remained stable over time, while protein intake at six months increased (0.81 ± 0.29 vs. 0.91 ± 0.29 g/kg body weight, p = 0.024). Four people were diagnosed with sarcopenia at follow-up, with a lower handgrip strength test result. These subjects were older and had worse glycemic control (HbA1c + 0.5%).

CONCLUSIONS

Lifestyle modification is important to prevent or reverse the development of the disease. Nutritional therapy in this population is therefore aimed at meeting all nutritional needs and promoting better glycemic control, in terms of glycated hemoglobin, in order to reduce the development of sarcopenia. Although promising, the intervention requires validation in larger studies with control groups.

Establishment of regression-based isometric strength reference values for the upper limb in persons with multiple sclerosis

BACKGROUND

Muscle weakness is common and significantly affects persons with multiple sclerosis (PwMS), with dysfunction in upper limb (UL) muscle groups occurring in approximately 60% of PwMS.

OBJECTIVE

To develop gender-specific regression-based prediction equations, with 95% confidence intervals for maximal bilateral UL isometric strength (shoulder abduction and adduction, wrist flexion and extension) and hand grip strength in PwMS.

DESIGN

Cross-sectional study.

SETTING

Comprehensive MS center.

PARTICIPANTS

256 PwMS.

INTERVENTIONS

Not Applicable.

MAIN OUTCOME MEASURES

Shoulder abduction and adduction and wrist flexion and extension isometric strength (Biodex System 4 Pro Dynamometer) and hand grip strength (Jamar handheld dynamometer) were measured. Disease characteristics (disability and disease duration) and demographics (age, height, and weight) were collected. Regression-based predictive equations were generated for the UL muscle groups for each gender and limb, using age, height, weight, disability, and disease duration as covariates. Variables were compared between genders using the Mann-Whitney U test. Maximal voluntary contraction (MVC) reference values (mean ± SD) were reported based on age (<30, 30-39, 40-49, 50-59, 60-69 years) and disability (mild, moderate, severe ambulant, and severe nonambulant) for each gender and limb.

RESULTS

Regression-based equations were developed for both genders' strongest and weakest limb, accounting for age, height, weight, disability, and disease duration. MVC was higher in men than women (p < .001) in all muscle groups. Overall, MVC was significantly related to age in 14, height in 5, weight in 6, disability in 14, and disease duration in none of the 20 models.

CONCLUSION

This is the first study to provide regression-based prediction equations for strongest and weakest MVC of UL muscle groups and demonstrated an inverse relationship between MVC with disability and age. Regression-based reference strength values can help clinicians understand muscular strength along a spectrum of PwMS and can aid in goal setting and education for realistic outcomes.

Predicting Persistent Reduced Physical Performance in Adults 65+ in Emergency Departments: A Temporal Validation

BACKGROUND AND PURPOSE

Targeted interventions to maintain physical performance in older adults are important. We aimed to validate an existing 4-item prediction model and, if necessary, develop a new model for early identification of adults aged 65+ with persistent reduced physical performance.

METHODS

A temporal validation study on adults aged 65+ admitted to the emergency department for medical reasons and who performed ≤8 repetitions in the 30-second chair-stand test (30s-CST) within the first 48 hours of admission. The primary outcome was the number of 30s-CST repetitions (≤8 or >8) performed at the older adults' homes 3 to 4 weeks after admission.

Physical performance and self-reported data were analyzed using univariate and multivariate logistic regressions. The optimal model was chosen based on the area under the curve.

RESULTS AND DISCUSSION

The validation of a previously developed 4-item prediction model indicated that the model did not consistently apply to other populations of older adults. To develop a new model aimed at identifying acutely hospitalized older adults with persistent reduced physical performance, we combined 2 samples comprising 132 older adults with a 30s-CST score > 8 and 250 adults with a 30s-CST score ≤ 8 when measured 3 to 4 weeks after admission. The new model included 5 variables: age >80, female, self-reported difficulties in climbing a flight of stairs, less good/poor self-rated health, and a 30s-CST score ≤ 5. The model had an area under the curve of 84%. The model is expected to improve the identification of older adults with persistent reduced physical performance compared to health professionals' subjective assessments and/or adults' self-reported information.

CONCLUSIONS

The initial 4-item prediction did not consistently apply to other populations of older adults. Consequently, 2 samples were combined and a 5-item model was developed. Since the model involves only 5 items, it is easy to implement and provides health professionals an opportunity for targeted intervention on older adults during and after acute hospitalization. A validation study for the 5-item model is necessary.

Handgrip strength and health outcomes in hospitalized children or children with chronic disease: A systematic review

Handgrip strength (HGS) is a simple measurement of maximum voluntary muscle strength and is widely used as a single indicator of overall muscle strength. This systematic review summarized the evidence about the relation between HGS and health outcomes in hospitalized children or chronically ill children. The primary outcome was the number of hospital days in a 2-month period for outpatients and the length of hospital stay for inpatients. After a systematic search in PubMed, Embase, Lilacs, and the Cochrane Library, 9282 unique papers were screened, 24 included. Studies assessed HGS in children with cystic fibrosis, neuromuscular disease, chronic kidney disease, type 1 diabetes mellitus, asthma, cardiac disease, juvenile idiopathic arthritis, intestinal failure, surgical patients, and a mixed hospitalized population. One study reported that children experienced a decline in HGS during hospitalization which was associated with prolonged hospital stay. Another reported no relation with the number of hospital days in 5 years. No studies reported on the association between HGS and infectious complications or antibiotic use. We did find a positive correlation between HGS and quality of life, different nutritional parameters and inflammatory biochemical markers. We concluded that the relation between HGS and hospital stay in children is poorly studied. HGS showed promise as a functional biomarker for children with chronic health conditions when inflammation is involved, but more attention should be paid to the methodological aspects of assessing HGS.

Impact of Polypharmacy on Symptoms and Health Outcomes in Older Adults With and Without Alzheimer's Disease and Related Dementias

BACKGROUND

There is a critical gap in understanding the symptom experience and health outcomes of older adults with and without Alzheimer's Disease and related dementias (ADRD) and polypharmacy (PPY). The primary aim of the study was to compare the number of symptoms experienced over time in older adults with and without ADRD by polypharmacy status. The secondary aim was to examine the trajectory of physical function and health outcomes over time in each group.

METHODS

This study utilized longitudinal data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries from 2016-2019. The sample was separated into four groups (N = 2,052): neither ADRD or PPY (n = 1,048), PPY only (n = 761), ADRD only (n = 116), and both ADRD and PPY(n = 127).

RESULTS

The overall sample was predominately female (57.9%), White (70.9%), aged 84 or younger (75%), married (46%), and had some college or a college degree (50%). Participants with both ADRD and PPY experienced more symptoms on average, had higher odds of falls, hospitalizations, and mortality than all other groups. Older adults with both ADRD and PPY had lower physical function, needed more assistance with activities of daily living and higher assistive device utilization compared to the other three groups.

CONCLUSIONS

Findings indicate that older adults with both ADRD and PPY experience more symptoms, negative health outcomes and physical function decline that can negatively impact their quality of life. Further research is needed to identify strategies for reducing PPY in people with ADRD.

Stair climbing outperforms gait speed in predicting postoperative outcomes in patients undergoing radical gastrectomy for gastric cancer: A prospective study

BACKGROUND

Stair climbing test (SCT) and gait speed test (GST) are two physical performance measures, both of which are associated with postoperative outcomes. However, few studies have compared these two tests for the prognostic value.

METHODS

A prospective study was conducted in patients undergoing radical gastrectomy for gastric cancer. Handgrip strength (HGS) test, 7-steps SCT and 6-m GST were performed before surgery. Body compositions were analyzed using abdominal computed tomography (CT). Sarcopenia was diagnosed by low HGS plus either low muscle mass or quality.

RESULTS

A total of 548 patients were included in this study. Time of GST and SCT were both significantly correlated with HGS, skeletal muscle index and skeletal muscle density, but not with subcutaneous or visceral fat area. Low SCT performance (SCT time ≥12.65s) was associated with higher incidence of postoperative complications and longer postoperative length of stay, whereas low GST performance (GST time ≥5.45s) did not. Low performance in SCT and GST were both associated with worse overall survival (OS) and disease-free survival (DFS) after surgery. Low SCT performance was an independent predictor for postoperative complications, OS, and DFS, whereas low GST performance was not significant in multivariate analyses adjusting for the same covariates. The combination of sarcopenia with low SCT performance showed higher accuracy in predicting postoperative complications and mortality compared with sarcopenia combined with low GST performance.

CONCLUSION

SCT outperformed GST in predicting outcomes after radical gastrectomy for gastric cancer, either as a singular indicator or in combination with sarcopenia assessments.

Voluntary activation of maximal single and all finger power grip contractions

When all four fingers are engaged together during a grip strength contraction, the force produced by an individual finger is less than the force produced when it acts in isolation. The purpose of this study was to evaluate whether the reduced force output of a digit during an all-finger grip contraction is due to a decline in voluntary activation. Fifteen young adults (n = 7 females) completed voluntary contractions of the index finger in isolation and all fingers together in a dynamometer capable of separately recording forces from each finger during voluntary and electrically evoked contractions. The median and ulnar nerves were electrically stimulated simultaneously at the elbow to record individual finger flexion forces from doublet (100 Hz) pulses. Doublet stimulations were applied during and immediately following contractions at 50, 65, 85, and 100% maximal voluntary contraction (MVC) forces. Two-way ANOVAs were used to compare the effects of sex and finger (single vs. all) on flexion forces and voluntary activation. The index finger produced ∼25% more force when engaged in isolation compared with the all-finger contraction; however, there were no differences in voluntary activation between the single and all-finger MVCs (P = 0.344). The index finger force deficit was larger in females compared with males (34 vs. 18%, P = 0.030), but this was not explained by sex-related differences in voluntary activation. These data indicate that the additional force produced during single-finger contractions is not due to an alteration in voluntary activation, as all-finger contractions display near-maximal activation of each digit.NEW & NOTEWORTHY The deficit in finger flexion force when multiple digits are engaged is well characterized and often attributed to reduced motor unit activation. Using a custom-built, multifinger dynamometer, we report that the index-finger force deficit may not be related to a deficit in voluntary activation. Furthermore, the index-finger force deficit was greater in females compared with males, but this was also not related to sex-related differences in voluntary activation.

Repeated passive heat treatment increases muscle tissue capillarization, but does not affect postprandial muscle protein synthesis rates in healthy older adults

Prolonged passive heat treatment (PHT) has been suggested to trigger skeletal muscle adaptations that may improve muscle maintenance in older individuals. To assess the effects of PHT on skeletal muscle tissue capillarization, perfusion capacity, protein synthesis rates, hypertrophy and leg strength, 14 older adults (9 males, 5 females; 73 ± 6 years) underwent 8 weeks of PHT (infrared sauna: 3× per week, 45 min at ∼60°C). Before and after PHT we collected muscle biopsies to assess skeletal muscle capillarization and fibre cross-sectional area (CSA). Basal and postprandial muscle tissue perfusion kinetics and protein synthesis rates were assessed using contrast-enhanced ultrasound and primed continuous l-[ring-13C6]phenylalanine infusions, respectively. One-repetition maximum (1RM) leg strength and vastus lateralis muscle CSA were assessed. Type I and type II muscle fibre capillarization strongly increased following PHT (capillary-to-fibre perimeter exchange index: +31 ± 18 and +33 ± 30%, respectively; P < 0.001). No changes were observed in basal (0.24 ± 0.27 vs. 0.18 ± 0.11 AU; P = 0.266) or postprandial (0.20 ± 0.12 vs. 0.18 ± 0.14 AU; P = 0.717) microvascular blood flow following PHT. Basal (0.048 ± 0.014 vs. 0.051 ± 0.019%/h; P = 0.630) and postprandial (0.041 ± 0.012 vs. 0.051 ± 0.024%/h; P = 0.199) muscle protein synthesis rates did not change in response to prolonged PHT. Furthermore, no changes in vastus lateralis muscle CSA (15.3 ± 4.6 vs. 15.2 ± 4.6 cm2; P = 0.768) or 1RM leg strength (46 ± 12 vs. 47 ± 12 kg; P = 0.087) were observed over time. In conclusion, prolonged PHT increases muscle tissue capillarization but this does not improve muscle microvascular blood flow or increase muscle protein synthesis rates in healthy, older adults. Prolonged PHT does not induce skeletal muscle hypertrophy or increase leg strength in healthy, older adults. KEY POINTS: Repeated exposure to heat has been suggested to trigger skeletal muscle adaptive responses. We investigated the effect of 8 weeks of whole-body passive heat treatment (PHT; infrared sauna: 3× per week for 45 min at ∼60°C) on skeletal muscle tissue capillarization, perfusion capacity, basal, and postprandial muscle protein synthesis rates, muscle (fibre) hypertrophy, and leg strength in healthy, older adults. Prolonged PHT increases muscle tissue capillarization, but this does not improve muscle microvascular blood flow or increase muscle protein synthesis rates. Despite increases in muscle tissue capillarization, prolonged PHT does not suffice to induce skeletal muscle hypertrophy or increase leg strength in healthy, older adults.

Association Between Dynapenia/Sarcopenia, Extrapyramidal Symptoms, Negative Symptoms, Body Composition, and Nutritional Status in Patients with Chronic Schizophrenia

Background/Objectives: This study aimed to determine the association between chronic schizophrenia, extrapyramidal symptoms (EPSs), body composition, nutritional status, and dynapenia/sarcopenia. Methods: Data from 68 chronic patients with schizophrenia were analyzed using Spearman's rho correlation coefficients, Kruskal-Wallis test, Mann-Whitney U test, and Cramér's V statistics. Results: Among the participants, 32.4% had no loss of muscle mass or function, 39.7% had dynapenia, and 27.9% had sarcopenia. This study identified five key findings: (1) Bilateral grip strength, skeletal muscle index, and walking speed are interrelated, with higher negative symptom scores linked to slower movement and rigidity, particularly in the sarcopenia group, indicating that negative symptoms may contribute to muscle weakness and progression to sarcopenia. (2) Increasing age is associated with a decrease in chlorpromazine equivalent dose and an increase in the severity of EPSs. (3) Blood urea nitrogen (BUN)/creatinine ratio and all sarcopenia risk indicators were significantly negatively correlated. (4) Dynapenia and sarcopenia groups exhibited significant differences in muscle mass and nutritional status compared to the non-penia group, including reduced muscle mass, lower basal metabolic rate, and lower visceral fat levels. (5) There was an association between the Barthel Index (BI) score for activities of daily living (ADL) and dynapenia/sarcopenia. Particularly with regard to ADL, it seems necessary to pay attention to muscle weakness in partially independent patients who score 60 points or more. Conclusions: BUN/creatinine ratio, BI, EPSs, body mass index, grip strength, total protein, and albumin were useful indicators for detecting the risk of dynapenia/sarcopenia in routine psychiatric care.

Beta-Alanine for Improving Exercise Capacity, Muscle Strength, and Functional Performance of Older Adults: A Systematic Review

BACKGROUND/OBJECTIVE

 Beta-alanine supplementation increases muscle carnosine content and also improves exercise capacity and performance in young adults, with mixed findings emerging from the few studies investigating its effects on older participants. Therefore, this study aimed to systematically review the evidence regarding the effects of beta-alanine on exercise capacity, muscle strength, and functional performance of older adults.

METHODS

 This systematic review was conducted following the specific methodological guidelines of the Preferred Report Items for Systematic Reviews and Meta-Analyses and the Physiotherapy Evidence Database scale. Furthermore, the Cochrane risk-of-bias assessment tool was used. The search was carried out in five relevant databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library) from inception up to March 2024.

RESULTS

 Of the 1,749 registers identified, only five met the established criteria and were included in this systematic review. A total of 163 older adults (mean age ± SD: 69.1 ± 2.8 years; range: 66.2-72.7 years) were included across all five studies. The majority of studies included participants from both genders. The mean intervention duration ± SD was 11.7 ± 1.0 weeks. The mean daily dosage was 2.7 ± 0.4 g/day (range: 2.4-3.2 g/day).

CONCLUSION

 Overall, exercise capacity may be improved following supplementation protocols with dosages ranging from 2.4 to 3.2 g/day. Muscle strength and functional performance do not seem to be improved by beta-alanine since these tasks are not significantly impacted by acidosis buildup.

Factors Affecting Handgrip Strength in Menopausal Women at High Risk of Sarcopenia: A National Population-Based Study

Background/Objectives: Hand grip strength (HGS) reflects muscle strength and is an important indicator of sarcopenia. There is a gap in the research regarding the determinants of relative HGS that take sex differences into account. Therefore, this study aimed to evaluate the association between relative HGS and physical, behavioral, and psychological factors in menopausal women from South Korea. Methods: This study used data obtained from the 7th National Health and Nutrition Examination Survey (2016-2018), which had a complex, stratified, and multistage sample design. A total of 2129 menopausal women aged between 40 and 64 were included in this cross-sectional study. To evaluate physical, behavioral, and psychological factors associated with relative HGS, a multiple regression analysis was used. Results: In this study, the sociodemographic factors that influenced relative HGS were education (high school: B = 0.03, p = 0.001; college: B = 0.04, p = 0.003) and marital status (live with: B = 0.04, p = 0.004). Among the physical factors, abdominal obesity (B = -0.16, p < 0.001) and comorbidities (B = -0.03, p = 0.026) were associated with a significantly lower relative HGS. Regarding behavioral factors, relative HGS was significantly lower for those who slept more than 8 h (B = -0.03, p = 0.041) than for those who slept 6-8 h. Regarding psychological factors, relative HGS was significantly higher for those with fair (B = 0.04, p = 0.001) and good (B = 0.06, p < 0.001) self-rated health. Conclusions: Relative HGS is associated with physical, behavioral, and psychological factors in menopausal women. These findings can inform research and guidelines for sarcopenia prevention using relative HGS as an indicator of health status.

Predicting grip strength-related frailty in middle-aged and older Chinese adults using interpretable machine learning models: a prospective cohort study

Introduction

Frailty is an emerging global health burden, and there is no consensus on the precise prediction of frailty. We aimed to explore the association between grip strength and frailty and interpret the optimal machine learning (ML) model using the SHapley Additive exPlanation (SHAP) to predict the risk of frailty.

Methods

Data for the study were extracted from the China Health and Retirement Longitudinal Study (CHARLS) database. Socio-demographic, medical history, anthropometric, psychological, and sleep parameters were analyzed in this study. We used the least absolute shrinkage and selection operator (LASSO) regression to filter the model for the best predictor variables and constructed six ML models for predicting frailty. The feature performance of six ML models was compared based on the area under the receiver operating characteristic curve (AUROC) and the light gradient boosting machine (LightGBM) model was selected as the best predictive frailty model. We used SHAP to interpret the LightGBM model and to reveal the decision-making process by which the model predicts frailty.

Results

A total of 10,834 eligible participants were included in the study. Using the lowest quartile of grip strength as a reference, grip strength was negatively associated with the risk of frailty when grip strength was >29.00 kg for males or >19.00 kg for females (p < 0.001). The LightGBM model predicted frailty with optimal performance with an AUROC of 0.768 (95% CI 0.741 ~ 0.795). The SHAP summary plot showed that all features predicted frailty in order of importance, with cognitive function being considered the most important predictive feature. The poorer the cognitive function, nighttime sleep duration, body mass index (BMI), and grip strength, the higher the risk of frailty in middle-aged and older adults. The SHAP individual force plot clearly shows that the LightGBM model predicts frailty in the individual decision-making process.

Conclusion

The grip strength-related LightGBM prediction model based on SHAP has high accuracy and robustness in predicting the risk of frailty. Increasing grip strength, cognitive function, nighttime sleep duration, and BMI reduce the risk of frailty and may provide strategies for individualized management of frailty.

Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Hospitalization: Randomized Clinical Trial

OBJECTIVES

Reduced physical function following hospitalization places older adults at risk of adverse health events. Many older adults receive home health physical therapy to reverse their deconditioning; however, optimal approaches to improve physical function are currently not known. This study aimed to evaluate the effectiveness of a home health care approach comprised of high-intensity exercise, enhanced care transition, and protein supplementation.

METHODS

Eligible participants included adults aged 65 years or older referred to home health care following hospitalization. Two hundred older adults who are medically complex were enrolled and were randomized 1:1 to (1) a high-intensity progressive, multi-component (PMC) intervention or (2) enhanced usual care (UC) comparison group. All participants received 12 visits over 60 days. The primary study outcome was change in the Short Physical Performance Battery (SPPB) from baseline to 60 days. Secondary outcomes included gait speed (usual, fast), modified Physical Performance Test, grip strength, Fatigue Severity Scale, Falls Efficacy Scale-International, physical activity (step count), and adverse events (falls, emergency department visits, hospitalizations). All outcomes were collected at baseline, then 30, 60, 90, and 180 days post baseline.

RESULTS

There was no difference in 60-day SPPB change between groups with both groups experiencing significant improvements (PMC = 1.53 [95% CI: 1.00-2.05]; enhanced UC = 1.39 [95% CI = 0.89-1.88]). Differences were also not observed in secondary measures or adverse events at any time point.

CONCLUSION

An intervention consisting of high-intensity exercise, enhanced care transition, and protein supplementation was not associated with greater functional improvement at 60 days compared to enhanced UC in older adults receiving home health physical therapy.

IMPACT

The findings of this study demonstrate that a high-intensity progressive, multi-component intervention results in similar physical functional changes as an enhanced UC intervention in older adults who are medically complex and receiving home health care following hospital-associated deconditioning.

The impact of creatine levels on musculoskeletal health in the elderly: a mendelian randomization analysis

BACKGROUND

Musculoskeletal health among the elderly emerges as a pivotal public health concern against the backdrop of a globally aging population. Creatine, popular within fitness circles, has emerged as a subject of scientific inquiry for its potential benefits on elderly' musculoskeletal well-being. Despite extensive documentation of its effects on athletic performance, investigations into creatine's long-term contributions to the musculoskeletal health of the elderly are comparatively limited. Utilizing publicly accessible genetic datasets, this study aimed to explore the potential causal link between creatine levels and a variety of musculoskeletal health markers in the elderly population, such as osteoarthritis (OA), rheumatoid arthritis (RA), osteoporosis (OP), bone-specific alkaline phosphatase, bone mineral density(BMD), serum calcium levels, and reduced hand grip strength in individuals aged 60 and above.

METHODS

Our methodological approach was grounded in Mendelian Randomization (MR) analysis, with a primary emphasis on the Inverse Variance Weighted (IVW) technique, to explore potential causal links under specific assumptions and limitations inherent to MR analysis.

RESULTS

A significant inverse relationship was observed between creatine levels and reduced hand grip strength in individuals aged 60 and above (OR = 0.64, b=-0.44, p = 0.01), suggesting higher creatine levels might be beneficial in maintaining hand grip strength. Conversely, analysis of other bone health parameters, including bone-specific alkaline phosphatase, bone mineral density, serum calcium levels, and conditions such as osteoarthritis, rheumatoid arthritis, and osteoporosis, yielded p-values exceeding 0.05, denoting no statistically significant associations.

CONCLUSIONS

This study provides preliminary evidence indicating a link between creatine levels and decreased hand grip strength among the elderly, notably in individuals aged 60 and older. This finding is significant for understanding the potential impact of creatine supplementation on elderly Musculoskeletal health and underscores the need for evidence-based decision-making in nutritional supplementation. To robustly validate these observations, it is essential to conduct future randomized controlled trials with large sample sizes.

Joint associations of handgrip strength and physical activity with incident cardiovascular disease and overall mortality in the UK Biobank

BACKGROUND & AIMS

Questions remain whether higher handgrip strength confers additional health advantages beyond adherence to current physical activity guidelines. We aimed to evaluate prospective associations of joint objectively measured handgrip strength and physical activity with incident cardiovascular disease (CVD) and all-cause mortality.

METHODS

We analysed the UK Biobank study in a cohort of participants who wore accelerometers for one week, with follow-up based on hospital records until 2022. Patterns of physical activity were compared: participants who met current moderate-vigorous physical activity guidelines (150 min per week) and those who did not. Handgrip strength was classified into sex- and age-specific tertiles. CVD events were identified as primary or secondary by examination of inpatient records and data extracted from the death registry. CVD-related deaths were also identified from the death registry. We examined prospective associations of moderate-vigorous physical activity with incident CVD and all-cause mortality by level of handgrip using Cox regressions, adjusted for confounding factors.

RESULTS

A total of 76 074 persons were included (mean 55.2 years). Meeting physical activity guidelines is necessary to reduce all-cause mortality in those at the lower and middle thirds of handgrip strength. However, meeting physical activity guidelines did not confer additional reduction of all-cause mortality of those with high handgrip strength. Those with the lowest handgrip strength showed the greatest benefit from meeting physical activity guidelines for reducing all-cause mortality (HR 0.74; 95 % CI 0.65-0.85).

CONCLUSION

Our results indicate that, while following physical activity guidelines does not reduce mortality in individuals with high handgrip strength, it is essential for preventing cardiovascular disease across all levels of handgrip strength. This underscores the importance of these guidelines for cardiovascular health.

Audio-biofeedback versus the scale method for improving partial weight-bearing adherence in healthy older adults: a randomised trial

PURPOSE

To investigate how audio-biofeedback during the instruction of partial weight-bearing affected adherence, compared to traditional methods, in older adults; and to investigate the influence of individual characteristics.

METHODS

The primary outcome measure of this randomised controlled trial was the amount of load, measured as the ground reaction force, on the partial weight-bearing leg. The secondary outcome was the influence of individual characteristics on the amount of load. Included were healthy volunteers 60 years of age or older without gait impairment. Participants were randomly allocated to one of two groups; blinding was not possible. Partial weight-bearing of 20 kg was trained using crutches with audio-biofeedback (intervention group) or a bathroom scale (control group). The degree of weight-bearing was measured during six activities with sensor insoles. A mean load between 15 and 25 kg was defined as adherent.

RESULTS

There was no statistically significant difference in weight-bearing between the groups for all activities measured. For the sit-stand-sit activity, weight-bearing was within the adherence range of 15-25 kg (audio-biofeedback: 21.7 ± 16.6 kg; scale: 22.6 ± 13 kg). For standing, loading was below the lower threshold (10 ± 7 vs. 10 ± 10 kg). Weight-bearing was above the upper threshold for both groups for: walking (26 ± 11 vs. 34 ± 16), step-up (29 ± 18 vs. 34 ± 20 kg) and step-down (28 ± 15 vs. 35 ± 19 kg). Lower level of cognitive function, older age, and higher body mass index were correlated with overloading.

CONCLUSION

Audio-biofeedback delivered no statistically significant benefit over the scale method. Lower cognitive function, older age and higher body mass index were associated with overloading.

TRIAL REGISTRATION

Not applicable due not being a clinical trial and due to the cross-sectional design (one measurement point, no health intervention, no change in health of a person).

Relative handgrip strength as a vitality measure in US stroke survivors

PURPOSE

Stroke is a leading cause of long-term disability in the US, yet a feasible assessment measure with predictive value for components of the International Classification of Functioning, Disability, and Health (ICF) Core Set for Stroke is lacking. The purpose of the present study was to explore the predictive value of potential assessment measures on factors within each ICF component in stroke survivors.

MATERIALS AND METHODS

Demographic, anthropometric, blood-based biomarker, physical functioning, and Global Physical Activity Questionnaire data were collected on stroke survivors in the 2011-2018 NHANES cycles. Potential predictors (handgrip strength relative to weight, age, sex, race, education level, marital status, poverty ratio, stroke chronicity) of physical function, activities of daily living (ADLs), participation in social activities, metabolic syndrome, and meeting physical activity recommendations were evaluated using weighted linear and ordinal logistic regression.

RESULTS

Relative handgrip strength was a significant predictor of physical function, difficulty participating in ADLs and social activities, and odds of meeting physical activity recommendations. As relative handgrip strength increased, these factors improved among stroke survivors.

CONCLUSIONS

To decrease disability rates and optimize function among stroke survivors, the use of assessment measures like relative handgrip strength that may predict multiple ICF components is warranted.

Wrist Wraps Do Not Affect Barbell Bench Press Muscular Strength, Power, or Endurance in Resistance-Trained Men and Women

Harris, DR, Harris, DR, Cardaci, TD, Cintineo, HP, Funderburk, LK, and Machek, SB. Wrist wraps do not impact barbell bench press muscular strength, power, or endurance in resistance-trained men and women. J Strength Cond Res XX(X): 000–000, 2024—Although wrist wraps have become increasingly prevalent in both competitive and recreational demographics to improve upper-body strength, their posited ability to augment bench press performance by enhanced wrist stability still remains underinvestigated. Furthermore, no data exist determining the efficacy of varying wrap styles on bench-specific muscular strength and associated power, and quantitative and subjective differences between sexes. Eighteen resistance-trained male and female subjects (9M/9F; 24 ± 4 years; 176 ± 33 cm; 80 ± 15 kg) visited the laboratory on 3 separate occasions in randomized, crossover, and counterbalanced design to wear either a flexible wrist wrap (FW), stiff wrap (SW), or an unwrapped/no-wrap control (NW) condition. All subjects underwent a bench press one-repetition maximum (1RM) test and linear position transducer-derived power and velocity assessments. Furthermore, subjective stability (SS) and discomfort (SD) were determined promptly following 1RM attempts. Analyses failed to detect any main condition or interaction effects for bench press 1RM; however, a statistically significant main sex effect was observed (p < 0.001; = 0.597) favoring male subjects relative to female subjects. Neither power nor velocity measurements revealed any significant main condition or sex effects, nor any interactions. Nonparametric assessments further revealed significant wrist wrap condition effects for both SS and SD (p < 0.001 in both cases), whereby NW was statistically more comfortable (p < 0.001) than either wrap condition, without any difference between FW and SW (p > 0.05). Although wrist wraps did not significantly alter bench press-specific strength and power, subjects nonetheless perceived wrist wraps as subjectively more stable irrespective of increased discomfort.

A cross-sectional study on the effects of physical activity on hand grip strength in type 2 diabetes mellitus patients

OBJECTIVES

The pervasiveness of type 2 diabetes mellitus (T2DM) is rapidly increasing worldwide, with physical inactivity being one of the major risk factors. Hand grip strength (HGS) is an important indicator of overall physical functioning and has been associated with various health-related outcomes. The purpose of this study was to investigate the impact of physical activity on the HGS of patients with type 2 diabetes mellitus (T2DM). Furthermore, it scrutinizes the relationship between physical activity and HGS in terms of sex.

METHODS

A cross-sectional study including a total of 140 patients with T2DM was performed. Physical activity levels were assessed via the International Physical Activity Questionnaire (IPAQ). HGS was measured via a Camry digital handgrip dynamometer. Statistical analysis was performed via SPSS software, and statistical approaches such as ANOVA, Pearson correlation and t tests were used.

RESULTS

The results of this research will contribute to the detection of the influence of physical activity and its association with HGS. These findings reveal that physical activity has a significant effect on HGS and that there is a positive correlation between physical activity and increased hand grip strength in individuals with T2DM.

CONCLUSIONS

The outcomes offer valuable insights into physical activity and muscle strength, which can aid in the early detection of physical disability. The findings of this study will be valuable for healthcare providers and professionals to suggest relevant physical activities for diabetic patients.

Comparison of grip strength measurements for predicting all-cause mortality among adults aged 20+ years from the NHANES 2011-2014

Little is known about the optimal measure of handgrip strength for predicting all-cause mortality and whether this association is modified by age or sex. We used data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES), 9,583 adults aged ≥ 20 years were included. Equal-length grip strength was measured using a digital handheld Takei dynamometer. We defined five measurements of grip strength, i.e., the average of handgrip strength (HGS), maximum of grip strength (MGS), HGS/body mass index (BMI), HGS/height (HT)2, and MGS/weight, and three indicators of low grip strength, namely, low reference grip strength, lowest 20% grip strength, and low grip strength in sarcopenia. Information on deaths were obtained through linkage to National Death Index (NDI). Cox regression was used to assess the association of grip strength with mortality risk. HGS, MGS, HGS/BMI, HGS/HT2, and MGS/weight were all inversely associated with all-cause mortality, with HGS or HGS/HT2 (the area under the curve (AUC) = 0.714) being the optimal predictor of mortality, followed by MGS (AUC = 0.712). Participants with low grip strength showed increased risk of mortality regardless of which indicator was used, and the highest effect size was seen for lowest 20% grip strength group (hazard ratio (HR) = 2.20 for men, 2.52 for women). The above-mentioned correlations were consistently found in people of different ages and sexes. This study suggests the simplest measure of absolute grip strength (HGS, MGS) was the optimal index for predicting all-cause mortality, followed by HGS/HT2. Keeping an adequate level of handgrip strength may be beneficial to reduce the risk of mortality.

Impact of Age Differences in Chronic Limb-Threatening Ischemia Outcomes in Octogenarians

BACKGROUND

The aging population is a growing challenge for healthcare services and as such multimorbidity and associated aging are the focus of research programs. Chronic limb-threatening ischemia (CLTI) in the older patient is perceived to be associated with high morbidity and mortality but a potentially contentious area with limited evidence.

METHODS

Retrospective review of all consecutive CLTI admissions to a UK tertiary vascular during 2020. Analysis included descriptive statistics and comparisons by age. The primary outcome was survival (by Kaplan-Meier) with secondary outcomes being major adverse limb and cardiovascular events.

RESULTS

One hundred eighty-three patients with a median age of 72 of which 55 (30%) were octogenarians. Fewer octogenarians were diabetic (38.2% vs. 58.6%, P = 0.015), but comorbidities such as previous stroke (25.5% vs. 10.9%, P = 0.015) and atrial fibrillation (36.4% vs. 16.4%, P = 0.004) were increasingly common. 87.3% of octogenarians had moderate or severe frailty compared to 57.8% in those <80 (P = 0.001) (by electronic frailty index). Median survival time was 30 months with no significant difference between groups (P = 0.406). Major adverse cardiovascular event (10.9% vs. 7.81%, P = 0.504) and major adverse limb event (34.5% vs. 24.2% P = 0.261) were comparable between groups. Octogenarians were less likely to have open surgery (10.9% vs. 25.8%, P = 0.024).

CONCLUSIONS

Octogenarians have similar cardiovascular, limb, and survival outcomes following intervention despite being increasingly frail and comorbid. Holistic assessment, perioperative optimization, and risk stratification are important in this group.

Do we know about dynapenia?

Dynapenia is a condition characterized by decreased muscle strength and function in older adults that is not due to a specific underlying disease or medical condition. Dynapenia is common among older adults and has significant health effects, including functional impairment, disability, increased risk of falls, hospitalization, and death. Oxidative stress, mitochondrial dysfunction and chronic inflammation are involved in the etiopathophysiology of dynapenia. Diagnosis of dynapenia is based on the evaluation of muscle strength and function using methods such as hand grip strength, timed up and go test and short physical performance battery. Management of dynapenia involves a multifaceted approach that includes exercise, nutrition, pharmacological interventions, management of underlying medical conditions, and fall prevention strategies. With appropriate interventions, older adults with dynapenia can improve muscle strength and function, reduce the risk of falls and disability, and maintain their independence and quality of life.

The Surgical Pause: The Importance of Measuring Frailty and Taking Action to Address Identified Frailty

CONCEPTUAL FRAMEWORK

The Surgical Pause is a rapid, scalable strategy for health care systems to optimize perioperative outcomes for high-risk, frail patients considering elective surgery. The first and most important step is to screen for frailty, thereby identifying the 5% to 10% of patients at most risk for postoperative complications, loss of independence, institutionalization, and mortality. The second step is to take action to improve outcomes. Action may include clarifying perioperative goals, optimizing perioperative decision-making, and mitigating frailty-associated risks through prehabilitation.

HISTORY OF DISSEMINATION

Initially implemented at the Omaha Veterans Affairs (VA) Medical Center in 2012, the Surgical Pause was associated with a nearly three-fold survival advantage among the frail. The program was subsequently replicated at more than 50 VA and private sector hospitals with similarly robust results, leading the Veterans Health Administration (VHA) National Surgery Office to formally adopt the program in January 2024. The Joint Commission and the National Quality Forum recognized the program with the Eisenberg Award for Patient Safety and Quality at the National Level.

LESSONS LEARNED

Successful dissemination grew from simultaneous real-world quality projects paralleled by rigorous, high-quality, peer reviewed publications demonstrating the need for and impact of the Surgical Pause. Adoption was facilitated in an iterative process to streamline feasibility and leverage existing resources. Success was accelerated by national infrastructure catalyzing a community of practice.

CONCLUSION

The Surgical Pause is changing surgical culture by proactively identifying frail patients, aligning treatment plans with patient-defined goals, optimizing perioperative decisions, and mitigating frailty-associated risks to deliver both quality and value.

The effect of resistance training on patients with secondary sarcopenia: a systematic review and meta-analysis

To analyse the effectiveness of resistance training on secondary sarcopenia, we conducted a meta-analysis to elucidate the effects of resistance training (RT) on muscle strength (handgrip strength [HGS]), muscle mass (Skeletal muscle mass index [SMI]), and physical function (Gait speed [GS]) in patients with secondary sarcopenia. All studies published between 2015 and January 2024 on the effects of resistance training on patients with secondary sarcopenia were retrieved from 6 electronic databases: PubMed, Web of Science Core Collection, Embase, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) Core journals and the Wanfang Database. Two researchers independently extracted and evaluated studies that met the inclusion and exclusion criteria. Finally, 12 randomized controlled trials were included. Pooled analyses of baseline data and results were performed using Review Manager 5.3 with standardized mean variance (SMD) and random effects model. The study included 12 randomized controlled trials involving 639 patients (mean age 57.28 ± 2.66 to 79.6 ± 5.4 years). There are five types of complications among the patients: obesity, type 2 diabetes, Alzheimer's disease, hemodiaysis, and pancreatic cancer. Compared with the control group, RT effectively improved HGS [SMD = 2.47, 95% CI (1.50, 3.43), p < 0.01, I2 = 94%]; SMI [SMD = 0.94, 95% CI (0.52, 1.36), p < 0.01, I2 = 56%]; and GS [SMD = 2.18, 95% CI (-0.01, 4.37), p ≥ 0.05, I2 = 97%]. Further subgroup analysis of the results showed that the intervention effect on grip strength was greater for non-elastic band resistance [SMD = 2.40, 95% CI (1.05, 3.75), p < 0.01, I2 = 94%] than for elastic band resistance (EBRT) [SMD = 1.22, 95% CI (-0.14, 2.58), p < 0.01, I2 = 95%]. The intervention effect of RT on grip strength is more significant in patients with T2D [SMD = 0.59, 95%CI (0.26-0.93, p < 0.01, I2 = 27%] and obesity [SMD = 0.74, 95%CI (0.32-1.15, p < 0.01, I2 = 0%]. For patients with secondary sarcopenia, Resistance training (RT) can effectively enhance muscle strength and muscle mass; however, it does not significantly improve physical function. Different RT intervention methods have different effects on patients, such as elastic band training and non-elastic band training (bounce ball RT; equipment RT, etc.). Different types of complications may influence the effectiveness of RT intervention.

Gender differences in longitudinal association of fear of falling with grip strength and depressive symptoms in older adults

The authors investigated the longitudinal associations of fear of falling (FOF) with grip strength and depressive symptoms. We also examined whether the longitudinal relationships are gendered. Data were obtained from the Korean Longitudinal Study of Aging from 2006 to 2018. A total of 6447 respondents from individuals aged 65 years or older (23,002 person-waves) were included. To account for the unobserved confounders, we estimated individual fixed effects (FE) regression models. Our results indicated that FOF is associated with grip strength and depressive symptoms. Older adults with fear of falling tend to have lower grip strength and great depressive symptoms. In gender-specific analyses, men with FOF are more likely to have lower grip strength and experience more depressive symptoms, while women with FOF are only more likely to present the latter. The authors of this study reveal the importance of managing FOF, which will help older adults age more healthily.

A study of the predictive value of different health indicators on the risk of all-cause mortality in older adults living in communities

OBJECTIVES

Intrinsic capacity(IC), self-rated health (SRH), and hand grip strength (HGS) reflect the health status from different aspects. This study aimed to investigate the relationship between IC, SRH, SRH combined with HGS and all-cause mortality among Chinese older adults living in communities.

METHODS

This study used data from the 2011 (baseline), 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS). We evaluated IC, SRH, and HGS using questionnaires. We assessed baseline levels of IC, SRH, and SRH combined HGS. Using the COX proportional hazards model, we investigated the associations between baseline IC, SRH, and SRH combined HGS and all-cause mortality. We used receiver operating characteristic curves (ROC) curves to compare the predictive effects of IC, SRH, and SRH combined HGS on all-cause mortality among Chinese older adults living in communities.

RESULTS

At baseline (2011), the study included a total of 4095 participants. The multifactorial Cox regression analysis results showed that older adults had a much higher risk of death from any cause compared to those who said they were in good health and had a normal hand grip strength, those who said they were in fair health and had a low hand grip strength [HR = 3.959, 95 % CI (2.892-5.421)], those who said they were in bad health and had a normal hand grip strength [HR = 3.150, 95 % CI (2.392-4.148)], and those who said they were in bad health and had a low hand grip strength [HR = 4.189, 95 % CI (3.123-5.618)]. The study looked at older adults who lived in the community. The area under the ROC curves (AUC) for IC and SRH combined HGS to predict death from any cause was 0.726 [95 % CI (0.708-0.744)] and 0.704 [95 % CI (0.683-0.725)], respectively.

CONCLUSION

Combining SRH and HGS improves older adults' health management by more accurately predicting the risk of all-cause mortality.

Exploring Older People's Experiences and Factors Associated With 30-Day Hospital Readmission: A Qualitative Study Using Interpretive Phenomenological Analysis

INTRODUCTION

Hospital readmission has a negative impact on older people and the healthcare system. Current hospital readmission research predominantly reports on clinical outcomes based on cross-sectional data. Research exploring patients' experiences and priorities is limited. This study aimed to explore older people's experiences of hospital readmission in order to develop an understanding of what matters most to them.

METHODS

Semi-structured qualitative interviews were conducted to generate data that were analysed using principles of interpretative phenomenological analysis.

RESULTS

Ten participants over 65 years old, who had experienced unplanned hospital readmission within a period of 30 days, were recruited from a large single tertiary referral centre. Four themes emerged: 'All about me without me', 'Fragmented and ad hoc post-discharge support', 'My readmission experience and what led me back' and 'Segregated health and social services that are detached from people's needs'.

CONCLUSION

The study findings suggest that patients should be more involved in decisions about their care, and health professionals should endeavour to better understand the contexts, resources and access to formal and informal support of patients. Effective communication and stronger continuum of care could be a key to patients' recovery and avoidance of hospital readmission. This research highlights the importance of shared decision-making and patient-centred care to improve quality of care, maintain independence and preserve older adult's right to feel valued.

Efficacy and Safety of Different Trapezium Implants for Trapeziometacarpal Joint Osteoarthritis: A Systematic Review and Meta-Analysis

Background: The trapeziometacarpal joint (TMCJ) is the most common hand joint affected by osteoarthritis (OA), and trapezium implant arthroplasty is a potential treatment for recalcitrant OA. This meta-analysis aimed to investigate the efficacy and safety of various trapezium implants as an interventional option for TMCJ OA. Methods: Web of Science, PubMed, Scopus, Google Scholar, and Cochrane library databases were searched for relevant studies up to May 28, 2022. Preferred Reported Items for Systematic Review and Meta-Analysis guidelines were adhered to, and the protocol was registered in PROSPERO. The methodological quality was assessed by National Heart, Lung, and Blood Institute tools for observational studies and the Cochrane risk of bias tool. Subgroup analyses were performed on different replacement implants; the analysis was done using Open Meta-Analyst software and P values <.05 were considered statistically significant. Results: A total of 123 studies comprising 5752 patients were included. Total joint replacement (TJR) implants demonstrate greater significant improvements in visual analogue scale pain scores postoperatively. Interposition with partial trapezial resection implants were associated with highest grip strength and highest reduction in the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Revision rates were highest in TJR (12.3%) and lowest in interposition with partial trapezial resection (6.2%). Conclusion: Total joint replacement and interposition with partial trapezial resection implants improve pain score, grip strength, and DASH scores more than other implant options. Future studies should focus on high-quality randomized clinical trials comparing different implants to accumulate higher quality evidence and more reliable conclusions.

The efficiency of activities of daily living (ADLs) skills in late adulthood: A mediational approach

The term "Activities of Daily Living" (ADLs) refers to a set of fundamental tasks (i.e., toileting, bathing, personal care, eating, grooming, and getting dressed) considered necessary for living and being autonomous in everyday life. Although in the clinical setting ADLs efficiency is a marker to diagnose dementia, limited evidence on the mechanism implicating muscular function and cognitive alterations in ADLs skills in late adulthood exists. This study primarily intended to determine the extent to which executive functions mediate between muscular strength, as assessed through handgrip strength (HGS) measurement, and ADLs skills of older community-dwellers. A further goal was to explore the impact of gender and cognitive status on ADLs and HGS scores, using education as a covariate. Three hundred and thirty-four older participants, 199 females and 135 males (Mage = 77.5 years, SD = 5.6 years, age range = 63-93 years) completed a battery of tests assessing ADLs, HGS, and executive functions. The results showed that 34-56% of the variance in the ADLs condition was explained by HGS and executive functioning. Furthermore, cognitively healthy participants exhibited better ADLs skills, whereas cognitively impaired individuals, both males and females, exhibited poorer HGS efficiency. In conclusion, in clinical settings, the concurrent evaluation of ADLs skills, motor, and higher-order cognitive processes should be encouraged to detect individuals needing a person-tailored intervention to boost their quality of life.

Tracking anthropometric dimensions and grip strength among children, adolescents and adults in an indigenous community of southern Mexico: 1968-1978-2000

PURPOSE

To track body size and proportions, arm dimensions and grip strength in children, adolescents, and adults resident in an indigenous community in Oaxaca who were measured on two or three occasions across surveys in 1968, 1978, and 2000.

METHODS

The three cross-sectional surveys included measures of height, weight, sitting height, arm circumference, triceps skinfold, and grip strength in surveys of schoolchildren in 1968 and of schoolchildren, adolescents and adults in 1978 and 2000. Cross-checks of surnames, forenames and ages/dates of birth of participants in the three surveys identified three samples of individuals measured on two occasions (1968-1978, two age groups in 1978-2000) and a subsample of individuals measured in the three surveys. Partial correlations controlling for age at each observation were calculated for each variable in the three sex-specific samples measured on two occasions, and for the subsamples of males and females measured on three occasions.

RESULTS

Allowing for variation in age among subsamples, inter-age correlations were moderate to high for stature, moderate for sitting height and estimated leg length, and low to moderate for weight, BMI, arm and estimated arm muscle circumference, triceps skinfold, and grip strength.

CONCLUSION

Allowing for the relatively broad chronological age intervals, the inter-age correlations for height, weight and BMI were at the low end, while those for grip strength and for strength per unit body weight for males (though not females) were generally in the range of correlations noted in studies of European samples. Likely associated with improved health, nutritional, and sanitation conditions, obesity and overweight were emerging among adults by 2000. Obesity and overweight in adults paralleled the introduction of mechanized agriculture that reduced routine physical work. Among children, the association of obesity and overweight is likely with increased nutritional availability, but poor choices in diet.

Multi-domain predictors of grip strength differentiate individuals with and without alcohol use disorder

Grip strength is considered one of the simplest and reliable indices of general health. Although motor ability and strength are commonly affected in people with alcohol use disorder (AUD), factors predictive of grip strength decline in AUD have not been investigated. Here, we employed a data-driven analysis predicting grip strength from measurements in 53 controls and 110 AUD participants, 53 of whom were comorbid with HIV infection. Controls and AUD were matched on sex, age, and body mass index. Measurements included commonly available metrics of brain structure, neuropsychological functioning, behavioural status, haematological and health status, and demographics. Based on 5-fold stratified cross-validation, a machine learning approach predicted grip strength separately for each cohort. The strongest (top 10%) predictors of grip were then tested against grip strength with correlational analysis. Leading grip strength predictors for both cohorts were cerebellar volume and mean corpuscular haemoglobin concentration. Predictors specific to controls were Backwards Digit Span, precentral gyrus volume, diastolic blood pressure, and mean platelet volume, which together significantly predicted grip strength (R2 = 0.255, p = 0.001). Unique predictors for AUD were comorbidity for HIV infection, social functioning, insular volume, and platelet count, which together significantly predicted grip strength (R2 = 0.162, p = 0.002). These cohort-specific predictors were doubly dissociated. Salient predictors of grip strength differed by diagnosis with only modest overlap. The constellation of cohort-specific predictive measurements of compromised grip strength provides insight into brain, behavioural, and physiological factors that may signal subtly affected yet treatable processes of physical decline and frailty.

Association of kidney function with physical performance: the Maastricht study

BACKGROUND

Kidney failure has been associated with decreased physical capacity, although evidence regarding the physical performance of individuals with earlier stages of chronic kidney disease (CKD) remains limited.

METHODS

Cross-sectional data were derived from the prospective, population-based Maastricht Study. Multivariate linear regression models were fitted to assess the association of estimated glomerular filtration rate (eGFR) and albuminuria categories with physical performance test outcomes.

RESULTS

Overall, 7396 participants were included. Compared to eGFR 60-90 ml/min/1.73 m2, values < 60 ml/min/1.73 m2 were associated with significantly shorter 6-min walk distance (β: - 13.04 m, 95% confidence intervals-CI - 19.95; - 6.13), worse timed chair rise stand test time (β: 0.91 s, 95% CI 0.36; 1.47), lower maximal grip (β: - 0.83 kg, 95% CI - 1.50; - 0.15) and elbow flexion (β: - 3.64 Nm, 95% CI - 7.11; - 0.16) strength. Additionally, eGFR > 90 ml/min/1.73 m2 was linked to significantly shorter 6-min walk distance (β: - 6.13 m, 95% CI - 9.44; - 2.82). Urinary albumin excretion > 30 mg/24 h was associated with shorter 6-min walk distance (β: - 12.48 m, 95% CI - 18.28; - 6.68), worse timed chair rise stand test time (β: 0.51 s, 95% CI 0.11; 1.06), lower maximal grip (β: - 1.34 kg, 95% CI - 1.91; - 0.76) and elbow flexion strength (β: - 3.31 Nm, 95% CI - 5.80; - 0.82).

CONCLUSIONS

Reduced eGFR and higher albuminuria levels were associated with worse physical performance, especially shorter 6-min walk distance and lower muscle strength. The relationship between eGFR and physical function was non-linear, with also high eGFR values being associated with worse performance, especially in the six-minute walk test.

The Causal Effect of Adult Height on Late-Life Handgrip Strength: The Singapore Chinese Health Study

BACKGROUND

Adult height has been associated with handgrip strength, which is a surrogate marker of physical frailty. However, it is uncertain if this association is causative or due to confounding bias.

METHODS

We evaluated pairwise associations among handgrip strength, adult height, and genetically determined height (using a polygenic score [PGS] for height in a mediation framework and a 2-sample Mendelian randomization approach) by means of a multivariable regression model using a prospective cohort of Chinese living in Singapore. We additionally evaluated pathway enrichments of height-related genes in relation to increased handgrip strength to discover common biological mechanisms underlying associations of genetically determined height with handgrip strength.

RESULTS

Height PGS exhibited a positive association with handgrip strength at late life after adjusting for midlife body weight and other baseline exposures (cigarette smoking, education, and physical activity status, p = 1.2 × 10-9). Approximately 66.4% of the total effect of height PGS on handgrip strength was mediated through adult height (βindirect-effect = 0.034, pindirect-effect = 1.4 × 10-40). Two-sample Mendelian randomization evaluations showed a consistent causal relationship between increased height and increased handgrip strength in late life (p between 6.6 × 10-4 and 3.9 × 10-18), with insignificant horizontal pleiotropic effects (pMR-Egger intercept = 0.853). Pathway analyses of genes related to both increased adult height and handgrip strength revealed enrichment in ossification and adipogenesis pathways (padj between .034 and 6.8 × 10-4).

CONCLUSIONS

The study highlights a potentially causal effect between increased adult height and increased handgrip strength in late life, which may be explained by related biological processes underlying the preservation of muscle mass and strength in aging.

Association of handgrip strength and risk of cardiovascular disease: a population-based cohort study

BACKGROUND

Handgrip strength (HGS) is a simple and non-invasive measure of muscle strength, which has been proposed as a potential predictor of cardiovascular disease (CVD) risk. However, the association between HGS and CVD risk in the Chinese population remains underexplored. This study aims to investigate the relationship between handgrip strength and the risk of cardiovascular disease using data from the 2015-2018 China Health and Retirement Longitudinal Study (CHARLS).

METHODS

We included 9369 participants aged 45 years and older from the CHARLS dataset. HGS was measured using a dynamometer, and the average of three measurements for each hand was recorded. Participants were categorized into quartile based on their HGS levels. The primary outcome was the incidence of CVD, including heart diseases, and stroke, obtained through self-reports and verified by medical records. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) for the association between HGS and CVD risk, and using restricted cubic spline to construct a linear relationship, adjusting for potential covariates including demographic factors, lifestyle factors, body composition, and health status. The robustness of the results was determined by stratified analysis.

RESULTS

During a mean follow-up of 3 years, 1198 CVD events were reported, including 851 heart diseases and 427 strokes. After multivariate adjustment, the HR and 95% CI corresponding to CVD risk for participants in the HGS 2nd, 3rd, and 4th quartiles compared with those in the lowest quartile were 0.824 (95% CI: 0.692-0.981), 0.756 (95% CI: 0.614-0.929), 0.625 (95% CI: 0.484-0.807) (Pfor trend: <0.001), respectively. All subgroups analyzed found similar results. For CVD components, HGS was similarly linearly associated with heart disease, and had an inverted U-shape relationship with the risk of stroke, with a potential threshold of 23.16 kg.

CONCLUSIONS

Higher HGS was significantly associated with decreased risk of CVD, including heart disease and stroke, in middle-aged and older adults, suggesting that HGS may be a promising measurable predictor of CVD in this population.

Handgrip strength: A simple and effective tool to recognize decreased intrinsic capacity in Chinese older adults

OBJECTIVES

Intrinsic capacity impairment results in poor outcomes among older adults. Here we tested handgrip strength as a screening tool for IC impairment in community-dwelling older adults in Xinjiang, China. We assessed the diagnostic accuracy and established optimal cut-off points for handgrip strength in the detection of intrinsic capacity impairment.

METHODS

In total, 1072 participants were included using a multilevel random sampling method. Intrinsic capacity was constructed according to the definition of the Integrated Care for Older People screening tool proposed by the WHO.

RESULTS

Altogether, 73.4 % (787/1072) participants had intrinsic capacity impairment. The prevalence of intrinsic capacity impairment for hearing, vision, mobility, cognition, psychological, and vitality domains was 8.6 %, 4.8 %, 39.6 %, 47.3 %, 12.0 %, and 18.8 %, respectively. The adjusted odds ratios [95 % confidence interval) for handgrip strength was 0.935 [0.914-0.956]. The area under the curve of the receiver operating characteristic curve for handgrip strength of older men, and handgrip strength of older women with intrinsic capacity impairment were 0.7278, and 0.7534, respectively. The handgrip strength cut-off points were 28.47 kg (60-69 years), 25.76 kg (70-79 years), and 24.45 kg (≥80 years) for men, and 20.75 kg (60-69 years), 19.90 kg (70-79 years), and 16.17 kg (≥80 years) for women.

CONCLUSIONS

Handgrip strength can be used as a convenient tool for evaluating intrinsic capacity. Weak handgrip strength and low education level were associated with intrinsic capacity impairment in community-dwelling older adults in Xinjiang. Using the cut-off points of handgrip strength for different age groups and genders, older adults with impaired intrinsic capacity can be identified, which may reduce the occurrence of adverse outcomes.

Shuttle Time for Seniors: The Impact of 8-Week Structured Badminton Training on Markers of Healthy Aging and Evaluation of Lived Experiences-A Quasi-Experimental Study

BACKGROUND/OBJECTIVES

Engagement in sport offers the potential for improved physical and psychological well-being and has been shown to be beneficial for promoting healthy aging. Opportunities for older adults to (re)engage with sport are limited by a paucity of age-appropriate introductory sports intervention programs. As such, the study evaluated the efficacy of a newly designed 8-week badminton training program (Shuttle Time for Seniors) on markers of healthy aging and the lived experiences of participation.

METHODS

Forty-three older adults assigned to a control (N = 20) or intervention group (N = 23) completed pre-post assessment of physical and cognitive function, self-efficacy for exercise, and well-being. Focus groups were conducted for program evaluation and to understand barriers and enablers to sustained participation.

RESULTS

Those in the intervention group increased upper body strength, aerobic fitness, coincidence anticipation time, and self-efficacy for exercise. Objectively improved physical and cognitive functions were corroborated by perceived benefits indicated in thematic analysis. Shuttle Time for Seniors was perceived as appropriate for the population, where the age-appropriate opportunity to participate with likeminded people of similar ability was a primary motivator to engagement. Despite willingness to continue playing, lack of badminton infrastructure was a primary barrier to continued engagement.

CONCLUSION

Shuttle Time for Seniors offered an important opportunity for older adults to (re)engage with badminton, where the physical and psychosocial benefits of group-based badminton improved facets important to healthy aging. Significance/Implications: Age-appropriate introductory intervention programs provide opportunity for older adults to (re)engage with sport. However, important barriers to long-term engagement need to be addressed from a whole systems perspective.

Purpose in life and grip strength: An individual-participant meta-analysis of 115,972 participants from 24 countries across four continents

This research examines the replicability and generalizability of the association between purpose in life and grip strength. An individual-participant meta-analysis of 27 samples (total N=115,972) from 24 countries that spanned four continents (Asia, Europe, North and South America) with self-reported purpose in life and dynamometer-assessed grip strength. Purpose in life was associated with stronger grip strength in every sample and aggregated in a random-effects meta-analysis (meta-analytic estimate=.06, p<.001). The association was similar across samples from different world regions and not moderated by methodological factors (e.g., scale content). The association was apparent across age, sex, race, and education and slightly stronger among males and participants with relatively less education. Every standard deviation in purpose was associated with a 23% lower likelihood of weak grip strength (meta-analytic OR=.81, 95% CI=.79-.84, p<.001) based on a standard threshold. Purpose in life is associated with grip strength, a marker of overall musculoskeletal health. The association replicates across diverse locations around the world and generalizes across sociodemographic groups.

Association of handgrip strength weakness and asymmetry with later life pain risk in middle-aged and older individuals: Results from four prospective cohorts

Objectives

The burden of pain in middle-aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts.

Methods

This longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk.

Results

We included 41,171 participants in the final analysis, with a mean follow-up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p-values for interaction >0.05).

Conclusions

Our findings suggest that HGS can be used as an independent predictor of pain in middle-aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations.

Low handgrip strength is associated with falls after the age of 50: findings from the Brazilian longitudinal study of aging (ELSI-Brazil)

AIM

This study examined the association of low handgrip strength (HGS) for falls in middle-aged adults and older adults every half-decade of life.

METHODS

This cross-sectional study was conducted using the public data from the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The participants were allocated into seven age groups 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, and ≥ 80 years. Binary logistic regression analysis was performed to identify the odds ratio (OR) of low HGS to the falls regardless of confounding variables such as sex, balance, gait speed, and total number of health conditions.

RESULTS

A total of 8,112 participants aged 50-105 years (median = 62.0 years): 3,490 males (median = 60.0 years) and 4,622 females (median = 63.0 years) attended the study. Altogether, 21.5% of participants experienced at least one fall. HGS gradually decreases over each half-decade of life. In addition, low HGS presented a significative OR (p < 0.05) for falls for age groups, until 80 s, even when considering confounding variables.

CONCLUSIONS

Low HGS is associated with falls in middle-aged adults over their 50 s and remained a strong measure of falls across each subsequent half-decade of life, until 80 s.

Association Between Dietary Acid Load and Grip Strength in Adults 50 Years and Older: A Cross-Sectional Study

Minimal data exist on whether the acid-base balance of the diet is linked to muscle strength. The aim of this study was to determine if dietary acid load is associated with grip strength in a nationally representative sample of middle- to older-age adults. We examined the cross-sectional association of grip strength with dietary acid load quantified through potential renal acid load (PRAL) and net endogenous acid production (NEAP) in 4,059 adults aged 50 years and older in the 2011-2014 NHANES survey cycles. PRAL and NEAP were estimated from two 24-h recalls and categorized into sex-specific quartiles. Grip strength was measured on a dynamometer. Multiple linear regression models were used to determine the associations of PRAL and NEAP (as quartiles) with grip strength for men and women separately, adjusting for total energy, age, race/ethnicity, weight, physical activity, smoking, serum 25-hydroxyvitamin D, and estimated glomerular filtration rate. Mean grip strength was 26.8 ± 0.2 kg in women and 43.0 ± 0.4 kg in men. Adjusted grip strength was inversely associated with quartiles of PRAL (ptrend = 0.049) and NEAP (ptrend = 0.034) in women with quartile 4 vs 1 differences of - 1.21 and - 1.08 kg (both p < 0.05), respectively. Adjusted grip strength was not associated with PRAL or NEAP in men. Overall, we found inverse associations between dietary acid load and grip strength in middle- and older-age women, suggesting that an alkaline diet may be important in maintaining muscle strength in this population. There was no association between dietary acid load and grip strength in men.

Altered Sensory Processing in People Attending Specialist Orthopaedic Consultation for Management of Persistent Shoulder Pain: An Observational Cross-Sectional Study

OBJECTIVES: The primary objective was to compare sensory processing measures in people attending specialist orthopaedic consultation for management of persistent shoulder pain with control participants. The secondary objective was to compare the groups' sociodemographic, clinical, general health and lifestyle, and psychological characteristics. DESIGN: Observational cross-sectional. METHODS: Participants with shoulder pain for ≥3 months, who attended a public hospital orthopaedic department (n = 119), and community participants without shoulder pain (n = 44) underwent a standardized quantitative sensory testing protocol, measuring pressure pain threshold, temporal summation, and conditioned pain modulation. Sociodemographic, clinical, general health and lifestyle, and psychological characteristics were also collected. RESULTS: Participants with shoulder pain had significantly lower pressure pain thresholds at all sites (ie, local and widespread mechanical hyperalgesia) and significantly decreased conditioned pain modulation effect (ie, descending inhibition of nociception) than control participants. There was no significant difference between groups for temporal summation. Participants with shoulder pain had decreased general health and function, less healthy lifestyles, and poorer psychological health compared with controls. CONCLUSION: People referred to specialist orthopaedic care for management of persistent shoulder pain had clinical signs of altered sensory processing and poor health outcomes. J Orthop Sports Phys Ther 2024;54(10):1-10. Epub 25 July 2024. doi:10.2519/jospt.2024.12512.

Long-Term Effects and Impressions of Minimal Footwear in Older Adults

INTRODUCTION

Foot pathologies can lead to difficulty walking and falls in older adults. Intrinsic foot muscles contribute to the structural support and alignment of the foot and provide somatosensory input from the ground. Minimally cushioned footwear may naturally strengthen intrinsic foot muscles and enhance sensory input to the foot; however, these effects are largely unknown in older adults. Further, there is little evidence regarding the prescription of minimal footwear and the perceptions of this footwear by older adults.

METHODS

Twenty-four adults age ≥65 volunteered to use minimal footwear for prescribed times during daily activities for 16 weeks. The cross-sectional area (CSA) of 5 intrinsic foot muscles was measured using ultrasound imaging at baseline, 8 weeks, and 16 weeks. Semi-structured interviews were recorded regarding participants' impressions of the footwear, the progressive wear schedule, the footwear's effects on orthopedic-related pain, balance, and foot awareness/sensation.

RESULTS

Across the cohort, there was no significant difference in CSA of the 5 muscles after 16 weeks of minimal footwear use. Thirteen participants had clinically meaningful increased CSA of the abductor hallucis muscle (Abh). These positive responders had no significant differences in age, grip strength, foot structure, or fall risk scores compared to participants with little to no CSA change. Interview results indicated a generally positive experience with minimal footwear for 68.1% of the cohort. A large percentage of the cohort reported no difficulty with the progressive wear schedule (77.2%), no aggravation of preexisting conditions and no new pain (77.2%), improved balance (63.6%), and improved foot awareness/sensation (72.7%) with minimal footwear use. The progressive wear schedule was perceived as inconvenient by some in the first few weeks (22.8%), but resulted in mild to no adverse effects when followed as prescribed.

CONCLUSION

Sixteen weeks of progressive minimal footwear use in older adults did not lead to changes in intrinsic foot muscle CSA; however, half of the cohort had clinically meaningful increased CSA in the Abh muscle. It is unclear what individual qualities were associated with this positive response. Older adults reported generally positive experiences with minimal footwear with self-reported improvements in balance and foot awareness/sensation. The wear schedule may have been too conservative or not long enough to produce foot muscle hypertrophy, but subjective reports suggest beneficial neuromuscular adaptations and sensory changes occurred. Future research may need a greater length of time and larger samples to further determine the effects of long-term minimal footwear use in older adults.

Quantitative relationship between grip strength and quality of life in the older adult based on a restricted cubic spline model

Background

Grip strength have been showed diverse associations with quality of life for the older adult population in the literature, still there is lack of evidence of the threshold value of grip strength for maintaining good quality of life in older adults. The purpose of this study was to study the dose-effect relationship between grip strength and quality of life in the older adult, and to explore the factors affecting quality of life in the older adult, so as to provide effective theoretical basis for realizing healthy aging.

Methods

A total of 105 older adult people over 60 years old were selected from 3 communities in Beijing. Grip strength was measured by hand dynamometer apparatus and quality of life was assessed by 36-item Short-Form (SF-36). On the basis of controlling confounding factors, the dose-effect relationship between grip strength and quality of life was analyzed with the restricted cubic spline model.

Results

The results showed that there was a dose-effect relationship between grip strength and physical component summary (PCS) (p < 0.01). However, grip strength was not significantly associated with mental component summary (MCS) (p > 0.05). The threshold value of grip strength for male and female is 34.75 and 23.2 kg, for normal weight group and overweight and obesity group is 24.82 and 29.00 kg, for 60-69, 70-79, 80+ years group is 24.88, 23.37, and 22.97 kg, respectively. When the grip strength value is lower than the threshold value, the increase of grip strength was related to significant improvement of quality of life of the older adult, and when the grip strength value is higher than the threshold value, the quality of life can be maintained in good condition.

Conclusion

A dose-effect relationship was found between grip strength and physical health in quality of life. Results of our study indicated that the grip strength of the older adults needed to be greater than certain threshold values to maintain good quality of life.

Common Characteristics Between Frailty and Myotonic Dystrophy Type 1: A Narrative Review

Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disorder often considered a model of accelerated aging due to the early appearance of certain age-related clinical manifestations and cellular and molecular aging markers. Frailty, a state of vulnerability related to aging, has been recently studied in neurological conditions but has received considerably less attention in neuromuscular disorders. This narrative review aims to describe 1) the common characteristics between Fried's frailty phenotype criteria (muscular weakness, slow gait speed, weight loss, exhaustion/fatigue, and low physical activity) and DM1, and 2) the psychological and social factors potentially contributing to frailty in DM1. This review gathered evidence suggesting that DM1 patients meet four of the five frailty phenotype criteria. Additionally, longitudinal studies report the deterioration of these criteria over time in DM1. Patients also exhibit psychological/cognitive and social factors that might contribute to frailty. Monitoring frailty criteria in the DM1 population could help to implement timely preventions and interventions to reduce the disease burden and severity of frailty symptoms.

Combined knee osteoarthritis and diabetes is associated with reduced muscle strength, physical inactivity, and poorer quality of life

OBJECTIVE

This study delves into the intriguing connection between knee osteoarthritis and diabetes in Malaysia. Specifically, the exacerbation of knee osteoarthritis in the presence of diabetes in terms of symptoms, physical performance, physical activity, psychological status, social participation, and quality of life was discussed.

DESIGN

This cross-sectional study recruited adults aged 50 and above by convenient sampling and grouped them into: knee osteoarthritis-diabetes-, knee osteoarthritis+diabetes-, knee osteoarthritis-diabetes+, and knee osteoarthritis+diabetes+.

SUBJECTS/PATIENTS

Of 436 recruited participants, 261 (59.8%) participants reported knee osteoarthritis.

METHODS

Handgrip strength, Timed Up and Go test, 6 Meter Walk Test, and 5 Times Sit to Stand Test were measured using standardized procedures. Six questionnaires were administered for the remaining parameters.

RESULTS

Across groups, there were significant differences: 6 Meter Walk Test (p = 0.024), Timed Up and Go test (p = 0.020), and 5 Times Sit to Stand Test (p < 0.001), quality of life (p = 0.009), and physical activity (p = 0.036). Knee osteoarthritis+diabetes+ was independently associated with reduced handgrip strength, 5 Times Sit to Stand Test, quality of life, and physical inactivity after adjustment. Knee osteoarthritis+diabetes- was independently associated with reduced Timed Up and Go test and social isolation.

CONCLUSION

The findings revealed the diabetic knee osteoarthritis subgroup's unique physical and psychosocial features of reduced muscle strength and physical inactivity. Future studies should investigate whether managing metabolic factors, and enhancing physical activity and strength exercises, can reduce knee osteoarthritis symptoms and disease severity.