Relation Between Respiratory Muscle Strength and Skeletal Muscle Mass and Hand Grip Strength in the Healthy Elderly

Evaluating Respiratory Muscle Strength in Sarcopenia Screening among Older Men in South Korea: A Retrospective Analysis

PURPOSE

To evaluate the potential of incorporating respiratory muscle strength, specifically maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), along with traditional sarcopenia screening measures such as hand grip strength (HGS) and skeletal muscle mass index (SMI), to identify sarcopenia in older men.

MATERIALS AND METHODS

A retrospective analysis was conducted involving male patients aged 65 years and older who underwent measurements of respiratory muscle strength, HGS, and muscle mass at a general hospital in Korea from July 2016 to May 2022. Statistical analysis utilized independent t-tests and receiver operating characteristic (ROC) curves to assess the sensitivity and specificity of MIP, MEP, HGS, and SMI in sarcopenia screening. The cut-off values for sarcopenia screening were determined based on the area under the ROC curve (AUC).

RESULTS

The analysis of 282 study participants revealed the following cut-off values for sarcopenia based on the AUC: for MIP, the cut-off value was 65.50 cmH2O (AUC=0.70, sensitivity: 0.63, specificity: 0.61), while for MEP, it was 84.50 cmH2O (AUC=0.74, sensitivity: 0.66, specificity: 0.68).

CONCLUSIONS

This study showed the utility of respiratory muscle strength in screening for sarcopenia among older men. We suggest the screening cut-off values as 65.50 cmH2O for MIP and 84.50 cmH2O for MEP. Even when HGS and SMI measurements are not feasible, sarcopenia can be reasonably predicted based on respiratory muscle strength.

Exploratory study of factors associated with probable respiratory sarcopenia in elderly subjects

BACKGROUND

The diagnostic criteria for respiratory sarcopenia have been recently reported. However, no studies have clarified the characteristics of skeletal muscle impairment of the limbs in subjects with respiratory sarcopenia. This study aimed to explore the factors, including skeletal muscle, associated with probable respiratory sarcopenia in elderly subjects.

METHODS

Subjects were classified into the probable respiratory sarcopenia group and nonrespiratory sarcopenia group. Probable respiratory sarcopenia was defined as the concurrent presence of respiratory muscle weakness (as less than the predicted value calculated from age, sex, and height) and low skeletal muscle mass (<7.0 kg/m2 in males and 5.7 kg/m2 in females). The following factors were measured: respiratory muscle strength, skeletal muscle mass index, muscle thickness and echo intensity of the rectus femoris, extracellular-to-intracellular water ratio, hand grip strength, 5 sit-to-stand, knee extension strength, bone mineral density, age, sex, body mass index, degree of frailty, presence or absence of medical history, presence or absence of habitual exercise, period of time since the start of exercise, and number of hours of exercise at a time. The association subjects with probable respiratory sarcopenia were analyzed using hierarchical logistic regression analysis.

RESULTS

Twenty-six with probable respiratory sarcopenia and 54 with nonrespiratory sarcopenia were included. Hierarchical logistic regression analysis revealed that echo intensity was a significant predictor of probable respiratory sarcopenia. The odds ratio for echo intensity was 2.54 (95% confidence interval: 1.04-6.23).

CONCLUSIONS

Our results suggest that a decrease in muscle quality in the lower extremity is associated with probable respiratory sarcopenia.

Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data

QUESTIONS

Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups?

DESIGN

Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression.

PARTICIPANTS

Adults undergoing major elective abdominal surgery.

INTERVENTIONS

Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone.

OUTCOME MEASURES

PPC, hospital length of stay and 12-month mortality.

RESULTS

Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD -3.2 days, 95% CI -6.2 to -0.3). Effects on mortality were uncertain.

CONCLUSION

There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.

Cardiorespiratory Performance, Physical Activity, and Depression in Thai Older Adults with Sarcopenia and No Sarcopenia: A Matched Case-Control Study

BACKGROUND

Older adults have a high risk for musculoskeletal, cardiorespiratory, and mental health problems. We compared respiratory muscle strength, cardiovascular endurance, physical activity (PA), and depression between older adults with and without sarcopenia.

METHODS

This matched case-control study included 200 Thai older adults (100 participants with and without sarcopenia). According to the Asian Working Group for Sarcopenia 2019, participants completed a handgrip dynamometer, a 6 m walk test, and bioimpedance analysis for sarcopenia screening. Individuals were required to evaluate their cardiovascular endurance and respiratory muscle strength and complete a set of questionnaires (i.e., depression and PA). Participants with and without sarcopenia were compared using a t-test, and ANOVA was used for subgroup analysis.

RESULTS

Participants with sarcopenia had significantly lower inspiratory muscle strength (p < 0.001), functional capacity (p = 0.032), PA (p < 0.001), and higher depression scores (p < 0.001) than those without sarcopenia. Respiratory muscle strength and PA were significantly reduced in those with severe sarcopenia, followed by those with sarcopenia, possible sarcopenia, and no sarcopenia. Older adults with severe sarcopenia had higher depression scores than those with sarcopenia, possible sarcopenia, or no sarcopenia.

CONCLUSIONS

Older adults with sarcopenia may exhibit lower cardiorespiratory performance, less PA, and higher depression than those without sarcopenia.

Low Phase Angle and Skeletal Muscle Index Increase Hospital-Acquired Infections During Stroke Rehabilitation

OBJECTIVES

Sarcopenia is common in patients with stroke and may increase the risk of medical complications such as infection. However, assessing sarcopenia in stroke patients with consciousness disturbance, aphasia or severe paralysis is challenging. This study aimed to investigate whether a combined assessment of phase angle (PhA) and skeletal muscle index (SMI), estimated using bioelectrical impedance analysis, was associated with 2 common nosocomial infections, hospital-acquired pneumonia (HAP) and urinary tract infection (UTI), during inpatient stroke rehabilitation.

DESIGN

Single-center retrospective observational study.

SETTINGS AND PARTICIPANTS

A total of 1068 patients with stroke admitted to a rehabilitation hospital between January 2016 and September 2019 were analyzed.

METHODS

The study variables included demographic characteristics, comorbidities, stroke severity, blood chemistry and urine analysis, SMI, and PhA obtained using bioelectrical impedance analysis. Patients were classified as normal, low PhA only, low SMI only, and low PhA + SMI. Multivariate Cox proportional analysis was used to determine the variables associated with HAP and UTI.

RESULTS

A combination of low PhA + SMI was observed in 429 (40.2%) patients. Over a median follow-up duration of 46 days, HAP occurred in 187 patients (17.5%) and UTI occurred in 155 patients (14.5%). The low PhA + SMI group showed a significantly higher incidence of HAP and UTI than the normal group (32.6% vs 4.6%, P < .001, for HAP; 20.7% vs 6.2%, P < .001, for UTI). In multivariate Cox analyses, low PhA and SMI were associated with significantly higher rates of HAP [hazard ratio (HR) 3.36, 95% CI 1.796-6.304, P < .001] and UTI (HR 1.71, 95% CI 1.002-2.947, P < .05) after adjusting for confounding variables.

CONCLUSIONS AND IMPLICATIONS

Combination of low PhA + SMI was independently associated with a higher risk of HAP and UTI in stroke patients who underwent inpatient rehabilitation. Measuring PhA and SMI using bioelectrical impedance analysis might be helpful in establishing care plans in these population.

Influence of hand grip strength test and short physical performance battery on FRAX in post-menopausal women: a machine learning cross-sectional study

BACKGROUND

Impaired physical performance and muscle strength are recognized risk factors for fragility fractures, frequently associated with osteoporosis and sarcopenia. However, the integration of muscle strength and physical performance in the comprehensive assessment of fracture risk is still debated. Therefore, this cross-sectional study aimed to assess the potential role of hand grip strength (HGS) and short physical performance battery (SPPB) for predicting fragility fractures and their correlation with Fracture Risk Assessment Tool (FRAX) with a machine learning approach.

METHODS

In this cross-sectional study, a group of postmenopausal women underwent assessment of their strength, with the outcome measured using the HSG, their physical performance evaluated using the SPPB, and the predictive algorithm for fragility fractures known as FRAX. The statistical analysis included correlation analysis using Pearson's r and a decision tree model to compare different variables and their relationship with the FRAX Index. This machine learning approach allowed to create a visual decision boundaries plot, providing a dynamic representation of variables interactions in predicting fracture risk.

RESULTS

Thirty-four patients (mean age 63.8±10.7 years) were included. Both HGS and SPPB negatively correlate with FRAX major (r=-0.381, P=0.034; and r=-0.407, P=0.023 respectively), whereas only SPPB significantly correlated with an inverse proportionality to FRAX hip (r=-0.492, P=0.001). According to a machine learning approach, FRAX major ≥20 and/or hip ≥3 might be reported for an SPPB<6. Concurrently, HGS<17.5 kg correlated with FRAX major ≥20 and/or hip ≥3.

CONCLUSIONS

In light of the major findings, this cross-sectional study using a machine learning model related SPPB and HGS to FRAX. Therefore, a precise assessment including muscle strength and physical performance might be considered in the multidisciplinary assessment of fracture risk in post-menopausal women.

Association of systemic anticholinergic medication use and accelerated decrease in lung function in older adults

Older adults are frequently exposed to medicines with systemic anticholinergic properties, which are linked to increased risk of negative health outcomes. The association between systemic anticholinergics and lung function has not been reported. The aim of this study was to investigate if exposure to systemic anticholinergics influences lung function in older adults. Participants of the southernmost centres of the Swedish National study on Aging and Care (SNAC) were followed from 2001 to 2021. In total, 2936 subjects (2253 from Good Aging in Skåne and 683 from SNAC-B) were included. An extensive medical examination including spirometry assessments was performed during the study visits. The systemic anticholinergic burden was described using the anticholinergic cognitive burden scale. The effect of new use of systemic anticholinergics on the annual change in forced expiratory volume (FEV1s) was estimated using mixed models. During follow-up, 802 (27.3%) participants were exposed to at least one systemic anticholinergic medicine. On average, the FEV1s of participants without systemic anticholinergic exposure decreased 37.2 ml/year (95% CI [33.8; 40.6]) while participants with low and high exposure lose 47.2 ml/year (95% CI [42.4; 52.0]) and 43.7 ml/year (95% CI [25.4; 62.0]). A novel association between new use of medicines with systemic anticholinergic properties and accelerated decrease in lung function in older adults was found. The accelerated decrease is comparable to that observed in smokers. Studies are needed to further explore this potential side effect of systemic anticholinergics.

Respiratory Muscle Strength Is Related to Handgrip Performance in Community-Dwelling Persons Aged 80+ from the BUTTERFLY Study

INTRODUCTION

This study aimed to evaluate the association of respiratory muscle strength with sarcopenia and its indicators in the oldest old.

METHODS

Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and sarcopenia-related factors (handgrip strength and appendicular lean mass) were evaluated in a cohort of n = 286 (45.5% female) non-frail, community-dwelling persons aged 83.6 ± 3.0 years (age range 80-97 years).

RESULTS

The sample presented a sarcopenia prevalence of 32.2%. Sarcopenic subjects showed comparable MIP and MEP as non-sarcopenic ones (female: MIP 43.9 ± 18.9 vs. 50.3 ± 19.5, p = 0.053; MEP 63.0 ± 23.0 vs. 69.2 ± 19.1, p = 0.067; male: MIP, 65.1 ± 24.4 vs. 64.4 ± 23.9, p = 0.433; MEP 87.7 ± 33.3 vs. 93.8 ± 30.9, p = 0.124). Statistically significant but very low associations were found between grip strength and MIP (r = 0.193 for male, p < 0.05 and r = 0.257 for female participants, p < 0.01) and MEP (r = 0.200 for male, p < 0.01 and r = 0.191 for female participants, p < 0.05). Lean mass was significantly correlated to MIP and MEP in female (r = 0.253, p < 0.01 and r = 0.343, p < 0.01, respectively), whereas this association was not found in male participants. Grip strength was the only statistically significant predictor of MEP (r2 = 0.212, p < 0.001), while MIP was independently predicted by age, male sex, and grip strength (r2 = 0.177, p < 0.001).

CONCLUSIONS

Peripheral muscle strength is a statistically significant, albeit weak predictor for respiratory muscle strength in well-functioning, community-dwelling persons aged 80+. When confronted to a low grip strength, one should be aware of concomitant respiratory muscle weakness, as this is a known risk factor for atelectasis and pneumonia. Given the relatively low association with handgrip strength, respiratory muscle strength testing might be indicated.

Relationship between walking speed, respiratory muscle strength, and dynamic balance in community-dwelling older people who required long-term care or support and used a daycare center

Background

Focusing on the relationship between frail older people and gait speed is vital to minimize the need for long-term care or increased support. The relationship between gait speed, respiratory muscle strength, and dynamic balance, is not well understood in older people requiring long-term care or support. Therefore, this study aimed to provide new insights into the relationship between gait speed, respiratory muscle strength, and dynamic balance in community-dwelling older people who required long-term care or support and used a daycare center.

Methods

This was a cross-sectional study of 49 community-dwelling older people (21 men, 28 women) aged ≥65 years who were certified as requiring long-term care or support under the Japanese system. The participants' maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), walking speed (maximal and normal walking speed), and maximal double-step length test (MDST) results were recorded. The measurement data were evaluated using Pearson's correlation coefficient and multiple regression analysis.

Results

Pearson's correlation coefficient revealed correlations between PImax and the following: maximal walking speed (r = 0.606, p < 0.001), normal walking speed (r = 0.487, p < 0.001), and MDST (r = 0.435, p = 0.002). Correlations were also observed between PEmax and the following: maximal walking speed (r = 0.522, p < 0.001), normal walking speed (r = 0.467, p < 0.001), and MDST (r = 0.314, p = 0.028). Moreover, a correlation was found between MDST and both maximal walking speed and (r = 0.684, p < 0.001) and normal walking speed (r = 0.649, p < 0.001). The effect size was 0.379. Multiple regression analysis using a forced entry method with maximal walking speed as the dependent variable showed that maximal walking speed was significantly associated with MDST (p < 0.001) and PEmax (p = 0.036), with an effect size of 0.272. The model's adjusted coefficient of determination was 0.593 (p < 0.001). Multiple regression analysis using a forced entry method with normal walking speed as the dependent variable showed that normal walking speed was significantly associated with MDST (p < 0.001) and PEmax (p = 0.021), with an effect size of 0.272. The model's adjusted coefficient of determination was 0.497 (p < 0.001). Multiple regression analysis using a forced entry method with MDST as the dependent variable showed that MDST was significantly associated with PImax (p < 0.025), with an effect size of 0.243. The model's adjusted coefficient of determination was 0.148 (p = 0.017).

Conclusions

Respiratory muscle strength and dynamic balance were related to walking speed in older people requiring long-term care or support.

Association between muscle quality index and pulmonary function in post-COVID-19 subjects

BACKGROUND

The SARS-CoV2 pandemic impacted many critically ill patients, causing sequelae, affecting lung function, and involving the musculoskeletal system. We evaluated the association between lung function and muscle quality index in severely ill post-COVID-19 patients.

METHODS

A cross-sectional study was conducted on a post-COVID-19 cohort at a third-level center. The study included patients who had experienced severe-to-critical COVID-19. Anthropometric measurements, such as body mass index (BMI) and handgrip strength, were obtained to calculate the muscle quality index (MQI). Additionally, spirometry, measurements of expiratory and inspiratory pressure, and an assessment of DLCO in the lungs were performed. The MQI was categorized into two groups: low-MQI (below the 50th percentile) and high-MQI (above the 50th percentile), based on sex. Group differences were analyzed, and a multivariate linear regression analysis was performed to assess the association between respiratory function and MQI.

RESULTS

Among the 748 patients analyzed, 61.96% required mechanical ventilation, and the median hospital stay was 17 days. In patients with a low MQI, it was observed that both mechanical respiratory function and DLCO were lower. The multivariate analysis revealed significantly lower findings in mechanical respiratory function among patients with a low MQI.

CONCLUSION

The Low-MQI is an independent predictor associated with pulmonary function parameters in subjects with Post-COVID-19 syndrome.

Reference Respiratory Muscle Strength Values and a Prediction Equation Using Physical Functions for Pulmonary Rehabilitation in Korea

BACKGROUND

In Korea, tests for evaluating respiratory muscle strength are based on other countries' clinical experience or standards, which can lead to subjective evaluations. When evaluating respiratory function based on the standards of other countries, several variables, such as the race and cultures of different countries, make it difficult to apply these standards. The purpose of this study was to propose objective respiratory muscle strength standards and predicted values for healthy Korean adults based on age, height, weight, and muscle strength, by measuring maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak cough flow (PCF).

METHODS

This cross-sectional study analyzed MIP, MEP, and PCF in 360 people, each group comprising 30 adult men and women aged 20-70, diagnosed as healthy after undergoing medical check-ups at a general hospital. Hand grip strength (HGS) and the five times sit-to-stand test (FTSST) results were also recorded. Correlations among respiratory muscle strength, participant demographics, and overall muscle strength were evaluated using Pearson's correlation analysis. The predicted values of respiratory muscle strength were calculated using multiple regression analysis.

RESULTS

Respiratory muscle strength differed from the values reported in studies from other countries. In the entire samples, both MIP and MEP had the highest correlations with peak HGS (r = 0.643, r = 0.693; P < 0.05), while PCF had the highest correlation with forced expiratory volume in 1 s (r = 0.753; P < 0.05). Age, body mass index, peak HGS, and FTSST results were independent variables affecting respiratory muscle strength. A predictive equation for respiratory muscle strength was developed using the multiple regression equation developed in this study.

CONCLUSION

Respiratory muscle strength index may differ by country. For more accurate diagnoses, standard values for each country are required. This study presents reference values for Korea, and a formula for estimation is proposed when no respiratory muscle strength measurement equipment is available.

TRIAL REGISTRATION

Clinical Research Information Service Identifier: KCT0006778.

Dynapenia and Sarcopenia in Post-COVID-19 Syndrome Hospitalized Patients Are Associated with Severe Reduction in Pulmonary Function

BACKGROUND

After hospital discharge, post-COVID-19 syndrome has been observed to be associated with impaired diffusing capacity, respiratory muscle strength, and lung imaging abnormalities, in addition to loss of muscle mass/strength, sarcopenia, and obesity impact exercise tolerance, pulmonary functions, and overall prognosis. However, the relationship between lung function and the coexistence of obesity with low muscle strength and sarcopenia in post-COVID-19 patients remains poorly investigated. Therefore, our aim was to evaluate the association between lung function and the coexistence of obesity with dynapenia and sarcopenia in post-COVID-19 syndrome patients.

METHODS

This cross-sectional study included subjects who were hospitalized due to moderate to severe COVID-19, as confirmed by PCR testing. Subjects who could not be contacted, declined to participate, or died before the follow-up visit were excluded.

RESULTS

A total of 711 subjects were evaluated; the mean age was 53.64 ± 13.57 years, 12.4% had normal weight, 12.6% were dynapenic without obesity, 8.3% had sarcopenia, 41.6% had obesity, 21.2% had dynapenic obesity, and 3.8% had sarcopenic obesity. In terms of pulmonary function, the dynapenic subjects showed decreases of -3.45% in FEV1, -12.61 cmH2O in MIP, and -12.85 cmH2O in MEP. On the other hand, the sarcopenic subjects showed decreases of -6.14 cmH2O in MIP and -11.64 cmH2O in MEP. The dynapenic obesity group displayed a reduction of -12.13% in PEF.

CONCLUSIONS

In post-COVID-19 syndrome, dynapenia and sarcopenia-both with and without obesity-have been associated with lower lung function.

Improving physical performance reduces dysphagia via improvement of tongue strength in patients with acute heart failure: a two-wave cross-lagged mediation model analysis

BACKGROUND

Physical performance improvement through whole-body exercise may have a positive impact on dysphagia via improvement of maximum tongue pressure (MTP).

AIMS

The present study aimed to quantitatively analyze whether improvement in physical performance reduces dysphagia by improving MTP in patients with acute heart failure (AHF).

METHODS

A total of 146 patients with AHF and dysphagia were included. Dysphagia was defined as a functional oral intake scale (FOIS) score < 6. The short physical performance battery (SPPB) indexed physical performance. A two-wave cross-lagged mediation model was used to examine whether an improvement in SPPB results improves the FOIS score via an improvement in MTP. The SPPB, MTP, and FOIS scores (T1: baseline, T2: hospital discharge) were included in the model.

RESULTS

A total of 146 patients were included in the final analysis. The SPPB result at T1 positively affected MTP (β = 0.150, P = 0.030) and the FOIS score (β = 0.249, P = 0.002) at T2. MTP at T1 also positively affected the FOIS score at T2 (β = 0.189, P = 0.026). Furthermore, the SPPB result indirectly affected the FOIS score by affecting the MTP (indirect effect = 0.028; 95% CI = 0.010, 0.078).

DISCUSSION

This study contributes to the knowledge base regarding the potential of exercise therapy as a new treatment strategy for dysphagia in patients with AHF.

CONCLUSION

An improvement in SPPB results improved the FOIS score by improving the MTP in patients with AHF.

Going beyond PA: Assessing sensorimotor capacity with wearables in multiple sclerosis-a cross-sectional study

BACKGROUND

Wearable technologies are currently clinically used to assess energy expenditure in a variety of populations, e.g., persons with multiple sclerosis or frail elderly. To date, going beyond physical activity, deriving sensorimotor capacity instead of energy expenditure, is still lacking proof of feasibility.

METHODS

In this study, we read out sensors (accelerometer and gyroscope) of smartwatches in a sample of 90 persons with multiple sclerosis over the course of one day of everyday life in an inpatient setting. We derived a variety of different kinematic parameters, in addition to lab-based tests of sensorimotor performance, to examine their interrelation by principal component, cluster, and regression analyses.

RESULTS

These analyses revealed three components of behavior and sensorimotor capacity, namely clinical characteristics with an emphasis on gait, gait-related physical activity, and upper-limb related physical activity. Further, we were able to derive four clusters with different behavioral/capacity patterns in these dimensions. In a last step, regression analyses revealed that three selected smartwatch derived kinematic parameters were able to partially predict sensorimotor capacity, e.g., grip strength and upper-limb tapping.

CONCLUSIONS

Our analyses revealed that physical activity can significantly differ between persons with comparable clinical characteristics and that assessments of physical activity solely relying on gait can be misleading. Further, we were able to extract parameters that partially go beyond physical activity, with the potential to be used to monitor the course of disease progression and rehabilitation, or to early identify persons at risk or a sub-clinical threshold of disease severity.

Handgrip strength associates with effort-dependent lung function measures among adolescents with and without asthma

Studies have shown association between handgrip strength (HGS) and FEV1, but the importance of this in relation to asthma pathophysiology and diagnostics remains unclear. We investigated the relationship between HGS and lung function metrics and its role in diagnosing asthma. We included 330 participants (mean age: 17.7 years, males: 48.7%) from the COPSAC2000 cohort and analyzed associations between HGS, asthma status, spirometry measures (FEV1, FVC, MMEF, FEV1/FVC), airway resistance (sRaw), methacholine reactivity (PD20) and airway inflammation (FeNO). Finally, we investigated whether HGS improved FEV1 prediction and classification of asthma status. HGS was only associated with forced flows, i.e., positive association with FEV1 and FVC for both sexes in models adjusted for age, height, and weight (P < 0.023). HGS improved adjusted R2-values for FEV1 prediction models by 2-5% (P < 0.009) but did not improve classification of asthma status (P > 0.703). In conclusion, HGS was associated with the effort-dependent measures FEV1 and FVC, but not with airway resistance, reactivity, inflammation or asthma status in our cohort of particularly healthy adolescents, which suggests that the observed associations are not asthma specific. However, HGS improved the accuracy of FEV1 estimation, which warrants further investigation to reveal the potential of HGS in asthma diagnostics.

Association of Diaphragm Thickness and Respiratory Muscle Strength With Indices of Sarcopenia

OBJECTIVE

To evaluate the relationship between respiratory muscle strength, diaphragm thickness (DT), and indices of sarcopenia.

METHODS

This study included 45 healthy elderly volunteers (21 male and 24 female) aged 65 years or older. Sarcopenia indices, including hand grip strength (HGS) and body mass index-adjusted appendicular skeletal muscle (ASM/BMI), were measured using a hand grip dynamometer and bioimpedance analysis, respectively. Calf circumference (CC) and gait speed were also measured. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were obtained using a spirometer, as a measure of respiratory muscle strength. DT was evaluated through ultrasonography. The association between indices of sarcopenia, respiratory muscle strength, and DT was evaluated using Spearman's rank correlation test, and univariate and multiple regression analysis.

RESULTS

ASM/BMI (r=0.609, p<0.01), CC (r=0.499, p<0.01), HGS (r=0.759, p<0.01), and gait speed (r=0.319, p<0.05) were significantly correlated with DT. In the univariate linear regression analysis, MIP was significantly associated with age (p=0.003), DT (p<0.001), HGS (p=0.002), CC (p=0.013), and gait speed (p=0.026). MEP was significantly associated with sex (p=0.001), BMI (p=0.033), ASM/BMI (p=0.003), DT (p<0.001), HGS (p<0.001), CC (p=0.001) and gait speed (p=0.004). In the multiple linear regression analysis, age (p=0.001), DT (p<0.001), and ASM/BMI (p=0.008) showed significant association with MIP. DT (p<0.001) and gait speed (p=0.050) were associated with MEP.

CONCLUSION

Our findings suggest that respiratory muscle strength is associated with DT and indices of sarcopenia. Further prospective studies with larger sample sizes are needed to confirm these findings.

Association between Low Forced Vital Capacity and High Pneumonia Mortality, and Impact of Muscle Power

Impaired % predicted value forced vital capacity (% FVC) is related to higher all-cause mortality in aged adults, and strong muscle force may improve this relationship. A muscle disease, sarcopenia, causes higher mortality. We aimed to identify the unknown disease that relates impaired % FVC with higher mortality in aged adults among the three major leading causes of death, and the effect of strong leg force on this relationship. Cox proportional hazard model analyzed the longitudinal Tsurugaya cohort that registered 1048 aged Japanese for 11 years. The primary outcome was the relationship between % FVC and mortality by cancer, cardiovascular disease, or pneumonia. Exposure variables were % FVC or leg force divided by 80% or median values, respectively. The secondary outcome was the effects of leg force on the relationship. Among the diseases, % FVC < 80% was related only to higher pneumonia mortality (hazard ratio [HR], 4.09; 95% CI, 1.90-8.83) relative to the % FVC ≥ 80% group before adjustment. Adding the leg force as an explanatory variable reduced the HR to 3.34 (1.54-7.25). Weak leg force might indicate sarcopenia, and its prevention may improve higher pneumonia mortality risk related to impaired % FVC, which we may advise people in clinical settings.

Prediction of Lung Function Status Using Handgrip Strength and Anthropometry among the Healthy Malay Population in Malaysia

Lung function depends primarily on the strength of the intercostal muscles and the diaphragm, which is indirectly related to handgrip strength (HGS). This study aims to determine the predictability of lung functions using HGS among healthy adults of Malay ethnicity in Malaysia. This study also aims to compare the equation using HGS with equations without HGS, such as the Global Lung Initiative (GLI). This study was carried out among adults between 35 to 70 years of age residing in urban and rural Malaysia. A series of standardized questionnaires were used to collect socio-demographic information. Lung functions were measured using a portable spirometer and HGS was measured using a Jamar dynamometer. The predictability of lung function indices (FEV1 and FVC) using HGS, age, and height was determined using multiple linear regression (MLR). Prediction of lung function indices was also generated using models without HGS for comparison with the equation that used HGS from this study. Pearson correlation analysis showed that both dominant (r = 0.49; p < 0.001) and non-dominant (r = 0.58; p < 0.001) HGS had a moderate significant correlation with lung function. In the MLR model, HGS was a significant (p < 0.001) predictor of lung function indices (FEV1 and FVC). The correlation of the predicted and measured lung indices using the equation generated in this study, which includes HGS, was higher compared with other lung function test equations that do not include HGS. The equations from MLR could be used to predict lung function indices among healthy Malay adults. The measurement of HGS may be used as a screening tool for lung function status when spirometry is unavailable.

Accuracy of handgrip and respiratory muscle strength in identifying sarcopenia in older, community-dwelling, Brazilian women

Certain cut-off points for sarcopenia screening and diagnosis are arbitrary and based on European populations, with normative references often obtained from healthy young adults. Although respiratory skeletal muscle strength tests represent low-cost clinical measures commonly performed in clinical practice by health professionals, a gap remains regarding whether respiratory skeletal muscle strength tests are adequate and sensitive measures for sarcopenia screening. This study aimed to verify the value of handgrip and respiratory muscle strength as possible discriminators to identify sarcopenia and to establish cut-off points for sarcopenia screening in community-dwelling, Brazilian women. In a cross-sectional study, 154 community-dwelling, Brazilian women (65-96 years) were assessed for appendicular skeletal muscle mass, handgrip (HGS), and respiratory muscular strength, including maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). The data were analyzed using the ROC curve and the Youden Index determined cut-off points. Statistical significance was set at 5%. 88 participants (57%) were sarcopenic. MEP (OR 0.98 [95%CI 0.97, 1.00], p = 0.023) and HGS (OR 0.82 [95% CI 0.75, 0.90], p < 0.001) were independent factors for sarcopenia in older. The optimal cut-off points for identifying sarcopenia were ≤ 77 cmH2O for MEP (AUC = 0.72), and ≤ 20 kg for HGS (AUC = 0.80). Simple muscular strength tests, including HGS and MEP, may be considered in the identification of sarcopenia in older, community-dwelling, Brazilian women. Future work is still needed to assess external validation of the proposed cut-offs before the clinical application.

Respiratory sarcopenia: A position paper by four professional organizations

We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5-15.

The Association between the Respiratory System and Upper Limb Strength in Males with Duchenne Muscular Dystrophy: A New Field for Intervention?

Progressive, irreversible muscle weakness is the leading symptom of Duchenne muscular dystrophy (DMD), often resulting in death from respiratory muscle failure. Little is known about the relationship between the functioning of the respiratory system and the hand grip-a function which remains long preserved. This study aimed to investigate the interdependence between muscle strength and the function of both hand grip and the respiratory system in patients with DMD.

MATERIALS AND METHOD

The study included cohort patients, aged 6-17, with DMD, recruited from the Rare Disease Centre, Gdansk, Poland. Clinical status (Vignos scale, Brook scale), pulmonary function (respiratory muscle strength-MIP, MEP); spirometry (FEV1; FVC), as well as upper limb function (performance of the upper limb-PUL 2.0) and hand grip strength (HGS) (hand-held dynamometer) were evaluated in all participants.

RESULTS

Finally, 53 boys (mean age 11.41 ± 3.70 years, 25 non-ambulant) were included. Each of the participants presented a lower %pv of MIP (48.11 ± 27), MEP (38.11 ± 22), PUL (75.64 ± 27), and HGS (33.28 ± 18). There were differences between the ambulatory and non-ambulatory groups in values of MIP, MEP, FVC, PUL, HGS (p < 0.001 for all), and FEV1 (p < 0.013). There were correlations between PUL, HGS, and MIP (R = 0.56; R = 0.61, p < 0.001 both), MEP (R = 0.59; R = 0.62, p < 0.001), FVC (R = 0.77; R = 0.77, p < 0.001), and FEV1 (R = 0.77; R = 0.79; p < 0.001). These correlations were found for all participants, but non-ambulatory patients presented stronger relationships.

CONCLUSIONS

1. The pulmonary and upper limb functions were within the normal range in ambulatory and low in non-ambulatory patients with DMD, but the muscle strength of both systems was low, regardless of the stage of the disease. 2. There seems to be an interdependence between the respiratory system and upper limb strength in terms of muscle strength and function in DMD patients, which is stronger in non-ambulatory patients. This may be the basis for the creation of a new personalized plan in rehabilitation-the simultaneous rehabilitation of the respiratory and upper limb muscles. Further studies on this theory should be conducted.

Respiratory Muscle Strength in Patients with Coronary Heart Disease and Different Musculoskeletal Disorders

Aim. To measure respiratory muscle strength (RMS) in patients with coronary heart disease (CHD) and different musculoskeletal disorders (MSD).

Material and methods. Patients were divided in four groups according to the MSD. Group I included 52 (13.4%) patients with sarcopenia, group II included 28 (7.2%) patients with osteopenia, group III included 25 (6.5%) patients with osteosarcopenia, group IV included 282 (72.9%) patients without MSD. All patients underwent the assessment of maximal expiratory (МЕР) and maximal inspiratory mouth pressures (MIP).

Results. The mean RMS values were lower than the normative values, and the strength of the expiratory muscles was 1.25 times lower compared to the inspiratory muscles. Both of these parameters were within the normal range in 191 (49.3%) patients, and lower values were noted in 196 (50.7%). An isolated decrease in MIP was observed in 24.8% of patients, an isolated decrease in МЕР in 6.5%, a combined decrease in MIP and МЕР in 19.4% of patients. Comparative analysis of МЕР and MIP (depending on the MSD) did not demonstrate statistically significant differences. Lower МЕР (76.9%) and MIP (75%) values were noted mainly in the group of patients with sarcopenia. A similar pattern was notes in patients with osteosarcopenia and in patients without MSD. Normative values of RMS were observed in patients with osteopenia. Correlation analysis revealed a unidirectional relationship between RMS and the parameters of muscle function (hand grip strength, muscle area and musculoskeletal index) and a multidirectional relationship between МЕР and BMI (r -0.743, p=0.013), MIP and patient age (r -0.624, p=0.021).

Conclusion. Respiratory muscle weakness was diagnosed in half of the patients with coronary heart disease. There were no statistically significant differences in RMS between patients with MSD and isolated CHD, despite lower values in the group with MSD. Correlation analysis revealed an association between RMS and muscle function.

High Mortality in an Older Japanese Population with Low Forced Vital Capacity and Gender-Dependent Potential Impact of Muscle Strength: Longitudinal Cohort Study

Generally, weak muscle power is associated with high mortality. We aimed to evaluate the unknown association between % predicted value forced vital capacity (FVC% predicted) and mortality in asymptomatic older people, and the impact of muscle power on this association. We analyzed the Tsurugaya cohort that enrolled Japanese people aged ≥70 for 15 years with Cox proportional hazards model. Exposure variables were FVC% predicted and leg power. The outcome was all-cause mortality. The subjects were divided into quartiles by FVC% predicted or leg power, or into two groups by 80% for FVC% predicted or by the strongest 25% for leg power. Across 985 subjects, 262 died. The males with lower FVC% predicted exhibited higher mortality risks. The hazard ratio (HR) was 2.03 (95% CI 1.30−3.18) at the lowest relative to the highest groups. The addition of leg power reduced the HR to 1.78 (95% CI 1.12−2.80). In females, FVC% predicted under 80% was a risk factor and the HR was 1.67 (95% CI 1.05−2.64) without the effect of leg power. In FVC% predicted <80% males HRs were 2.44 (95% CI 1.48−4.02) in weak and 1.38 (95% CI 0.52−3.64) in strong leg power males, relative to ≥80% and strong leg power males. Low FVC% predicted was associated with high mortality with potential unfavorable effects of weak leg power in males.

Nutritional status in female patients with nontuberculous mycobacterial lung disease and its association with disease severity

Background

In women, slender body habitus has been reported to be one of the predisposing factors underlying the development and poor prognosis of non-tuberculous mycobacterial lung disease (NTM-LD). Given the lack of nutritional data contributing to treatment strategies, we aimed to clarify the nutritional status of female patients with NTM-LD and its association with disease severity.

Methods

In this single-center observational study, we enrolled 81 female outpatients with NTM-LD. Data on healthy women of similar ages were selected from our previous survey data and categorized as controls. First, we compared anthropometric and dietary survey data between patients and controls. Second, after the patients were categorized into relatively mild (mild, n = 40) and relatively severe groups (severe, n = 41) based on pulmonary X-ray-image finding scores, body composition, nutritional intake, and biochemical markers were compared between the groups. To identify nutritional factors associated with disease severity, logistic regression analyses were performed.

Results

Compared with controls, patients with NTM-LD had significantly lower energy intake, body mass index, body fat, and skeletal muscle mass (all p < 0.001). Compared with the mild group, the severe group had significantly lower skeletal muscle mass (p = 0.037), albumin (p = 0.029), transthyretin (prealbumin) (p = 0.002), retinol-binding protein (p = 0.011), and hemoglobin (p = 0.001); however, no between-group differences were observed in energy or nutrient intake. Logistic analyses revealed that transthyretin (p = 0.025) and hemoglobin (p = 0.003) levels were independent factors associated with disease severity.

Conclusions

This is the first study to comprehensively report the association between NTM-LD severity and nutritional status, including body composition, nutrient intake, and biomarkers. The results suggest that initiating nutritional therapy from the mild stage of the disease to prevent undernutrition is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-02109-5.

Association between changes in handgrip strength and depression in Korean adults: a longitudinal panel study

Depression in older adults is a global socioeconomic burden. Identifying factors, such as physical activity or exercise that can help prevent depression is important. We aimed to investigate the relationship between changes in handgrip strength and the presence of depression using longitudinal, nationwide data of older Korean adults. Data from the Korean Longitudinal Study of Aging were used in this study. A total of 6783 participants who had undergone a handgrip strength test and completed the short-form Center for Epidemiologic Studies Depression Scale (CESD-10-D) questionnaire from 2006 to 2018 were included. General estimating equations were used to assess the temporal effect of the changes in handgrip strength on depression. A decrease in handgrip strength was associated with high CESD-10-D scores (β = 0.1889 in men, β = 0.1552 in women). As a continuous variable, handgrip strength was negatively correlated with CESD-10-D scores(β = - 0.0166 in men, β = - 0.0196 in women). Changes in the handgrip strength were associated with depressive symptoms in our longitudinal study. Those who experienced a decrease in handgrip strength had severe depressive symptoms compared to those with unchanged or increased handgrip strength. These findings can be used to guide general health policies for the prevention of depression.

[Maximum expiratory pressure is a good predictor of the incidence of the frailty syndrome in elderly men]

This article aims to investigate the association between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) with the incidence of frailty syndrome (FS), in addition to testing the predictive ability of MIP and MEP to discriminate FS in elderly adults, according to sex. It is a longitudinal study with a five-year follow-up period (2014-2019), carried out with 104 elderly adults registered in the Family Health Strategy of a municipality in Bahia. The incidence of frailty syndrome was diagnosed according to criteria proposed by Fried et al., using data from 2019, after a five-year follow-up. The MIP and MEP were evaluated according to the recommendations of the Brazilian Society of Pulmonology and Phthisiology data in 2014 (baseline data). The total incidence of frailty syndrome was 16.3% (95%CI: 9.2-23.6), with 13.6% (95%CI: 4.56-22.55) in women and 20% (95%CI: 7.85-32.15) in men. The mean values of MIP and MEP were, respectively, 60,8±21,2 cmH2O and 76,7±23,1 cmH2O in women, and 79,5±27,0 cmH2O and 114,7±29,8 cmH2O in men. The frailty syndrome was associated with MEP in elderly adult men (adjusted RR: 0.96; 95%CI: 0.95-0.98; P-value: 0.002), indicating that the increase of 1cmH2O in MEP reduces by 4% the risk of developing the syndrome.

Association between sarcopenia and respiratory function in elderly orthopedic outpatients

The relationship between sarcopenia and respiratory function has not been investigated in elderly Japanese orthopedic outpatients. This study aimed to assess the relationship between sarcopenia and respiratory function in elderly orthopedic outpatients in Japan. Elderly outpatients (n = 102; aged ≥65 years) with orthopedic diseases were enrolled in the study. Muscle mass was measured using the bioelectrical impedance analysis. Grip strength and walking speed were measured (2 trials). The respiratory function (e.g., percent vital capacity [VC] and percent forced expiratory volume in 1 second) was also measured. The association between sarcopenia and respiratory function was assessed using logistic regression analysis, adjusting for sex, comorbidities, and smoking status. The mean ages for men and women were 77.7 ± 8.3 and 76.5 ± 6.8 years, respectively, and the overall prevalence of sarcopenia was 25.5% (30.0% and 24.4% in men and women, respectively). The study demonstrated that low respiratory function, which was represented by decreased percent VC, was associated with sarcopenia in outpatients visiting an orthopedic department (odds ratio, 1.73; 95% confidence interval: 1.02-2.97). Sarcopenia was significantly associated with a lower percentage of VC in orthopedic outpatients after adjustment for sex, comorbidity, and smoking. Further studies are needed to determine the causality.

Air pollution enhance the progression of restrictive lung function impairment and diffusion capacity reduction: an elderly cohort study

BACKGROUND

Some evidences have shown the association between air pollution exposure and the development of interstitial lung diseases. However, the effect of air pollution on the progression of restrictive ventilatory impairment and diffusion capacity reduction is unknown. This study aimed to evaluate the effects of long-term exposure to ambient air pollution on the change rates of total lung capacity, residual volume, and diffusion capacity among the elderly.

METHODS

From 2016 to 2018, single-breath helium dilution with the diffusion capacity of carbon monoxide was performed once per year on 543 elderly individuals. Monthly concentrations of ambient fine particulate matters (PM_2.5) and nitric dioxide (NO₂) at the individual residential address were estimated using a hybrid Kriging/Land-use regression model. Linear mixed models were used to evaluate the association between long-term (12 months) exposure to air pollution and lung function with adjustment for potential covariates, including basic characteristics, indoor air pollution (second-hand smoke, cooking fume, and incense burning), physician diagnosed diseases (asthma and chronic airway diseases), dusty job history, and short-term (lag one month) air pollution exposure.

RESULTS

An interquartile range (5.37 ppb) increase in long-term exposure to NO₂ was associated with an additional rate of decline in total lung volume (- 1.8% per year, 95% CI: - 2.8 to - 0.9%), residual volume (- 3.3% per year, 95% CI: - 5.0 to - 1.6%), ratio of residual volume to total lung volume (- 1.6% per year, 95% CI: - 2.6 to - 0.5%), and diffusion capacity (- 1.1% per year, 95% CI: - 2.0 to - 0.2%). There is no effect on the transfer factor (ratio of diffusion capacity to alveolar volume). The effect of NO₂ remained robust after adjustment for PM_2.5 exposure.

CONCLUSIONS

Long-term exposure to ambient NO₂ is associated with an accelerated decline in static lung volume and diffusion capacity in the elderly. NO₂ related air pollution may be a risk factor for restrictive lung disorders.

Serum Creatinine to Cystatin C Ratio is an Effective Indicator for Muscle Strength Decline in Men with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Purpose

This study explored the value of the serum creatinine/cystatin C (Cr/CysC) ratio in diagnosing the reduction of muscle strength in men with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Patients and Methods

In this study, we enrolled 72 male patients with AECOPD and 32 male patients with stable chronic obstructive pulmonary disease (COPD). We compared clinical characteristics between the AECOPD and stable COPD groups. Then, we subdivided AECOPD patients into normal muscle strength and low muscle strength groups; we compared the clinical characteristics between these two groups. We analyzed the relationships of serum creatinine (Cr), cystatin C (CysC), and Cr/CysC ratio with clinical characteristics in male AECOPD patients. We also investigated whether the Cr/CysC ratio could aid in the diagnosis of muscle strength decline via receiver operating characteristic curve and binary logistic regression analysis.

Results

We found that handgrip strength, Cr/CysC ratio, serum Cr, FEV₁, FVC, and FEV₁%pred were lower in AECOPD patients than in stable COPD patients. Among AECOPD patients, BMI, weight, FEV₁, FVC, FEV₁%pred, and Cr/CysC ratio were lower in the low muscle strength group than in the normal muscle strength group; there were more patients with ≥2 acute exacerbations within the past year in the low muscle strength group. The Cr/CysC ratio was correlated with handgrip strength, FEV₁, FVC, FEV₁%pred, BMI and weight. The area under curve for low handgrip strength was greater for the Cr/CysC ratio than for Cr. Binary logistic regression analysis showed that a Cr/CysC ratio <0.99 was a risk factor for decreased muscle strength in male patients with AECOPD.

Conclusion

The Cr/CysC ratio is a useful predictor of muscle strength decline in male AECOPD patients, while a low Cr/CysC ratio is a risk factor for muscle strength decline in male patients with AECOPD.

Acute changes in handgrip strength, lung function and health-related quality of life following cardiac surgery

Background

Handgrip strength (HGS), lung function and health-related quality of life (HRQoL) are relevant indicators of future cardiovascular risk and mortality. The impact of cardiac surgery on these predictive variables has been under-explored. The aim of this study was to determine the acute (within hospital) changes in HGS, lung function and HRQoL, and their relationships, in adults undergoing elective cardiac surgery. Further, the study examined the relationship between these variables and the predictors for lung function and HRQoL in these patients.

Methods

The study was a prospective cohort study that involved 101 patients who completed pre-operative (1–2 days before surgery) and physiotherapy discharge (5–7 days after surgery) assessments. Handgrip strength, lung function and HRQoL were assessed using JAMAR dynamometers, Vitalograph-Alpha or EasyOne spirometer, and Short-Form 36 questionnaire, respectively. Changes in these variables and their relationships were analysed using paired t-test and Pearson correlation coefficients, respectively. Prediction of lung function and HRQoL using HGS and other co-variates was conducted using regression analysis.

Results

At the time of physiotherapy discharge, lung function, HGS and the physical component of HRQoL were significantly (<0.001) reduced compared to their pre-operative values. Significant (<0.001) and moderate correlations were identified between HGS and lung function at pre-operation and physiotherapy discharge. Handgrip strength was a significant predictor of lung function pre-operatively but not at physiotherapy discharge. Pre-operative lung function and HRQoL, as well as other variables, were significant predictors of lung function and HRQoL during physiotherapy discharge.

Conclusions

Undergoing cardiac surgery acutely and significantly reduced lung function, HGS and physical component of HRQoL in adults with cardiac disease. Assessment of HGS at physiotherapy discharge may be a poor indicator of operative changes in lung function and HRQoL. Clinicians may consider HGS as an inadequate tool in predicting lung function and HRQoL following cardiac surgery.

Sarcopenia is not associated with inspiratory muscle strength but with expiratory muscle strength among older adults requiring long-term care/support

BACKGROUND

Recently, the concept of respiratory sarcopenia has been advocated, but evidence is lacking regarding which respiratory parameters are appropriate indicators. Therefore, we investigated the association between sarcopenia, respiratory function, and respiratory muscle strength to identify the most appropriate parameters for respiratory sarcopenia.

METHODS

We included 124 older adults (67 men, 57 women; average age 77.2 ± 8.3 years) requiring long-term care/support who underwent Day Care for rehabilitation. Handgrip strength, usual gait speed, and skeletal muscle mass were measured using bioelectrical impedance analysis. Participants were then diagnosed with sarcopenia using the algorithm of the Asian Working Group for Sarcopenia 2019. Parameters of respiratory function (forced vital capacity, forced expiratory volume in one second [FEV1.0], FEV1.0%, and peak expiratory flow rate) and respiratory muscle strength (maximal expiratory pressure [MEP] and maximal inspiratory pressure) were also measured according to American Thoracic Society guidelines. Respiratory parameters significantly related to sarcopenia were identified using binomial logistic regression and receiver operating characteristic analyses.

RESULTS

Seventy-seven participants were classified as having sarcopenia. Binomial logistic regression analysis showed that MEP was the only respiratory parameter significantly associated with sarcopenia. The cut-off MEP value for predicting sarcopenia was 47.0 cmH₂0 for men and 40.9 cmH₂0 for women.

CONCLUSIONS

The most appropriate parameter for assessing respiratory sarcopenia may be MEP, which is an indicator of expiratory muscle strength, rather than FVC, MIP, or PEFR, as suggested in previous studies. Measuring MEP is simpler than measuring respiratory function parameters. Moreover, it is expected to have clinical applications such as respiratory sarcopenia screening.

Are maximum respiratory pressures predictors of sarcopenia in the elderly?

Objective:

To compare maximum respiratory pressures and spirometric parameters among elderly individuals classified as having no sarcopenia, probable sarcopenia, and confirmed sarcopenia, and to test the ability of these variables to discriminate sarcopenia in a community-dwelling elderly population.

Methods:

This was a cross-sectional study involving 221 elderly (≥ 60 years of age) individuals of both sexes. Sarcopenia was diagnosed in accordance with the new consensus of the European Working Group on Sarcopenia in Older People. Maximum respiratory pressures and spirometry parameters were assessed.

Results:

The prevalences of probable sarcopenia and confirmed sarcopenia were 20.4% and 4.1%, respectively. Regardless of the sex, those with confirmed sarcopenia had significantly lower MEP than those with no sarcopenia and probable sarcopenia, whereas only males with confirmed sarcopenia presented with significantly lower MIP than did the other individuals. There was an inverse association of MIP and MEP with sarcopenia, indicating that the decrease by 1 cmH₂O in these parameters increases the chance of sarcopenia by 8% and 7%, respectively. Spirometric parameters were not associated with sarcopenia. Cutoff points for MIP and MEP, respectively, were ≤ 46 cmH₂O and ≤ 50 cmH₂O for elderly women, whereas they were ≤ 63 cmH₂O and ≤ 92 cmH₂O for elderly men, and both were identified as predictors of sarcopenia (area under the ROC curve > 0.70).

Conclusions:

Sarcopenia was associated with lower maximum respiratory pressures, but not with spirometric parameters. Maximum respiratory pressures can be used as markers of sarcopenia in a community-dwelling elderly population regardless of the sex.

The Relationship between Sarcopenia and Respiratory Muscle Weakness in Community-Dwelling Older Adults

An association between respiratory muscle weakness and sarcopenia may provide a clue to the mechanism of sarcopenia development. We aimed to clarify this relationship among community-dwelling older adults. In total, 117 community-dwelling older adults were assessed and classified into 4 groups: robust, respiratory muscle weakness, sarcopenia, and respiratory sarcopenia. The respiratory sarcopenia group (12%) had a significantly higher percentage of males and had lower BMI, skeletal muscle index, skeletal muscle mass, phase angle, and oral function than the robust group (32.5%). All physical functions were significantly lower. The respiratory muscle weakness group (54.7%) had a significantly lower BMI and slower walking speed, compared with the robust group. The sarcopenia group (0.8%) was excluded from the analysis. The percent maximum inspiratory pressure was significantly lower in both the respiratory muscle weakness and respiratory sarcopenia groups, compared with the robust group. Almost all participants with sarcopenia showed respiratory muscle weakness. In addition, approximately 50% had respiratory muscle weakness, even in the absence of systemic sarcopenia, suggesting that respiratory muscle weakness may be the precursor of sarcopenia. The values indicating physical function and skeletal muscle mass in the respiratory muscle weakness group were between those in the robust and the respiratory sarcopenia groups.

Correlation between Handgrip Strength and Rapid Shallow Breathing Index for Assessment of Weaning from Mechanical Ventilation

Background

Assessment of weaning from mechanical ventilation (MV) is an important process. Rapid shallow breathing index (RSBI) is a standard tool to evaluate a patient's readiness before the spontaneous breathing trial (SBT). Handgrip strength (HGS) is an alternative method for assessment of respiratory muscle strength. Relationship between HGS and RSBI has not been explored. This study aimed to determine the correlation between HGS and RSBI to predict successful extubation in mechanically ventilated patients.

Methods

A prospective study was conducted in screened 120 patients requiring MV with tracheal intubation >48 h. HGS was performed at 48 h after intubation, 10 min before and 30 min after SBT, and 1 h after extubation. RSBI was performed at 10 min before SBT.

Results

A total of 93 patients (58% men) were included in the final analysis. Mean age was 71.6 ± 15.2 years. Patients admitted in general medical wards were 84.9%. APACHE II score was 13.5 ± 4.7. Most patients were intubated from pneumonia (39.8%). Weaning failure was 6.5%. The main result shows that HGS was negatively correlated with RSBI (regression coefficient −0.571, P < 0.001). The equation for predicting RSBI, derived from the linear regression model, was predicted RSBI (breaths/min/L) = 39.285 + (age ∗ 0.138)–(HGS ∗ 0.571).

Conclusions

HGS had significantly negative correlation with RSBI for assessment of weaning from MV. A prospective study of the HGS cutoff value is needed to investigate the difference between patients who succeeded and those who failed extubation. This trial is registered with TCTR20180323004.

Type 2 Diabetes Mellitus Related to Decreased Peripheral and Respiratory Muscle Strength in Sarcopenic Thai Elderly

BACKGROUND

Age is related to a decline in muscle mass and physical function in both respiratory and peripheral muscle strength, which could lead to mobility and mortality. In addition, older people have suffered from one or multiple chronic conditions in particular in type 2 Diabetes Mellitus (type 2 DM). However, a few studies have reported the relationship between sarcopenic elderly and respiratory and peripheral muscle strengths in type 2DM.

OBJECTIVE

To explore the prevalence of sarcopenia in type 2 DM elderly people among community- dwelling patients and the relationships with peripheral and respiratory muscle loss in sarcopenic type 2 DM older patients.

METHODS

A total of 330 older individuals were recruited from community-dwelling centers. Respiratory muscle and quadriceps muscle were assessed. According to the defined criteria for sarcopenia (defined by Asian Working Group for Sarcopenia), muscle mass, gait speed (six-meter walk test), and handgrip strength were examined.

RESULTS

Of 330 elderly people, 82 volunteers had a history of type 2 DM. Participants with type 2DM had a risk for sarcopenia (odds ratio= 2.324, 95% CI=1.251-4.317). The prevalence of sarcopenia was 25.61% among older participants with type 2 DM. In addition, decreased respiratory muscle strength and quadriceps muscle strength were observed in type 2 DM with sarcopenia compared to type 2 DM with non-sarcopenia. These relationships also remained after controlling for age and sex.

CONCLUSION

Sarcopenia in type 2 DM leads to a decrease in respiratory muscle and peripheral muscle strength.

Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.

Handgrip strength cutoff value predicting successful extubation in mechanically ventilated patients

Background

Handgrip strength (HGS) is an alternative tool to evaluate respiratory muscle function. HGS cutoff value indicating extubation success or failure has not been investigated. This study aimed to determine HGS cutoff value to predict successful extubation.

Methods

A prospective study was conducted. Patients requiring intubated mechanical ventilation with intubation ≥ 48 hours in medical wards were recruited. HGS test was performed at 10 minutes before and 30 minutes after spontaneous breathing trial (SBT). Rapid shallow breathing index (RSBI) was measured at 10 minutes before SBT.

Results

Ninety-three patients (58% men) were included. Mean age was 71.6 ± 15.2 years. Weaning failure rate was 6.5%. The area under the ROC curve of 0.84 for the best HGS cutoff value at 10 minutes before SBT was 12.7 kg, with 75.9% sensitivity and 83.3% specificity (P = 0.005). The best HSG cutoff value at 30 minutes after SBT was 14.9 kg, with the area under the ROC curve of 0.82, with 58.6% sensitivity and 83.3% specificity (P = 0.009). The best RSBI cutoff value was 43.5 breaths/min/L, with the area under the ROC curve of 0.46, 33.3% sensitivity and 66.6% specificity (P = 0.737).

Conclusions

HGS may be a predictive tool to guide extubation with better sensitivity and specificity than RSBI. A prospective study is needed to verify HGS test as adjunctive to RSBI in ventilator weaning protocol.

Dietary Protein Requirement Threshold and Micronutrients Profile in Healthy Older Women Based on Relative Skeletal Muscle Mass

Although multiple nutrients have shown protective effects with regard to preserving muscle function, the recommended amount of dietary protein and other nutrients profile on older adults for maintenance of high muscle mass is still debatable. The aims of this paper were to: (1) identify dietary differences between older women with low and high relative skeletal muscle mass, and (2) identify the minimal dietary protein intake associated with high relative skeletal muscle mass and test the threshold ability to determine an association with skeletal muscle phenotypes. Older women (n = 281; 70 ± 7 years, 65 ± 14 kg), with both low and high relative skeletal muscle mass groups, completed a food questionnaire. Skeletal muscle mass, fat-free mass (FFM), biceps brachii thickness, vastus lateralis anatomical cross-sectional area (VL_ACSA), handgrip strength (HGS), maximum elbow flexion torque (MVC_EF), maximum knee extension torque (MVC_KE), muscle quality (HGS/Body mass), and fat mass were measured. Older women with low relative skeletal muscle mass had a lower daily intake of protein, iodine, polyunsaturated fatty acid (PUFA), Vit E, manganese, milk, fish, nuts and seeds (p < 0.05) compared to women with high relative skeletal muscle mass. The minimum required dietary protein intake for high relative skeletal muscle mass was 1.17 g/kg body mass/day (g/kg/d) (sensitivity: 0.68; specificity: 0.62). Women consuming ≥1.17 g/kg/d had a lower BMI (B = -3.9, p < 0.001) and fat mass (B = -7.8, p < 0.001), and a higher muscle quality (B = 0.06, p < 0.001). The data indicate that to maintain muscle mass and function, older women should consume ≥1.17 g/kg/d dietary protein, through a varied diet including milk, fish and nuts that also contain polyunsaturated fatty acid (PUFA) and micronutrients such as iodine, Vit E and manganese.

Unbiased, comprehensive analysis of Japanese health checkup data reveals a protective effect of light to moderate alcohol consumption on lung function

The overall effect of lifestyle habits, such as alcohol consumption, on general health remains controversial and it is important to clarify how such habits affect aging-related health impairments. To discover novel impacts of lifestyle on general health, we employed a mathematical approach to perform a comprehensive, unbiased, cross-sectional analysis of data from 6036 subjects who participated in a Japanese health checkup. Notably, we found that moderate alcohol consumption was positively correlated with lung function, muscle mass, and strength. Health checkup data were collected periodically from the same subjects. These people were light to moderate drinkers who had high health awareness and were basically free of major underlying diseases. We next analyzed 5 years of data from 1765 of these subjects. We found that higher baseline alcohol consumption, as well as increased alcohol intake over 5 years attenuated time-related deterioration of forced vital capacity without affecting total lung volume. This effect was independent of smoking. Our study suggests a possible protective effect of moderate amounts of alcohol on lung function, due to increased muscle mass/strength and forced vital capacity.

Relationship between handgrip strength and lung function in adults: a systematic review

Handgrip strength (HGS) is a functional test that has been directly associated with lung function in some healthy populations; however, inconsistent findings have been reported for populations with chronic diseases. The aim of this study was to identify the relationship between HGS and lung function in both healthy and unhealthy adults. A systematic search was conducted using six databases from their earliest inception to February 29, 2020. Two authors reviewed and assessed methodological quality of eligible studies using the Crowe Critical Appraisal Tool (CCAT). Twenty-five studies met the inclusion criteria with 8 and 17 studies examining healthy and unhealthy populations, respectively. Reported average methodological quality of all included studies using the CCAT was 38-85% with most rated as Good to Excellent. Despite the use of heterogeneous equipment and protocols during HGS and lung function assessments, significant positive and moderate correlations and/or regression coefficients were reported for healthy populations consistently. Conversely, the reported relationships between HGS and lung function for unhealthy counterparts were variable. Handgrip strength was significantly associated with lung function in most healthy adults. Future robust studies are needed to confirm the suitability of HGS to assess lung function for healthy and unhealthy adults.

Inspiratory Muscle Strength and Cardiorespiratory Fitness Association With Health-Related Quality of Life in Healthy Older Adults

The main purpose of this study was to explore similarities and differences in the association between two capabilities affecting the cardiorespiratory system (overall and multifactorial cardiorespiratory fitness and inspiratory muscle strength) and the health-related quality of life (HRQoL), in a group of active healthy seniors. Sixty-five individuals (age, 73.01 ± 5.27 years; 53 women) who participated regularly in a multicomponent training program completed the EuroQol 5D-5L questionnaire, the 6-min walking test (6MWT), and the maximum inspiratory pressure test (MIP). Non-parametric correlations (Spearman's rho) were conducted to analyze the association between HRQoL indices (EQindex and EQvas), MIP, and 6MWT, considering both, the whole sample and men and women separately. Furthermore, partial correlation was made by controlling age and sex. We found a moderate association between HRQoL and cardiorespiratory fitness (EQvas: r = 0.324, p = 0.009; EQindex: r = 0.312, p = 0.011). Considering sex, relationship EQvas-6MWT decrease to small (r = 0.275; p = 0.028) whereas EQindex-6MWT remained moderated (r = 0.425; p = 0.000). When we considered women and men separately, the association between HRQoL and 6MWT appeared only in women, while the observed strong trend (p = 0.051) toward a large and positive association between EQindex and MIP, mediated by the covariate age, appeared only in men. Conversely to the cardiorespiratory fitness, MIP is not a limiting factor of HRQoL in healthy active elderly. Moreover, MIP and HRQoL should be included in the assessment of exercise interventions because they provide different information about the cardiorespiratory system deterioration. Similarly, EQvas and EQindex confirm to be complementary in the assessment of HRQoL. Furthermore, like aging process is different for men and women, the association between MIP and cardiorespiratory fitness with HRQoL may behave differently, so keeping on research these associations could help to improve training programs for this population.

Handgrip Force and Maximum Inspiratory and Expiratory Pressures in Critically Ill Patients With a Tracheostomy

BACKGROUND

The association between peripheral striated muscle strength and respiratory muscle strength has been confirmed in a number of disorders. However, this association is unknown in intensive care unit patients with tracheostomies.

OBJECTIVE

To examine correlations between handgrip force, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) in intensive care unit patients with tracheostomies.

METHODS

Twenty patients (7 women, 13 men) with tracheostomies, in the intensive care unit longer than 11 days, in stable condition, with functional limbs, and with Glasgow Coma Scale scores of 15 were recruited. Both MIP and MEP were measured with a membrane manometer; handgrip force was measured with a hydraulic hand dynamometer.

RESULTS

Handgrip force was significantly correlated with MIP (r = 0.45, P = .04) and MEP (r = 0.78, P = .001). Handgrip force was significantly predicted by MIP and MEP when the effect of sex was controlled for (P < .05). However, when MIP and MEP were included as predictors in a regression model, MEP was the only significant predictor (R = 0.80, R2 = 0.63, adjusted R2 = 0.57).

CONCLUSIONS

Strength of the hand flexors and strength of the expiratory muscles (abdominal) were significantly correlated in intensive care unit patients. Handgrip strength appears to be an easy, fast way to evaluate expiratory muscle strength by using a simple handhold command without special equipment. A strong handhold may also correspond to strong expiratory muscles. ClinicalTrials.gov: NCT03457376.

Peak expiratory flow rate and sarcopenia risk in older Indonesian people: A nationwide survey

Reduced peak expiratory flow is a common physiological change in older individuals and age is an important predictor for sarcopenia. We analyzed nationwide survey data to determine the relationship between peak expiratory flow rate and sarcopenia in older Indonesians. Community-dwelling Indonesian individuals aged ≥60 years (n = 2422; mean age = 67.21 y) from the fifth-wave data of the Indonesian Family Life Survey was selected. Sarcopenia was diagnosed based on handgrip strength, gait speed, and appendicular skeletal muscle mass measurements. Peak expiratory flow rates (PEFRs) were categorized according to their percentage of predicted flow rates as <50%, 50% to 80%, and >80%. Confounders previously determined to be associated with sarcopenia occurrence were included. Sarcopenia prevalence was 50.25%. After adjustment for confounders, PEFRs of <50% and 50% to 80% were associated with an increased sarcopenia risk (odds ratio = 5.22 and 1.88, respectively) compared with PEFRs of >80%. Poor lung function was independently associated with sarcopenia occurrence. Future studies should explore the usefulness of PEFR as a risk factor of sarcopenia.

Respiratory Sarcopenia and Sarcopenic Respiratory Disability: Concepts, Diagnosis, and Treatment

The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.

Relationship between respiratory muscle strength and grip strength in institutionalized and community-dwelling older adults

OBJECTIVE: To evaluate the relationship between respiratory muscle strength and grip strength in institutionalized and community-dwelling older adults. METHODS: This cross-sectional study had 64 voluntary participants, and 33 were institutionalized and 31 lived in the community. Maximal inspiratory pressure, maximal expiratory pressure, peak expiratory flow, grip strength, anthropometric data, and physical activity level were assessed. RESULTS: In the institutionalized group, there was no correlation between respiratory variables and grip strength, but maximal expiratory pressure was the respiratory predictor most strongly associated with grip strength (p = 0.04). In the community-dwelling group, there was a correlation between maximal inspiratory pressure and grip strength (r = 0.54), maximal expiratory pressure and grip strength (r = 0.62), and peak expiratory flow and grip strength (r = 0.64); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). In a joint group analysis, there was an association between maximal inspiratory pressure and grip strength (r = 0.40), maximal expiratory pressure and grip strength (r = 0.57), and peak expiratory flow and grip strength (r = 0.57); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). CONCLUSIONS: Peak expiratory flow and maximal expiratory pressure seem to be good predictors of grip strength in community-dwelling older adults, but this relationship does not seem to be maintained in institutionalized patients, possibly because of a greater loss of respiratory function.

Association between skeletal muscle mass index and lung function/respiratory muscle strength in older adults requiring long-term care or support

[Purpose] We focused on skeletal muscle mass index, one of the biomarkers of sarcopenia, and investigated the association between skeletal muscle mass index and the parameters of lung function and respiratory muscle strength. [Participants and Methods] After applying the exclusion criteria, we included, in this cross-sectional study, 120 community-dwelling older adults aged ≥65 years who required long-term care/support and underwent ambulatory rehabilitation under the long-term care insurance system in Japan. We measured the skeletal muscle mass index, forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow rate, maximum expiratory pressure, and maximum inspiratory pressure. The data were analyzed using Pearson correlation coefficient and multiple regression analysis. [Results] The skeletal muscle mass index was positively correlated with only maximum expiratory pressure for both male and female participants by Pearson's correlation coefficient. With the skeletal muscle mass index as a dependent variable, only the maximum expiratory pressure was significant for both male and female participants by the multiple regression analysis. [Conclusion] Therefore, the findings of this study suggested that compared with lung function tests, maximum expiratory pressure, which is an indicator of respiratory muscle strength, is related to muscle mass. Maximum expiratory pressure might be the most useful indicator for sarcopenia.

Respiratory Muscle Strengths and Their Association with Lean Mass and Handgrip Strengths in Older Institutionalized Individuals

The study of reduced respiratory muscle strengths in relation to the loss of muscular function associated with ageing is of great interest in the study of sarcopenia in older institutionalized individuals. The present study assesses the association between respiratory muscle parameters and skeletal mass content and strength, and analyzes associations with blood cell counts and biochemical parameters related to protein, lipid, glucose and ion profiles. A multicenter cross-sectional study was performed among patients institutionalized in nursing homes. The respiratory muscle function was evaluated by peak expiratory flow, maximal respiratory pressures and spirometry parameters, and skeletal mass function and lean mass content with handgrip strength, walking speed and bioimpedance, respectively. The prevalence of reduced respiratory muscle strength in the sample ranged from 37.9% to 80.7%. Peak expiratory flow significantly (p < 0.05) correlated to handgrip strength and gait speed, as well as maximal inspiratory pressure (p < 0.01). Maximal expiratory pressure significantly (p < 0.01) correlated to handgrip strength. No correlation was obtained with muscle mass in any of parameters related to reduced respiratory muscle strength. The most significant associations within the blood biochemical parameters were observed for some protein and lipid biomarkers e.g., glutamate-oxaloacetate transaminase (GOT), urea, triglycerides and cholesterol. Respiratory function muscle parameters, peak expiratory flow and maximal respiratory pressures were correlated with reduced strength and functional impairment but not with lean mass content. We identified for the first time a relationship between peak expiratory flow (PEF) values and GOT and urea concentrations in blood which deserves future investigations in order to manage these parameters as a possible biomarkers of reduced respiratory muscle strength.

The Effect of a Pulmonary Rehabilitation on Lung Function and Exercise Capacity in Patients with Burn: A Prospective Randomized Single-Blind Study

We performed pulmonary function (PF) tests and factors affecting PF evaluation in 120 patients with inhalation injury to evaluate the effects of pulmonary rehabilitation (PR) in burn patients with inhalation injury. Patients were randomized into pulmonary rehabilitation (PR) group and conventional rehabilitation (CON) group. PF tests, including forced vital capacity (FVC), 1-s forced expiratory volume FEV1), maximum voluntary ventilation (MVV), and respiratory muscles strength (maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP)), were measured by mouth pressure meter in the sitting position. Diffusing capacity for carbon monoxide (DLco) was determined by the single-breath carbon monoxide technique. Peak cough flow (PCF) was measured by a peak flow meter. Diaphragmatic mobility (DM) was evaluated on anteroposterior fluoroscopy. All evaluations were performed in all groups at baseline and after 12 weeks. There were no differences in evaluations between the PR group and CON group before the intervention. There were significant improvements in the PCF and MIP (%) changes, taken before and after rehabilitation in the PR group, compared with the changes in the CON group (p = 0.01, and p = 0.04). There were no significant changes in the other parameters in the PR group compared with the changes in the CON group (p > 0.05). There were significant differences in DLco (%), MIP, MIP (%), and DM between the PR group and the CON group (p = 0.02, p = 0.005, and p = 0.001) after 12 weeks of rehabilitation. There were no differences between the PR group and CON group after 12 weeks rehabilitation in the other parameters (p > 0.05). PR for patients with major burns and smoke inhalation induced improved PCF, MIP, MIP (%), DLco (%), and DM. These results show that PR should be a fundamental component of the treatment program for patients with burns.

Interest of hand grip strength to predict outcome in mechanically ventilated patients

BACKGROUND

Weaning from mechanical ventilation is a crucial process for critically ill patients. Hand grip strength (HGS) is an assessment tool for respiratory muscle function to assist guidance of extubation.

OBJECTIVE

To evaluate HGS as a predictor for in-hospital clinical outcomes in mechanically ventilated patients.

METHODS

A prospective study was conducted. Patients requiring mechanical ventilation with tracheal intubation in medical wards and intensive care units were recruited. HGS, reintubation, number of ventilator-free days and mortality were recorded.

RESULTS

A total of 34 patients (52.9% men) were included. When compared to the non re-intubation group, the re-intubation group had significantly lower HGS at 10 min and 30 min after starting spontaneous breathing trial (7.6 ± 4.8 kg Vs 13.4 ± 6.5 kg, P = 0.045, and 8 ± 5.1 kg Vs 13.2 ± 5.7 kg, P = 0.047). Moreover, at 1 h and 48 h of post extubation, the re-intubation group had lower HGS than the non re-intubation group. HGS at 1 h of post extubation was positively correlated with ventilator-free day at 28 days (r = 0.34, P = 0.05). HGS did not differ between survival group and death group in hospital over time.

CONCLUSIONS

Hand grip strength may be a predictive tool for extubation failure in mechanically ventilated patients. Low strength corresponded to significantly increased re-intubation rate. Furthermore, this measurement could not predict in-hospital mortality.

Relationship Between Low Handgrip Strength and Chronic Kidney Disease: KNHANES 2014-2017

OBJECTIVE

Accelerated loss of muscle mass is common in patients with chronic kidney disease (CKD). Various factors associated with CKD, such as nutritional deficiencies, metabolic acidosis, and chronic inflammation, contribute to muscle wasting. This study aimed to investigate the relationship between CKD and handgrip strength (HGS) in the Korean population.

DESIGN AND METHODS

This is a population-based, cross-sectional study of a nationally representative sample of 18,765 patients aged ≥19 years from the Korea National Health and Nutrition Examination Survey in 2014-2017. We measured HGS using a digital hand dynamometer and determined the cutoff for low HGS by deriving -2 standard deviation values of sex-matched healthy young adults (19-39 years old). We defined CKD as eGFR <60 mL/min/1.73 m² or the presence of CKD based on a self-reported questionnaire.

RESULTS

The prevalence of CKD was 4.0% in the total population. The cutoff values for the low HGS were 29.5 kg for men and 16.8 kg for women. The prevalence of low HGS was 6.2% in patients without CKD, and 25.2% in patients with CKD. There was a significant correlation between HGS and eGFR in both men and women. In multivariate logistic regression adjusted by age group, diabetes, hypertension, and obesity, CKD showed an independent relationship with low HGS in both men (odds ratio [OR] 1.910, 95% confidence interval [CI] 1.468-2.485) and women (OR 1.570, 95% CI 1.202-2.052).

CONCLUSIONS

The prevalence of low HGS was higher in patients with CKD. We suggest that the sarcopenia should be evaluated in patients with CKD.