Association of handgrip strength with chronic diseases and multimorbidity: a cross-sectional study

Could self-reported physical performance help predict individuals at the highest risk of mortality and hospital admission events in clinical practice? Findings from the Hertfordshire Cohort Study

AIM

To consider how self-reported physical function measures relate to adverse clinical outcomes measured over 20 years of follow-up in a community-dwelling cohort (aged 59-73 at baseline) as compared with hand grip strength, a well-validated predictor of adverse events.

BACKGROUND

Recent evidence has emphasized the significant association of physical activity, physical performance, and muscle strength with hospital admissions in older people. However, physical performance tests require staff availability, training, specialized equipment, and space to perform them, often not feasible or realistic in the context of a busy clinical setting.

METHODS

In total, 2997 men and women were analyzed. Baseline predictors were measured grip strength (Jamar dynamometer) and the following self-reported measures: physical activity (Dallosso questionnaire); physical function score (SF-36 Health Survey); and walking speed. Participants were followed up from baseline (1998-2004) until December 2018 using UK Hospital Episode Statistics and mortality data, which report clinical outcomes using ICD-10 coding. Predictors in relation to the risk of mortality and hospital admission events were examined using Cox regression with and without adjustment for sociodemographic and lifestyle characteristics.

FINDINGS

The mean age at baseline was 65.7 and 66.6 years among men and women, respectively. Over follow-up, 36% of men and 26% of women died, while 93% of men and 92% of women were admitted to hospital at least once. Physical activity, grip strength, SF-36 physical function, and walking speed were all strongly associated with adverse health outcomes in both sex- and fully adjusted analyses; poorer values for each of the predictors were related to greater risk of mortality (all-cause, cardiovascular-related) and any, neurological, cardiovascular, respiratory, any fracture, and falls admissions. SF-36 physical function and grip strength were similarly associated with the adverse health outcomes considered.

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

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

Exploring the Association between Elevated Anxiety Symptoms and Low Skeletal Muscle Mass among Asymptomatic Adults: A Population-Based Study in Republic of Korea

Individuals with mental health problems are at higher risk of musculoskeletal diseases. However, the association between low muscle mass (LMM) and anxiety symptoms remains uninvestigated. This cross-sectional study enrolled 174,262 adults (73,833 women, 100,429 men), aged 18 to 89, who completed the anxiety scale and body composition analyses. Using bio-electrical impedance analysis, skeletal muscle mass index (SMI) was calculated based on appendicular skeletal muscle mass (ASM) (kg)/height (m2). LMM was defined as SMI < 7.0 kg/m2 in men and <5.4 kg/m2 in women. Anxiety symptoms were screened using the Clinical Useful Anxiety Outcome Scale (CUXOS) with cut-off scores of 20, 30, and 40. Multivariable logistic regression analyses were performed. LMM prevalence was 20.17% in women, 3.86% in men (p < 0.001). The prevalence of anxiety symptoms in LMM group decreased from mild (CUXOS > 20: women, 32.74%, men, 21.17%) to moderate (CUXOS > 30: 13.34%, 7.32%), to severe anxiety symptoms (CUXOS > 40: 4.00%, 1.73%). In multivariable-adjusted models, LMM was associated with mild (aOR (95% confidence interval)), women, 1.13 (1.08-1.17); men, 1.17 (1.08-1.27)), moderate (1.17 (1.11-1.24); 1.35 (1.19-1.53) and severe anxiety symptoms (1.18 (1.07-1.3), 1.36 (1.06-1.74)), demonstrating an increased risk of ORs with escalating anxiety severity. LMM was independently associated with a higher prevalence of anxiety symptoms.

Identifying characteristics and clinical conditions associated with hand grip strength in adults: the Project Baseline Health Study

Low hand grip strength (HGS) is associated with several conditions, but its value outside of the older adult population is unclear. We sought to identify the most salient factors associated with HGS from an extensive list of candidate variables while stratifying by age and sex. We used data from the initial visit from the Project Baseline Health Study (N = 2502) which captured detailed demographic, occupational, social, lifestyle, and clinical data. We applied MI-LASSO using group methods to determine variables most associated with HGS out of 175 candidate variables. We performed analyses separately for sex and age (< 65 vs. ≥ 65 years). Race was associated with HGS to varying degrees across groups. Osteoporosis and osteopenia were negatively associated with HGS in female study participants. Immune cell counts were negatively associated with HGS for male participants ≥ 65 (neutrophils) and female participants (≥ 65, monocytes; < 65, lymphocytes). Most findings were age and/or sex group-specific; few were common across all groups. Several of the variables associated with HGS in each group were novel, while others corroborate previous research. Our results support HGS as a useful indicator of a variety of clinical characteristics; however, its utility varies by age and sex.

Respiratory Oscillometry and Functional Performance in Different COPD Phenotypes

Purpose

Chronic obstructive pulmonary disease (COPD) phenotypes may introduce different characteristics that need to be known to improve treatment. Respiratory oscillometry provides a detailed analysis and may offer insight into the pathophysiology of COPD. In this paper, we used this method to evaluate the differences in respiratory mechanics of COPD phenotypes.

Patients and Methods

This study investigated a sample of 83 volunteers, being divided into control group (CG = 20), emphysema (n = 23), CB (n = 20) and asthma-COPD overlap syndrome (ACOS, n = 20). These analyses were performed before and after bronchodilator (BD) use. Functional capacity was evaluated using the Glittre‑ADL test, handgrip strength and respiratory pressures.

Results

Initially it was observed that oscillometry provided a detailed description of the COPD phenotypes, which was consistent with the involved pathophysiology. A correlation between oscillometry and functional capacity was observed (r=-0.541; p = 0.0001), particularly in the emphysema phenotype (r = -0.496, p = 0.031). BD response was different among the studied phenotypes. This resulted in an accurate discrimination of ACOS from CB [area under the receiver operating curve (AUC) = 0.84] and emphysema (AUC = 0.82).

Conclusion

These results offer evidence that oscillatory indices may enhance the comprehension and identification of COPD phenotypes, thereby potentially improving the support provided to these patients.

Consideration and Assessment of Patient Factors When Selecting an Inhaled Delivery System in COPD

Because guidelines and strategies for pharmacologic treatment of COPD focus on specific classes of inhaled medications, there is an unmet need for information to guide health care professionals for selecting an inhaled medication delivery system that matches the unique characteristics of individual patients. This article provides guidance for selecting an inhaled medication delivery system based on three "key" patient factors: cognitive function, manual dexterity/strength, and peak inspiratory flow. In addition, information is provided about specific tests to assess these patient factors. Cognitive impairment with an estimated prevalence of 25% among patients with COPD adversely affects patients' ability to correctly use a handheld device. To our knowledge, the prevalence of impaired manual dexterity/strength has not been reported in those with COPD. However, 79% of patients with COPD have reported one or more physical impediments that could influence their ability to manipulate an inhaler device. The measurement of peak inspiratory flow against the simulated resistance (PIFr) of a dry powder inhaler establishes whether the patient has the inhalation ability for creating optimal turbulent energy within the device. A suboptimal PIFr for low to medium-high resistance dry powder inhalers has been reported in 19% to 84% of stable outpatients with COPD. Health care professionals should consider cognitive function, manual dexterity/strength, and PIFr in their patients with COPD when prescribing inhaled pharmacotherapy. Impairments in these patient factors are common among those with COPD and can affect the individual's competency and effectiveness of using inhaled medications delivered by handheld devices.

Preterm-Born Young Women Have Weaker Hand Grip Strength Compared to Their Full-Term-Born Peers

Prematurity has been linked to lower muscular fitness and increased morbidity across the human lifespan. Hand grip strength is widely used as a measure of muscle strength. Previous studies have shown inconsistent results regarding the role of vitamin D in hand grip strength. Here, we investigated hand grip strength and the effects of a yearlong vitamin D supplementation in healthy preterm-born young adults. We recruited 38 young adults born preterm at either ≤32 weeks' gestation or <34 weeks' gestation and weighing <1500 g, as well as 39 gender- and age-matched controls, for this study. Anthropometric measurements, hand grip strengths, and vitamin D concentrations were recorded. These investigations were repeated after a yearlong vitamin D supplementation intervention. There was a significant difference in the age- and gender-specific hand grip strength ranks between the preterm- and full-term-born young adults: 57.9% and 30.7%, respectively, were below average (p = 0.009). In the preterm-born group, the females had significantly lower hand grip strengths compared to their full-term-born peers, with a mean difference of -3.46 kg (95% CI: -6.68 to -0.247; p = 0.035). In a linear regression analysis, the preterm-born female adult height was negatively associated with hand grip strength (R2 = 0.24, F (1.43) = 13.61, p < 0.001). The vitamin D concentrations were increased after the supplementation period, with no association with hand grip strength. According to our results, preterm-born young females are at risk for lower muscle strength, independent of their current vitamin D status.

Association of possible sarcopenia with major chronic diseases and multimorbidity among middle-aged and older adults: Findings from a national cross-sectional study in China

AIM

This study investigated the prevalence of possible sarcopenia (PSA) in a large sample of middle-aged and older adults, and determined the association between PSA, major chronic diseases and the number of chronic diseases.

METHODS

A total of 14 917 adults aged ≥40 years were included in the analysis. The handgrip strength and the five-time chair stand test were used to assess PSA. The participants' major chronic diseases were divided into 14 categories. Four categories were created based on the participants' number of chronic illnesses: 0, 1, 2 and ≥3.

RESULTS

The present study found an overall prevalence of PSA of 23.6% among Chinese middle-aged and older adults aged ≥40 years, with the risk increasing with advancing age. PSA was significantly associated with most categories of chronic diseases and multimorbidity. The closely independent associations were obtained for stroke; emotional, nervous or psychiatric problems; chronic lung disease, asthma, heart disease, hypertension and arthritis or rheumatism. Compared with participants with 0 chronic disease, those with two or more chronic diseases had higher odds for PSA. However, the association between PSA and the number of chronic diseases varied in different sex and age groups.

CONCLUSIONS

The findings suggest that PSA is associated with major chronic diseases among middle-aged and older adults. People with two or more chronic diseases have a greater likelihood of PSA compared with those without chronic diseases, and the association between PSA and the number of chronic diseases largely depended on sex and age. Geriatr Gerontol Int 2023; 23: 925-931.

Reference values for Jamar+ digital dynamometer hand grip strength in healthy adults and in adults with non-communicable diseases or osteoarthritis: the Norwegian Tromsø study 2015-2016

Hand grip strength (HGS) is a key indicator of intrinsic capacity and has shown good predictive ability for morbidity and mortality. Reference values from normative populations are valuable, and such data from the Norwegian population are scarce. Normative values for the digital Jamar+ dynamometer are largely lacking.HGS was assessed in the Norwegian Tromsø study, survey 7 in 2015-2016 for 7824 participants (9324 invited) aged 40+ using a Jamar+ digital dynamometer, and three measurements for each hand were performed following the Southampton protocol. To account for non-response, full Tromsø population data, by age, education and sex, were collected from registry data from microdata.no, a service from Statistics Norway, and were then used as post-stratification weights, to provide standardized HGS values. HGS was higher in men than in women and inversely associated with age. Men and women with a history of non-communicable diseases had lower HGS than those without these conditions, while osteoarthritis was associated with lower HGS only among men. Lower height was associated with lower HGS, especially at younger ages in men. This article provides up-to-date references values for HGS in the community-dwelling population aged 40+ with or without osteoarthritis or non-communicable diseases, in Tromsø, Norway. These reference values will guide clinicians and researchers.

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION

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

Muscle Strength and Biochemical Markers as Predictors of Depression in Hemodialysis Patients: A Cross-Sectional Study

Patients with chronic renal failure, many of which treated with hemodialysis, present a high prevalence of impaired muscle strength which suggest that muscle mass parameters may be used as markers for changes in muscle in these patients. Measurement of handgrip strength (HGS) is a common, simple, and quick measure of muscle function an indicator of overall muscle strength which has been associated with physical activity and several anthropometric traits. Intercellular adhesion molecule-1 (ICAM-1) and insulin-like growth factor-1 (IGF-1) are biochemical markers associated with inflammatory processes which are a common consequence of dialysis. Additionally, hemodialysis patients frequently present signs of malnutrition and depression. This cross-sectional study aimed to evaluate if muscle and biochemical markers could be used to predict the risk of depression in hemodialysis patients. Several anthropometric parameters, nutrient intake, depression state and the serum levels of ICAM-1 and IGF-1 were determined and Pearson's correlation coefficient and/or Spearman's correlation coefficient were used to test the correlation between them. Our results do not show a correlation between HGF, IGF-1 and ICAM-1 with the depression status of the patients, but mid-arm muscle circumference (MAMC) was statistically and positively correlated with depression. Additionally, ICAM-1 levels were negatively correlated with HGS, MAMC, and IGF-1. Overall, the results of the present study suggest that HGS may be used as an indicator of cardiovascular diseases and MAMC may be a good predictor of the level of depression in hemodialysis patients, although further studies are required.

Prediction models of grip strength in adults above 65 years using Korean National Physical Fitness Award Data from 2009 to 2019

PURPOSE

We aimed to determine the best machine learning (ML) regression model for predicting grip strength in adults above 65 years using various independent variables, such as body composition, blood pressure, and physical performance.

METHODS

The data comprised 107,290 participants, of whom 33.3% were male and 66.7% were female in Korean National Fitness Award Data from 2009 to 2019. The dependent variable was grip strength, which was calculated as the mean of right and left grip strength values.

RESULTS

The results showed that the CatBoost Regressor had the lowest mean squared error (M [Formula: see text] SE:16.659 ± 0.549) and highest R2 value (M [Formula: see text] SE:0.719 ± 0.009) among the seven prediction models tested. The importance of independent variables in facilitating model learning was also determined, with the Figure-of-8 walk test being the most significant. These findings suggest that walking ability and grip strength are closely related, and the Figure-of- 8 walk test is a reasonable indicator of grip strength in older adults.

CONCLUSION

The findings of this study can be used to develop more accurate predictive models of grip strength in older adults.

Discordance in Frailty Measures in Old Community Dwelling People with Multimorbidity - A Cross-Sectional Study

Purpose

Assessment of frailty is a key method to identify older people in need of holistic care. However, agreement between different frailty instrument varies. Thus, groups classified as frail by different instruments are not completely overlapping. This study evaluated differences in sociodemographic factors, cognition, functional status, and quality of life between older persons with multimorbidity who were discordantly classified by five different frailty instruments, with focus on the Clinical Frailty Scale (CFS) and Fried's Frailty Phenotype (FP).

Participants and Methods

This was a cross-sectional study in a community-dwelling setting. Inclusion criteria were as follows: ≥75 years old, ≥3 visits to the emergency department the past 18 months, and ≥3 diagnoses according to ICD-10. 450 participants were included. Frailty was assessed by CFS, FP, Short Physical Performance Battery (SPPB), Grip Strength and Walking Speed.

Results

385 participants had data on all frailty instruments. Prevalence of frailty ranged from 34% (CFS) to 75% (SPPB). Nine percent of participants were non-frail by all instruments, 20% were frail by all instruments and 71% had discordant frailty classifications. Those who were frail according to CFS but not by the other instruments had lower cognition and functional status. Those who were frail according to FP but not CFS were, to a larger extent, women, lived alone, had higher cognitive ability and functional status.

Conclusion

The CFS might not identify physically frail women in older community-dwelling people with multimorbidity. They could thus be at risk of not be given the attention their frail condition need.

Number of Teeth According to Hand Strength in Adults: A Cross-Sectional Study of 11,499 South Korean Adults

Background and Objectives: Grip strength is a measure of general health and is associated with oral health. This study aimed to investigate the relationship between the number of teeth and grip strength in Korean adults. Methods and Materials: We recruited adult participants who underwent oral examinations in the Korean National Health and Nutrition Examination Survey (KNHANES) between 2016-2018. When performing the KNHANES oral examination, an experienced dentist performed it according to the oral examination guidelines and recorded the results. A total of 24,269 participants from the 2016-2018 KNHANES were included in this study. Of these, only 16,489 participants underwent oral screening. A total of 3209 were non-adult children and adolescents, and 1781 did not respond to the grip strength test; those who did not respond to the main independent confounder were excluded. The relationships between grip strength, general characteristics, general health, oral health, and the number of remaining teeth were analyzed. There were 11,499 subjects in total in this study, with 4839 males and 6660 females. The age groups were 19-65 years of age, with 8387 subjects, and 65 years and older, with 3112 subjects, and the number of remaining teeth was 0-9 for 936 subjects, 10-19 for 1015 subjects, and 20-28 for 9548 subjects. Results: The probability that the higher the grip strength, the higher the residual number of gingiva was estimated by multinomial logistic regression analysis using complex sampling. The higher the grip strength, the higher the probability of having 20-28 teeth remaining (adjusted odds ratio, 1.59; 95% confidence interval, 1.19-2.13). Conclusions: Maintaining general health is related to maintaining teeth; the higher the grip strength, the higher the number of remaining teeth.

Association of grip strength and comorbidities with all-cause mortality in the older hypertensive adults

Background

With growing concerns about global population aging, comorbidity, and disability have emerged as key variables that influence the health of the older adults in terms of disease and function. This study sought to examine the impact of comorbidity and impairment using disease and functional status indicators of all-cause mortality in the older adults. Hypertension, which was chosen as the indicator chosen for disease, has the greatest prevalence in the older population. A total of 15 self-reported chronic conditions were added as indicators of comorbidity, and grip strength was chosen as a measure of functional status. The study also evaluated the association between grip strength and comorbidity, as well as its consequences on all-cause death and survival in a hypertensive senior population.

Methods

We chose a total of 2,990 hypertensive participants aged ≥60 years whose data for grip strength were collected in the National Health and Nutrition Examination Survey conducted between 2011 and 2014. The association of all-cause death with grip strength and comorbidity was examined using a Cox proportional hazard regression model. The interaction between comorbidity and all-cause mortality, as well as its association with grip strength, was also examined.

Results

The hazard ratio [95% confidence intervals (CIs)] for all-cause mortality in the highest grip strength tertile was 0.266 (0.168-0.419), compared to the lowest grip strength tertile. The all-cause mortality decreased with an increase in the number of co-morbidities [2.677 (1.557-4.603) in the group with ≥3 chronic diseases]. The weighted generalized model revealed a negative correlation between grip strength and comorbidities in more than three groups after accounting for all possible variables (β = -2.219, -3.178 ~ -1.260, p < 0.001). The risk of mortality reduced with increasing grip strength in patients with ≥3 comorbidities (p-value for trend <0.05), but no meaningful difference was found in the interaction between comorbidities and grip strength (p-value for interaction >0.05).

Conclusion

In older hypertension patients, grip strength and comorbidities were correlated with all-cause death, and there was a negative correlation between grip strength and comorbidities. Higher grip strength was associated with fewer fatalities in patients with ≥3 comorbidities, suggesting that functional exercise can improve the prognosis of comorbidities.

Effects of a Single Session of Systemic Vibratory Therapy on Flexibility, Perception of Exertion and Handgrip Strength in Chronic Obstructive Pulmonary Disease Individuals: A Quasi-Experimental Clinical Trial

BACKGROUND

Whole-body vibration exercises (WBVE), that are generated in systemic vibratory therapy (SVT), may benefit individuals with chronic obstructive pulmonary disease (COPD). This study evaluated acute effects of SVT on the flexibility, on the perception of exertion to perform the anterior trunk flexion (ATF), and on the handgrip strength (HG).

METHODS

Thirty-eight individuals, separated into two groups, performed a single session of SVT (five bouts, 25 Hz, 2.5 of amplitude) on a side-alternating vibrating platform (SAVP), in two postures: sitting (Sitting group-SitG, n = 21) or standing (Stand group-StandG, n = 17). In both positions, the feet were on the base of the SAVP. The HG and the AFT were performed before and after the session, and the perception of effort (RPE) was measured during the ATF.

RESULTS

The ATF in the SitG (p ≤ 0.05) and in the StandG (p ≤ 0.05) was significantly improved, but in the comparison between both groups, no significant reduction was found (p = 0.14). The RPE was not influenced by the session. A significant increase of the HG in StandG post session (33.49 ± 10.30 kgf) p = 0.03 was found, but not in the SitG (p = 0.12) or between the two groups (p = 0.55).

CONCLUSIONS

SVT, in a single acute session, would be capable of promoting some functional benefits for the COPD individuals without altering the perception of exertion to perform the ATF.

TRIAL REGISTRATION

49219115.3.0000.5259, RBR-72dqtm.

A scoping review on how physical fitness is evaluated in sitting volleyball players

INTRODUCTION

Sitting volleyball is a widely practiced paralympic sport. A correct and standardized physical evaluation helps coaches to plan and manage the training. It is also important to evaluate physical fitness accurately and adopt standardized protocols to compare and normalize the data. The aim of the study was to evaluate physical fitness evaluation methods adopted in sitting volleyball and to eventually propose standard operating procedures.

EVIDENCE ACQUISITION

English-written and peer-reviewed original articles were included in this review. The population studied was composed only of athletes practicing sitting volleyball. Articles were searched on the electronic databases PubMed, Web of Science, and Scopus using keywords matched with Boolean operators. Two independent investigators collected and screened the studies against the eligibility criteria. Data were analyzed narratively.

EVIDENCE SYNTHESIS

Only 7 studies were eligible and included in this review, but a wide testing methodology exists. There are some tests commonly adopted in the studies included and these are the handgrip test, the agility t-test, the speed, and endurance test. These tests with the 2-site skinfold thickness evaluation, the modified push-ups, the shoulder-stretch test, the chest throw test and the simple reaction time task were included in the standard operating procedure.

CONCLUSIONS

The literature on the topic is poor and standardization of the testing procedure to evaluate the physical fitness of people practicing SV has been provided.

[Multimorbity in elderly municipal of northeast Brazil: prevalence and associated factors]

OBJECTIVE

To estimate the prevalence and the factors associated with the presence of multimorbidity in the elderly population of the municipality of Ibicuí - BA.

METHODS

This study was carried out with 310 elderly individuals, aged > 60 years old, of both sexes, living in the municipality of Ibicuí - BA. Sociodemographic information and personal information, living conditions, life habits, body mass, stature and presence of multimorbidity were collected. The descriptive analysis was used and multimorbidity prevalence ratios were estimated according to variables of interest. As a measure of statistical significance, the qui-quadrado de Pearson test was used, adopting p≤0.05. The multivariate analysis hierarchized by Poisson regression was employed after bivariate analysis to select the independent variables (p<0.20).

RESULTS

The general prevalence of multimorbidity was 80.3%. The hierarchical multi-varied analysis showed the variables of gender and monthly income (p<1.5) were significantly related to the problem. The results reveal also a high prevalence of multimorbidity in the studied population. Mainly women and the poorest suffer from it.

CONCLUSIONS

It is necessary to redirect the planning of health actions in the municipality, with changes in the health care policy of the elderly, and especially in the social support networks that support these individuals, considering that in this locality the presence of multimorbidity was related to socio-economic grounds.

Handgrip strength in older adults with chronic diseases from 27 European countries and Israel

BACKGROUND/OBJECTIVES

Understanding the association of deconditioned strength with the most prevalent chronic diseases in older adults and inferring possible interventional strategies is of utmost importance. We aimed to investigate the association between handgrip strength and chronic diseases in a large representative European population of adults over the age of 50 years.

SUBJECTS/METHODS

Individuals aged 50 or older residing in 27 European countries and Israel participated in this cross-sectional study. Data on prior or current chronic disease and handgrip strength were retrieved from the 7th wave of Survey of Health, Ageing and Retirement in Europe (SHARE). We tested associations using binary logistic regression adjusted for potential confounders.

RESULTS

Based on data from 73,463 participants, the examined diseases showed a negative association with handgrip strength in the fully adjusted model. Participants from the highest tertile of handgrip strength had particularly lower odds for Parkinson ((Adjusted odds ratio (AOR) = 0.42 [95% Confidence Interval = 0.32-0.56])), stroke (AOR = 0.51 [95% Confidence Interval = 0.44-0.59], and emotional disorders ((Adjusted odds ratio (AOR) = 0.51 [95% Confidence Interval = 0.45-0.58])) compared with participants with the lowest level of handgrip strength in the fully adjusted model.

CONCLUSIONS

There is a negative association between handgrip strength and a wide range of chronic diseases. Evaluating handgrip strength in this population may provide a valuable clinical measure and a simple preventive strategy in relation to these diseases. The present findings support the use of resistance training for the prevention of specific chronic conditions, particularly Parkinson, stroke and emotional disorders.

Is Carer Management Style Associated with Longitudinal Functional Decline in Dementia?

BACKGROUND

Various intrinsic (related to dementia) and extrinsic (not related to dementia) factors have been suggested to contribute separately to disability in people living with dementia (PLwD).

OBJECTIVE

To investigate if the combination of specific intrinsic and extrinsic factors at baseline is associated with longitudinal declines in activities of daily living (ADL) performance of PLwD at 12-month follow-up.

METHODS

141 community-dwelling PLwD-carer dyads were assessed on their global cognition (ACE-III), apathy (CBI-R), carer management styles (DMSS), medical comorbidities (CCI), and ADL performance (DAD) at baseline, and for a subset of participants (n = 53), at 12-month follow-up. Multiple linear regression models were run to assess: 1) the relationships between PLwD's DAD scores and the remaining variables at baseline and 2) whether these variables' scores at baseline were associated with longitudinal change in the PLwD's DAD scores.

RESULTS

At baseline, having lower ACE-III (β= 0.354, p < 0.001), higher CBI-R (β= -0.284, p < 0.001), higher DMSS criticism (β= -0.367, p = 0.013), lower DMSS encouragement (β= 0.370, p = 0.014), and higher CCI scores (β= -2.475, p = 0.023) were significantly associated with having lower DAD scores. The PLwD's DAD scores significantly declined from baseline to follow-up (p < 0.001, d = 1.15), however this decline was not associated with the baseline scores of any of the independent variables. Instead, it was associated with declines in the PLwD's ACE-III scores from baseline to follow-up (β= 1.021, p = 0.001).

CONCLUSIONS

In our limited sample, cognitive changes seem to be the main factor underlying longitudinal decline in ADL performance for PLwD. Carer management styles appear associated with current ADL performance but not with longitudinal ADL decline.

Low handgrip strength is associated with diabetic foot disease in geriatric patients with type 2 diabetes

BACKGROUND

This study aims to reveal the prevalence of low handgrip strength in older patients with type 2 diabetes who have diabetic foot disease and to assess the association of handgrip strength with diabetic foot disease in older patients with type 2 diabetes.

METHODS

Eighty-nine geriatric patients with diabetic foot ulcers and 69 patients without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were included in the study. The exclusion criteria were the usage of steroids, stroke-induced quadriplegia, myopathy, disability, hemodialysis treatment, type 1 diabetes, patients under 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. A handgrip strength test was performed with a handheld digital dynamometer. For females <16 kg (kilograms), for males <27 kg was accepted as low handgrip strength.

RESULTS

Forty-nine patients (55.1%) with diabetic foot ulcers and 25 (36.2%) patients without diabetic foot ulcers had low handgrip strength. There was a significant difference between two groups (p = 0.019). The patients with diabetic foot ulcers who had lower handgrip strength had higher rates of peripheral artery disease than patients with diabetic foot ulcers who had normal handgrip strength (p = 0.02 and p = 0.009, respectively). The patients with diabetic foot ulcers who had lower handgrip strength, had significantly higher rates of Wagner scores 4 and 5 and lower rates of Wagner scores 1 and 3 (p = 0.039).

DISCUSSION

Older patients with type 2 diabetes and diabetic foot disease had a higher rate of low handgrip strength. Low handgrip strength was significantly associated with the occurrence of diabetic foot ulcers and directly correlated with Wagner score in geriatric patients with type 2 diabetes.

Relationship between physical fitness and arterial stiffness in Korean older adults

Pulse-wave velocity (PWV) is a widely used clinical marker of arterial stiffness. Associations between several physical fitness measures and arterial stiffness have been examined. However, these results were inconsistent. Therefore, we conducted a cross-sectional study to assess the relationship between various physical fitness parameters and arterial stiffness in older adults. From January 2014 to December 2015, 1500 participants (men, n = 587; mean age, 71.78 ± 5.10 years) in South Korea were enrolled in the study. Koreans aged >65 years who agreed to participate in the study were enrolled. Individuals who were unable to exercise because of underlying conditions were excluded. VO2 max (mL/kg/min), handgrip strength (kg), handgrip strength (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were measured. The brachial-ankle pulse wave velocity (baPWV) was measured using a VP-1000 instrument. VO2 max (mL/kg/min), handgrip (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were significantly inversely associated with baPWV. This association was consistent even after adjusting for confounding factors. Our study revealed a significant association between various aspects of physical fitness and arterial stiffness. This study suggests that physical fitness is a useful predictor of arterial stiffness in older adults.

Associations of low handgrip strength and hand laterality with cognitive function and functional mobility - the Yishun Study

Background

Emerging evidence suggest that in addition to low hand grip strength (HGS), HGS asymmetry is associated with declining cognitive and physical functions. We examined the associations of low HGS and asymmetry with cognitive function and functional mobility in older adults.

Methods

Cross-sectional data of 330 community-dwelling adults (55.2% women) aged ≥ 55 years included HGS, Repeated Battery for the Assessment of Neuropsychological Status (RBANS), and Timed-Up-and-Go (TUG). Low HGS was defined as < 28 kg for men and < 18 kg for women. Participants with HGS above 10% stronger on either hand were considered as having HGS asymmetry. Multiple linear regression models were adjusted for sociodemographic, smoking, education, comorbidity count, physical activity participation, obesity, self-rated health and hand dominance.

Results

Low HGS, but not asymmetry, was independently associated with lower functional mobility performance (β = 1.3, 95%CI = 0.6,1.9), global cognitive function (β = -10.4, 95%CI = -17.0,-3.8), immediate (β = -2.6, 95%CI = -4.5,-0.7) and delayed (β = -2.8, 95%CI = -5.0,-0.7) memory. Compared to normal and symmetric HGS participants, low HGS in combination with HGS asymmetry was associated with poorer language scores. In participants with normal HGS, asymmetric HGS was associated with slower TUG than corresponding groups with symmetric HGS.

Conclusion

Low HGS, but not asymmetry, was associated with lower cognition and functional mobility. Associations of combined low HGS and asymmetry with cognitive and physical functions were driven by grip strength rather than asymmetry.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03363-2.

Relationship between handgrip strength, depression and cognitive functioning among older adults: Evidence from longitudinal ageing study in India

BACKGROUND

Handgrip strength (HGS) is a frequent and general indicator of muscle strength and it may affect several aspects of mental health among older people. This study explored the association of HGS with depression and cognitive impairment among community-dwelling older adults in resource-constrained setting of India.

METHOD

Data were drawn from the Longitudinal Ageing Study in India (LASI), and the analysis was conducted on 27,707 older adults aged 60 years and above. Outcome measures included depression (assessed by the Short Form Composite International Diagnostic Interview (CIDI-SF) and the Center for Epidemiological Studies-Depression (CES-D) scales) and cognitive impairment. Descriptive statistics and mean scores of HGS were reported and multivariable linear regression analyses were conducted to test the research hypotheses of the study.

RESULTS

Mean score of HGS was 24.33 (SD: 7.22) for males and 15.94 (SD: 5.14) for females. Mean age was 68.86 (SD: 7.19) and 68.40 (SD: 7.31) years among males and females respectively. Older participants who had weak HGS were significantly more likely to be depressed in CIDI-SF scale (B: 0.06, CI: 0.01-0.13) and CES-D scale (B: 0.02, CI: 0.01-0.03) in comparison to those who had strong HGS after adjusting for a large number of confounders. Older participants who had weak HGS were significantly more likely (B: 0.92, CI: 0.76-1.07) to have cognitive impairment compared to those who had strong HGS.

CONCLUSION

The findings highlight the independent association of HGS with major depression, depressive symptoms and cognitive impairment that have implications on promoting resistance-training programs among aged population.

Association between changes in working status and hand-grip strength among Korean middle-aged and older adults: a longitudinal panel study

We investigated the association between working status changes and hand-grip strength (HGS) among middle-aged and older Korean adults using data from the 2006–2018 Korean Longitudinal Study of Aging. After excluding those with less than normal HGS in the baseline year, newly added panels, and missing values, 3843 participants (2106 men; 1737 women) were finally included. After adjusting for potential confounders, we used a 2-year lagged multivariable generalized estimating equation model to examine this association longitudinally. Men who quit working or who continued to be non-working were more likely to have lower HGS than those who continued to work (working → non-working, adjusted odds ratio [OR]: 1.47, 95% confidence interval [CI] 1.26–1.70; non-working → non-working, adjusted OR: 1.52, 95% CI 1.34–1.72). Compared to women who continued to work, the other three groups showed high ORs with low HGS (working → non-working, adjusted OR: 1.19, 95% CI 1.01–1.40; non-working → working, adjusted OR: 1.18, 95% CI 0.98–1.42; non-working → non-working, adjusted OR: 1.38, 95% CI 1.22–1.56). Middle-aged and older adults whose working status changed to non-working were at higher risk of reduced HGS than others and required muscular strength training interventions to improve HGS and prevent sarcopenia.

Greater Muscular Strength Is Associated with a Lower Risk of Pulmonary Dysfunction in Individuals with Non-Alcoholic Fatty Liver Disease

This study investigated the combined effect of handgrip strength (HGS) and non-alcoholic fatty liver disease (NAFLD) on pulmonary function using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2016 to 2018. For the present study, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), the FEV1/FVC ratio, handgrip strength (HGS) and the hepatic steatosis index (HSI) to estimate NAFLD were obtained from nationwide cross-sectional surveys. For HGS, subjects were divided into higher HGS (upper 50%) and lower HGS (lower 50%). For NAFLD, subjects were divided into the NAFLD cohort (HSI > 36) and the normal cohort (HSI ≤ 36). Of 1651 subjects (men, n = 601), 25.5% of subjects (n = 421) met the HSI > 36. Based on the normal cohort with high HGS, the normal cohort with low HGS showed an increased risk of reduced FVC (OR = 3.062, 95% CI = 2.46−4.83, p < 0.001) and the NAFLD cohort with low HGS showed a further increased risk of reduced FVC (OR = 4.489, 95% CI = 3.43−7.09, p < 0.001). However, the risk of reduced FVC was not significantly increased in NAFLD with high HGS (OR = 1.297, 95% CI = 0.67−2.50, p = 0.436). After adjusted for covariates such as age, sex, smoking, FBG, HDL-C, TG, SBP, DBP, CRP and alcohol consumption, the results remained similar. More importantly, these results were consistent in the obesity-stratified analysis. The current findings of the study suggest that higher muscle strength is associated with a lower risk of reduced pulmonary function in individuals with NAFLD.

Multimorbidity

Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.

Plasma neurofilament light levels associate with muscle mass and strength in middle-aged and older adults: findings from GenoFit

BACKGROUND

Efforts to enhance diagnostic measures for sarcopenia have led to an increased focus on the screening utility of blood-based biomarkers. In this regard, circulating neurofilament light chain (NfL) levels are a potent indicator of axonal damage and have been linked with several neurological disorders. However, despite the strong neurogenic contribution to skeletal muscle health, no studies have explored the relevance of NfL concentrations to sarcopenia. With that in mind, this study aimed to examine the association between plasma NfL concentration and sarcopenic domains.

METHODS

Three hundred adults aged between 50 and 83 years participated to this study (male participants, n = 150; mean age: 64.2 ± 8.7 years and female participants, n = 150; mean age: 63.9 ± 8.3 years). Body composition was assessed using dual-energy X-ray absorptiometry, and a skeletal muscle index (SMI) was calculated. Muscle strength was assessed with hand dynamometry. Sarcopenia was classified using the European Working Group on Sarcopenia in Older People criteria. Plasma NfL concentration was determined using a highly sensitive, enzyme-linked immunosorbent assay.

RESULTS

Neurofilament light chain levels were associated with grip strength and SMI (P = 0.005 and P = 0.045, respectively) and were significantly elevated in sarcopenic individuals, compared with non-sarcopenic participants (P < 0.001). Individuals with pre-sarcopenia (either low grip strength or low SMI) had significantly higher NfL levels, compared with healthy controls (P = 0.001 and P = 0.006, respectively). Male participants with either low grip strength or low SMI had significantly raised NfL levels (P = 0.006 and P = 0.002, respectively), while in female participants, NfL concentrations were significantly elevated only in those with low grip strength (P = 0.049). NfL concentration displayed acceptable diagnostic accuracy for sarcopenia (area under the curve = 0.726, P < 0.001).

CONCLUSIONS

Our study clearly demonstrates the indicative pertinence of circulating NfL levels to sarcopenic domains, supporting its potential use as a biomarker of sarcopenia. More studies are needed, however, to further illuminate the diagnostic value of circulating NfL. Future research should explore whether NfL levels are more powerfully linked with muscle strength than mass and whether sex mediates the relevance of NfL concentrations to sarcopenic phenotypes.

Impact of Activity Tracker Usage in Combination with a Physical Activity Intervention on Physical and Cognitive Parameters in Healthy Adults Aged 60+: A Randomized Controlled Trial

Regular physical activity (PA) is of central importance for healthy aging and has a well-known impact on helping older adults maintain their cognitive and physical health. Thus, we aimed to compare the effectiveness of two physical activity interventions primarily conducted at home (print-based or web-based vs. web-based plus the use of an activity tracker) on cognitive and physical health parameters in older adults. Data of participants (n = 551, 60–80 years) were analyzed after being randomly allocated to a waitlist control group (CG), a web-based or print-based intervention group (IG) or a web-based intervention group that also included the use of an activity tracker (AG). Measured parameters were grip strength, endurance (two-minute step test), gait speed (four-meter walk test), cognition (Simon task; balanced integration score (BIS), reaction time and accuracy) and physical self-concept (Physical Self-Description Questionnaire (PSDQ)). We found the highest effect sizes in all measured dimensions for AG (grip strength, endurance, gait speed, reaction time, physical self-concept), followed by IG (endurance, gait speed, reaction time, physical self-concept) and CG (endurance, gait speed, BIS). Findings suggest that a combined web-based and activity tracker intervention may improve physical functions, physical self-concept, and cognition in community-dwelling older adults.

The independent and joint associations between muscle strength, health variables and cardiovascular disease among adults

OBJECTIVES

We investigated the independent and joint association between muscle strength and health variables according to individual health status among adults.

METHODS

Cross-sectional population-based study comprising 643 adults (39.6 ± 11.1 years, 44.9% men) from Florianópolis, Southern Brazil. Muscle strength was assessed by handgrip strength. Health variables included were systolic (SBP) and diastolic blood pressure (DBP), waist circumference (WC), carotid intima-media thickness (IMT), high-sensitivity C-reactive protein (CRP), total cholesterol (CHOL), HDL cholesterol (HDL-C), triglycerides (TRG), glycated hemoglobin (HbA1c), and insulin resistance index (HOMA-IR). Participants were grouped into three health status categories: 1) healthy (without CVD and risk for CVD); 2) at risk for CVD (obesity, high blood pressure, and hyperglycemia); 3) with CVD. Multiple linear regression adjusted for confounding factors was used.

RESULTS

Muscle strength was inversely associated with IMT (β = -0.02, SE: 0.03), CHOL (β = -0.14, SE: 0.02) and HbA1c (β = -0.01, SE: 0.10), and directly associated with SBP (β = 0.16, SE: 0.06) and WC (β = 0.02, SE: 0.03). Among adults with CVD, muscle strength was inversely associated with IMT (p < 0.05). Higher muscle strength was directly associated with SBP among healthy adults (p < 0.05).

CONCLUSION

The main finding of the present study indicated that among individuals with CVD, muscle strength was associated with lower IMT values.

Handgrip Strength to Predict the Risk of All-Cause and Premature Mortality in Korean Adults: A 10-Year Cohort Study

The prospective association of muscular weakness with the risk of all-cause and premature mortality in a general population remains unknown. The aim of this study was to investigate the prospective effects of handgrip strength and muscular weakness on risk for all-cause and premature mortality over 10 years using a large nationwide sample of Korean adults. The study participants included 9229 middle and older adults (4131 males and 5098 females), using data from the Korean Longitudinal Study of Ageing 2006-2016. Muscular strength was measured using handgrip strength. Muscle weakness was defined using the sex-specific handgrip strength index based on the Asian Working Group on Sarcopenia in Older People (AWGSOP). The primary outcome was all-cause and premature mortality assessed based on the death certificate. The hazard ratio (HR) for all-cause mortality was negatively associated with level of handgrip strength independent of potential confounding factors (HR: 2.06, 95% confidence interval [CI]: 1.62-2.63 for lowest quartile vs. highest quartile). When examined using muscle weakness defined using the AWGSOP diagnosis, the mortality was 1.56 times higher in the weak group (HR: 1.56, 95% CI: 1.36-1.78). We also found that risk of premature mortality was observed in the lowest quartile (HR: 2.34, 95% CI: 1.80-3.05) and the muscle weakness group (HR: 1.80, 95% CI: 1.52-2.13) in the fully adjusted model. Our 10-year prospective cohort study showed that handgrip strength and muscle weakness are strongly associated with an increased risk of all-cause and premature mortality in healthy middle-aged and older adults.

Physical multimorbidity and incident urinary incontinence among community-dwelling adults aged ≥50 years: findings from a prospective analysis of the Irish Longitudinal Study on Ageing

BACKGROUND

There are no prospective studies on the association between multimorbidity and urinary incontinence (UI), while mediators in this association are unknown. Thus, we aimed to (i) investigate the longitudinal association between multimorbidity and UI in a large sample of Irish adults aged ≥50 years and (ii) investigate to what extent physical activity, polypharmacy, cognitive function, sleep problems, handgrip strength and disability mediate the association.

METHODS

Data on 5,946 adults aged ≥50 years old from the Irish Longitudinal Study on Aging were analysed. The baseline survey was conducted between 2009 and 2011 and follow-up after 2 years was conducted. Information on self-reported occurrence of UI in the past 12 months and lifetime diagnosis of 14 chronic conditions were obtained. Multivariable logistic regression and mediation analysis were conducted.

RESULTS

After adjustment for potential confounders, compared to having no chronic conditions at baseline, having three (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.30-2.48) and four or more (OR = 1.86; 95% CI = 1.32-2.60), chronic conditions were significantly associated with incident UI. Mediation analysis showed that polypharmacy, sleep problems and disability explained 22.7, 17.8 and 14.7% of the association between multimorbidity (i.e. two or more chronic conditions) and incident UI, respectively.

CONCLUSION

A greater number of chronic conditions at baseline were associated with a higher risk for incident UI at 2-year follow-up among adults aged ≥50 years in Ireland. Considering the effects of different medications on UI and improving sleep quality and disability among people aged ≥50 years with multimorbidity may reduce the incidence of UI.

Healthy Eating Index-2015 Is Associated with Grip Strength among the US Adult Population

The Healthy Eating Index-2015 (HEI-2015) was designed to reflect adherence to the 2015-2020 Dietary Guidelines for Americans (DGA). The study aims to examine the association between HEI-2015 and grip strength in a nationally representative sample of the U.S. adult population. This cross-sectional study used data from the National Health and Nutrition Examination Surveys of 2011-2014. Low grip strength was defined as <35.5 kg for men and <20 kg for women. HEI-2015 was computed from two days of 24-h dietary recalls and comprised 13 components. Each component was scored on the density out of 1000 calories and summed to a total score divided into quartiles. Weighted logistic regressions examined the study aim while controlling for associated covariates. The sample included 9006 eligible participants, of those, 14.4% (aged 20+ years), and 24.8% (aged ≥50 years) had low grip strength. Mean (±SD) HEI-2015 total score was 54.2 ± 13.6 and in the lowest and highest quartiles 37.3 ± 5.1 and 72.0 ± 6.5, respectively. In the multivariable model, participants in the highest vs. lowest HEI-2015 quartile had 24% lower odds of having low grip strength (Odds Ratio (OR) = 0.76; 95% CI: 0.60-0.96). Specifically, participants who met the DGA for protein intakes, whole grains, greens and beans, vegetables, or whole fruits had 20-35% lower odds of having low grip strength than those who did not. Higher compliance to the DGA might reduce the risk for low grip strength as a proxy measure for sarcopenia among U.S. adults, particularly adequate intakes of proteins, whole grains, greens and beans, vegetables, and whole fruits.

Associations Between Muscular Strength and Gastroesophageal Reflux Disease in Older Adults

BACKGROUND

The association between muscular strength (MS) and prevalent gastroesophageal reflux disease (GERD) in the older adults is not well established.

METHODS

This study included 542 older adults with no history of myocardial infarction, stroke, or cancer. MS was measured by handgrip dynamometry. Participants were categorized into sex-specific quartiles of MS, while cases of GERD were identified by self-reported physician diagnosis. Logistic regression was used to calculate the odds ratios and 95% confidence intervals of GERD by quartiles of MS.

RESULTS

There were 112 GERD cases. Compared with the first quartile of MS, the odds ratios (95% confidence intervals) of GERD were 0.50 (0.27-0.95), 0.39 (0.20-0.75), and 0.55 (0.29-1.04) in the second, third, and fourth quartiles of MS, respectively, after adjusting for possible confounders including body mass index. In a joint analysis of MS and body mass index, participants were dichotomized into weak (first MS quartile) or strong (upper 3 MS quartiles) and normal weight, overweight, or obese. Compared with the weak-obese group, odds ratios (95% confidence intervals) were 0.34 (0.14-0.80), 0.43 (0.16-1.13), 0.29 (0.12-0.68), 0.18 (0.06-0.55), and 0.07 (0.03-0.21) for the strong-obese, weak-overweight, strong-overweight, weak-normal weight, and strong-normal weight.

CONCLUSIONS

MS was independently and inversely associated with GERD in older adults.

Sex Differences in the Associations of Handgrip Strength and Asymmetry With Multimorbidity: Evidence From the English Longitudinal Study of Ageing

OBJECTIVES

To determine the sex-specific associations of handgrip strength (HGS) and asymmetry with incident multimorbidity and examine whether these relationships differ by sex.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

Secondary analyses of data from the English Longitudinal Study of Ageing (ELSA, waves 2-8). The analytic sample included 3977 participants (51.4% female) aged ≥50 years who had data for HGS on both hands and were living without multimorbidity at baseline.

MEASURES

HGS was assessed with a handheld dynamometer. Individuals in the lowest tertile of sex-specific age-adjusted HGS were defined as having low HGS. The largest HGS readings from the nondominant and dominant hand were used to calculate HGS ratio [nondominant HGS (kg)/dominant HGS (kg)]. Those with HGS ratio <0.90 or >1.10 had any HGS asymmetry. Further, those with HGS ratio <0.90 had dominant HGS asymmetry, whereas those with HGS ratio >1.10 had nondominant HGS asymmetry. Multimorbidity was defined as the coexistence of ≥2 chronic diseases. Cox proportional hazards regression models were conducted for analyses.

RESULTS

Low HGS was associated with multimorbidity among older men [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.03-1.40] and women (HR 1.19, 95% CI 1.03-1.38). No significant effect modification by sex was observed (P-interaction = .71). HGS asymmetry increased the risk of multimorbidity in women only (HR 1.23, 95% CI 1.07-1.41). The relationship between HGS asymmetry and multimorbidity risk differed by sex (P-interaction = .01). Similarly, both dominant HGS asymmetry (HR 1.21, 95% CI 1.05-1.40) and nondominant HGS asymmetry (HR 1.32, 95% CI 1.03-1.68) were related to incident multimorbidity in women only. There was a significant interaction between dominant HGS asymmetry and sex (P-interaction = .02).

CONCLUSIONS AND IMPLICATIONS

Examining HGS asymmetry in HGS test protocols can provide novel insights for the predictive power of HGS in the accumulation of diseases, particularly in women.

Effects of 1 Year of Lifestyle Intervention on Institutionalized Older Adults

The socio-economic and health consequences of our ageing population are well documented, with older adults living in long-term care facilities amongst the frailest possessing specific and significant healthcare and social care needs. These needs may be exacerbated through the sedentary behaviour which is prevalent within care home settings. Reducing sedentary time can reduce the risk of many diseases and improve functional health, implying that improvements in health may be gained by simply helping older adults substitute time spent sitting with time spent standing or in light-intensity ambulation. This study identified the impact of 1 year of lifestyle intervention in a group of older adults living in a long-term care setting in Italy. One hundred and eleven older adults (mean age, 82.37 years; SD = 10.55 years) participated in the study. Sixty-nine older adults were in the intervention group (35 without severe cognitive decline and 34 with dementia) and 42 older adults were in the control group. Data on physical functioning, basic activities of daily living (BADL) and mood were collected 4 times, before, during (every four months) and after the 1 year of intervention. The lifestyle intervention focused on improving the amount of time spent every week in active behaviour and physical activity (minimum 150 min of weekly activities). All participants completed the training program and no adverse events, related to the program, occurred. The intervention group showed steady and significant improvements in physical functioning and a stable situation in BADL and mood following the intervention in older adults with and without dementia, whilst the control group exhibited a significant decline over time. These results suggest that engagement in a physical activity intervention may benefit care home residents with and without dementia both physically and mentally, leading to improved social care and a reduced burden on healthcare services.

Using hand grip strength to detect slow walking speed in older adults: the Yilan study

Background

Walking speed is an important health indicator in older adults, although its measurement can be challenging because of the functional decline due to aging and limited environment. The aim of this study was to examine whether hand grip strength can be a useful proxy for detecting slow walking speed in this population.

Methods

A cross-sectional study was conducted using the cohort from the Yilan Study in Taiwan. Community-dwelling older adults aged 65 years and older were included. Slow walking speed was defined as a 6-meter walking speed < 1.0 m/s, according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Stepwise multiple linear regression was used to determine the most significant variables associated with walking speed. Receiver operating characteristic analysis was used to determine the optimal cutoff values for hand grip strength in detecting slow walking speed.

Results

A total of 301 participants with an average age of 73.9 ± 6.8 years were included; 55.1 % participants were women. In stepwise multiple linear regression analysis that included various variables, hand grip strength was found to be the most explainable factor associated with walking speed among all participants and among participants of each sex. The optimal cutoff values for hand grip strength in the detection of slow walking speed were 19.73 kg for all participants (sensitivity: 55 %, specificity: 83 %, area under the curve: 0.74, accuracy: 66.9 %), 35.10 kg for men (sensitivity: 92 %, specificity: 42 %, area under the curve: 0.70, accuracy: 66.4 %), and 17.93 kg for women (sensitivity: 62 %, specificity: 80 %, area under the curve: 0.76, accuracy: 67.9 %).

Conclusions

Hand grip strength was found to be a useful proxy for the identification of slow walking speed in older adults.

Relationship of Multimorbidity, Obesity Status, and Grip Strength among Older Adults in Taiwan

Background: The combination of multiple disease statuses, muscle weakness, and sarcopenia among older adults is an important public health concern, and a health burden worldwide. This study evaluates the association between chronic disease statuses, obesity, and grip strength (GS) among older adults in Taiwan. Methods: A community-based survey was conducted every 3 years among older adults over age 65, living in Chiayi County, Taiwan. Demographic data and several diseases statuses, such as diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, and certain cancers, were collected using a questionnaire. Anthropometric characteristics were measured using standard methods. Grip strength was measured using a digital dynamometer (TKK5101) method. Results: A total of 3739 older individuals were recruited (1600 males and 2139 females) with the mean age of 72.9 years. The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females. GS significantly decreased most in males with cerebrovascular disease (from 33.0—29.5 kg, p < 0.001) and in females with diabetes mellitus (from 21.8—21.0 kg, p < 0.01). GS was highest in older adults with obesity (body mass index ≥ 27 kg/m²); however, there was no significant change of GS as the disease number increased. Conclusion: Older adults who have two, rather than one or greater than three chronic diseases, have significantly lower GSs than those who are healthy. Stroke and CKD for males, and hypertension and diabetes for females, are important chronic diseases that are significantly associated with GS. Furthermore, being overweight may be a protective factor for GS in older adults of both sexes.

Handgrip and sex-specific cardiometabolic risk factors in Hispanic/Latino migrant farmworkers

Studies have suggested that handgrip strength might be a marker for cardiometabolic risk (CMR), but it has not been studied in Hispanic/Latino farmworker population. This study aimed to characterize absolute and relative handgrip strength in Hispanic/Latino farmworkers, and investigate the sex-specific association between handgrip strength and CMR factors. CMR factors and seated isometric absolute (the sum of both hands) and relative (absolute handgrip strength divided by body mass index) handgrip strengths were collected in 173 Hispanic/Latino farmworkers (mean age 35.1 ± 0.7 years; 49% female). The absolute and the relative handgrip strengths were 89.2 ± 1.8 kg, 3.3 ± 0.1 kg among males, and 56.5 ± 1.9 kg, 1.9 ± 0.1 kg among females, respectively. Age was correlated with absolute (r = - 0.17, p = 0.03) and relative handgrip strengths (r = - 0.28, p < 0.01). In males, absolute handgrip was related to triglycerides (r = - 0.25, p < 0.05), whereas relative handgrip was related to waist circumference (r = - 0.32, p < 0.01), waist/hip circumference ratio (r = - 0.36, p < 0.01), high-density lipoprotein (r = 0.24, p < 0.05), and triglycerides (r = - 0.35, p < 0.01). In females, absolute handgrip was related to fasting plasma glucose (r = - 0.28, p = 0.03), whereas relative handgrip was related to waist circumference (r = - 0.38, p < 0.01) and fasting plasma glucose (r = - 0.22, p < 0.05). Males had lower absolute handgrip strength when their triglycerides levels were at risk (p = 0.021), and lower relative handgrip strength when their plasma glucose (p = 0.034) and triglycerides (p = 0.002) levels were at risk. Females had lower relative handgrip strength when their plasma glucose (p = 0.001) and blood pressure (p = 0.004) were at risk. This study suggests that handgrip strength may be associated with sex-specific CMR factors in a Hispanic/Latino farmworker population.

Strength, Motor Skills, and Physical Activity in Preschool-Aged Children Born Either at Less Than 30 Weeks of Gestation or at Term

OBJECTIVE

Children born <30 weeks of gestation have more motor impairment than do children born at term (37-42 weeks gestation), but reported outcomes have largely focused on cerebral palsy and developmental coordination disorder. The aim of this study was to compare muscle strength, motor skills, and physical activity (PA) of preschool-aged children born <30 weeks with those born at term.

METHODS

In this cohort study, 123 children born <30 weeks and 128 born at term were assessed. Children were aged ≥4 years, 0 months and <6 years, 0 months' corrected age at the time of the assessment. Outcomes included grip strength (kg), Movement Assessment Battery for Children 2nd edition (MABC-2), Little Developmental Coordination Disorder Questionnaire, accelerometer-measured PA, and a parent-completed PA diary. Linear regression and mixed effects models were used to examine differences between children born <30 weeks and those born at term.

RESULTS

Children born <30 weeks had poorer grip strength (preferred hand; mean difference [95% CI] -0.60 kg [-1.04 to -0.15]) and poorer motor competence (Movement Assessment Battery for Children 2nd edition standard score mean difference -2.17 [-3.07 to -1.27]; Little Developmental Coordination Disorder Questionnaire total score mean difference -5.5 [-9.2 to -2.8]) than term-born children. Children born <30 weeks also completed fewer minutes of accelerometer-measured PA (mean difference -41 minutes [-62 to -20]), more minutes of accelerometer-measured stationary behavior (mean difference 33 minutes [12 to 54]), and more minutes of parent-reported screen time (mean difference 21 minutes [10 to 32]) per day.

CONCLUSION

Preschool-aged children born <30 weeks had poorer muscle strength, motor skills, and PA levels than term-born children. These findings suggest that preschool-aged children born <30 weeks may benefit from enhanced surveillance and PA promotion to improve life-long health outcomes.

IMPACT

In our study, children born <30 weeks had reduced muscle strength and poorer motor skills, participated in less PA, and had more stationary and screen behavior than term-born children. These findings emphasize that awareness of multidomain motor deficits in children born <30 weeks' gestation is needed in clinical practice. Given the associations between higher PA and health benefits and the recognition that PA levels can track from early childhood into adulthood, our study highlights the need for assessment and promotion of PA in preschool-aged children born <30 weeks' gestation. Lay Summary. Preschool-aged children born <30 weeks' gestation have poorer strength, motor skills, and physical activity behaviors than their term-born peers. Clinicians and early childhood educators should recognize that the preschool period is a critical time for the assessment and promotion of PA in children born <30 weeks.

Handgrip strength and health outcomes: Umbrella review of systematic reviews with meta-analyses of observational studies

PURPOSE

The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.

METHODS

An umbrella review of systematic reviews with meta-analyses of observational studies was conducted. We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV).

RESULTS

From 504 articles returned in a search of the literature, 8 systematic reviews were included in our review, with a total of 11 outcomes. Overall, nine of the 11 of the outcomes reported nominally significant summary results (p < 0.05), with 4 associations surviving the application of the more stringent p value (p < 10^-6). No outcome presented convincing evidence. Three associations showed Class II evidence (i.e., highly suggestive): (1) higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population (n = 34 studies; sample size = 1,855,817; relative risk = 0.72, 95% confidence interval (95%CI): 0.67-0.78), (2) cardiovascular death risk in mixed populations (n = 15 studies; relative risk = 0.84, 95%CI: 0.78-0.91), and (3) incidence of disability (n = 7 studies; relative risk = 0.76, 95%CI: 0.66-0.87).

CONCLUSION

The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality, as well as disability. To further inform intervention strategies, future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.

Comparison of functional exercise capacity, quality of life and respiratory and peripheral muscle strength between patients with stable angina and healthy controls

Objective

We aimed to compare functional exercise capacity, respiratory and peripheral muscle strength, pulmonary function and quality of life between patients with stable angina and healthy controls.

Methods

We compared 33 patients with stable angina (55.21 ± 6.12 years old, Canada Class II–III, left ventricular ejection fraction: 61.92 ± 7.55) and 30 healthy controls (52.70 ± 4.22 years old). Functional capacity (6-minute walk test (6-MWT)), respiratory muscle strength (mouth pressure device), peripheral muscle strength (dynamometer), pulmonary function (spirometer) and quality of life (Short Form 36 (SF-36)) were evaluated.

Results

6-MWT distance (499.20 ± 51.91 m versus 633.05 ± 57.62 m), maximal inspiratory pressure (85.42 ± 20.52 cmH₂O versus 110.44 ± 32.95 cmH₂O), maximal expiratory pressure (83.33 ± 19.05 cmH₂O versus 147.96 ± 54.80 cmH₂O) and peripheral muscle strength, pulmonary function and SF-36 sub-scores were lower in the angina group versus the healthy controls, respectively.

Conclusion

Impaired peripheral and respiratory muscle strength, reduction in exercise capacity and quality of life are obvious in patients with stable angina. Therefore, these parameters should be considered in stable angina physiotherapy programmes to improve impairments.

Linear and non-linear associations between physical activity, body composition and multimorbidity over 10 years among community-dwelling older adults

BACKGROUND

This study aims to describe the relationships between physical activity (PA), body composition and multimorbidity over 10 years.

METHODS

Participants (N=373; 49% women; average age 61.3±6.7 years) were followed for 10 years. Multimorbidity was defined by self-report as the presence of two or more of 12 listed chronic conditions. PA (steps-per-day) at baseline was assessed by pedometer, handgrip strength (HGS) by dynamometer and appendicular lean mass (ALM) and total body fat mass by dual x-ray absorptiometry . Relative HGS and ALM were calculated by dividing each body mass index (BMI). Regression cubic splines were used to assess evidence for a non-linear relationship.

RESULTS

After 10 years, 45% participants had multimorbidity. There was a non-linear relationship between PA and multimorbidity - PA was associated with lower multimorbidity risk among individuals who engaged in <10,000 steps-per-day (RR=0.91, 95% CI: 0.85, 0.97, per 1000 steps-per-day), but not among those who participated in ≥10,000 steps-per-day (RR=1.04, 95% CI: 0.93, 1.09, per 1000 steps-per-day). Higher BMI (RR=1.05, 95% CI: 1.02, 1.08, per kg/m 2) and fat mass (RR=1.03, 95% CI: 1.01, 1.04, per kg), and lower relative HGS (RR=0.85, 95% CI: 0.77, 0.94, per 0.1 psi/kg/m 2) and ALM (RR=0.93, 95% CI: 0.88, 0.98, per 0.1 kg/kg/m 2) were linearly associated with a higher risk of multimorbidity. Absolute HGS and ALM were not significantly associated with multimorbidity.

DISCUSSION

These findings highlight the potential clinical importance of maintaining adequate levels of PA and of reducing adiposity and maintaining muscle function for minimising the risk of multimorbidity in older adults.

[Longitudinal Study of the Association Between Handgrip Strength and Chronic Disease Multimorbidity among Middle-aged and Older Adults]

OBJECTIVE

To investigate the potential association between multimorbidity and the handgrip strength of middle-aged and older adults.

METHODS

The baseline (2011) and second-round follow-up (2015) data of China Health and Retirement Longitudinal Study (CHARLS) were used. Adults≥40 were selected as the subjects of the study. Variables incorporated in the study included handgrip strength, chronic disease prevalence, demographic variables, and health behavior variables. Generalized estimating equations were used to analyze the longitudinal association between handgrip strength and multimorbidity.

RESULTS

A total of 28 368 middle-aged and older adults were included in the baseline and follow-up samples, with an average age of (59.1±9.7) years old, the oldest being 96 while the youngest being 40. Among them, 6 239 were male, accounting for 47.3%. In the second-round follow-up, 9 186 baseline respondents and 5 994 new respondents were covered, reaching a total of 15 180 respondents. Compared with the baseline, a higher proportion of the second-round follow-up respondents were female ( P=0.033) and were older ( P<0.001). From the baseline to the second-round follow-up, Q1, the lowest grip strength category, increased from 23.4% to 26.6%, while Q4, the highest grip strength category, decreased from 26.5% to 21.2%. The prevalence of having more than three chronic diseases increased from 18.2% to 24.2% and the prevalence of having more than five chronic diseases increased from 3.3% to 6.2%. After adjusting for confounding variables, the interaction items of handgrip strength and time showed statistical significance. After stratification by gender, the interaction items of male handgrip strength and follow-up time were statistically significant in both models ( P<0.05). The marginal effect graph of the interactive item showed that the multimorbidity prevalence of respondents with lower handgrip levels grew faster with age. Individual effect analysis showed that the correlation between handgrip strength and multimorbidity was not statistically significant at baseline, but the follow-up done four years afterwards showed statistical significant correlation between handgrip strength and multimorbidity.

CONCLUSION

Respondents with lower baseline handgrip strength are associated with increasingly higher risk of multimorbidity over time. Handgrip strength can be used as an effective screening tool for middle-aged and older adults in China to identify those at higher risks of multimorbidity of chronic diseases.

Effects of core strengthening exercise on colon transit time in young adult women

Background/objective

This study investigated the effects of core strengthening exercise (CSE) on colon transit time (CTT) in young adult women.

Methods

Eighty women (mean age 23 years) were enrolled and randomly assigned to participate in a 12-week, instructor-led group CSE program (CSE group [CSEG]; n = 40) or to maintain usual daily activities (control group [CG]; n = 40). 27 participants in the CSEG and 21 participants in the CG completed the study. The CSE program consisted of 60-min sessions, two days a week, for 12 weeks. CTT was measured using a multiple marker technique with a radio-opaque marker. Data were analyzed with a 2-way, repeated measures ANCOVA.

Results

After the 12-week intervention, The CSEG showed significant improvements in trunk flexor power (P = 0.031), peak torque (P = 0.032), and endurance (P = 0.011). The CSEG also showed improvements in the sit-up (P < 0.001) and side-step (P = 0.043) tests compared to the CG. While there was not a significant group difference between the CSEG and CG, left CTT (P = 0.021) and total CTT (P = 0.006) decreased significantly within the CSEG group only.

Conclusion

The 12-week CSE program increased abdominal strength but did not improve CTT compared to the control group. This study also provides preliminary data that CSE may reduce left CTT and total CTT, but additional clinical trials are needed.

Development and Validation of a Risk Score to Predict the First Hip Fracture in the Oldest Old: A Retrospective Cohort Study

BACKGROUND

To evaluate whether the common risk factors and risk scores (FRAX, QFracture, and Garvan) can predict hip fracture in the oldest old (defined as people aged 80 and older) and to develop an oldest-old-specific 10-year hip fracture prediction risk algorithm.

METHODS

Subjects aged 80 years and older without history of hip fracture were studied. For the derivation cohort (N = 251, mean age = 83), participants were enrolled with a median follow-up time of 8.9 years. For the validation cohort (N = 599, mean age = 85), outpatients were enrolled with a median follow-up of 2.6 years. A five-factor risk score (the Hong Kong Osteoporosis Study [HKOS] score) for incident hip fracture was derived and validated, and its predictive accuracy was evaluated and compared with other risk scores.

RESULTS

In the derivation cohort, the C-statistics were .65, .61, .65, .76, and .78 for FRAX with bone mineral density (BMD), FRAX without BMD, QFracture, Garvan, and the HKOS score, respectively. The category-less net reclassification index and integrated discrimination improvement of the HKOS score showed a better reclassification of hip fracture than FRAX and QFracture (all p < .001) but not Garvan, while Garvan, but not HKOS score, showed a significant over-estimation in fracture risk (Hosmer-Lemeshow test p < .001). In the validation cohort, the HKOS score had a C-statistic of .81 and a considerable agreement between expected and observed fracture risk in calibration.

CONCLUSION

The HKOS score can predict 10-year incident hip fracture among the oldest old in Hong Kong. The score may be useful in identifying the oldest old patients at risk of hip fracture in both community-dwelling and hospital settings.

A cross-sectional study investigating the relationship between handgrip strength with multimorbidity in Korean adults: Findings from the Korea National Health and Nutrition Examination Survey VI-VII (2014-2017)

To date research investigating the associations between handgrip strength and multimorbidity when stratifying by age and sex is limited. Furthermore, this is the first study in a Korean population, and the first to include adults ≥ 19 years of age. Here we investigated the associations between handgrip strength and multimorbidity in Korean adults aged ≥ 19 years.In this cross-sectional study data from the Korean National Health and Nutrition Examination Survey were used. Multimorbidity was defined as having 2 or more chronic diseases. A total of 19,779 participants were eligible for the study (8730 male and 11,049 female). We grouped and analysed participants based on age and sex (men and women aged 19-49 years, men and women aged 50-80 years) and examined the associations between handgrip strength and multimorbidity using multivariate logistic regressions using stratification by age, sex and body mass index (BMI).Multivariate logistic regressions revealed a significant inverse association irrespective of sex, between relative handgrip strength and multimorbidity. Participants with the lowest handgrip strength had a significantly higher odds ratio (OR) of multimorbidity (men aged 19-49 years: 3.76 and aged 50 years to 80 years: 2.11; women aged 19 years to 49 years: 1.52 and aged 50-80 years: 2.15) when compared to those with highest handgrip strength after adjusting for confounding variables. The highest OR was observed in men aged 19 years to 49 years with a BMI ≥ 25 kg/m2.In the current study we observed a significant inverse relationship between handgrip strength and multimorbidity in males and females with 2 or more chronic diseases. Male participants with a low handgrip strength aged between 19 years to 49 years with a BMI ≥25 kg/m2 may be at greater risk of multimorbidity. This study highlights the need for further longitudinal studies to investigate the effects of increasing handgrip strength combined with weight loss, as an effective strategy to reduce the incidence of multimorbidity.