Handgrip Strength and Health in Aging Adults

Sex-related differences in the associations between wishing to die, grip strength, and physical activity: An analysis in European middle-aged and older adults

BACKGROUND

The desire to die among older adults has been reported in several European countries. This study aimed to investigate the associations between grip strength (GS) and the frequency of weekly moderate physical activity (MPA) with wish to die (WTD) in European middle-aged and older adults.

METHODS

A cross-sectional analysis was conducted with 39,377 participants (22,313 women) from 27 European countries, aged ≥50 years, responding to wave 8 of the SHARE project. GS was assessed for both hands by a dynamometer, WTD was obtained by asking: 'In the last month, have you felt that you would rather be dead?' from the 12-item EURO-D scale, and the weekly frequency of moderate physical activity (MPA) was self-reported.

RESULTS

Greater GS (per 1 unit) was associated with a 26 % to 55 % lower chances of WTD among men. Among women, a 1 kg increase in GS was associated with a 40 % to 70 % lower chance of WTD. MPA once a week or more than once a week (compared to MPA less than once a week) was associated with a 57 % and 58 % lower chance of WTD among men. Among women, MPA once a week or more than once a week (compared to MPA less than once a week) was associated with 44 % and 48 % lower odds of WTD.

CONCLUSION

GS was inversely associated with WTD, particularly in women. Engaging in MPA once a week showed a greater association with less WTD for both sexes than MPA more than once a week, particularly in men.

The Association Between the Non-essential Metal Mixture and Handgrip Strength in Chinese Community-Dwelling Older Adults

There is limited research on the effects of non-essential metal (NEM) mixture on handgrip strength in the elderly. This study aimed to assess the associations of single NEMs and their mixture with handgrip strength in Chinese community-dwelling older adults. A total of 3807 elderly people aged 60 years or above were included in this study. Measurement of urinary aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), and gallium (Ga) concentrations was conducted by inductively coupled plasma mass spectrometry (ICP-MS). Handgrip strength was measured using a hand dynamometer. Four statistical models, including general linear regression and generalized additive models (GAMs), as well as Bayesian kernel machine regression (BKMR) and quantile-based computation regression (QGC) models, were used to assess the individual and joint effects of urine NEMs with handgrip strength, respectively. After adjusting for covariates, Ga (ß = - 0.27; 95% CI, - 0.54 ~  - 0.01) and As ( β  = - 0.34; 95% CI, - 0.61 ~  - 0.07) were negatively associated with handgrip strength. The GAMs and BKMR further suggested that the negative associations of Ga and As with handgrip strength were linear and inverted U-shaped, respectively. The BKMR and QGC models showed that the NEM mixture was negatively related to handgrip strength, with Ga and As contributing the most within the mixture. Moreover, we also observed an interaction between As and Ga on handgrip strength. Longitudinal studies are needed to verify these findings.

Association between handgrip strength asymmetry and all-cause mortality in United States-based older adults: A cross-sectional study

BACKGROUND

Although handgrip strength is commonly measured in both hands for sarcopenia screening, the nonmaximum readings are frequently discarded. We aimed to evaluate whether handgrip strength asymmetry, in addition to weakness, could provide additional prognostic information in older adults.

METHODS

Participants aged ≥60 years from the 2011-2014 National Health and Nutrition Examination Survey with available handgrip strength measurements were included. Study outcomes are all-cause and cardiovascular disease mortality. Participants were categorized into the weakness-/asymmetry- (reference), weakness-/asymmetry+, weakness+/asymmetry-, and weakness+/asymmetry+ groups based on the status of handgrip weakness and asymmetry.

RESULTS

Overall, 3116 older adults (mean age, 69.47 years) were included. Weighted percentages of participants in the reference, weakness-/asymmetry+, weakness+/asymmetry-, and weakness+/asymmetry+ groups were 54.28%, 39.88%, 2.86%, and 2.97%, respectively. During a median follow-up of 79 months, 679 deaths (232 from cardiovascular causes) occurred. Compared with the reference group, hazard ratios (HRs) and 95% confidence intervals (CIs) for the weakness-/asymmetry+, weakness+/asymmetry-, and weakness+/asymmetry+ groups were 1.02 (95% CI 0.84-1.24), 1.57 (95% CI 1.09-2.26), and 2.34 (95% CI 1.47-3.71), respectively, for all-cause mortality (P for trend < 0.01) and 1.19 (95% CI 0.78-1.81), 1.22 (95% CI 0.54-2.78), and 2.30 (95% CI 1.20-4.39), respectively, for cardiovascular disease mortality (P for trend = 0.03). Subgroup analysis indicated anemia and diabetes significantly modified the associations between handgrip strength and/or weakness status with all-cause and cardiovascular disease mortality.

CONCLUSION

Handgrip strength asymmetry, in addition to weakness, provided additional prognostic information for all-cause and cardiovascular mortality in older adults in the United States.

High muscle-to-fat ratio predicts slow muscle strength decline in middle-aged and older adults: Longitudinal aging study of Taipei

BACKGROUND

Handgrip strength is a vital marker of muscle function and predictor of health outcomes in older adults. This study investigated the relationship between the muscle-to-fat ratio and 3-year decrease in handgrip strength in community-dwelling adults aged ≥50 years.

METHODS

Data were obtained from the Longitudinal Aging Study of Taipei (LAST), a cohort study of adults aged 50 years and older. Measurements from two waves, 3 years apart, were analyzed. Demographics, laboratory data, and handgrip strength data were collected. Appendicular skeletal muscle mass was assessed using bioimpedance analysis, and the relative appendicular skeletal muscle mass index was calculated by dividing appendicular muscle mass by height squared. The muscle-to-fat ratio was derived by dividing appendicular muscle mass by total body fat. Handgrip strength decrease was divided into quartiles; slow decliners experienced the smallest decrease, whereas rapid decliners had the greatest decrease. Associations between the muscle-to-fat ratio and other risk factors were analyzed.

RESULTS

Over 3 years, the Charlson Comorbidity Index, medication use, waist-to-hip ratio, and fat percentage increased, whereas skeletal muscle mass, the muscle-to-fat ratio, and handgrip strength decreased. Rapid decliners were less likely to be male (21.6% vs 33.3%, p = 0.008) or alcohol drinkers (53.8% vs 66.2%, p = 0.01) and had lower skeletal muscle mass (6.3 ± 0.9 vs 6.6 ± 1.0, p = 0.006) and muscle-to-fat ratios (1.0 ± 0.4 vs 1.1 ± 0.5, p = 0.004) but greater fat percentages (30.4 ± 6.6 vs 29.0 ± 7.6, p = 0.045). A greater muscle-to-fat ratio (odds ratio [OR] = 3.751, p = 0.047), greater physical activity (OR = 1.694, p = 0.04), and lower glycated hemoglobin (HbA1c; OR = 0.61, p = 0.008) reduced the risk of rapid decline.

CONCLUSION

The muscle-to-fat ratio, together with physical activity and glycemic control, predicts a decrease in handgrip strength, highlighting its potential as a biomarker of intrinsic capacity and muscle-fat interplay. Further research is needed to explore the underlying biological mechanisms involved.

Randomized Controlled Trial of Walking Training with and without Blood Flow Restriction in Patients Treated with Maintenance Hemodialysis

Key Points

Background

The decline in walking capacity among patients undergoing maintenance hemodialysis can worsen physical function, leading to impaired health-related quality of life (HRQOL). This randomized controlled trial compared the effectiveness of walking training with blood flow restriction (WT-BFR) and walking training (WT) versus usual care controls on walking capacity among hemodialysis patients.

Methods

Patients treated with maintenance hemodialysis were recruited from two dialysis units in Suzhou, China, between February and June 2024 and were randomly allocated into three groups using block randomization. The control group (CG) received usual care. The WT group received 8 weeks of low-to-moderate intensity walking intervention. The WT-BFR group received the same intervention as the WT group, with the addition of 40%–50% limb occlusion pressure applied during walking sessions. Walking capacity (primary outcome), physical function, HRQOL, anxiety, and depression were assessed at baseline, 8, and 16 weeks.

Results

Fifty-seven eligible patients with a mean age of 54 years (SD=10) were recruited. They were randomly allocated equally into the CG (n=19), WT-BFR group (n=19), and WT group (n=19). From baseline to 8 weeks, the improvements in walking capacity were greater in the WT-BFR (mean differences and 95% confidence interval, 48.48, 28.81 to 68.16 m) and WT (31.70, 9.29 to 54.11 m) groups compared with the CG. At 16 weeks, the WT-BFR group also demonstrated a greater improvement in walking capacity than the WT group (34.63, 8.90 to 60.36 m). Similarly, the WT-BFR and WT groups showed greater improvements in physical function and disease-specific domains of HRQOL, compared with the CG.

Conclusions

After an 8-week intervention, both WT-BFR and WT improved walking capacity, physical function, and HRQOL in maintenance hemodialysis patients. However, the prolonged benefits of WT-BFR in the hemodialysis population require further investigation.

Clinical Trial registry name and registration number:

Chinese Clinical Trial Register registration number: ChiCTR2400080779.

Body mass index and trajectories of muscle strength and physical function over time in Mexican American older adults: Sex differences

BACKGROUND AND AIMS

Worldwide, the prevalence of overweight and obesity has increased. We examined sex-specific patterns in the relationship of body mass index (BMI) with muscle strength and physical function among older Mexican Americans over time.

METHODS AND RESULTS

Participants (N = 1975) aged ≥65 years (mean = 72.4) were from a longitudinal study of Mexican American older adults (1993/94-2016). Measures collected at each interview included socio-demographics and health status; BMI (independent variable); short physical performance battery (SPPB) and handgrip strength (HGS) (outcomes). Participants were grouped into underweight (<18.5 kg/m2); normal weight (18.5-24.9 kg/m2); overweight (25-29.9 kg/m2); class I obesity (30-34.9 kg/m2); and class II/morbid obesity (≥35 kg/m2). Changes in SPPB and HGS by BMI and sex over time were estimated using general linear mixed models. Males deemed overweight (β = 0.46; Standard Error [SE] = 0.11; p-value = 0.0001), class I obesity (β = 0.43; SE = 0.15; p-value = 0.0037), and class II/morbid obesity (β = 0.66; SE = 0.29; p-value = 0.0246) scored higher in SPPB than those with normal weight. Females deemed overweight (β = 0.49; SE = 0.10; p-value = 0.0001) and class I obesity (β = 0.32; SE = 0.11; p-value = 0.0047) scored higher on the SPPB than those with normal weight. Males and females deemed overweight (β = 0.56; SE = 0.29; p-value = 0.0535 and β = 0.65; SE = 0.18; p-value = 0.0003, respectively) and class I obesity (β = 1.08; SE = 0.39; p-value = 0.0062 and β = 0.92; SE = 0.22; p-value = 0.0001, respectively) scored higher in HGS than those with normal weight.

CONCLUSION

We found no sex differences in the trajectories of decline for HGS and physical function. Females and males classed as overweight or class I obesity experienced slower decline in HGS and physical function.

Polygenic Associations between Motor Behaviour, Neuromotor Traits, and Active Music Engagement in Four Cohorts

Phenotypic investigations have shown that actively engaging with music, i.e., playing a musical instrument or singing may be protective of motor decline in aging. For example, music training associated with enhanced sensorimotor skills accompanied by changes in brain structure and function. Although it is possible that the benefits of active music engagement "transfer" to benefits in the motor domain, it is also possible that the genetic architecture of motor behaviour and the motor system structure may influence active music engagement. This study investigated whether polygenic scores (PGS) for five behavioural motor traits, 12 neuromotor structural brain traits, and seven rates of change in brain structure traits trained from existing discovery genome-wide association studies (GWAS) predict active music engagement outcomes in four independent cohorts of unrelated individuals of European ancestry: the Canadian Longitudinal Study on Aging (CLSA; N=22,198), Wisconsin Longitudinal Study (WLS; N=4,605), Vanderbilt's BioVU Repository (BioVU; N=6,150), and Vanderbilt's Online Musicality study (OM; N=1,559). Results were meta-analyzed for each PGS main effect across outcomes and cohorts, revealing that PGS for a faster walking pace was associated with higher amounts of active music engagement. Within CLSA, a higher PGS for walking pace was associated with greater odds of engaging with music. Findings suggest a shared genetic architecture between motor function and active music engagement. Future intervention-based research should consider the genetic underpinnings of motor behavior when evaluating the effects of music engagement on motor function across the lifespan.

Individual and Joint Associations of Cancer Diagnosis and Handgrip Strength with Depression in European Middle-Aged and Older Adults

Background/Objectives: Depression is influenced by a multitude of interconnected factors, including cancer and handgrip strength. The purpose of our study is to examine how handgrip strength and cancer diagnosis are individually and jointly associated with depression. Methods: An observational study was employed using secondary data from the Survey of Health, Aging, and Retirement in Europe waves 7 and 8. The sample comprised 7 641 participants (71.1 ± 7.7 years), from 12 European countries. Results: Having a cancer diagnosis was associated with greater odds of depression (depression 2017 model: OR = 1.35, 95% CI = 1.03, 1.75; depression 2019 model: OR = 1.48, 95% CI = 1.12, 1.95). Being in a higher handgrip tertile was associated with lower odds of depression (depression 2017 model: tertile 2, OR = 0.65, 95% CI = 0.56, 0.74 and tertile 3, OR = 0.56, 95% CI = 0.49, 0.65; depression 2019 model: tertile 2, OR = 0.74, 95% CI = 0.64, 0.86 and tertile 3, OR = 0.76, 95% CI = 0.65, 0.88). The greatest reduction in odds for depression was found for participants without cancer and in the third handgrip strength tertile (depression 2017: OR = 0.42, 95% CI = 0.29, 0.61; depression 2019: OR = 0.40, 95% CI = 0.28, 0.58). Conclusions: Both cancer and handgrip strength were associated with depression, with the first increasing its risk and the latter reducing it. Individuals without cancer and in the highest tertile of handgrip strength have lower odds of depression in both analyses.

Longitudinal association between handgrip strength and depressive symptoms in middle-aged and older Chinese adults: mediating role of functional limitation

Background

The relationship between handgrip strength (HGS) at baseline and subsequent depressive symptoms among middle-aged and older Chinese adults remains highly uncertain. This research endeavored to investigate the effect of functional limitation on the association between these two variables.

Methods

A total of 5,684 participants aged ≥45 years from the China Longitudinal Study of Health and Retirement (CHARLS) were enrolled, using data from the 2015 and 2018 waves. Functional limitation was evaluated based on participants' self-reported basic activities of daily living (BADL) and instrumental activities of daily living (IADL). Logistic regression models were utilized to analyze the relationship between HGS and subsequent depressive symptoms, and bootstrap analysis was performed to explore the potential mediating role of functional limitation.

Results

After adjusting for confounders, an inverse correlation was detected between HGS and functional limitation (B = -0.885, p < 0.001), a positive correlation was found between functional limitation and subsequent depressive symptoms (B = 1.054, p < 0.001). The mediated effect size of HGS on depressive symptoms through functional limitation was a*b = -0.933 (BCa 95% CI: -1.224, -0.642). Functional limitation had a significant impact on 18.9% of the overall association.

Conclusion

Among the Chinese middle-aged and senior population, functional limitation accounted for 18.9% of the connection between HGS and depressive symptoms. Interventions targeting the enhancement of muscle strength should be regarded as crucial elements for maintaining physical function and preventing depressive symptoms.

Sex-Based Effects on Muscle Oxygenation During Repeated Maximal Intermittent Handgrip Exercise

BACKGROUND

This investigation aimed to examine sex-based differences in deoxy[heme] (HHb), tissue saturation (StO2), and force-deoxygenation ratio (FD) of the forearm flexor muscles during a maximal-effort intermittent fatiguing handgrip protocol.

METHODS

Thirty-three healthy males (n = 15) and females (n = 18) completed a fatiguing handgrip protocol consisting of 60 4 s contractions separated by a 1 s rest. Near-infrared spectroscopy was used to measure muscle oxygenation before, during, and after the protocol.

RESULTS

Sex differences in HHb (p = 0.033) and StO2 (p = 0.021) were observed with significantly greater values for females (HHb: 110.204 ± 12.626% of baseline; StO2: 72.091 ± 5.812%) in comparison to males (HHb: 101.153 ± 12.847% of baseline; StO2: 66.978 ± 7.799%). Females (0.199 ± 0.081 AU) also demonstrated significantly (p = 0.001) lower FD in comparison to males (0.216 ± 0.094 AU). However, males (b = -0.023 ± 0.008 AU) demonstrated a significantly (p < 0.001) greater rate of decline in FD in comparison to females (b = -0.017 ± 0.006 AU).

CONCLUSIONS

Prior to, during, and after a maximal-effort intermittent fatiguing handgrip fatiguing protocol, males demonstrate significantly lower StO2 than females and a faster rate of decline in FD. Moreover, females demonstrate greater HHb values than males when assessed relative to a resting baseline.

Reliability and validity of the hand-held dynamometer "NOD": a new instrument for assessment of isometric grip strength

INTRODUCTION

Hand grip strength (HGS) is an important measure in a physiotherapy assessment and for this purpose it is necessary to have valid and reliable instruments to measure it. In this study we aimed at investigating the reliability, validity, and agreement of the new hand-held dynamometer NOD (OT-Bioelettronica, To-Italy) compared to Jamar® hydraulic dynamometer (JD), the gold standard.

METHODS

Fifty healthy subjects were selected; 9 trials for the dominant hand and 9 trials for the non-dominant hand were administrated to each of them: 3 trials of HGS with the JD in rung #3, 3 trials with the JD-adapted-grip (like the NOD one), and 3 trials with NOD. To verify the reliability of NOD, the Intraclass Correlation Coefficient (ICC 3,1) was calculated with a mixed effects model with the addition of adjustment variables (age, gender, dominant / non-dominant limb, trials). The model used single HGS measurements to estimate variance components, so reflecting both degree of correspondence and agreement among devices. To assess concurrent validity NOD was compared to the "gold standard" JD, in terms of ICCs and through Pearson correlation. The agreement between the methods of measurement was calculated with the Limits of Agreement (LoA) and the plots of Bland-Altman.

RESULTS

All ICCs show high inter-reliability; the results are very similar for both dynamometers. The value of the adjusted ICC of NOD was 0.90. For validity, Pearson correlations of NOD towards JD and JD-adapted-grip were high (r = 0.87 and 0.88). However, the LoA and the plots of Bland-Altman demonstrated that there is no agreement between NOD and JD and between NOD and JD-adapted-grip, with NOD showing lower mean scores than JD.

CONCLUSIONS

NOD is a reliable and valid instrument for HGS. However, even if it cannot be considered interchangeable with JD because there is no agreement between them in free-living adults, NOD is easier to carry than other dynamometers, it has a Bluetooth® connection with a free App and it is a multi-purpose tool that should be considered both in daily practice and in clinical settings.

Absolute Agreement Between Subjective Hand Squeeze and Objective Handgrip Strength in Adults

ABSTRACT

Kieser, J, Langford, M, Stover, E, Tomkinson, GR, Clark, BC, Cawthon, PM, and McGrath, R. Absolute agreement between subjective hand squeeze and objective handgrip strength in adults. J Strength Cond Res 39(1): 16-23, 2025-Despite handgrip strength (HGS) being considered a convenient muscle strength assessment, HGS lacks routine measurement in sports medicine and healthcare settings because barriers such as time and lack of instrumentation may exist. Alternatives to circumvent these barriers should be sought. This study examined the absolute agreement of a subjective estimate of strength capacity on objectively measured HGS in adults aged 18-84 years. We also evaluated the test-retest reliability of an electronic handgrip dynamometer as a secondary purpose. There were 4 trained interviewers (i.e., assessors) who were assigned completely at random to subject laboratory visits occurring on 2 separate days. Trained interviewers carefully positioned their fingers into the hand of each subject before asking them to squeeze their fingers with maximal effort, and interviewers estimated each subject's HGS. An electronic handgrip dynamometer objectively measured HGS. Intraclass correlation coefficients (ICCs) were used for the analyses. The analytic sample included 100 subjects (age: 48.0 ± 20.2 years; 61% women). Poor agreement between mean objective HGS and averaged subjective hand squeeze was observed (ICC: 0.47; 95% confidence interval [CI]: 0.40-0.53). However, there was moderate agreement between dynamometer-derived maximal HGS and the most accurate HGS estimate (ICC: 0.75; CI: 0.65-0.86). An excellent test-retest reliability was found for mean (ICC: 0.97; CI: 0.95-0.98) and maximal HGS with the electronic dynamometer (ICC: 0.97; CI: 0.96-0.98). Trained interviewers performing subjective hand squeezes can approximate objective HGS with adequate accuracy, which could be useful when time and handgrip dynamometry access are lacking. Expanded interviewer training and testing may help with implementation.

Handgrip Strength has Declined Among Adults, Particularly Males, from Shanghai Since 2000

BACKGROUND

Handgrip strength (HGS) is an excellent marker of general strength capacity and health among adults. We aimed to calculate temporal trends in HGS for adults from Shanghai between 2000 and 2020.

METHODS

Adults aged 20-59 years from Shanghai, China, were included. Representative cross-sectional HGS data (n = 127,756) were collected in 2000, 2005, 2010, 2014, and 2020. HGS was measured using isometric dynamometry and was adjusted for body size (i.e., height-squared). Trends in mean adjusted HGS were calculated using general linear models with adjustments for age, sex, location, occupation, blood pressure, and exercise time. Trends in distributional characteristics were described visually and calculated as the ratio of coefficients of variation (CVs).

RESULTS

We found a significant, small decline in mean adjusted HGS (effect size (ES) [95%CI]: -0.21 [-0.22, -0.20]) since the year 2000. Negligible temporal differences were found across age, location, and occupation groups, with a 2.8-fold greater decline for men than for women. Overall, distributional variability declined negligibly (ratio of CVs [95% CI]: 0.92 [0.91, 0.93]). We also observed a negligible trend (ES < 0.20) in distributional asymmetry among adults with low adjusted HGS (below the 25th percentile) and a small decline (ES = 0.20-0.49) in adults with high adjusted HGS (above the 75th percentile).

CONCLUSIONS

There was a recent small decline in adjusted HGS for adults from Shanghai, which was greater for men than for women and nonuniform across the population. A decline in adjusted HGS may represent a decline in the general/functional health of the population.

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

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

Association between handgrip strength and mortality risk among cardiovascular disease patients: A cohort study from the NHANES 2011-2014

BACKGROUND

Cardiovascular disease (CVD) and handgrip strength (HGS) are recognized mortality risk factors. However, the synergistic effect of CVD and HGS on mortality remains unclear. This study investigated the relationship between HGS and mortality in CVD patients.

METHODS

Data from the National Health and Nutrition Examination Survey (2011-2014) were analyzed. Weighted Cox proportional hazards models and restricted cubic splines (RCS) were used to examine associations, with subgroup, sensitivity and predictive performance analyses.

RESULTS

Among 8,262 adults (50.56% female; 851 with CVD), 695 deaths (6.74%) occurred over a median follow-up of 80 months. Compared to non‒CVD individuals with high-HGS, CVD patients with low-HGS had the highest risk of all-cause mortality [hazard ratio (HR) = 8.76; 95% CI: 4.20-18.30] and CVD mortality (HR = 4.83; 95% CI: 3.48-6.70), while CVD patients with high-HGS showed no significant mortality risk increase. Among CVD patients, the HRs for all-cause and CVD mortality in the low-HGS group were 3.60 (95% CI, 2.21-5.86) and 4.01 (95% CI, 1.68-9.59). RCS analyses revealed that the relationships were linear (P‒nonlinear >0.05), and subgroup analyses revealed stroke status potentially modified the association for CVD mortality (P‒interaction = 0.002). The addition of HGS significantly improved the predictive performance of current models for mortality (P < 0.001).

CONCLUSION

Low HGS may be associated with a higher risk of all-cause and CVD mortality among CVD patients. High HGS appears to reduce mortality risk among CVD patients. These findings suggest that HGS may serve as a valuable predictor of mortality risk in CVD patients.

International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years from 69 countries and regions

BACKGROUND

Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability. Handgrip strength (HGS) using isometric dynamometry is a convenient, feasible, and widely used method of assessing muscular strength among people of all ages. While adult HGS norms have been published for many countries, no study has yet synthesized available data to produce international norms. The objective of this study was to generate international sex- and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.

METHODS

Systematic searches were conducted in 6 databases/web search engines (MEDLINE, SPORTDiscus, Embase, Web of Science, CINAHL, and Google Scholar) up to December 1, 2023. We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age. Pseudo data were generated using Monte Carlo simulation following harmonization for methodological variation. Population-weighted Generalized Additive Models for Location, Scale, and Shape were used to develop sex- and age-specific norms for absolute HGS (kg) and HGS normalized by height (Ht, m) squared (i.e., HGS/Ht2 in kg/m2). Norms were tabulated as percentile values (5th to 95th) and visualized as smoothed percentile curves.

RESULTS

We included data from 100 unique observational studies representing 2,405,863 adults (51.9% female) aged 20 to 100+ years from 69 countries and regions tested from the year 2000 onward. On average, absolute and normalized HGS values negligibly improved throughout early adulthood, peaked from age 30-39 years (at 49.7 kg (males) and 29.7 kg (females) for absolute HGS or 16.3 kg/m2 (males) and 11.3 kg/m2 (females) for HGS/Ht2), and declined afterwards. The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.

CONCLUSION

This study provides the world's largest and most geographically comprehensive international norms for adult HGS by sex and age. These norms have utility for global peer-comparisons, health screening, and surveillance.

Dynapenia-abdominal obesity and mortality risk, is independent effect obscured by age and frailty?:Birjand Longitudinal Aging Study (BLAS)

Background

Abdominal obesity and low muscle strength, known separately as risk factors for mortality, might have a synergistic effect when they co-occur. Dynapenic abdominal obesity (DAO) is a condition defined by the presence of both. However, DAO's independent and combined impact on mortality remains under investigation.

Objective

The objective of the present study was to evaluate the association of dynapenia, abdominal obesity, and dynapenic abdominal obesity with all-cause mortality among community-dwelling older adults.

Methods

This is a longitudinal study with a 5-year follow-up conducted involving 1,354 community-dwelling older adults (≥ 65 years) of the Birjand Longitudinal Aging Study (BLAS). Abdominal obesity and dynapenia were respectively defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), dynapenic/non-abdominal obesity (D/NAO), non-dynapenic/abdominal obesity (ND/AO), and dynapenic/abdominal obesity (D/AO). The outcome was all-cause mortality registered through four methods: 1- telephone interview with the family of the participants during September 2018 and February 2024, 2- hospital information systems, 3- death registry of the deputy of the Health of Birjand University of Medical Sciences 4- in a subject who died at home or out of hospital death registry was verified by a verbal autopsy performed by a clinician. Univariate and multiple Logistic regression models were used to estimate the risk of all-cause mortality as a function of dynapenia and abdominal obesity in competing events controlled by age, sex, multi-morbidity, and frailty.

Results

The mean age of the study participants was 69.77 ± 7.55 years, and about 703 (51.71%) were female. There was a statistical difference between the alive and the deceased groups in terms of sex, age, multimorbidity, and frailty. Mortality was statistically higher among dynapenic participants (P < 0.001). Unadjusted logistic regression analysis explored the relationship between D/NAO and mortality (OR = 2.18; CI 95% 1.25-3.78). In the adjusted models, no significant relationships were observed. Age and frailty had significant associations with mortality.

Conclusion

While our study found an association between dynapenia without abdominal obesity and increased mortality risk, factors like age and frailty might play a stronger role. These require further investigation to understand the independent effect of dynapenia on mortality fully.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01501-8.

Adapted Taekwondo Improves Postural Balance and Health-Related Quality of Life Concerning Multicomponent Training and Walking Exercise in Older Females: A Randomized Controlled Trial (TKD and Aging Project)

Background/Objectives: This study aimed to assess and compare the effects of an adapted taekwondo (TKD) program, multicomponent training (MCT), walking exercise (WE), and inactive control group (CG) on blood pressure, morphological variables, frequency of food consumption, cognitive status, health-related quality of life (HRQoL), physical fitness tests, and postural balance in independent older females. Methods: A randomized controlled trial study was conducted with the following groups: TKD (n = 13), MCT (n = 12), WE (n = 12), and CG (n = 14), considering three/weekly 60-min/sessions for 16-weeks. A two-factor mixed analysis of the variance model with repeated measures was performed. Results: TKD improved significantly more in phonetic fluency (p = 0.021; ES = 1.89) than WE and in general health (p = 0.033; ES = 1.11) than CG. Both TKD and MCT improved significantly more than CG in the 30 s chair stand, arm curl, chair sit-and-reach, timed up-and-go, maximal isometric handgrip strength, and postural balance for the eyes closed condition in the area and anteroposterior velocity (p < 0.05). Conclusions: Only TKD improved the area (p = 0.008; ES = 1.00) and mediolateral velocity (p = 0.019; ES = 0.79) for the eyes open condition, and mediolateral velocity (p = 0.021; ES = 1.57) for the eyes closed condition. Blood pressure, morphological variables, and food consumption frequency showed no significant intragroup or intergroup interactions. TKD equivalently improved HRQoL and physical fitness to MCT, with better postural balance in older females.

Urinary pentosidine as a potential biomarker of muscle and physical performance in young adult men

Pentosidine is representative of the cross-linked structure of advanced glycation end products (AGEs) and has been suggested as a biomarker to assess bone and muscle quality. As studies on pentosidine in young adult men remain limited, we aimed to clarify the associations of urinary pentosidine with musculoskeletal status and physical performance in young men. Participants in this study comprised 32 men (age range: 19-39 years). Anthropometric measurements (body composition by InBody 430; stiffness index by ultrasound), muscle performance (grip strength by dynamometer, thigh muscle thickness by ultrasound), physical performance (functional reach test, 30-s chair stand test, and timed up and go test), and urinary biomarkers (pentosidine, N-telopeptide of type I collagen, and creatinine) were measured. In partial correlation analysis adjusted for age and height, higher urinary pentosidine levels were significantly associated with lower fat-free mass index (rho = - 0.368, p = 0.046), grip strength (rho = - 0.433, p = 0.017), rectus femoris thickness (rho = - 0.393, p = 0.032), and anterior thigh thickness (rho = - 0.416, p = 0.022), and a marginally inverse correlation was noted between urinary pentosidine levels and functional reach test (rho = - 0.327, p = 0.078). Our findings suggest that pentosidine correlates inversely with a few muscle and physical performance indicators. Pending future validations, urinary pentosidine may be a biomarker of AGEs in young men.

Impacts of Square Stepping Exercise on Physical-Cognitive Function, Biomarkers, Body Composition and Mental Health in Healthy Senior Aged 60 and Above: A Systematic Review

Background: The aim of this systematic review is to analyze the effects of Square Stepping Exercise (SSE) on physical and cognitive function in older people, including its effects on biomarkers, body composition and mental health, focusing only on research that assessed the efficacy of SSE-based interventions. Methods: PubMed, Web of Science, Scopus and Cochrane databases were searched from June 2006 to June 2024 according to the PRISMA guidelines. The main search terms used were related to "older people" and "square-stepping exercise". Controlled trials that included at least one intervention group focused on SSE were included. Participants had to be healthy, without physical or cognitive impairment, and the studies published in English or Spanish. The methodological quality of the selected research was assessed using the Physiotherapy Evidence Database (PEDro). Results: Twelve studies were selected from a total of 444 original records, with a total sample size of 577 participants. The health parameters of the participants were homogeneous, with ages ranging from 60 to 80 years. Significant gains were reported in certain physical function assessments, including balance, lower body strength and power, gait speed and flexibility. There were also significant findings in cognitive function, particularly in general cognitive status, focused attention, response time, basic task performance, and executive function. In addition, SSE can improve metrics such as body composition, brain-derived neurotrophic factor (BDNF), and mental health characteristics. Conclusions: SSE has the potential to significantly improve physical function, cognitive performance and body composition, as well as provide mental health benefits and have variable effects on biomarkers and cardiovascular health.

The relationship between grandparental childcare experience and relative handgrip strength among middle-aged and older adults

Delayed marriage and childbirth often result in individuals becoming grandparents in middle and older age, coinciding with significant physical transitions. This study examines the relationship between the intensity of grandparental childcare, measured in terms of time-commitment over the last year, and relative handgrip strength among South Korea adults aged 45-84. Data from 3,742 participants with grandchildren were analyzed using the 2008-2010 waves of the Korean Longitudinal Study of Aging. After applying propensity score matching, a final sample of 286 participants was analyzed with multivariate logistic regression model. Results showed that grandparents who provided childcare for an average of less than 40 h per week (Odds Ratio [OR] = 3.62) were more likely to have lower handgrip strength compared to those without caregiving experience. Additionally, those over the age of 65 showed a similar trend (OR = 2.76). Conversely, grandparents with positive self-rated health were less likely to exhibit lower handgrip strength than those rating their health as moderate (OR = 0.28). Grandparents who provided care for more than half the year were also less likely to have lower handgrip strength than those who provided less frequent care (OR = 0.26). This study highlights grandparental childcare as both a vital family support mechanism and a factor influencing physical health. Findings on caregiving intensity, particularly the role of moderate weekly childcare hours and longer terms involvement, underscore the importance of aligning caregiving commitments with grandparents' health perceptions and capacities. Developing guidelines for optimal childcare duration and recommending physical activities tailored to support grandparents' well-being would further promote healthy aging within a family-centered caregiving system.

Causal Associations Between Sleep Traits and Low Grip Strength: A Bidirectional Mendelian Randomization Study

Background

Sleep disorders and low grip strength often co-occur clinically and are geriatric symptoms that cause significant socioeconomic burden. Previous observational studies have found an association between sleep behaviors and grip strength, but the causal relationship remains unclear.

Purpose

With the Mendelian randomization (MR) approach, the study aimed to determine the causal association between sleep traits (sleep duration, insomnia, daytime napping, sleep-wake disorders, chronotype) and low grip strength.

Methods

The study used genetic variants from the genome-wide association study (GWAS) archived in UK Biobank and FinnGen. We assessed the potential causal relationship between sleep behaviors and grip strength using inverse variance weighting (IVW), weighted median (WM), and MR-Egger. Additionally, we performed sensitivity analyses using Cochran's Q test, MR Egger Intercept test, funnel plots, and leave-one-out method.

Results

We found that sleep duration is causally negatively associated with low grip strength (OR = 0.618, 95% CI = 0.424-0.900, P = 0.012). Sleep-wake disorders have a positive association with low grip strength (OR = 1.018, 95% CI = 1.002-1.034, P = 0.029). Reversely, high low grip strength risk was causally associated with increased daytime napping (OR = 1.018, 95% CI = 1.004-1.032, P = 0.011).

Conclusion

The study revealed causal associations between sleep duration, sleep-wake disorders, and low grip strength. Understanding their relationship helps in early clinical intervention to improve the life quality of the elderly.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The change in handgrip strength, after physical exercise, is moderated by digit ratio (2D:4D): A study among the young adults in Poland

BACKGROUND

The digit ratio (2D:4D), the ratio of the lengths of second (2D) to the fourth (4D) fingers, is a proxy indicator of prenatal androgen exposure. On average, males display lower 2D:4D than females. Previous studies have shown that lower 2D:4D ratios were associated with better sports and physical abilities.

AIM

To assess whether a challenge condition, imposed by intense exercise, could increase handgrip strength (HGS) associated with 2D:4D.

METHODS

This cross-sectional experimental study included 90 healthy young Polish adults (40 males, 50 females). They underwent intense physical exercise, before (7 days) and after which they were measured for HGS and 2D:4D. Height and weight were also measured. Analyses of Covariance were employed to delineate associations.

RESULTS

2D:4D had significant predictive effects on the differences in HGS (DHGS) measured in two occasions, without and after, physical exercises. The lower was the 2D:4D, the higher the DHGS, particularly, for the left hand.

CONCLUSION

The results reconfirmed that the link between prenatal testosterone exposure (indicated by 2D:4D) and physical strength depends on the context, such as a challenged condition.

Associations of body mass index, waist circumference and the weight-adjusted waist index with daily living ability impairment in older Chinese people: A cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey

AIM

To investigate the associations of body mass index (BMI), waist circumference (WC) and the weight-adjusted waist index (WWI) with the impairment of activities of daily living (ADL) in older Chinese people.

METHODS

A total of 13 260 participants aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey were included in this cross-sectional study. BMI, WC and the WWI were calculated from measurements of height, weight and WC. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Non-linear correlations were investigated using restricted cubic spline curves.

RESULTS

In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between WC and WWI and ADL impairment, with adjusted ORs (95% CI) of 1.01 (1.00, 1.01) and 1.08 (1.03, 1.12), respectively. Meanwhile, participants with a high WWI had a higher risk of ADL impairment compared with those with a low WWI, with an adjusted OR (95% CI) of 1.12 (1.02, 1.23). Subgroup analyses showed that only the association between WWI and ADL impairment did not differ in any of the different populations. In addition, we found that BMI, WC and WWI were non-linearly associated with ADL impairment.

CONCLUSIONS

There are significant associations between WC and WWI and ADL impairment in older Chinese people. The findings show the ability of the WWI to serve as a comprehensive and effective indicator of obesity in older Chinese people and emphasize the importance of assessing WWI in screening and preventing ADL impairment in older people.

Handgrip Strength and Dehydroepiandrosterone Sulfate in a Frailty Unit: A Retrospective Study

INTRODUCTION

Frailty is characterized by vulnerability and decline in physical, mental, and social activity, significantly contributing to adverse health outcomes. Frailty encompasses nutritional status, muscle strength, inflammation, and hormones. Dehydroepiandrosterone sulfate (DHEAS) is one of the hormones hypothesized to play a role in frailty. Handgrip strength (HGS) correlates with overall muscle strength. The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale can be used to readily screen frailty. Identifying markers associated with frailty can facilitate its early diagnosis, risk stratification, and target interventions to prevent or mitigate its negative consequences. This study sought to evaluate the associations between frailty, HGS, and DHEAS in a Portuguese frailty unit (FU).

METHODS

We developed an observational retrospective study in an FU. Patients admitted to the FU underwent a rehabilitation program. We assessed frailty with the FRAIL scale. We assayed DHEAS upon admission to the FU. We measured HGS at admission (i-HGS) and discharge (f-HGS). We also considered HGS variation (∆ HGS) and length of stay.

RESULTS

Out of 119 subjects, 97 fulfilled the eligibility criteria (mean age 78.35 ± 9.58 years; 44.33% men). Overall, 88 (90.72%) patients had a FRAIL scale score of 3 or more. DHEAS values were not significantly different in either the categories of the FRAIL scale or frailty status. DHEAS values were also not significantly correlated with either i-HGS, f-HGS, ∆ HGS, age, or FU length of stay. Frail patients had a significantly lower i-HGS (p = 0.002) and f-HGS (p = 0.001) and a significantly higher length of stay (p = 0.006). Also, the i-HGS and f-HGS significantly decreased with the increase of the FRAIL scale score (p < 0.0001 for both). The cut-off values of the i-HGS and the f-HGS for detecting frail patients in our study were 13.3 kg and 19.1 kg, respectively (p < 0.0001 for both). The i-HGS was significantly and independently associated with the frailty status of frail (p = 0.001), with a 15% probability reduction of a patient being frail for every kilogram increase in the i-HGS.

CONCLUSION

Frail patients assessed with the FRAIL scale had a significantly lower i-HGS and f-HGS and a higher length of stay. In this study, we found frailty and DHEAS to be not associated and DHEAS values to be not correlated with i-HGS or f-HGS. In our opinion, the creation of an FU with an initial FRAIL scale screening and HGS measurement might have a significant impact on identifying frail people and ensuring the implementation of a multimodal multidisciplinary approach.

Association of handgrip strength with health care utilisation among older adults: A longitudinal study in China

Background

Evidence on the association between handgrip strength (HGS) and health care utilisation among Chinese older adults is scarce. In this study, we aimed to investigate the association of HGS with health care utilisation and to identify whether these associations varied by gender.

Methods

The analytic sample of this prospective cohort study included 6007 Chinese older adults (≥60 years) from 2011 to 2018 waves of the China Health and Retirement Longitudinal Study. A handgrip dynamometer was used to measure HGS. We measured health care utilisation by outpatient visits, inpatient visits, and unmet hospitalisation needs. We used covariates-adjusted general estimating equations for the analyses.

Results

Longitudinal results showed that participants with weakness increased the likelihood of outpatient visits (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.01-1.27), inpatient visits (OR = 1.51; 95% CI = 1.32-1.73), and unmet hospitalisation needs (OR = 1.44; 95% CI = 1.19-1.79) than their counterparts. Participants with weakness increased the number of outpatient visits (incidence rate ratio (IRR) = 1.29; 95% CI = 1.11-1.51) and the number of inpatient visits (IRR = 1.39; 95% CI = 1.10-1.61). Participants with HGS asymmetry increased the likelihood of unmet hospitalisation needs (OR = 1.19; 95% CI = 1.03-1.43) than their counterparts. The results of the impact of every one-kilogramme (kg) increase in HGS on health care utilisation indicated consistent results. The associations were similarly observed irrespective of gender.

Conclusions

Chinese older adults with weakness or HGS asymmetry used more health care. Interventions for improving muscle strength and correcting strength asymmetry are highly recommended, with the potential to considerably save households and health care systems.

Adherence to Mediterranean, Dietary Approaches to Stop Hypertension and Healthy Eating Indices are associated with lower risk of disability among Puerto Rican adults from the longitudinal Boston Puerto Rican Health Study

BACKGROUND

Emerging evidence suggests that poor dietary quality is an important risk factor for disability. However, few studies have compared adherence to dietary patterns with disability and none among Puerto Rican adults.

OBJECTIVES

This study was designed to examine relationships between 3 dietary patterns-including Dietary Approaches to Stop Hypertension (DASH), Mediterranean dietary score (MeDS), and Healthy Eating Index (HEI)-2010-and ∼6-y incidence of activities of daily living (ADL) and instrumental activities of daily living (IADL) disability and to assess potential mediation by handgrip strength.

METHODS

Data are from the Boston Puerto Rican Health Study, a longitudinal cohort of Puerto Rican adults aged 45-75 y (N = 1502). Adherence to dietary pattern variables were derived from food frequency questionnaire (FFQ) data averaged at baseline and ∼2 y. Handgrip strength was assessed at baseline. Cox proportional hazards models were used to assess longitudinal associations between DASH, MeDS, and HEI-2010 and incident ∼6-y ADL (and subscales) and IADL disability. Mediation by handgrip strength was also tested.

RESULTS

Participants with higher adherence DASH had lower risk of ADL, ADL mobility, and ADL manual dexterity disabilities (hazards ratio [HR]: 0.96; 95% confidence interval [CI]: 0.91, 0.98; HR: 0.96; 95% CI: 0.92, 0.99; and HR: 0.95; 95% CI: 0.92, 0.98, respectively). Higher adherence to MeDS was associated with lower risk of ADL and ADL mobility disabilities (HR: 0.89; 95% CI: 0.81, 0.98; HR: 0.90; 95% CI: 0.82, 1.00), and higher adherence to HEI with lower risk of ADL manual dexterity (HR: 0.98; 95% CI: 0.97, 0.99) in fully adjusted models. Only DASH tended to be associated with IADL (HR: 0.97; 95% CI: 0.94, 1.00). Baseline handgrip strength was a mediator between HEI and ADL manual dexterity (23.7% of the indirect effect was explained through handgrip strength).

CONCLUSIONS

Higher adherence to a healthy diet pattern may decrease risk of disability and may be an important prevention strategy for ADL and IADL disability associated with aging.

The relationship between muscle strength and epicardial fat in healthy adults

BACKGROUND

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

METHODS AND MATERIALS

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

RESULTS

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

CONCLUSIONS

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

Collective Weakness Is Associated With Time to Mortality in Americans

ABSTRACT

McGrath, R, McGrath, BM, Jurivich, D, Knutson, P, Mastrud, M, Singh, B, and Tomkinson, GR. Collective weakness is associated with time to mortality in Americans. J Strength Cond Res 38(7): e398-e404, 2024-Using new weakness cutpoints individually may help estimate time to mortality, but their collective use could improve value. We sought to determine the associations of (a) each absolute and body size normalized cut point and (b) collective weakness on time to mortality in Americans. The analytic sample included 14,178 subjects aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. Date of death was confirmed from the National Death Index. Handgrip dynamometry measured handgrip strength (HGS). Men were categorized as weak if their HGS was <35.5 kg (absolute), <0.45 kg·kg -1 (body mass normalized), or <1.05 kg·kg -1 ·m -2 (body mass index [BMI] normalized). Women were classified as weak if their HGS was <20.0 kg, <0.337 kg·kg -1 , or <0.79 kg·kg -1 ·m -2 . Collective weakness categorized persons as below 1, 2, or all 3 cutpoints. Cox proportional hazard regression models were used for analyses. Subject values below each absolute and normalized cutpoint for the 3 weakness parameters had a higher hazard ratio for early all-cause mortality: 1.45 (95% confidence interval [CI]: 1.36-1.55) for absolute weakness, 1.39 (CI: 1.30-1.49) for BMI normalized weakness, and 1.33 (CI: 1.24-1.43) for body mass normalized weakness. Those below 1, 2, or all 3 weakness cut points had a 1.37 (CI: 1.26-1.50), 1.47 (CI: 1.35-1.61), and 1.69 (CI: 1.55-1.84) higher hazard for mortality, respectively. Weakness determined by a composite measure of absolute and body size adjusted strength capacity provides robust prediction of time to mortality, thus potentially informing sports medicine and health practitioner discussions about the importance of muscle strength during aging.

Collective Weakness and Fluidity in Weakness Status Associated With Basic Self-Care Limitations in Older Americans

Aims

To examine the associations of 1) absolute and normalized weakness cut-points, 2) collective weakness categories, and 3) changes in weakness status on future activities of daily living (ADL) limitations in older Americans.

Methods

The analytic sample included 11,656 participants aged ≥65-years from the 2006-2018 waves of the Health and Retirement Study. ADL were self-reported. A handgrip dynamometer measured handgrip strength (HGS). Males were classified as weak if their HGS was <35.5-kg (absolute), <0.45-kg/kg (body mass normalized), or <1.05-kg/kg/m2 (body mass index (BMI) normalized); females were considered weak if their HGS was <20.0-kg, <0.337-kg/kg, or <0.79-kg/kg/m2. Collective weakness categorized those below 1, 2, or all 3 absolute and normalized cut-points. These collective categories were also used to classify observed changes in weakness status over time (onset, persistent, progressive, recovery).

Results

Older Americans below absolute and normalized weakness cut-points had greater future ADL limitations odds: 1.34 (95% confidence interval (CI): 1.22-1.47) for absolute, 1.36 (CI: 1.24-1.50) for BMI normalized, and 1.56 (CI: 1.41-1.73) for body mass normalized. Persons below 1, 2, or 3 cut-points had 1.36 (CI: 1.19-1.55), 1.60 (CI: 1.41-1.80), and 1.70 (CI: 1.50-1.92) greater odds for future ADL limitations, respectively. Those in each changing weakness classification had greater future ADL limitation odds: 1.28 (CI: 1.01-1.62) for onset, 1.53 (CI: 1.22-1.92) for persistent, 1.72 (CI: 1.36-2.19) for progressive, and 1.34 (CI: 1.08-1.66) for recovery.

Conclusions

The presence of weakness, regardless of cut-point and change in status over time, was associated with greater odds for future ADL limitations.

Prognostic Features of Sarcopenia in Older Hospitalized Patients: A 6-Month Follow-Up Study

Background: Sarcopenia is associated with adverse health outcomes. Understanding the association between sarcopenia, multidimensional frailty, and prognosis is essential for improving patient care. The aim of this study was to assess the prevalence and prognostic signature of sarcopenia in an acute hospital setting co-led by internists and geriatricians. Methods: Sarcopenia was assessed by applying the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, including the SARC-F score, handgrip strength, bioelectrical impedance analysis (BIA), and Timed Up and Go (TUG) test, to 97 older multimorbid inpatients (76.5 ± 6.8 years, 55% women). The patients underwent a Comprehensive Geriatric Assessment (CGA) including an evaluation of Geriatric Syndromes (GSs) and Resources (GR) and prognosis calculation using the CGA-based Multidimensional Prognostic Index (MPI), European Quality of life-5 Dimensions (EQ-5D-5L) scale, Rosenberg Self-Esteem Scale (RSES), and Geriatric Depression Scale (GDS). Information on survival and rehospitalizations was collected 1, 3, and 6 months after discharge. Results: Sarcopenia was present in 63% (95% CI: 54-72%) of patients and categorized as probable (31%), confirmed (13%), and severe sarcopenia (18%). Sarcopenic patients showed significantly higher median MPI-values (p < 0.001), more GSs (p = 0.033), fewer GR (p = 0.003), lower EQ-5D-5L scores (p < 0.001), and lower RSES scores (p = 0.025) than non-sarcopenic patients. Six months after discharge, being sarcopenic at baseline was predictive of falls (p = 0.027) and quality of life (p = 0.043), independent of age, gender, and MPI. Conclusions: Sarcopenia is highly prevalent in older hospitalized multimorbid patients and is associated with poorer prognosis, mood, and quality of life up to 6 months after discharge, independent of age, sex, and MPI as surrogate markers of biological age.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

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.

Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study

BACKGROUND

Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory.

OBJECTIVE

This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China.

METHODS

A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms.

RESULTS

Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ≥3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively.

CONCLUSIONS

The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms.

Association of diet quality with hand grip strength weakness and asymmetry in a multi-ethnic Asian cohort

Hand grip strength (HGS) is an important diagnostic tool for sarcopenia and a reliable predictor for age-related chronic diseases and mortality. Interventions in nutrition have been shown as a low-cost strategy to maintain muscular strength and mass. However, there are limited data on the effect of diet on HGS in Southeast Asian populations. This study aims to investigate the association of diet quality with HGS weakness and asymmetry in a multi-ethnic population in Singapore. This cross-sectional study used data from the Singapore Multi-Ethnic Cohort (n = 1547). Dietary data were collected using a validated semi-quantitative FFQ and summarised as the Dietary Quality Index - International (DQI-I). HGS was calculated as the maximum value of six measurements from both hands. HGS weakness and asymmetry were defined using well-recognised criteria. Multivariable linear regression and logistic regression were utilised for continuous and binary outcomes, respectively, adjusting for age, sex, ethnicity, physical activity and smoking status. It was found that the highest quartile of DQI-I was significantly associated with higher HGS (β = 1·11; 95 % CI 0·41, 1·82; Pfor trend < 0·001) and lower odds of HGS asymmetry (OR = 0·71; 95 % CI 0·53, 0·94; Pfor trend = 0·035) and both HGS weakness and asymmetry (OR = 0·50; 95 % CI 0·32, 0·76; Pfor trend = 0·004). Among the different components of DQI-I, only dietary adequacy was significantly associated with higher HGS (Pfor trend < 0·001) and lower odds for both HGS weakness and asymmetry (Pfor trend = 0·006). Our findings support that DQI-I, an indicator of overall diet quality, can be used to provide dietary guidelines for prevention and management of muscle wasting, sarcopenia and frailty.

Association of handgrip strength asymmetry and weakness with functional disability among middle-aged and older adults in China

Background

Little is known about the association of handgrip strength (HGS) asymmetry with functional disability in China. We aimed to examine the individual and combined association of HGS asymmetry and weakness with functional disability among middle-aged and older Chinese adults.

Methods

We included participants aged ≥45 years from two waves of the China Health and Retirement Longitudinal Study (2011 and 2015). HGS weakness was defined as the maximal HGS<28 kg for men and <18 kg for women. HGS asymmetry was measured by dividing the maximal nondominant HGS (kg) by the maximal dominant HGS (kg), with the value <0.90 or >1.10 considered as asymmetry. Functional disability was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL) and was defined as encountering difficulty in completing one or more ADL/IADL tasks. The logistic regression models were used to explore the association between HGS measures and functional disability.

Results

11 950 (mean age 59.2 ± 9.6 years, 47.9% males) and 7540 (mean age 57.5 ± 8.6 years, 50.1% males) participants were included in the cross-sectional and prospective study, respectively. HGS asymmetry and weakness, individually or simultaneously, were associated with an increased prevalence of functional disability. During the four-year follow-up, 1822 (24.2%) participants had incident functional disability. The separate exposure to HGS asymmetry (odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.05-1.32) or weakness (OR = 1.59; 95% CI = 1.30-1.95) was independently associated with functional disability. For combined associations, those with both weakness and asymmetry showed the greatest risk of new-onset functional disability (OR = 1.91; 95% CI = 1.45-2.52).

Conclusions

HGS asymmetry and weakness were associated with a higher risk of functional disability. Assessing HGS asymmetry together with weakness may help to better identify those at risk of functional disability to enable early interventions.

Cross-cultural perception of strength, attractiveness, aggressiveness and helpfulness of Maasai male faces calibrated to handgrip strength

Previous research has demonstrated that Maasai and Europeans tend to align in their ratings of the physical strength and aggressiveness of Maasai male faces, calibrated to hand grip strength (HGS). However, perceptions of attractiveness of these faces differed among populations. In this study, three morphs of young Maasai men created by means of geometric morphometrics, and depicting the average sample and two extrema (± 4 SD of HGS), were assessed by men and women from Tanzania, Czech Republic, Russia, Pakistan, China, and Mexico (total sample = 1540). The aim of this study was to test cross-cultural differences in the perception of young Maasai men's composites calibrated to HGS, focusing on four traits: physical strength, attractiveness, aggressiveness, and helpfulness. Individuals from all six cultures were able to distinguish between low, medium, and high HGS portraits. Across all study populations, portrait of Maasai men with lower HGS was perceived as less attractive, more aggressive, and less helpful. This suggests that people from diverse populations share similar perceptions of physical strength based on facial shape, as well as attribute similar social qualities like aggressiveness and helpfulness to these facial images. Participants from all samples rated the composite image of weak Maasai men as the least attractive.

Functionality, muscular strength and cardiorespiratory capacity in the elderly: relationships between functional and physical tests according to sex and age

Introduction: There are several tests that provide information about physical fitness and functionality in older adults. The aims of this study were: (i) to analyze the differences between sex and age in functional, strength and cardiorespiratory tests; and (ii) to study the correlations between functional, strength and cardiorespiratory tests according to sex and age. Methods: A total of 171 older adults (72.09 ± 13.27 kg; 1.59 ± 0.09 m; 72.72 ± 6.05 years) were divided according to sex (men: n = 63; women: n = 108) and age (≥60 <70: n = 65; ≥70 <80: n = 89; ≥80: n = 18). Anthropometry, body composition, upper limb strength (hand grip; HG), lower limb strength (countermovement jump; CMJ), cardiorespiratory capacity (6 min walking test; 6MWT), timed up and go test (TUG) and Short Physical Performance Battery (SPPB) were assessed. Results: Men showed higher values in CMJ height, HG and expired volume (VE) (p < 0.05). There were no significant differences between sexes in TUG and SPPB. Regarding age, there were significant differences in CMJ, VE and peak oxygen uptake (VO2peak), TUG, gait speed, chair and stand test and SPPB total (p < 0.05). The test times were higher in older people. Regarding correlations, the TUG showed significant correlations in all strength and cardiorespiratory tests, regardless of sex and age. The CMJ correlated more significantly with functional tests compared to HG. Discussion: There were sex and age differences in functional, strength, and cardiorespiratory tests. The execution of quick and low-cost tests such as the CMJ and TUG could provide information on overall physical fitness in older adults.

Higher handgrip strength is linked to higher salience ventral attention functional network segregation in older adults

Converging evidence suggests that handgrip strength is linked to cognition in older adults, and this may be subserved by shared age-related changes in brain function and structure. However, the interplay among handgrip strength, brain functional connectivity, and cognitive function remains poorly elucidated. Hence, our study sought to examine these relationships in 148 community-dwelling older adults. Specifically, we examined functional segregation, a measure of functional brain organization sensitive to ageing and cognitive decline, and its associations with handgrip strength and cognitive function. We showed that higher handgrip strength was related to better processing speed, attention, and global cognition. Further, higher handgrip strength was associated with higher segregation of the salience/ventral attention network, driven particularly by higher salience/ventral attention intra-network functional connectivity of the right anterior insula to the left posterior insula/frontal operculum and right midcingulate/medial parietal cortex. Importantly, these handgrip strength-related inter-individual differences in salience/ventral attention network functional connectivity were linked to cognitive function, as revealed by functional decoding and brain-cognition association analyses. Our findings thus highlight the importance of the salience/ventral attention network in handgrip strength and cognition, and suggest that inter-individual differences in salience/ventral attention network segregation and intra-network connectivity could underpin the handgrip strength-cognition relationship in older adults.

Effectiveness of Community-Based Rehabilitation (CBR) Centers for Improving Physical Fitness for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

To synthesise the best available evidence for the effectiveness of interventions delivered in community-based rehabilitation (CBR) centers on physical fitness, for community-dwelling older adults living in Asian countries. This study is a systematic review and meta-analysis. Seven English and two Chinese electronic databases were searched for randomised controlled trials (RCTs) and quasi-experimental studies that were conducted by centers providing CBR. Independent reviewers screened, quality-appraised and extracted data. The primary outcome was physical fitness measured by validated assessment tools, including the Timed Up and Go Test (TUG), gait speed, hand grip strength, Functional Reach Test (FRT), and one-leg standing test. Assessments of activity of daily living and quality of life using tools including the Barthel Index, Short Form (SF)-12, and SF-36 were secondary outcomes. After screening 5,272 studies, 29 studies were included (16 RCTs, 13 quasi-experimental studies) from four countries. Meta-analyses found that CBR programs significantly decreased TUG time (mean difference [MD], -1.89 seconds; 95% confidence interval [95% CI], -2.84 to -0.94; I2=0%; Z=3.90, p<0.0001), improved gait speed (MD, 0.10 m/s; 95% CI, 0.01-0.18; I2=0%; Z=2.26, p=0.02), and increased one-leg standing time (MD, 2.81 seconds; 95% CI, 0.41-5.22; I2=0%; Z=2.29, p=0.02). Handgrip strength and FRT showed no statistically significant improvement in the meta-analyses. CBR may improve aspects of physical fitness for older adults in Asian countries. However, variability in intervention components and measurement tools reduced the ability to pool individual studies. Further trials are required with robust designs including standardised measures of physical fitness.

Short-Term Impact of Low-Intensity Exercise with Blood Flow Restriction on Mild Knee Osteoarthritis in Older Adults: A Pilot Study

This pilot study aimed to investigate the immediate impact of low-intensity exercises with blood flow restriction (BFR) on older adults with knee osteoarthritis (KOA). Fifteen patients with KOA who were over 50 years old, participated and underwent low-intensity resistance knee exercises at 30% of their one-repetition maximum with BFR three times/week for two weeks. Pre- and post-exercise assessments included pain levels, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, isokinetic knee strength, lower extremity muscle volume (via leg circumference and muscle thickness), functional performance tests (timed up-and-go [TUG] and sit-to-stand [STS]), skeletal muscle index (SMI) using bioelectrical impedance analysis, and handgrip strength (HGS). Post-exercise, there was a significant reduction in pain. WOMAC scores showed significant improvements across all three domains: pain, stiffness, and physical function. In the TUG and STS tests, completion times were significantly reduced. Thigh and calf circumferences, as well as thigh muscle thickness significantly increased after exercise. Post-exercise SMI and HGS also significantly increased. However, isokinetic knee strength did not show significant changes. In conclusion, low-intensity BFR exercises provide immediate benefits in symptoms and physical performance for patients with KOA, potentially inducing local and systemic muscle mass increase, even after a short-term intervention.

Effects of Physical Activity on Body Composition, Muscle Strength, and Physical Function in Old Age: Bibliometric and Meta-Analyses

OBJECTIVES

Accumulating evidence suggests that physical activity (PA) is an efficient intervention to maintain functional capabilities and mitigate physiological changes in the older population. However, an attempt has yet to be made to comprehensively investigate the published landscape on the subject.

METHODS

This study had two aims. The first aim was to perform a bibliometric analysis for two keywords, "aging" and "PA", to analyze the research trend. Since "frailty" was the most noticeable co-occurring keyword with the two keywords, the second aim was to investigate the effects of PA, particularly, resistance training (RT), on frailty using a meta-analysis to provide a summary of the current evidence base.

RESULTS

The bibliometric analysis revealed that the number of publications on this research topic has gradually increased, highlighting the importance of understanding the role of PA in aging. The meta-analysis found that RT had significant beneficial effects on physical frailty factors, including handgrip strength, lower limb strength, balance, gait speed, and stair-climbing ability.

CONCLUSION

These findings demonstrate that RT is an effective intervention for improving physical function in frail populations; thus, it has important implications for the development of PA programs for older adults with frailty. Future research is warranted to explore the optimal dose, frequency, and duration of RT programs for older adults, as well as the potential benefits of combining RT with other forms of PA, such as aerobic or balance exercises.

Examining factors contributing to the socioeconomic inequalities in handgrip strength among older adults in India: a decomposition analysis

The purpose of this study was to examine (a) the socioeconomic status (SES)-related inequalities associated with handgrip strength (HGS); and (b) the extent to which several demographic, health, and behavioral factors contributed to such SES disparities in HGS among older adults in India. Data were drawn from the 2017-2018 wave 1 of the Longitudinal Ageing Study of India (LASI). The study sample included 27,707 older adults (13,199 men and 14,508 women) aged 60 years and older. HGS was assessed using a handheld Smedley's Hand Dynamometer with a cut-off of 19.5 kg for men and 12.5 kg for women. Bivariate analysis showed the weighted percentage distribution of weak HGS across respondent characteristics. Multivariate logistic regression assessed factors linked to weak HGS. The concentration curve and index (CCI) was used to determine the inequalities in the prevalence of weak HGS by wealth index scores. Wagstaff's decomposition approach was used to test the contribution of each explanatory variable to weak HGS. Around 9% of older adults in this study reported a weak HGS. It was significantly higher among those aged 80 or older (19.21%) and males (15.55%). Weak HGS was concentrated among older adults from poor SES (CCI: 0.05, p < 0.001). A higher percentage of wealth-based inequality in weak HGS was explained by being underweight (38.83%), belonging to the richest wealth quintile (27.95%), and having a higher subjective social status (32.20%). Moreover, about 23.29% of the inequality in weak HGS was explained by Western region and 22.54% by female gender. Additionally, having a secondary level of education explained a higher percentage (22.09%) of inequality, followed by current working status (- 20.68%). Rural residence (13.08%), limitations in instrumental activities of daily living (IADL) (12.21%), and engagement in yoga-related activities (11.55%) explained a higher percentage of wealth-based inequalities. The findings provide evidence of significant SES-related inequalities in HGS and the contribution of various demographic, health, and behavioral factors to such inequality. As such, public health policies and programs focusing on reducing the burden of disability must consider the contribution of social and economic equity to the preservation of muscle strength among older adults.

Evaluation of health factors on artificial intelligence and the internet of things-based older adults healthcare programmes

Objective

This study evaluates Artificial intelligence and the Internet of Things-based older adults' healthcare programmes (AI·IoT-OAHPs), which offer non-face-to-face and face-to-face health management to older adults for health promotion.

Methods

The study involved 146 participants, adults over 60 who had registered in AI·IoT-OAHPs. This study assessed the health factors as the outcome of pre- and post-health screening and health management through AI·IoT-OAHPs for six months.

Results

Preand post-health screening and management through AI·IoT-OAHPs were evaluated as significant outcomes in 14 health factors. Notably, the benefits of post-cognitive function showed a twofold increase in older female adults through AI·IoT-OAHPs. Adults over 70 showed a fourfold increase in post-walking days, a threefold in post-dietary practice, and a twofold in post-cognitive function in the post-effects compared with pre via AI·IoT-OAHPs.

Conclusions

AI·IoT-OAHPs seem to be an effective program in the realm of face-to-face and non-face-to-face AI·IoT-based older adults' healthcare initiatives in the era of COVID-19. Consequently, the study suggests that AI·IoT-OAHPs contribute to the upgrade in health promotion of older adults. In future studies, the effectiveness of AI·IoT-OAHPs can be evaluated as a continuous project every year in the short term and every two years in the long term.

Using Powerlifting Athletes to Determine Strength Adaptations Across Ages in Males and Females: A Longitudinal Growth Modelling Approach

INTRODUCTION

Several retrospective studies of strength sport athletes have reported strength adaptations over months to years; however, such adaptations are not linear.

METHODS

We explored changes in strength over time in a large, retrospective sample of powerlifting (PL) athletes. Specifically, we examined the rate and magnitude of strength adaptation based on age category and weight class for PL competition total, and the squat, bench press, and deadlift, respectively. Mixed effects growth modelling was performed for each operationalised performance outcome (squat, bench press, deadlift, and total) as the dependent variables, with outcomes presented on both the raw, untransformed time scale and on the common logarithmic scale. Additionally, the fitted values were rescaled as a percentage.

RESULTS

Collectively, the greatest strength gains were in the earliest phase of PL participation (~ 7.5-12.5% increase in the first year, and up to an ~ 20% increase after 10 years). Females tended to display faster progression, possibly because of lower baseline strength. Additionally, female Masters 3 and 4 athletes (> 59 years) still displayed ~ 2.5-5.0% strength improvement, but a slight strength loss was observed in Masters 4 (> 69 years) males (~ 0.35%/year).

CONCLUSION

Although directly applicable to PL, these findings provide population-level support for the role of consistent and continued strength training to improve strength across the age span and, importantly, to mitigate, or at least largely attenuate age-related declines in strength compared to established general population norms. This information should be used to encourage participation in strength sports, resistance training more generally, and to support future public health messaging.

The Role of Different Weakness Cut-Points for Future Cognitive Impairment in Older Americans

OBJECTIVES

New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans.

DESIGN

Longitudinal panel.

SETTING AND PARTICIPANTS

The analytic sample included 11,116 participants aged ≥65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews.

METHODS

The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations.

RESULTS

Persons considered weak under the absolute cut-point had 1.62 (95% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points.

CONCLUSIONS AND IMPLICATIONS

Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.

Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States

ABSTRACT

McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1% (95% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (≥65 years) Americans (64.2%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5%; CI: 53.1-55.9) than in men (50.4%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

Untangle the relationship of muscle mass and bone mineral content on handgrip strength: Results of ELSA-Brasil

The study aims to investigate the independent association of muscle mass (MM) and bone mineral content (BMC) in the performance of the handgrip strength (HGS) test and whether there is effect modification by sex and age. In 12,491 participants from the ELSA-Brasil we estimated the associations between MM, BMC and HGS using linear regression models. All the analyses were performed for total population, also stratified for sex and age. For total population an interaction term was included between each explanatory variable of interest with sex and age to verify the presence of effect modification. We observed that the higher quintiles of MM and BMC were associated to an increasing in the mean of HGS compared to the first quintile, with greater magnitudes in men compared to women, also adults compared to elderly. When we estimated the independent effect of each exposure of interest, MM showed stronger effect in HGS in women, men and adults then BMC. In conclusion, we observed that higher amounts of MM and BMC are associated with higher HGS, regardless of sociodemographic characteristics, health conditions and lifestyle, with this effect being greater in men and adults.