Temporal Trends in the Handgrip Strength of 2,592,714 Adults from 14 Countries Between 1960 and 2017: A Systematic Analysis

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.

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.

Instruments for measuring the neuromuscular function domain of vitality capacity in older persons: an umbrella review

PURPOSE

Recently, handgrip, knee extensor and respiratory muscle strength were proposed as candidate biomarkers to assess the neuromuscular function of vitality capacity in older persons. This umbrella review aims to provide an overview of the available instruments and their measurement properties to assess these biomarkers.

METHODS

The databases PubMed, Web of Science and Embase were systematically screened for systematic reviews and meta-analyses reporting on handgrip, knee extensor or respiratory muscle strength assessments, resulting in 7,555 articles. The COSMIN checklist was used to appraise psychometric properties and the AMSTAR for assessing methodological quality.

RESULTS

Twenty-seven systematic reviews were included in this study. Some of the identified reviews described the psychometric properties of the assessment tools. We found five assessment tools that can be used to measure neuromuscular function in the context of healthy ageing. Those are the handheld dynamometer for handgrip strength, the dynamometer for knee extensor strength and regarding respiratory muscle strength, the sniff nasal inspiratory pressure, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP).

CONCLUSION

The handheld dynamometer for hand grip strength, the dynamometer for knee extensor strength, sniff nasal inspiratory pressure, MIP and MEP were identified. Therefore, these assessments could be used to identify community-dwelling older adults at risk for a declined neuromuscular function in the context of vitality capacity.

Handgrip Strength and Low Muscle Strength Rate in Chinese Adults - China, 2020

What is already known on this topic?

Handgrip strength (HS) serves as a diagnostic marker for low muscle strength rate (LMSR) and reflects the level of skeletal muscle. Over the past two decades, global data indicate a downward trend in HS across various countries.

What is added by this report?

According to the latest national data, the mean HS among Chinese adults aged 20 years and older was recorded at 40.4 kg for males and 25.1 kg for females in 2020. A decline in HS was observed with increasing age, particularly among women. Additionally, lower HS values were reported in rural areas, whereas LMSR was more prevalent in these regions.

What are the implications for public health practice?

The analysis of HS and LMSR among Chinese adults is essential for the development and implementation of targeted interventions aimed at improving HS prevalence rates. This analysis is highly significant for public health, contributing to increased public awareness of LMSR and the promotion of preventative measures.

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.

Regional differences of physical fitness and overweight and obesity prevalence among college students before and after COVID-19 pandemic since the "double first-class" initiative in China

Introduction

Physical fitness has been widely recognized as a powerful marker of health in children and adolescents, and it negatively affected by the COVID-19 pandemic. The construction of world-class universities and first-class disciplines, known as the "Double First-Class" Initiative (DFC), is a major commitment made by the Chinese government to adapt to changes in the educational environment, both domestically and internationally, in order to promote the development and practice of international higher education. The aim of the study was to look deep into the regional differences of physical fitness and overweight and obesity prevalence among college students before and after the COVID-19 pandemic since the DFC.

Methods

The original physical fitness parameters of students from 10 DFC universities and colleges in Central South China were downloaded from the official website of Chinese National Student Physical Fitness Database (CNSPFD) and then divided into 3 groups based on the pandemic periods: pre-pandemic (2019), the first year after pandemic outbreak (2020), and the second year after pandemic outbreak (2021). All the data were stored in Excel 2010, analyzed by SPSS 17.0, and plotted with ArcGIS 10.4.

Results

The total "fail" percentage (from 9.19% in 2019 to 12.94% in 2021) and the prevalence of overweight and obesity in boys (from 22.53 to 29.25% in 2021) exhibited a continuous increase year by year, and among all the physical fitness indicators the score of strength in boys and endurance quality in all individuals were the lowest in overweight and obesity groups. Students with 'fail' rate developed from northern and northeastern province to southern areas from 2019 to 2021. For grade 2019th, overweight and obesity students who also failed the test had covered nationwide and the most affected areas including northeast, east, as well as central north in senior year. The distribution of overall fitness assessments in Hubei province was in accordance with the national data, and the overall scoring growths in both class of 2021st and 2022nd were measured with a negative increase (p < 0.01).

Conclusion

The government and related functional departments should take into consideration the student regional sources, especially in western and northeast regions of China, and school polices and physical education (PE) teachers should pay more attention to put training efforts on endurance for all adolescents and strength for boys and the group of overweight and obesity who also failed in the standard test, when designing specific interventions to promote physical health and counteract the negative effects of COVID-19 pandemic in college students.

The association of handgrip strength with all-cause and cardiovascular mortality: results from the National Health and Nutrition Examination Survey database prospective cohort study with propensity score matching

Objective

To investigate the association between handgrip strength (HGS) with all-cause and cardiovascular disease (CVD) mortality in US adults.

Method

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) prospective cohort study (2011-2014) with 10,470 participants. The cox regression analysis, Kaplan-Meier survival curves, fitted curves, ROC curves, and propensity score-matched analysis (PSM) with inverse probability of treatment weighting (IPTW), SMRW (PSM with repeated weights), PA (pairwise algorithm), and OW (overlap weighting) regression analysis were performed to assess the relationship between HGS and all-cause and CVD mortality.

Results

The low HGSs (men <37.4 kg, women <24 kg), was found to be associated with higher all-cause and CVD mortality in a reverse J-shaped curve (p < 0.05). Adjusting for multiple covariates including age, BMI, race, education level, marriage status, smoking and alcohol use, and various comorbidities, the hazard ratio (HR) for all-cause mortality in the lowest HGS quintile 1 (Q1) was 3.45 (2.14-5.58) for men and 3.3 (1.88-5.79) for women. For CVD mortality, the HR was 2.99 (1.07-8.37) for men and 10.35 (2.29-46.78) for women. The area under the curve (AUC) for HGS alone as a predictor of all-cause mortality was 0.791 (0.768-0.814) for men and 0.780 (0.752-0.807) for women (p < 0.05), while the AUC for HGS and age was 0.851 (0.830-0.871) for men and 0.848 (0.826-0.869) for women (p < 0.05). For CVD mortality, the AUC for HGS alone was 0.785 (95% CI 0.738-0.833) for men and 0.821 (95% CI 0.777-0.865) for women (p < 0.05), while the AUC for HGS and age as predictors of all-cause mortality was 0.853 (0.861-0.891) for men and 0.859 (0.821-0.896) for women (p < 0.05). The HGS Q1 (men <37.4 kg and women <24 kg) was matched separately for PSM. After univariate, multivariate Cox regression models, PSM, IPTW, SMRW, PA, and OW analyses, women had 2.37-3.12 and 2.92-5.12 HRs with low HGS for all-cause and CVD mortality, while men had 2.21-2.82 and 2.33-2.85 for all-cause and CVD mortality, respectively (p < 0.05).

Conclusion

Adults with low HGS exhibited a significantly increased risk of both all-cause and CVD mortality, regardless of gender. Additionally, low HGS served as an independent risk factor and predictor for both all-cause and CVD mortality.

Temporal changes in physical fitness in Norwegian male and female military conscripts between 2006 and 2020

Reduced physical fitness has been documented in Western children and adults over the past five decades. The same trend has been observed among soldiers, but the number of studies is scarce. Thus, the aim of the present study was to investigate temporal changes in physical fitness in Norwegian conscripts. All conscripts who performed entry fitness tests between 2006 and 2020 were included in the study (n = 105 100; 17% females). Endurance was measured with the 3000 m run, while push-ups, sit-ups, and pull-ups (2006-2016) and medicine ball throw, standing long jump, and pull-ups (2017-2020) were used to measure muscle strength. Mean (95% confidence intervals) 3000 m run time was reduced by 52 (47, 57) seconds in men, 90 (76, 105) seconds in women, and 16 (11, 20) seconds in both sexes combined. Muscle strength increased statistically significantly in four out of five tests in men, three out of six tests in women, and two out of five tests for both sexes combined. Effect sizes for statistically significant changes ranged from 0.06 to 0.82. In conclusion, Norwegian conscripts improved their cardiorespiratory endurance between 2006 and 2020, with improvements observed for most muscle strength tests. When analyzing both sexes combined, the improvements diminished. The latter is attributed to a sevenfold increase in relative number of female conscripts over the 15-year period. The present findings should not be generalized to all young Norwegian men and women since conscripts are selected based on fitness, and only ~15% of the population end up serving.

Reference Values of Absolute and Relative Handgrip Strength in Chilean Schoolchildren with Intellectual Disabilities

Handgrip strength is a simple measure of general muscle strength and is related to functionality in people with intellectual disabilities. The objective of this research was to describe the normative values of absolute and relative handgrip strength in children, adolescents and adults according to sex. The sample was made up of 264 schoolchildren (n = 168 men) belonging to five special education schools in Santiago of Chile. The results show higher levels of absolute handgrip strength in males compared to females. The maximum peak of the absolute manual handgrip is reached in females in adolescence with a decrease in adulthood. Relative handgrip strength levels are similar in boys and girls. In females, the relative handgrip strength is similar in childhood and adolescence. Relative handgrip strength declines in both sexes from adolescence to adulthood. The reference values of this study can be used by professionals in the areas of health and education as a guide for interpretation, monitoring and follow-up of Chilean schooled people with intellectual disabilities.

Changes of agonist and synergist muscles activity during a sustained submaximal brake-pulling gesture

We analyzed the time course of changes in muscle activity of the prime mover and synergist muscles during a sustained brake-pulling action and investigated the relationship between muscle activity and braking force fluctuation (FF). Thirty-two participants performed a continuous fatiguing protocol (CFP) at 30% of maximal voluntary contraction (MVC) until failure. Surface electromyography was used to analyze root mean square (RMS) values in the flexor digitorum superficialis (FD), flexor carpi radialis (FC), extensor digitorum communis (ED), extensor carpi radialis (EC), brachioradialis (BR), biceps brachii (BB), and triceps brachii (TB). The FF and RMS in all muscles increased progressively (P<0.01) during the CFP, with sharp increments at time limit particularly in FD and FC (P<0.001). The RMS of the FD and FC were comparable to the baseline MVC values at time limit, in comparison to the other muscles that did not reach such levels of activity (P<0.003). The three flexor/extensor ratios used to measure coactivation levels decreased significantly (P<0.001). In contrast to RMS, MVC was still depressed at the minute 10 of recovery. The results suggest that the time limit was mainly constrained by fatigue-related mechanisms of the FD and FC but not by those of other synergist and antagonist muscles.

Comparison of Physical Fitness Profiles Obtained before and during COVID-19 Pandemic in Two Independent Large Samples of Children and Adolescents: DAFIS Project

COVID-19 pandemic restrictions might have negatively affected the health-related physical fitness of children and adolescents. The aim of this study was to contrast the body composition and physical fitness data of two independent samples of children and adolescents obtained from an online database (DAFIS project) before (n = 15,287) and during (n = 2101) the first academic year of the COVID-19 pandemic. The results revealed higher values for the body mass index (p = 0.002), waist circumference (p < 0.001), and waist to hip and waist to height ratios (p < 0.001) during than before the pandemic, particularly in the case of boys. On the other hand, lower muscular fitness was observed for girls during the pandemic. Quantitative and qualitative analysis did not detect relevant changes in cardiorespiratory fitness in children or adolescents (p > 0.05). Our data suggested that pandemic constraints might have affected body composition and muscular fitness of children and adolescents. These results might be of interest for designing specific interventions oriented toward counteracting the negative effects of pandemic restrictions on health-related physical fitness.

The mouth-opening muscular performance in adults with and without temporomandibular disorders: A systematic review

Background

The mouth‐opening muscular performance in patients with temporomandibular disorders (TMDs) is unclear. Understanding the impairments of this muscle group within specific TMDs is important to develop proper management strategies.

Objective

To characterise the mouth‐opening muscular performance in adults with and without TMDs.

Methods

PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane databases were searched from inception to 12 November 2020. Bibliographies were searched for additional articles, including grey literature. Case‐control, cross‐sectional and interventional studies reporting mouth‐opening muscular strength and/or endurance were included. Risk of bias was assessed by the SIGN checklist for case‐control studies and by the NIH quality assessment tool for cross‐sectional studies. Results were pooled with a random‐effects model. Confidence in cumulative evidence was determined by means of the GRADE guidelines.

Results

Fourteen studies were included; most were rated as having a moderate risk of bias. Only three studies assessed patients with TMDs and the other 11 assessed healthy adults. Significant sex differences in muscular performance were found for healthy adults in the review (strength deficit for females versus males). There was a significant reduction in maximal mouth opening performance (strength and endurance) in the three studies that assessed patients with temporomandibular disorders.

Conclusion

Sex plays a significant role in maximal mouth opening strength. There is a lack of reliable data on the normal mouth‐opening strength and endurance of healthy adults as well as for patients with TMDs.

Implications

Lack of reliable TMDs patient data and comparable healthy adult data highlight future direction for research.

Assessing Additional Characteristics of Muscle Function With Digital Handgrip Dynamometry and Accelerometry: Framework for a Novel Handgrip Strength Protocol

Maximal handgrip strength (HGS) is a convenient and reliable, but incomplete, assessment of muscle function. Although low HGS is a powerful predictor of poor health, several limitations to maximal HGS exist. The predictive value of HGS is restricted because low HGS is associated with a wide range of unspecified health conditions, and other characteristics of muscle function aside from strength capacity are not evaluated. Current HGS protocol guidelines emphasize the ascertainment of maximal force, which is only a single muscle function characteristic. Muscle function is intrinsically multivariable, and assessing other attributes in addition to strength capacity will improve screenings for age-related disabilities and diseases. Digital handgrip dynamometers and accelerometers provide unique opportunities to examine several aspects of muscle function beyond strength capacity, while also maintaining procedural ease. Specifically, digital handgrip dynamometry and accelerometry can assess the rate of force development, submaximal force steadiness, fatigability, and task-specific tremoring. Moreover, HGS protocols can be easily refined to include an examination of strength asymmetry and bilateral strength. Therefore, evaluating muscle function with new HGS technologies and protocols may provide a more comprehensive assessment of muscle function beyond maximal strength, without sacrificing feasibility. This Special Article introduces a novel framework for assessing multiple attributes of muscle function with digital handgrip dynamometry, accelerometry, and refinements to current HGS protocols. Such framework may aid in the discovery of measures that better predict and explain age-related disability, biological aging, and the effects of comorbid diseases that are amenable to interventions. These additional HGS measures may also contribute to our understanding of concepts such as resilience. Using sophisticated HGS technologies that are currently available and modernizing protocols for developing a new muscle function assessment may help transform clinical practice by enhancing screenings that will better identify the onset and progression of the disabling process.

Examining Additional Aspects of Muscle Function with a Digital Handgrip Dynamometer and Accelerometer in Older Adults: A Pilot Study

Background: Maximal handgrip strength (HGS) could be an incomplete and unidimensional measure of muscle function. This pilot study sought to examine the relationships between maximal HGS, radial and ulnar digit grip strength, submaximal HGS force control, HGS fatigability, neuromuscular HGS steadiness, and HGS asymmetry in older adults. Methods: A digital handgrip dynamometer and accelerometer was used to collect several HGS measurements from 13 adults aged 70.9 ± 4.0 years: maximal strength, radial and ulnar digit grip strength, submaximal force control, fatigability, neuromuscular steadiness, and asymmetry. Pearson correlations determined the relationships between individual HGS measurements. A principal component analysis was used to derive a collection of new uncorrelated variables from the HGS measures we examined. Results: The individual HGS measurements were differentially correlated. Maximal strength (maximal HGS, radial digit strength, ulnar digits strength), contractile steadiness (maximal HGS steadiness, ulnar digit grip strength steadiness), and functional strength (submaximal HGS force control, HGS fatigability, HGS asymmetry, HGS fatigability steadiness) emerged as dimensions from the HGS measurements that we evaluated. Conclusion: Our findings suggest that these additional measures of muscle function may differ from maximal HGS alone. Continued research is warranted for improving how we assess muscle function with more modern technologies, including handgrip dynamometry and accelerometry.