Relation Between Relative Handgrip Strength, Chronological Age and Physiological Age with Lower Functional Capacity in Older Women

Multifactorial risk factors for hospital readmissions among patients with symptoms of advanced heart failure

AIMS

Economic burden of heart failure is attributed to hospital readmissions. Previous studies assessing risk factors for readmissions have focused on single group of risk factors, were limited to 30-day readmissions, or did not account for competing risk of mortality. This study investigates the biological, socio-economic, and behavioural risk factors predicting hospital readmissions while accounting for the competing risk of mortality.

METHODS AND RESULTS

In this prospective cohort study, we recruited 250 patients hospitalized with symptoms of advanced heart failure [New York Heart Association (NYHA) Class III and IV] between July 2017 and April 2019. We analysed their baseline survey data and their hospitalization records over the next 4.5 years (July 2017 to January 2022). We used a joint-frailty model to determine the multifactorial risk factors for all-cause and unplanned hospital readmissions and mortality. At the time of recruitment, patients' mean (SD) age was 66 (12) years, majority being male (72%) and NYHA class IV (68%) with reduced ejection fraction (72%). 87% of the patients had poor self-care behaviours, 51% had diabetes and 56% had weak grip strength. Within 2 years of a hospital admission, 74% of the patients had at least one readmission. Among all readmissions during follow-up, 68% were unplanned. Results from the multivariable regression analysis shows that the independent risk factors for hospital readmissions were biologic-weak grip strength [hazard ratio (95% CI): 1.59 (1.06, 2.13)], poor functional status [1.79 (0.98, 2.61)], diabetes [1.42 (0.97, 1.86)]; behavioural-poor self-care [1.66 (0.84, 2.49)], and socio-economic-preference for maximal life extension at high cost for those with high education [1.98 (1.17, 2.80)]. Risk factors for unplanned hospital readmissions were similar. A higher hospital readmission rate increased the risk of mortality [1.86 (1.23, 2.50)]. Other risk factors for mortality were biologic-weak grip strength [3.65 (0.57, 6.73)], diabetes [2.52 (0.62, 4.42)], socio-economic-lower education [2.45 (0.37, 4.53)], and being married [2.53 (0.37, 4.69)]. Having a private health insurance [0.40 (0.08, 0.73)] lowered the risk for mortality.

CONCLUSIONS

Risk factors for hospital readmissions and mortality are multifactorial. Many of these factors, such as weak grip strength, diabetes, poor self-care behaviours, are potentially modifiable and should be routinely assessed and managed in cardiac clinics and hospital admissions.

Effects of chemotherapy treatment on muscle strength indicators, functional capacity and biopsychosocial aspects of women with breast cancer

Evidences on the effects of chemotherapy treatment cycles on measures of muscle, mental state, social and cognitive performance are scarce. The objective of this study was to analyze the effects of chemotherapy cycles on muscle strength and activation, functional capacity, quality of life, fatigue and anxiety of women with breast cancer. Therefore, twenty-two women divided into a treatment group (n = 10; 46.6 ± 9.6 years) and control group (n = 12; 51.6 ± 7.0 years) participated in the study. Analysis of muscle performance, quality of life, fatigue and anxiety after the 2nd and 4th cycle of chemotherapy with anthracyclines were performed in women with breast cancer (TRA) and compared to healthy women (CTR). Two-way ANOVA was used to compare the variance of the means and the significance level was set as P≤0.05. The results showed Differences in the muscular activation of the vastus mediallis between the groups at post time (P = 0.038), as well as in the sit and stand test in the baseline (P<0.001) and post moment (P<0.001). Functional capacity performance was different between baseline (P<0.001) and post-time (P<0.001) groups. Additionally, the TRA group worsened the quality of life in the domains of functional capacity (P<0.001) and limitation of physical aspects (P = 0.002), besides presenting negative changes in fatigue. Thus, anthracycline chemotherapy cycles reduce muscular performance and affect biopsychosocial variables in women with breast cancer.

Hand Grip Strength Relative to Waist Circumference as a Means to Identify Men and Women Possessing Intact Mobility in a Cohort of Older Adults with Type 2 Diabetes

Possessing intact mobility in older adults assures their continued independence. The early identification of reduced mobility in older adults with type 2 diabetes (T2DM) is paramount for preventing their future physical deterioration. Hand grip strength (HGS), relative to body size, is associated with mobility in older T2DM patients. This study aims to identify an HGS index that best identifies mobilityintact older T2DM patients, along with its optimal cut-off point. The baseline data are from a cohort of 122 older T2DM patients (59% women) (mean age of 70.2 ± 4.4 years). Three mobility tests encompassing three main mobility domains were measured, including usual gait speed (UGS), timed up and go (TUG), and a two-minute walk test (2MWT). Passing scores were defined as those either above the established cut-off points or above the 25th percentile of population norms. Passing all three tests was considered as possessing intact mobility. Receiver operating characteristic (ROC) curves of the most relevant HGS indices were constructed to determine the area under the curve (AUC) that best identifies patients with intact mobility. In a sample of 122 older adults with T2DM, 63.9% of women and 60% of men were found to possess intact mobility. HGS relative to waist circumference (WC) was found to have the strongest association with intact mobility, presenting the highest AUC in both men (0.78) and women (0.72) for discriminating mobility status, with an optimal cut-off of 0.355 (kg/cm) and 0.245 (kg/cm) in men and women, respectively. HGS relative to WC best differentiated between mobility-intact older adults with T2DM and those with mobility limitations, especially in men. Using HGS/WC as a simple and safe screening mode for mobility in a clinical setting could potentially identify older patients with T2DM that require therapeutic interventions.

Relationship Between Handgrip Strength and Metabolic Syndrome Among Middle-Aged and Elderly Cancer Survivors: A National Population Study

BACKGROUND

The number of middle-aged and elderly cancer survivors is rising. Metabolic syndrome, which has been established as an important risk factor for mortality and cardiovascular disease, has also been linked to quality of life in middle-aged and elderly cancer survivors. Recent studies documented a relationship between handgrip strength and metabolic syndrome.

OBJECTIVE

The aim of this study was to investigate the relationship between relative handgrip strength in middle-aged and elderly cancer survivors and metabolic syndrome in a national population-based sample from Korea.

METHODS

This was a cross-sectional, secondary descriptive analysis of data from the sixth to seventh (2014-2018) Korea National Health and Nutrition Examination Survey (KNHANES VI-VII). A final total of 1096 cancer survivors aged 45 years and older were selected.

RESULTS

Lower relative handgrip strength was linked to a higher risk of metabolic syndrome. For men, the adjusted odds ratio for having metabolic syndrome in individuals with a relative handgrip strength score of the 2 Quartile was 4.43 (95% confidence interval, 2.25-8.71) compared with the 4 Quartile (reference) ( P < .001), whereas for women, this was 3.67 (95% confidence interval, 2.06-6.53) ( P < .001).

CONCLUSIONS

Lower relative handgrip strength is correlated with components of metabolic syndrome and is a risk factor for metabolic syndrome among middle-aged and elderly cancer survivors.

IMPLICATIONS FOR PRACTICE

Physicians and nurses need to identify and monitor the handgrip strength for managing the risk of metabolic syndrome among middle-aged and elderly cancer survivors. Preventive and therapeutic programs that focus on handgrip strength should be developed to prevent metabolic syndrome during their rehabilitation.

Absolute and Relative Handgrip Strength as Indicators of Self-Reported Physical Function and Quality of Life in Breast Cancer Survivors: The EFICAN Study

Simple Summary

Breast cancer is the most diagnosed type of cancer worldwide and it has a high survival rate. Thus, side effects related to breast cancer and treatments compromise lots of people’s physical functions and health-related quality of life. For this reason, it is important to manage these side effects in the follow up after treatments. The handgrip strength and the handgrip strength relative to body mass index may constitute useful, simple, quick and economically feasible tools that may help clinicians detecting these side effects, which is key to undertake actions for improving the physical function and health-related quality of life of breast cancer survivors.

Abstract

Background: Although breast cancer (BC) is the most prevalent type of cancer in the world, its high survival rate implies that many people live long after the treatments and face their side effects. The physical function (PF) and health-related quality of life (HRQoL) of people surviving BC decreases significantly, which makes important to identify markers that may be associated with a better health status and prognosis. Previous studies suggest that handgrip strength (HGS) and HGS relative to the body mass index (rHGS) are good indicators of PF and HRQoL in different populations. However, it is unknown whether this applies to BC survivors. This study aimed to evaluate the association of HGS and rHGS with PF and HRQoL in this population. Methods: Sixty female BC survivors participated. Handgrip strength was assessed with a dynamometer. Arm volume was estimated and upper limb impairments, as well as cancer-related fatigue, depression, life satisfaction and HRQoL, were assessed using standardized questionnaires. Results: Higher levels of HGS and rHGS were associated with higher levels of HRQoL, lower cancer-related fatigue, and fewer problems with the affected arm. Conclusions: These results suggest that HGS may be a good indicator of self-reported PF and HRQoL in female BC survivors.