Is Handgrip Strength a Useful Measure to Evaluate Lower Limb Strength and Functional Performance in Older Women?

Figures & data

Table 1 Physical Characteristics, Handgrip Strength, Isometric and Isokinetic Strength of the Ankle, Knee and Hip Flexor, and Extensor Muscles, and Functional Tests of All (ALL), Older (OLD) and Very Old (VOD) Participants

Physical, Strength and Functional Parameters	ALL	OLD	VOD	p*	ES	Power (%)	MDC
	M ± SD n; [95% CI]	M ± SD n; [95% CI]	M ± SD n; [95% CI]
Age (years old)	70.3 ± 5.3 199; [69.6–71.1]	66.1 ± 2.2 97; [65.7–65.5]	74.3 ± 4.2 102; [73.5–75.2]	N.A.	-	-	-
Stature (m)	1.56 ± 0.07 199; [1.55–1.57]	1.56 ± 0.07 97; [1.55–1.58]	1.56 ± 0.07 102; [1.55–1.57]	N.A	-	-	-
Body Mass (Kg)	68.3 ± 12.0 199; [65.6–69.9]	69.8 ± 12.4 97; [67.4–72.4]	66.7 ± 11.4 97; [64.5–69.0]	N.A	-	-	-
Body Mass Index (kg.m^−2)	27.9 ± 4.4 199; [27.3–28.5]	28.5 ± 4.5 97; [27.6–29.4]	27.4 ± 4.2 102; [26.6–28.2]	N.A	-	-	-
Handgrip Strength (kgf)	23.5 ± 6.0 199; [22.7–24.4]	24.6 ± 6.7 97; [23.2–25.9]	22.5 ± 5.2 102; [21.5–23.6]	0.07	0.35	69.2	1.12
Plantarflexor isometric strength (kgf)	56.2 ± 19.8 69; [51.5–61.0]	60.5 ± 21.5 31; [52.6–68.4]	52.8 ± 17.9 38; [46.9–58.7]	0.18	0.39	35.7	6.28
Plantarflexor isokinetic 60°.s^−1 (kgf)	38.2 ± 13.5 148; [36.0–40.4]	39.9 ± 13.8 72; [36.7–43.1]	36.6 ± 13.1 76; [33.6–39.6]	0.21	0.24	31.9	2.89
Plantarflexor isokinetic 180°.s^−1 (kgf)	26.3 ± 10.9 148; [24.5–28.1]	28.1 ± 11.8 72; [25.3–30.8]	24.6 ± 9.8 76; [22.4–26.9]	0.13	0.32	49.9	2.37
Dorsiflexor isometric strength (kgf)	22.8 ± 5.8 69; [21.4–24.2]	22.9 ± 5.4 31; [21.0–24.9]	22.7 ± 6.3 38; [20.6–24.7]	0.85	0.03	3.5	1.84
Dorsiflexor isokinetic 60°.s^−1 (kgf)	17.3 ± 3.6 148; [16.7–17.9]	17.7 ± 3.4 72; [16.9–18.5]	17.0 ± 3.7 76; [16.1–17.8]	0.32	0.19	22.3	0.77
Dorsiflexor isokinetic 180°.s^−1 (kgf)	15.5 ± 3.9 148; [14.8–16.1]	16.1 ± 4.0 72; [15.4–17.0]	14.9 ± 3.7 76; [14.1–15.8]	0.15	0.31	42.3	0.84
Knee extensor isometric strength (kgf)	92.0 ± 27.3 69; [85.4–98.6]	96.2 ± 30.0 31; [85.2–107.2]	88.6 ± 24.7 38; [80.5–96.7]	0.34	0.36	20.4	8.63
Knee extensor isokinetic 60°.s^−1 (kgf)	82.8 ± 20.1 199; [79.9–85.7]	86.3± 20.7 97; [82.1–25.9]	79.5 ± 20.7 102; [75.4–83.6]	0.08	0.32	63.9	3.89
Knee extensor isokinetic 180°.s^−1 (kgf)	63.1 ± 19.7 199; [60.3–65.8]	67.5 ± 21.4 97; [63.1–71.8]	58.8 ± 17.0 102; [55.5–62.2]	0.01	0.45	87.3	2.99
Knee flexor isometric strength (kgf)	37.5 ± 9.8 69; [35.1–39.8]	39.0 ± 8.9 31; [35.7–42.3]	36.2 ± 10.5 38; [32.8–39.7]	0.32	0.28	22.3	3.12
Knee flexor isokinetic 60°.s^−1 (kgf)	40.4 ± 12.7 199; [38.6–42.2]	43.2 ± 12.7 97; [40.6–45.7]	37.7 ± 12.2 102; [35.4–40.2]	0.02	0.44	87.6	2.37
Knee flexor isokinetic 180°.s^−1 (kgf)	40.4 ± 12.7 199; [38.6–42.2]	37.9 ± 10.7 97; [35.7–40.0]	33.2 ± 11.8 102; [30.9–35.5]	0.02	0.41	83.8	2.14
Hip extensor isokinetic 60°.s^−1 (kgf)	69.5 ± 27.3 51; [61.8–77.2]	70.8 ± 31.4 25; [57.9–83.8]	68.3 ± 23.4 26; [58.9–77.8]	0.79	0.1	5.1	10.07
Hip extensor isokinetic 180°.s^−1 (kgf)	43.9 ± 20.7 51; [38.1–49.8]	46.3 ± 22.7 25; [36.9–55.7]	41.7 ± 18.7 26; [34.1–49.2]	0.48	0.22	12.1	7.62
Hip flexor isokinetic 60°.s^−1 (kgf)	58.5 ± 12.1 51; [55.1–61.9]	61.5 ± 13.1 25; [56.1–66.9]	55.6 ± 10.5 26; [51.3–59.8]	0.15	0.49	42.5	4.45
Hip flexor isokinetic 180°.s−^Citation1 (kgf)	46.6 ± 10.7 51; [43.5–49.7]	50.1 ± 10.8 25; [45.6–54.5]	43.2 ± 9.7 26; [39.3–47.1]	0.13	0.67	66.9	3.95
5STS (s)	11.5 ± 3.42 196; [11.0–11.98]	11.1 ± 3.21 96; [10.5–11.8]	11.83 ± 3.6 100; [11.1–12.5]	0.47	0.21	32.3	0.64
TUG (s)	9.32 ± 2.58 198; [8.95–9.68]	8.63 ± 1.33 97; [8.35–8.89]	9.97± 3.23 102; [9.33–10.65]	0.02	0.54	97.1	0.48
W6M (s)	7.68 ± 1.67 199; [7.44–7.97]	7.30 ± 1.27 97; [7.04–7.55]	8.05 ± 1.91 102; [7.62–8.24]	0.08	0.46	90.6	0.31

Notes: OLD = 60 to 70 years old; VOD = 71 to 86 years old. p* = adjusted Benjamini-Hochberg Procedure.

Abbreviations: M, mean; S.D., standard deviation; n, number of participants assessed; 95%CI, 95% confidence interval; 5STS, five times sit-to-stand test; TUG, time up and go test; W6M, 6-meter walk test; p, significance level; N.A., not applicable; ES, effect size; MDC, minimal detectable change.

Figure 1 Handgrip strength correlations with isometric and isokinetic strength at 60°.s−¹ and 180°.s⁻¹ of the plantar flexor and dorsiflexor muscles (left panel) and of the extensor and flexor muscles of the knee (right panel). Correlation coefficient (r) and number of participants (n) for all individuals (ALL) and divided by group (OLD: 60–70 years-old; VOD: 71–86 years-old).

Figure 2 Handgrip strength correlations with isokinetic strength at 60°.s−¹ and 180°.s−¹ of hip extensor and flexor muscles (left panel) and with the functional tests (right panel). Correlation coefficient (r) and number of participants (n) for all individuals (ALL) and divided by group (OLD: 60–70 years-old; VOD: 71–86 years-old).

Table 2 Correlations of Isometric and Isokinetic Strength at 60°.s⁻¹ and 180°.s⁻¹ of Plantar Flexor, Dorsiflexor, Extensor and Flexor Muscles of the Knee and Hip Joints with Functional Tests and Age Groups

Isometric and Isokinetic Lower Limb Strength	5STS		TUG		W6M
	OLD	VOD	OLD	VOD	OLD	VOD
Plantarflexor isometric strength	− 0.26	− 0.25	− 0.18	− 0.36*	− 0.02	− 0.43**
Plantarflexor isokinetic 60°.s^−1	− 0.33**	− 0.34**	− 0.33*	− 0.39**	− 0.23*	− 0.53**
Plantarflexor isokinetic 180°.s^−1	− 0.35**	− 0.32**	− 0.23	− 0.39**	− 0.07	− 0.37**
Dorsiflexor isometric strength	− 0.05	− 0.19	− 0.04	− 0.15	0.00	− 0.02
Dorsiflexor isokinetic 60°.s^−1	− 0.23*	0.01	− 0.27*	0.03	− 0.27*	− 0.08
Dorsiflexor isokinetic 180°.s^−1	− 0.14	0.09	− 0.21	0.11	− 0.21	− 0.07
Knee extensor isometric strength	− 0.28	− 0.32*	− 0.38*	− 0.35*	− 0.34	− 0.41*
Knee extensor isokinetic 60°.s^−1	− 0.22*	− 0.27**	− 0.22*	− 0.37**	− 0.27*	− 0.23*
Knee extensor isokinetic 180°.s^−1	− 0.21*	− 0.01	− 0.03	− 0.35**	0.08	− 0.21*
Knee flexor isometric strength	− 0.09	− 0.04	− 0.10	− 0.11	0.04	− 0.17
Knee flexor isokinetic 60°.s^−1	− 0.11	− 0.21*	− 0.17	− 0.36**	− 0.02	− 0.32**
Knee flexor isokinetic 180°.s^−1	0.09	− 0.20*	− 0.17	− 0.50**	0.06	− 0.34**
Hip extensor isokinetic 60°.s^−1	− 0.36	− 0.02	− 0.31	− 0.18	− 0.12	− 0.15
Hip extensor isokinetic 180°.s^−1	− 0.34	− 0.34	− 0.29	− 0.25	− 0.20	− 0.23
Hip flexor isokinetic 60°.s−^Citation1	0.08	0.00	− 0.16	− 0.24	− 0.08	− 0.14
Hip flexor isokinetic 180°.s−^Citation1	0.19	− 0.19	− 0.08	− 0.04	0.16	− 0.02

Notes: OLD: 60–70 years old; VOD: 71–86 years old. *p < 0.05, **p < 0.01.

Abbreviations: 5STS, five-times-sit-to-stand; TUG, time up and go; W6M, 6m-walk test.

Table 3 Linear Multiple Regression Analysis to Predict TUG Performance Using Strength Measurements (HS, Isokinetic Torque of the Ankle and Knee Joints) for All Participants (ALL), Old Adults (OLD) and Very Old Adults (VOD)

		Explanatory Variable	Coefficient (STD Error)	95% Confidence Interval		T Statistics		P value
60°.s−^Citation1	ALL	(n=148; R^2 = 0.150; R^2 adjusted = 0.120)
		Constant	11.975 (1.318)	(9.37, 14.58)		9.08		<0.01
		HS	0.026 (0.047)	(−0.067, 0.12)		0.55		0.58
		Knee ext. 60°.s−^Citation1	−0.012 (0.015)	(−0.041, 0.018)		−0.79		0.43
		Knee flex. 60°.s−^Citation1	−0.028 (0.022)	(−0.072, 0.017)		−1.23		0.22
		Plantar flex. 60°.s^−1	−0.051 (0.021)	(−0.092, −0.011)		−2.50		0.01*
		Dorsi flex. 60°.s^−1	0.035 (0.064)	(−0.091, 0.162)		0.550		0.58
	OLD	(n= 72; R^2 = 0.176; R^2 adjusted = 0.114)
		Constant	10.371 (1.009)	(8.356, 12.386)		10.27		<0.01
		HS	0.034 (0.031)	(−0.028,0.097)		1.10		0.27
		Knee ext. 60°.s−^Citation1	−0.009 (0.010)	(−0.029, 0.012)		−0.85		0.40
		Knee flex. 60°.s^−1	0.015 (0.015)	(−0.0125, 0.045)		0.97		0.33
		Plantar flex. 60°.s^−1	−0.029 (0.013)	(−0.055, −0.003)		−2.22		0.03*
		Dorsi flex. 60°.s^−1	−0.075 (0.047)	(−0.0169, 0.019)		−1.59		0.12
	VOD	(n=76; R^2 = 0.191; R^2 adjusted = 0.133)
		Constant	12.308 (2.210)	(7.899, 16.716)		5.57		<0.01
		HS	0.036 (0.091)	(−0.146, 0.217)		0.39		0.69
		Knee ext. 60°.s^−1	−0.005 (0.027)	(−0,059, 0.048)		−0.19		0.85
		Knee flex. 60°.s^−1	−0.051(0.043)	(−0.136,0.033)		−1.21		0.23
		Plantar flex. 60°.s^−1	−0.078 (0.041)	(−0.160, 0.004)		−1.91		0.06*
		Dorsi flex. 60°.s^−1	0.106 (0.110)	(−0.115, 0.326)		0.95		0.34
180°.s−^Citation1	ALL	(n=148; R^2 = 0.158; R^2 adjusted = 0.129)
		Constant	11.851 (1.213)	(9.453, 14.248)		9.77		<0.01
		HS	0.010 (0.048)	(−0.086, 0.106)		0.20		0.84
		Knee ext. 180°.s^−1	0.015 (0.015)	(−0.014, 0.045)		1.03		0.30
		Knee flex. 180°.s^−1	−0.091 (0.056)	(−0.144, 0.038)		−3.37		<0.01*
		Plantar flex. 180°.s^−1	−0.032 (0.023)	(−0.076, −0.013)		−1.41		0.16
		Dorsi flex. 180°.s^−1	0.016 (0.056)	(−0.095, 0.128)		0.29		0.77
	OLD	(n= 72; R^2 = 0.110; R^2 adjusted = 0.042)
		Constant	9.669 (0.950)	(7.772, 11.566)		10.17		<0.01
		HS	0.017 (0.034)	(−0.052,0.086)		0.49		0.63
		Knee ext. 180°.s^−1	0.011 (0.010)	(−0.009, 0.030)		1.11		0.27
		Knee flex. 180°.s^−1	−0.013 (0.020)	(−0.052, 0.027)		−0.64		0.52
		Plantar flex. 180°.s^−1	−0.021 (0.014)	(−0.049, 0.007)		−1.51		0.14
		Dorsi flex. 180°.s^−1	−0.074 (0.041)	(−0.0155, 0.007)		−1.82		0.07
	VOD	(n=76; R^2 = 0.232; R^2 adjusted = 0.178)
		Constant	12.143 (2.098)	(7.959, 16.327)		5.78		<0.01
		HS	−0.008 (0.090)	(−0.188, 0.172)		−0.09		0.93
		Knee ext. 180°.s^−1	0.028 (0.032)	(−0.035, 0.092)		0.89		0.38
		Knee flex. 180°.s^−1	−0.142(0.050)	(−0.242,-0.043)		−2.85		<0.01*
		Plantar flex.180°.s^−1	−0.035 (0.051)	(−0.137, 0.066)		−0.70		049
		Dorsi flex. 180°.s^−1	0.121 (0.102)	(−0.083, 0.324)		1.18		0.24

Note:*Indicates significant differences.

Briggs AM, Cross MJ, Hoy DG, et al. Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 world health organization world report on ageing and health. Gerontologist. 2016;56(Suppl 2):S243–55. doi:10.1093/geront/gnw00226994264

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