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PubMed1996

The relationship between physical performance measures and independence in instrumental activities of daily living. The FICSIT Group. Frailty and Injury: Cooperative Studies of Intervention Trials.

OBJECTIVES: Understanding the relationship between physical capacity and functional status is required to design exercise interventions to maintain independent living. This study assessed the importance of physical performance in maintaining independence in Instrumental Activities of Daily Living (IADL). DESIGN: A pre-planned meta-analysis of cross-sectional data from six sites of the Frailty and Injury: Cooperative Studies of Intervention Trials (FICSIT). Linear regression was used to estimate the relationship between physical performance and IADL. PARTICIPANTS: 2190 community-dwelling older subjects. MEASUREMENTS: IADL was the dependent variable; gait velocity, balance function, grip strength and chair rise time were the predictor variables. Age, gender, education, falls self-efficacy, and cognitive status were covariates. RESULTS: Gait velocity, balance function, and grip strength were independently related to IADL deficits, after correcting for covariates. The linear slopes were relatively steep. For gait, a decrease of 0.1 m s-1 was associated with 0.10 (95% Cl: 0.17, 0.04) increase in IADL deficits, which is equivalent to 1 ADL deficit in 10 subjects. The linear slopes for hand grip and balance were similar or steeper. In the sites where chair stand time was measured, an increase of 1 second in the time to rise was associated with a 0.14 (0.04, 0.24) increase in IADL deficits. The relationships found in the meta-analytic analysis were consistent across sites which enrolled subjects with widely varying levels of physical performance. CONCLUSION: Simple measures of physical performance were strongly associated with IADL independence after correcting for many previously identified predictors of functional status. The data from this meta-analysis support testing interventions designed to improve physical performance to determine whether improved performance can maintain or improve independence in IADLs.

Activities of Daily Living↗
PubMed2000

Muscle strength, functional mobility and vitamin D in older women.

Vitamin D deficiency may lead to loss of type II muscle fibres, and thereby to atrophy of proximal muscles with an increased risk of falling and bone fractures. The aim of the study was to determine if six months of vitamin D treatment (0.5 microg alphacalcidol) could positively influence values for muscle strength and functional mobility in vitamin D-deficient older women. Twenty-seven women entered the study which took place at a teaching hospital outpatient department. Ten vitamin D-deficient (serum 25(OH)D3 <20 nmol/L) older (>70 years) women and 13 age-matched female subjects with normal vitamin D levels (serum 25(OH)D3 >30 nmol/L) completed the study. Preand post-treatment data were obtained for isometric knee extensor strength, handgrip strength and functional mobility (walking distance over 2 minutes and the timed i'Up & Go" test). Six months of treatment with alphacalcidol led to significant improvements (compared to the controls) in values of isometric knee extensor strength (left leg: 14.6% +/- 5.7%. p=0.03; right leg: 11.5% +/- 5.0%, p=0.02) (mean +/- SEM). The achievements in the timed "Up & Go" test and 2-minute walking test did not improve in the alphacalcidol group compared to the controls after 6 months. However, within the vitamin D-deficient group, 6 months of alphacalcidol treatment led to a significant increase in the walking distance over 2 minutes (increase from 137.6 +/- 12.6 to 151.3 +/- 11.2 meters, p=0.03). The controls, with normal vitamin D levels, did not exhibit improvements in performance of any of the tests over a period of 6 months. Summarized, alphacalcidol seems to improve muscle strength and walking distance over 2 minutes in vitamin D-deficient older women.

Aged↗
PubMed2006

[Functional outcome after corrective osteotomy of the distal radius].

BACKGROUND: Malunited fractures of the distal radius frequently show disabling and painful reductions in active range of motion (AROM) of the wrist and forearm with reduced grip strength. Shortening and three-dimensional torsion of the distal radius occur with relative ulnar lengthening. Corrective osteotomy of the distal radius is indicated in these conditions. METHODS: We examined 24 of 30 patients after corrective osteotomy with respect to AROM, grip strength, DASH, and pain perception (visual analogue scale). The mean age of the population was 49 years (18-69 years), and the mean follow-up period was 22 months (6-63 months). RESULTS: Preoperative extension/flexion was 65 degrees , postoperative 92 degrees (p<0.05). Forearm rotation improved from 129 degrees preoperative to 160 degrees postoperative (p<0.01). The DASH score could be reduced from 40 (n=9) to 18 (n=24). Grip strength increased from 17 kg to 27 kg postoperative (p<0.01). Radioulnar inclination increased from 15 degrees preoperative to 24 degrees postoperative (p<0.05). Relative ulnar lengthening could be minimized from 4.3 mm to 0.7 mm (p<0.05). CONCLUSION: Data show that reconstruction of the distal radius improves grip strength and range of motion significantly with simultaneous reduction of pain perception and DASH scores.

Adolescent↗
PubMed2001

Age, sex, and grip strength determine architectural bone parameters assessed by peripheral quantitative computed tomography (pQCT) at the human radius.

The purpose of this study was to estimate the relation of some noninvasively derived mechanical characteristics of radial bone including architectural parameters for bone strength to grip strength and muscle cross-section. Sixty-three males between 21 and 78yr of age and 101 females between 18 and 80yr of age were measured at the nondominant forearm using peripheral quantitative computed tomography (pQCT). We assessed the integral bone mineral density (BMD(I)) and content (BMC(I)) by pQCT at the distal and at the mid-shaft radius. Integral bone area (Area(I)), cortical thickness (C-th), and a newly proposed index for bone strength; the stress-strain index (SSI) were also calculated. The dynamometrically measured maximum grip strength was taken as a mechanical loading parameter and muscle cross-section as a substitute for it. Sex, grip strength, BMC(I) and BMD(I) (distal radius) were identified in a multiple regression analysis to significantly predict bone strength as expressed by SSI, after adjusting for all other independent variables, including age and sex (p<0.0001). Grip strength was closest related to age, sex, BMD(I) and SSI(p) of the distal radius. The cross-sectional area of muscle was not significantly determining the grip strength within the analysis model. In conclusion, our results suggested that architectural parameters at the distal radius were better related to grip strength than to cross-sectional muscle area in both males and females. Maximum muscle strength as estimated by grip strength might be a stronger determinant of mechanical characteristics of bones as compared with cross-sectional muscle area.

Adult↗
PubMed1995

The ulno-carpal abutment syndrome. Follow-up of the wafer procedure.

Seven wrists in six patients with ulno-carpal abutment syndrome were treated by a subchondral distal ulna resection (wafer procedure). The average follow-up was 36 months. Wrist function was evaluated using a clinical scoring chart. The parameters were pain, range of motion, grip strength and activities. One patient had a poor result, one a fair result and the remaining had good to excellent results. In all cases grip strength showed dramatic improvement. Complications were limited to palpable subcutaneous nylon sutures requiring removal in three patients and extensor carpi ulnaris tendinitis in one.

Adult↗
PubMed1995

Early results of conventional versus two-portal endoscopic carpal tunnel release. A prospective study.

The authors compare in a prospective, randomized study the early outcome of carpal tunnel release using either a conventional palmar open release (n = 40) or a two-portal endoscopic release (n = 56). Both groups were similar. No statistically significant differences were found regarding pain, disappearing of paraesthesiae or time to return to work. However, better recovery of grip strength was observed in the endoscopic group at 1 and 3 months. No surgical complications were observed in either group.

Adult↗
PubMed1998

Self-control as limited resource: regulatory depletion patterns.

If self-regulation conforms to an energy or strength model, then self-control should be impaired by prior exertion. In Study 1, trying to regulate one's emotional response to an upsetting movie was followed by a decrease in physical stamina. In Study 2, suppressing forbidden thoughts led to a subsequent tendency to give up quickly on unsolvable anagrams. In Study 3, suppressing thoughts impaired subsequent efforts to control the expression of amusement and enjoyment. In Study 4, autobiographical accounts of successful versus failed emotional control linked prior regulatory demands and fatigue to self-regulatory failure. A strength model of self-regulation fits the data better than activation, priming, skill, or constant capacity models of self-regulation.

Adaptation, Psychological↗
PubMed2001

Effect of suture locking and suture caliber on fatigue strength of flexor tendon repairs.

The objectives of this cadaveric study were 2-fold: to determine the effect of different locking configurations on the cyclical fatigue strength of flexor tendon repairs and to assess the differences between each repair when a 3-0 or 4-0 suture is used. One hundred twenty flexor digitorum profundus tendons were cut and repaired using nonlocked, simple locked, and cross-stitch locked variations of 2- and 4-strand flexor tendon repairs. Using an incremental cyclical loading protocol we performed 10 trials of each repair with both 3-0 and 4-0 sutures and analyzed the number of Newton-cycles to failure using a 3-way ANOVA. The use of a 3-0 suture led to a 2- to 3-fold increase in fatigue strength in all repairs tested and the fatigue strength of the 4-strand repairs was significantly greater than the 2-strand repairs. All repairs performed with 4-0 suture failed by suture rupture. Of the 3-0 suture repairs, the three 2-strand repairs and the 4-strand cross-stitch locked repair failed by suture rupture. In contrast, 6 of 10 of the 4-strand simple locked and nonlocked repairs failed by suture pullout. There was no significant difference in fatigue strength between the 2 locked and the nonlocked 2-strand repairs using either 3-0 or 4-0 suture. There also was no significant difference in holding capacity or fatigue strength between the simple locked or nonlocked 4-strand repairs. However, the 4-strand cross-stitch locked repair with a 3-0 suture had significantly improved fatigue strength and holding capacity compared with the other repairs tested. Based on the consistently inferior biomechanical performance of 4-0 suture, we recommend that 3-0 suture be considered for 2- or 4-strand tendon repairs when early active motion is planned. The orientation of the transverse and longitudinal components of simple locked repairs did not significantly influence their holding capacity or fatigue strength. The cross-stitch type of locked repair provides better holding capacity and fatigue strength compared with simple locked or nonlocked 4-stranded flexor tendon repairs.

Analysis of Variance↗
PubMed2002

Aerobic and neuromuscular performance capacity of physically active females with early or long-term rheumatoid arthritis compared to matched healthy women.

OBJECTIVE: To examine aerobic capacity and neuromuscular performance in physically active females with early or long-term rheumatoid arthritis (RA) and healthy women. METHODS: Twenty-three RA-patients (12 early RA patients (ERA). 11 long-term RA (LRA) and 12 healthy controls (HC) performed maximal aerobic oxygen uptake (VO2max), muscle force production. walking and jump tests. RESULTS: The VO2max ranged between 23-27 ml x kg(-1) min(-1) and did not differ between the groups. Isometric grip strength was 25% (p = 0.017) and bilateral leg extension strength 19% (p = 0.031) lower in LRA patients compared to ERA. In LRA the explosive force (p = 0.023) and relaxation times (p = 0.025-0.032) of bilateral leg extension and vertical squat jump (p = 0.015) did not reach the level of HC or ERA. The trunk muscle forces did not differ between the groups. CONCLUSIONS: The physically active females even with LRA could maintain their aerobic fitness comparable to that of age matched healthy subjects. However, the neuromuscular profile suggests that especially explosive strength characteristics of the leg extensors cannot be maintained at the normal level with habitual physical activities.

Adult↗
PubMed1998

The Nottingham Longitudinal Study of Activity and Ageing: a methodological overview.

OBJECTIVES: first, to describe the background and methodological approach to the assessment of customary physical activity, health and psycho-social status used by the Nottingham Longitudinal Study of Activity and Ageing; second, to provide information on the sampling strategy and survey response rates for three waves of data collection; and, third, to provide information on the reliability and validity of the survey assessments. DESIGN: longitudinal study. SUBJECTS: 1042 people originally aged 65 and over, randomly sampled from general practitioner lists in Nottingham, UK. METHODS: a descriptive overview of response rates (%), instrument reliability (alpha coefficients) and intercorrelations among measured outcomes (correlation coefficients and principal components analysis). MAIN OUTCOME MEASURES: questionnaire-assessed levels of physical activity; instrumental measurements of handgrip strength, weight, demi-span and shoulder flexibility; brief assessments of depression, social engagement, life-satisfaction and cognitive impairment. RESULTS: the study achieved a baseline (TI) response rate of 80%, with re-interview rates of 88% and 73% for T2 (1989) and T3 (1993) surveys respectively. For both men and women, factor scores derived from first principal components extracted from T1 survey data showed significant (r > or = 0.4; P < 0.001) product moment correlations with instrumental measurements of handgrip strength and shoulder flexibility. All the brief assessment measures showed satisfactory levels of reliability (alpha > or = 0.7).

Activities of Daily Living↗
PubMed1995

Muscle strength in healthy people and in patients suffering from recent-onset inflammatory arthritis.

Neuromuscular function was compared among 20 patients with relatively recent onset (symptomatic period 17 +/- 24 months) rheumatoid arthritis (RA) (experimental group; EG), and 20 age- and sex-matched healthy people (control group; CG). The comparison was repeated after a period of 6 months, when 16 patients had carried out progressive strength training. At baseline maximal grip strength and maximal dynamic unilateral strength of the knee extensors in the EG were significantly (P < 0.05) lower in comparison to the CG. The groups did not differ from each other in maximal isometric strength of the trunk flexors and extensors or the knee extensors. The 6-month dynamic strength training in the EG resulted in significant increases in maximal dynamic strength of the knee extensors (P < 0.001), in isometric grip strength (P < 0.001) and in isometric strength of the trunk flexors (P < 0.05) and extensors (P < 0.05) to the level of the healthy controls. Only minor changes took place in explosive strength and maximal isometric strength of the knee extensors. Erythrocyte sedimentation rate (P < 0.001), Ritchie's articular index (P < 0.01) and modified health assessment questionnaire (P < 0.01) improved significantly during the training period. The results suggest that inflammatory arthritis decreases dynamic and/or isometric muscle strength in selected muscle groups of the body already in the early stages of disease. However, progressive dynamic strength training rapidly increases the neuromuscular performance capacity of the patients even to the level of healthy people without detrimental effects on disease activity.

Adult↗
PubMed2005

Fiber-optic sensor for handgrip-strength monitoring: conception and design.

Handgrip strength is an easy measure of skeletal muscle function as well as a powerful predictor of disability, morbidity, and mortality. In order to measure grip strength, a novel fiber-optic approach is proposed and demonstrated. The strain-dependent wavelength response of fiber Bragg gratings has been utilized to obtain the strength of individual fingers. Finite-element analysis is carried out to optimize the pressure transmission from the finger to the fiber Bragg grating. The effect of stiffness of the pressurizing media, its thickness, and the effect of contact fraction are evaluated. It is found that significant enhancement in the pressure sensitivity and wavelength-tuning range is achievable by optimizing these parameters. Also the stress-induced birefringence could be reduced to an insignificant near-zero value. The device is calibrated in terms of load to convert the wavelength shift to the strength of the grip. The time-dependent wavelength fluctuation is also studied and presented.

Computer-Aided Design↗
PubMedDate not supplied

Modeling growth and senescence in physical performance among the ache of eastern Paraguay.

This article seeks to partially fill a paucity of available data on physical performance in hunter-gatherer societies. Quantitative data are presented on various physical performance measures conducted on the Ache of eastern Paraguay, hunter-gatherers up to the 1970s and now part-time foragers and horticulturists. The performance battery was conducted on most individuals over 10 years of age, allowing for cross-sectional examination of growth and senescence patterns across the lifespan for both sexes. These measures tend to display steep ascents and peak in the early 20s with slight declines thereafter with age for males, whereas females demonstrate peaks in performance earlier in life, with lower or no senescence rates thereafter. The result is a convergence in physical performance between men and women at later ages. We suggest that the female physiology faces reproductive constraints to performance early in life but shifts allocation to increased work output later in life during the long human postmenopausal stage. In contrast, the male physiology maximizes work output in early adult life. These schedules of physical performance are contrasted with schedules of food production ability, which tend to occur later in life, and therefore imply that skill rather than strength alone is an important component of the human foraging niche.

Adolescent↗
PubMed1998

The relationship of peripheral motor nerve conduction velocity to age-associated loss of grip strength.

Age-associated loss of muscle strength is attributed to decreasing muscle mass. Both strength and mass are dependent on peripheral innervation. However, the association between nerve function and age-associated strength loss has not been studied directly. The median nerve contribution to grip strength was estimated using nerve conduction velocity (NCV). Grip strength and NCV were measured in 197 male participants of the Baltimore Longitudinal Study of Aging (age 59.0 +/- 13.9 years). Multiple regression and path analyses were used separately to examine the association between median NCV and grip strength. Grip strength showed a negative quadratic relationship with increasing age (r2 = 0.32, p < 0.001) with a major change in slope occurring after 64.7 years of age. Median NCV (r2 = 0.14, p < 0.001) declined linearly with age. Median NCV significantly contributed to grip strength (p < 0.001) while controlling for forearm muscle mass (forearm circumference), self-reported 24-hour caloric expenditures, and age. The median nerve has an independent contribution to age-associated levels of muscle strength. The level of the effect was smaller than what could be attributed to forearm muscle mass or age.

Aged↗
PubMed2004

Quantitative assessment of deficits and recovery of forelimb motor function after cervical spinal cord injury in mice.

A large proportion of spinal cord injuries (SCIs) in humans are at the cervical (C) level, but there are few tests to quantitatively assess forelimb motor function after cervical spinal cord injury in rodents. Here, we describe a simple and reliable technique for assessing forelimb grip strength over time. Female C57Bl/6 mice were trained on the Grip Strength Meter (GSM, TSE-Systems), then received a lateral hemisection of the spinal cord at level C5, C6, C7, or T1. Gripping ability by each forepaw was then tested for 4 weeks postinjury. Before injury, there was no significant difference in the force exerted by either forepaw. After hemisections at C5, C6, or C7, the forepaw ipsilateral to the injury was initially completely unable to grip (day 2 postinjury), and there was a slight transient decrease in the strength of the contralateral paw compared to presurgical levels. The ipsilateral forepaw exhibited no ability to grip until about 10-14 days postlesion, at which time grip reappeared and strength then recovered over a period of a few days to a level that was about 50% of preinjury levels. Grip strength was minimally and transiently affected by hemisection at T1. The grip strength analysis provides a convenient, quantitative measure of the loss and recovery of forelimb function after cervical injury.

Animals↗
PubMed2006

Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort.

BACKGROUND: Although muscle strength and mass are highly correlated, the relationship between direct measures of low muscle mass (sarcopenia) and strength in association with mortality has not been examined. METHODS: Total mortality rates were examined in the Health, Aging and Body Composition (Health ABC) Study in 2292 participants (aged 70-79 years, 51.6% women, and 38.8% black). Knee extension strength was measured with isokinetic dynamometry, grip strength with isometric dynamometry. Thigh muscle area was measured by computed tomography (CT) scan, and leg and arm lean soft tissue mass were determined by dual energy x-ray absorptiometry (DXA). Both strength and muscle size were assessed as in gender-specific Cox proportional hazards models, with age, race, comorbidities, smoking status, level of physical activity, fat area by CT or fat mass by DXA, height, and markers of inflammation, including interleukin-6, C-reactive protein, and tumor necrosis factor-alpha considered as potential confounders. RESULTS: There were 286 deaths over an average of 4.9 (standard deviation = 0.9) years of follow-up. Both quadriceps and grip strength were strongly related to mortality. For quadriceps strength (per standard deviation of 38 Nm), the crude hazard ratio for men was 1.51 (95% confidence interval, 1.28-1.79) and 1.65 (95% confidence interval, 1.19-2.30) for women. Muscle size, determined by either CT area or DXA regional lean mass, was not strongly related to mortality. In the models of quadriceps strength and mortality, adjustment for muscle area or regional lean mass only slightly attenuated the associations. Further adjustment for other factors also had minimal effect on the association of quadriceps strength with mortality. Associations of grip strength with mortality were similar. CONCLUSION: Low muscle mass did not explain the strong association of strength with mortality, demonstrating that muscle strength as a marker of muscle quality is more important than quantity in estimating mortality risk. Grip strength provided risk estimates similar to those of quadriceps strength.

Age Factors↗
PubMed1997

Transverse carpal ligament: its effect on flexor tendon excursion, morphologic changes of the carpal canal, and on pinch and grip strengths after open carpal tunnel release.

A three-part study is described that examines postoperative weakness after open carpal tunnel release and investigates the role of the transverse carpal ligament in the digital flexor pulley system. The effect of this ligament on flexor tendon excursion is evaluated in a cadaver study. Magnetic resonance imaging analysis is used to determine whether division of the transverse carpal ligament promotes volar migration of the median nerve and flexor tendons. Finally, the effects of ligament division and various methods of transverse carpal ligament reconstruction on the return of grip and pinch strengths after open carpal tunnel release are evaluated. The authors were able to determine that transverse carpal ligament reconstruction, particularly the transposition flap repair technique, after open carpal tunnel release confers a mechanical advantage and that the transverse carpal ligament is an important pulley for flexor tendon excursion. Based on the magnetic resonance imaging studies, volar displacement of carpal contents is reduced in patients undergoing transverse carpal ligament reconstruction by means of a transposition flap compared with those undergoing no ligament reconstruction and those undergoing reconstruction using the palmar aponeurosis. Postoperative grip and pinch strength values for the transposition flap repair group surpassed those of the other two groups at 12 weeks.

Carpal Tunnel Syndrome↗