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PubMed2005

Low grip strength is associated with bone mineral density and vertebral fracture in women.

OBJECTIVES: Grip strength has been reported to be associated with bone mass locally at the forearm and also at distant skeletal sites, including the spine and hip. Less is known about the association between low grip strength and risk of vertebral fracture. The aim of this study was to examine the association between low grip strength, bone mineral density at the hip and spine, and vertebral fracture in middle-aged and elderly European men and women. METHODS: Men and women aged 50 yr and over were recruited for participation in a screening survey of vertebral osteoporosis across Europe. Subjects who agreed to take part had an interviewer-administered questionnaire and lateral spinal radiographs performed. Subjects were assessed also for grip strength using a handgrip dynamometer (range 0-300 mmHg). A subsample of those recruited had bone mineral density measurements performed at the spine and femoral neck. Subjects had repeat lateral spine radiographs performed a mean of 3.8 yr following the baseline survey. Linear regression analysis was used to determine the association between low grip strength and bone mineral density at the hip and spine. Logistic regression was used to determine the association between grip strength and both prevalent and incident vertebral fracture. RESULTS: One thousand two hundred and sixty-five men and 1380 women with data concerning grip strength and bone mineral density were included in the analysis. In women, after age adjustment, compared with those with 'normal' grip, those with 'impaired' (231-299 mmHg) and low grip (<231 mmHg) had significantly lower bone mass at the spine and femoral neck. In men, those with low grip strength had a lower BMD at the spine and hip than those in the normal group. However, because of the small numbers with submaximal grip strength, the confidence intervals around all estimates included zero. Adjustment for body size and levels of physical activity had little effect on the results. In addition, among women, after adjustment for age, body mass index and physical activity levels, compared with those with normal grip, those with low grip strength had an increased risk of developing incident vertebral fracture (odds ratio = 2.67; 95% confidence interval 1.13, 6.30). Further adjustment for spine bone density had little influence on the association (odds ratio = 2.60). CONCLUSIONS: In women, low grip strength is associated with low bone mineral density at both the spine and hip and an increased risk of incident vertebral fracture. These associations cannot be explained by differences in body size or lifestyle.

Absorptiometry, Photon↗

PubMed2005

The association of sex hormone levels with poor mobility, low muscle strength and incidence of falls among older men and women.

OBJECTIVE: The objective of this study was to examine whether low levels of oestradiol and testosterone are associated with impaired mobility, low muscle strength and the incidence of falls in a population-based sample of older men and women. DESIGN: Cross-sectional population-based study, based on data of the Longitudinal Ageing Study Amsterdam (LASA), including 623 men and 663 women, aged 65-88 years. MEASUREMENTS: Serum levels of oestradiol, testosterone, albumin and sex hormone-binding globulin (SHBG) were measured. Physical performance, functional limitations and muscle strength were assessed, and a follow-up on falls was performed prospectively within 3 years. RESULTS: After adjustment for age, level of education, alcohol use, physical activity, chronic disease and body mass index (BMI), men in the highest quartile of the oestradiol/SHBG ratio had significantly higher physical performance scores than men in the lowest quartile (beta = 0.103). Serum levels of total testosterone were positively associated with muscle strength (beta = 0.085). Calculated bioavailable testosterone levels were positively associated with physical performance and muscle strength (beta = 0.128 and 0.109 respectively). No associations of oestradiol levels with mobility were seen in women. Levels of oestradiol and testosterone were not associated with falls. CONCLUSIONS: It can be concluded that low levels of sex hormones were associated with impaired mobility and low muscle strength in men, but not in women. Levels of sex hormones were not associated with the incidence of falls neither in men, nor in women.

Accidental Falls↗

PubMed1996

Changes in muscle strength, relaxation rate and fatiguability during the human menstrual cycle.

1. The effect of the different phases of the menstrual cycle on skeletal muscle strength, contractile properties and fatiguability was investigated in ten young, healthy females. Results were compared with a similar group on the combined (non-phasic) oral contraceptive pill (OC). Cycle phases were divided into the early and mid-follicular, mid-cycle (ovulatory) and mid- and late luteal. Cycle phases were estimated from the first day of the menstrual bleed. 2. Subjects were studied weekly through two complete cycles. Measurements included quadriceps and handgrip maximum voluntary isometric force and the relaxation times, force-frequency relationship and fatigue index of the quadriceps during percutaneous stimulation at a range of frequencies from 1 to 100 Hz. 3. In the women not taking the OC there was a significant increase of about 11% in quadriceps and handgrip strength at mid-cycle compared with both the follicular and luteal phases. Accompanying the increases in strength there was a significant slowing of relaxation and increase in fatiguability at mid-cycle. No changes in any parameter were found in the women taking the OC. 4. The changes in muscle function at mid-cycle may be due to the increase in oestrogen that occurs prior to ovulation.

Adult↗

PubMed2006

[Relationship between activity of daily living and motor function in the community-dwelling elderly after hip fracture].

AIM: To clarify the relationship between ADL and motor functions in 44 community-dwelling elderly patients with hip fracture. METHODS: The questionnaire comprised items on BADL, IADL, ability to walk, and certification for long-term care. The assessment of motor functions included grip strength, knee extension strength, 10 m walking time, TUG, FRT, and Romberg rate and shift length of the center of gravity measured by a stabilometer. Based on these tests, relationships between the motor functions and ADL were evaluated in elderly patients after hip fracture. RESULTS: Significant correlations were found between BADL and grip strength, knee extension strength, and FRT. As for IADL, significant correlations were found with grip strength, knee extension strength, 10-m walking speed, TUG, FRT, and MMSE items. Similarly, regarding ability to walk and the certification of long-term care, significant correlations were shown with grip strength, knee extension strength, 10 m walking speed, and MMSE items. CONCLUSION: The relationships between ADL and motor functions were confirmed in community-dwelling elderly patients with hip fracture. The parameters related to muscle strength and balance ability that were assessed in this study are those that can be improved through constant training after discharge from hospital. The validity of these parameters as the indices for future intervention studies to assess the maintenance and improvement of ADL after discharge and prognosis was indicated.

Activities of Daily Living↗

PubMed2005

Imaging of rock climbing injuries.

Competition climbing has grown increasingly in popularity, and many people are being drawn to this sport with a parallel increase in the occurrence of sport-related injuries. One of the most common and unique lesions occurring in the rock climbing population is the closed rupture of the flexor pulley system of the fingers. This lesion is strictly related to some climbing techniques in which the entire body weight is placed on fingerholds, which causes bowstringing of the flexor tendons with subsequent loss of strength across the full range of motion of the finger. This article summarizes the current literature regarding the application of imaging modalities in the diagnosis of rock climbing injuries with a specific focus on ultrasound and magnetic resonance imaging. Biomechanics of the sporting activity and resultant pathophysiologic and clinical considerations concerning flexor pulley system injuries are also discussed.

Athletic Injuries↗

PubMed1998

Glutamate uptake is decreased tardively in the spinal cord of FALS mice.

This study examined high affinity Na+-dependent uptake of glutamate in synaptosomal preparations from spinal cord in mice that express a dominant mutation of human copper/zinc superoxide dismutase (SOD1) and represent an animal model of amyotrophic lateral sclerosis (ALS). Their muscle strength was also monitored by a grip traction test throughout their lifespan. The high affinity Na+-dependent uptake of [3H]glutamate was decreased between 120 and 150 days of age. A marked and significant decrease in Vmax (-40.2%; p < 0.001) on whole spinal cord synaptosomes was observed at 150 days, with no change in Km. This significant decrease was reached a week before the animals died (157.2 +/- 2.2 days) and corresponded to a considerable fall in muscle strength (25% loss between 120 and 140 days, p < 0.001). The FALS mouse model therefore reproduces the decrease in glutamate uptake reported in humans suffering from sporadic or familial ALS. These results are discussed in terms of a possible tardive involvement of glutamate uptake deficiency in human ALS.

Amyotrophic Lateral Sclerosis↗

PubMed2001

Association of IGF-I levels with muscle strength and mobility in older women.

The functional consequences of the age-associated decline in IGF-I are unknown. We hypothesized that low IGF-I levels in older women would be associated with poor muscle strength and mobility. We assessed this question in a population representative of the full spectrum of health in the community, obtaining serum IGF-I levels from women aged 70-79 yr, enrolled in the Women's Health and Aging Study I or II. Cross-sectional analyses were performed using 617 women with IGF-I levels drawn within 90 d of measurement of outcomes. After adjustment for age, there was an association between IGF-I and knee extensor strength (P = 0.004), but not anthropometry or other strength measures. We found a positive relationship between IGF-I levels and walking speed for IGF-I levels below 50 microg/liter (P < 0.001), but no relationship above this threshold. A decline in IGF-I level was associated with self-reported difficulty in mobility tasks. All findings were attenuated after multivariate adjustment. In summary, in a study population including frail and healthy older women, low IGF-I levels were associated with poor knee extensor muscle strength, slow walking speed, and self-reported difficulty with mobility tasks. These findings suggest a role for IGF-I in disability as well as a potential target population for interventions to raise IGF-I levels.

Activities of Daily Living↗

PubMed1999

No advantage from splinting the wrist after open carpal tunnel release. A randomized study of 82 wrists.

To study the value of postoperative splinting after open carpal tunnel surgery, we randomly selected 82 wrists for 4 weeks of postoperative immobilization or no immobilization. The distributions of scar discomfort or pain and "pillar pain" were equal in the two groups both at 6 weeks and 6 months. Median sick leave was 6 weeks in both groups. Median VAS values for persistent discomfort and pain at 2 weeks, 6 weeks and 6 months were similar in the two groups. Grip strength was reduced compared to preoperative values by about 20% and keypinch strength by about 10% in both groups at 6 weeks and had returned to normal by 6 months. Pinch between the thumb and the tips of fingers 4 and 5 was considerably reduced postoperatively, but similar in both groups. We conclude that 4 weeks of postoperative immobilization confers no detectable benefit.

Absenteeism↗

PubMed1997

Muscle power, dexterity skill and visual perception in community home girls trained in yoga or sports and in regular school girls.

The present study was conducted to compare critical flicker fusion frequency (CFF), degree of optical illusion ("di"), dexterity scores, and grip strength in three groups of subjects, viz community home girls who had learned yoga for 6 months (CHY), age-matched community home girls who had physical activity training for 6 months (CHP), and girls who were attending a regular school (SCH). There were equal numbers in each group for each of the 4 assessment (range 11 to 30 subjects) and age range was 12 to 16 years of age. The CHP group had significantly lower CFF and "di" was significantly higher (one factor ANOVA, t test for unpaired data) in the CHP group, both compared to CHY and SCH groups. Right hand grip strength was also significantly less in the CHP group compared to SCH. The results were explained by previous reports of high levels of anxiety and aggression in community-home groups, which is known to influence the four parameters described here. The better performance of the CHY group compared to CHP, suggested that yoga practice has a beneficial effect in these subjects.

Adolescent↗

PubMed1994

Effects of 10 and 20 days bed rest on leg muscle mass and strength in young subjects.

Sedentary voluntary students were exposed to 10 (n = 8) and 20 (n = 14) days bed rest to study effects of prolonged bed rest on isometric strength of knee extension and flexion, total leg strength, right hand grip and elbow flexion using different dynamometers. Further, muscle mass of right leg and arm was measured by dual energy X-ray absorptiometry, and cross sectional area of right thigh by X-ray computed tomography before and after bed rest and after 4 or 8 weeks of recovery. After 10 days bed rest, these variables tended to decrease except for the muscle mass of right arm which increased. After 20 days of bed rest, a similar trend was observed, but at a statistically significant level of p < 0.05. However, no correlation was observed between the decrease in knee extensor strength and cross sectional area of the thigh. Nor was a correlation observed between the sum total of isometric strength of the leg and the total muscle mass measured. The 24h urinary excretion of N2 and creatinine was not changed through the experiments. During recovery, the variables measured had reached the initial levels after 4 or 8 weeks. These changes were not affected by mild supine exercise training. The results suggest that isometric muscle strength was decreased in non-antigravity muscles as well as antigravity muscles by prolonged bed rest, but the rate of changes did not correlate to the corresponding changes in muscle mass. The decreases in maximum voluntary strength are probably not only due to the decrease in muscle mass but also due to reductions of neuromuscular function.

Absorptiometry, Photon↗

PubMed2001

[Experiences with Eaton-Littler reconstruction for therapy of ligament instability of the thumb saddle joint].

UNLABELLED: Painful instability of the thumb carpometacarpal joint is a rare diagnosis. Between October 1995 and August 1999, eight operations of ligament reconstruction for unstable thumb carpometacarpal joints were performed. We report on the follow-up of these patients which took place at an average time of 12.27 months (range 5 through 36 months) after the operation. Painful hypermobility of the non-arthrotic thumb carpometacarpal joint was the indication for performing the operation in all cases. By this operation, the joint capsule is reinforced in two planes: the existing palmar ligament of the carpometacarpal joint is reinforced while it provides ligament support for the radial aspect of the joint that is otherwise membranous. In our study, we compared the pinch strength, the overall strength of the hand, the motion of the thumb, and radiographic findings for the amount of subluxation before and after performing the operation. In addition, each result was investigated with the DASH-questionnaire (DASH = Disability of Arm--Shoulder--Hand). The results were good or excellent in six cases, satisfactory in one case, and poor in one case. Pinch strength increased from a preoperative average of 19.6 N to 34.3 N and the vigor increased from 84.8 N to 113.1 N. Subluxation on the radiographs could be reduced from an average of 6.0 mm to 3.5 mm. All operated patients were investigated using the DASH-questionnaire. Herein the average score was 22.92 on a scale whereby 0 reflects minimum and 100 maximum disability. CONCLUSIONS: Our experience with the Eaton-Littler procedure for stabilisation of the hypermobile painful thumb carpometacarpal joint were mostly positive. The objective results as well as the results of the evaluation of the DASH-questionnaire could confirm this impression.

Adolescent↗

PubMed2004

The scaling of motor noise with muscle strength and motor unit number in humans.

Understanding the origin of noise, or variability, in the motor system is an important step towards understanding how accurate movements are performed. Variability of joint torque during voluntary activation is affected by many factors such as the precision of the descending motor commands, the number of muscles that cross the joint, their size and the number of motor units in each. To investigate the relationship between the peripheral factors and motor noise, the maximum voluntary torque produced at a joint and the coefficient of variation of joint torque were recorded from six adult human subjects for four muscle/joint groups in the arm. It was found that the coefficient of variation of torque decreases systematically as the maximum voluntary torque increases. This decreasing coefficient of variation means that a given torque or force can be more accurately generated by a stronger muscle than a weaker muscle. Simulations demonstrated that muscles with different strengths and different numbers of motor units could account for the experimental data. In the simulations, the magnitude of the coefficient of variation of muscle force depended primarily on the number of motor units innervating the muscle, which relates positively to muscle strength. This result can be generalised to the situation where more than one muscle is available to perform a task, and a muscle activation pattern must be selected. The optimal muscle activation pattern required to generate a target torque using a group of muscles, while minimizing the consequences of signal dependent noise, is derived.

Action Potentials↗

PubMed2007

Collapsed scaphoid non-union with dorsal intercalated segment instability and avascular necrosis treated by vascularised wedge-shaped bone graft and fixation.

Patients with the specific problem of a collapsed Nakamura volar type, scaphoid synovial pseudarthrosis with avascular necrosis on both magnetic resonance imaging and intraoperative inspection were studied to determine the ability of a trapezoidal wedge-shaped structural bone graft vascularised by the 1,2 intercompartmental supraretinacular artery to simultaneously achieve correction of the scaphoid dimension and a high union rate. Fifteen patients with this specific problem were followed for a mean of 32.1 months and achieved union in all cases at a mean of 11.5 weeks. Improvements were seen postoperatively in wrist flexion and extension, grip strength, degree of dorsal intercalated segment instability and degree of scaphoid collapse. Two complications relating to the fixation technique occurred. Although technically difficult, it is possible to achieve a high rate of union for scaphoid pseudarthrosis while correcting substantial collapse deformity by the use of a structural, wedge-shaped, vascularised bone graft.

Adolescent↗

PubMed2006

Waist circumference and BMI are independently associated with the variation of cardio-respiratory and neuromuscular fitness in young adult men.

OBJECTIVE: To test two hypotheses: (1) cardiorespiratory (CRF) and neuromuscular (NMF) fitness is associated with body mass index (BMI) and waist circumference (WC), independent of each other and of leisure-time physical activity; (2) individuals with high CRF and NMF have lower WC for a given BMI, compared with those with low CRF and NMF. DESIGN: Cross-sectional study. SETTING: Men participating in refresher training organized by the Finnish Defence Forces. PARTICIPANTS: A total of 951 men (mean age 29.1, s.d. 4.2 years; BMI 25.3 kg/m(2), s.d. 3.8; WC 91, s.d. 11 cm). MAIN OUTCOME MEASURES: Body mass index, WC, maximal oxygen uptake (VO(2)max), height of vertical jump, number of push-ups and sit-ups during a 1-min test, static back extension endurance, isometric grip strength, self-reported leisure-time vigorous physical activity. Multiple linear regressions were used to explain the variation in fitness. RESULTS: Waist circumference had significant (P<0.001) negative association with all test results (standardized beta coefficients from -0.23 to -0.77), except for grip strength. Body mass index had significant negative association with VO(2)max (-0.12; P<0.05), but positive association (P<0.01) with grip strength (0.28), vertical jump (0.21) and push-ups (0.55). For a given BMI, the estimated WC was highest among those with the poorest results for VO(2)max, vertical jump, sit-ups and push-ups. CONCLUSIONS: Despite stronger isometric grip strength, the functional muscle fitness of the upper body, trunk and lower extremities is impaired in individuals with abdominal obesity. Although the known loss of CRF is a serious consequence of obesity, the deterioration of NMF deserves increased attention.

Adult↗

PubMed2006

Handgrip strength among nonagenarians and centenarians in three European regions.

BACKGROUND: Handgrip strength is an important predictor of disability and mortality among old people. The aim was to compare the grip strength among very old people in three regions of Europe. METHODS: In this substudy of the European Challenge for Healthy Aging project, only the long-lived probands were included. The maximum value of three measurements of handgrip strength was selected for the analysis. Adjustment for factors known to be correlated with grip strength was made by linear regression. RESULTS: Among 598 very old people (median age = 98 years) a clear North-South gradient was observed: For men, handgrip strength dropped from 24.2 kg in Southern Denmark to 20.8 kg in Languedoc-Roussillon, France and 14.2 kg in Calabria, Italy (p < .0001), whereas for women the drop was smaller (from 12.2 to 9.2 kg; p = .0021). The difference remains significant after adjustment for age, gender, housing, knee height, Activities of Daily Living (ADL) scale score, score on the Six-Item Mini-Mental State Examination, chair stand, and number of age-related diseases, although these factors explain two thirds of the variation in handgrip strength. CONCLUSIONS: Among nonagenarians and centenarians in three different European regions, we found a significant North-South gradient in handgrip strength with substantially lower values in Calabria. This finding may be due both to population background differences (e.g., genetic variations, birth weight, childhood growth) and to sociocultural differences (e.g., lifestyle, health care).

Aged↗

PubMed2004

Anemia is associated with disability and decreased physical performance and muscle strength in the elderly.

OBJECTIVES: To examine the association between anemia and disability, physical performance, and muscle strength in older persons. DESIGN: Cross-sectional. SETTING: Community-dwelling older persons in the Chianti area in Italy. PARTICIPANTS: A total of 1,156 persons aged 65 and older participating in the InChianti Study ("Invecchiare in Chianti," i.e., Aging in the Chianti Area). MEASUREMENTS: Anemia was defined according to World Health Organization criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. Disability in six basic and eight instrumental activities of daily living was assessed. Physical performance was assessed using the short physical performance battery (4-m walk, balance, and chair stands), which yields a summary performance score ranging from 0 to 12 (high). Muscle strength was determined using knee extensor and handgrip strength assessments. RESULTS: Overall, 11.1% of the men and 11.5% of the women had anemia. After adjustment for age, sex, body mass index, Mini-Mental State Examination score, creatinine level, and presence of various comorbid conditions, anemic persons had more disabilities (1.71 vs 1.04, P=.002) and poorer performance (8.8 vs 9.6, P=.003) than persons without anemia. Anemic persons also had significantly lower knee extensor strength (14.1 vs 15.2 kg, P=.02) and lower handgrip strength (25.3 vs 27.1 kg, P=.04) than persons without anemia. Further adjustment for inflammatory markers (interleukin-6, C-reactive protein, tumor necrosis factor-alpha) did not change these associations. CONCLUSION: Anemia is associated with disability, poorer physical performance, and lower muscle strength. Further research should explore whether treating anemia has a beneficial effect on the functional status of older persons.

Activities of Daily Living↗

PubMed2003

Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam.

The age-related change in hormone concentrations has been hypothesized to play a role in the loss of muscle mass and muscle strength with aging, also called sarcopenia. The aim of this prospective study was to investigate whether low serum 25-hydroxyvitamin D (25-OHD) and high serum PTH concentration were associated with sarcopenia. In men and women aged 65 yr and older, participants of the Longitudinal Aging Study Amsterdam, grip strength (n = 1008) and appendicular skeletal muscle mass (n = 331, using dual-energy x-ray absorptiometry) were measured in 1995-1996 and after a 3-yr follow-up. Sarcopenia was defined as the lowest sex-specific 15th percentile of the cohort, translating into a loss of grip strength greater than 40% or a loss of muscle mass greater than 3%. After adjustment for physical activity level, season of data collection, serum creatinine concentration, chronic disease, smoking, and body mass index, persons with low (<25 nmol/liter) baseline 25-OHD levels were 2.57 (95% confidence interval 1.40-4.70, based on grip strength) and 2.14 (0.73-6.33, based on muscle mass) times more likely to experience sarcopenia, compared with those with high (>50 nmol/liter) levels. High PTH levels (>or=4.0 pmol/liter) were associated with an increased risk of sarcopenia, compared with low PTH (<3.0 pmol/liter): odds ratio = 1.71 (1.07-2.73) based on grip strength, odds ratio = 2.35 (1.05-5.28) based on muscle mass. The associations were similar in men and women. The results of this prospective, population-based study show that lower 25-OHD and higher PTH levels increase the risk of sarcopenia in older men and women.

Absorptiometry, Photon↗

PubMed2000

The role of osteoporosis in distal radius fractures.

Our study was designed to establish whether the degree of osteoporosis of the distal forearm affects the outcome of distal radius fractures in elderly women. We assessed the Gartland and Werley score, wrist mobility, grip strength, ulnar variance, radial inclination and palmar tilt of both wrists in 27 postmenopausal women who had sustained a unilateral distal radius fracture following a simple fall. Bone mineral density of the contralateral uninjured wrist and mid-tibial ultrasound velocity were measured. The Gartland and Werley score, wrist mobility, loss of grip strength and the radiological results of the fractured wrist did not correlate with bone mineral density of the uninjured distal radius or with mid-tibial ultrasound velocity. These results may indicate that the influence of osteoporosis on the radiological and clinical outcome in distal radius fractures is not very important.

Aged↗