Changes In Handgrip Strength Research Articles

Assessment of Muscle Strength and Volume Changes in Patients with Breast Cancer-Related Lymphedema

Introduction: To determine whether complete decongestive therapy (CDT) used in breast cancer-related lymphedema affects muscle strength in the affected arm while assessing the efficacy of the therapy itself. Material and Methods: Seventy-four patients with breast cancer-related lymphedema were included in this study. The demographic and clinical history characteristics of the patients were taken. The patients were then evaluated with measurements of extremity volumes and handgrip strengths using a hand dynamometer before and after the CDT. Data were then assessed using relevant statistical methods. Results: The mean CDT duration was 17.5 ± 8.93 days for the patients. Therapy resulted in significant improvement in the affected arm (p < 0.01). The difference between the arm with lymphedema and the other side was statistically significant, and this difference remained after the therapy (p < 0.01). The change in handgrip strength in the side with lymphedema was not found to be statistically significant after therapy (p > 0.05). Handgrip strength differences and volume differences before and after the treatment in the affected arm were not correlated (p > 0.05). Conclusion: Limbs affected with lymphedema were found to be weaker in handgrip strength and this weakness continued throughout the therapy. Strengthening exercises should be considered to be added into the treatment of patients undergoing CDT to gain better functional potential.

Does a brief functional assessment in the emergency department predict outcomes of patients admitted with heart failure? The FASTER-HF study

Evaluation of patients with acute decompensated heart failure includes symptom review, biomarker measurement and comorbidity assessment. Early objective evaluation of functional status is generally not performed. To investigate whether a simple low-impact functional assessment and measurement of sarcopenia would be safe, feasible and predictive of hospital length of stay and all-cause 30-day hospital readmission. We administered 3-minute bicycle ergometry and hand grip strength tests at admission and discharge to patients for whom a decision to admit for heart failure management was made in the emergency department. Associations were examined between test results and length of stay and 30-day readmission. Exclusion criteria included acute coronary syndrome, hypoxia, end-stage renal disease, dementia/delirium and inability to sit at bedside. The Kansas City Cardiomyopathy Questionnaire-12, the Patient Health Questionnaire-2 and the visual analogue scale for dyspnoea were administered at admission, the visual analogue scale at discharge and the Kansas City Cardiomyopathy Questionnaire-12 at 30 days. Fifty patients were enrolled: 58% were female; the mean age was 66.2±12.5 years; 24% had heart failure with preserved ejection fraction. Bicycle ergometry variables did not correlate with outcomes. Change in handgrip strength correlated with readmission, but not after adjustment (rpartial=0.14; P=0.35). Total diuretic dose correlated with length of stay; only discharge visual analogue scale and baseline lung disease had significant adjusted correlations with readmission. Functional assessment in the emergency department of patients admitted for heart failure did not predict outcomes. However, the prognostic value of these assessments for decision-making about disposition (admission or discharge) may still be warranted.

Iron deficiency, fatigue and muscle strength and function in older hospitalized patients

Background/ObjectivesIron deficiency is common in older patients. We investigated whether iron deficiency is an independent risk factor for functional impairment, low muscle function, fatigue, and rehabilitation progress in older hospitalized patients.Subjects/MethodsTwo hundred twenty-four patients (age range 65–95 years; 67% females) who were consecutively admitted to a geriatric acute care ward participated in this prospective longitudinal observational study. Ferritin, iron, transferrin in serum, and blood hemoglobin were measured and current iron supplementation was recorded. Fatigue and comorbidity were measured using the fatigue severity scale and Charlson Comorbidity Index, respectively. Barthel Index, handgrip strength, and isometric knee extension strength were conducted at the time of hospital admission and before discharge.ResultsNinety-one (41%) patients had iron deficiency in which the majority had functional iron deficiency (78/91, 86%). Absolute iron deficiency with and without anemia was diagnosed in 12 (13%) and one patients, respectively. Barthel Index and handgrip and knee extension strength significantly improved during hospitalization in iron deficiency and non-iron deficiency groups. Knee extension strength showed better improvement in iron-deficient patients receiving iron supplementation and iron supplementation during hospital stay was the main predictor for improvement in knee extension strength. Comorbidity, iron deficiency, and changes in handgrip strength were the major independent risk factors for poor improvement in Barthel Index during hospitalization. There were significant associations between patients’ fatigue and iron deficiency, comorbidity, and female gender.ConclusionIron deficiency is an independent risk factor for fatigue and poor functional recovery among older hospitalized patients. Iron supplementation seems to be capable of improving functional performance.

Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: Sub-group analysis of the NOURISH study

Hospitalized, malnourished older adults with chronic obstructive pulmonary disease (COPD) have an elevated risk of readmission and mortality. Post-hoc, sub-group analysis from the NOURISH study cohort examined the effect of a high-protein oral nutritional supplement (ONS) containing HMB (HP-HMB) in malnourished, hospitalized older adults with COPD and to identify predictors of outcomes. The NOURISH study (n=652) was a multicenter, randomized, placebo-controlled, double-blind trial. The COPD subgroup (n=214) included hospitalized, malnourished (based on Subjective Global Assessment), older adults (≥65y), with admission diagnosis of COPD who received either standard-of-care plus HP-HMB (n=109) or standard-of-care and a placebo supplement (n=105) prescribed 2 servings/day from within 3 days of hospital admission (baseline) and up to 90 days after discharge. The primary study outcome was a composite endpoint of incidence of death or non-elective readmission up to 90-day post-discharge, while secondary endpoints included changes in hand-grip strength, body weight, and nutritional biomarkers over time. Categorical outcomes were analyzed using Cochran-Mantel-Haenszel tests, longitudinal data by repeated measures analysis of covariance; and changes from baseline by analysis of covariance. p-values ≤ 0.05 were considered statistically significant. Multivariate logistic regression was used to model predictors of the primary outcome and components. In patients with COPD, 30, 60, and 90-day hospital readmission rate did not differ, but in contrast, 30, 60, and 90-day mortality risk was approximately 71% lower with HP-HMB supplementation relative to placebo (1.83%, 2.75%, 2.75% vs. 6.67%, 9.52% and 10.48%, p=0.0395, 0.0193, 0.0113, resp.). In patients with COPD, compared to placebo, intake of HP-HMB resulted in a significant increase in handgrip strength (+1.56kg vs.-0.34kg, p=0.0413) from discharge to day 30; increased body weight from baseline to hospital discharge (0.66kg vs.-0.01kg, p<0.05) and, improvements in blood nutritional biomarker concentrations. The multivariate logistic regression predictors of the death, readmission or composite endpoints in these COPD patients showed that participants who were severely malnourished (p=0.0191) and had a Glasgow prognostic score (GPS) Score of 1 or 2 had statistically significant odds of readmission or death(p=0.0227). Among malnourished, hospitalized patients with COPD, supplementation with HP-HMB was associated with a markedly decreased mortality risk, and improved handgrip strength, body weight, and nutritional biomarkers within a 90-day period after hospital discharge. This post-hoc, subgroup analysis highlights the importance of early identification of nutritional risk and administration of high-protein ONS in older, malnourished patients with COPD after hospital admission and continuing after hospital discharge.

Reduced Handgrip Strength in Hospital Admission Predicts Prolonged Hospital Stay and Death but Is Not Accurate to Identify Malnutrition: A Longitudinal Study of Reduced Handgrip Strength in Hospitalized Patients.

Malnourished patients present impairment of functionality due to loss of strength and muscle mass. However, the validity of handgrip strength (HGS) in identifying malnutrition and its association with clinical outcomes in hospitalized patients requires investigation. Evaluate the accuracy of HGS in identifying malnutrition, its association with clinical outcomes, and the change in HGS in the first 2 weeks of hospitalization. A prospective cohort study with adult/elderly patients. Subjective Global Assessment (SGA) was applied in the first 48 hours for malnutrition diagnosis, and HGS was measured in this moment and after 7 and 14 days of hospital admission. HGS <20 kg for females and <30 kg for males was considered reduced. Outcomes of interest were prolonged hospital stay (LOS) and in-hospital death. Six hundred patients (55.75 ± 14.78 years, 51.5% males) were included, 34.0% of them were malnourished (SGA-B or SGA-C), and 37.2% presented reduced HGS. The concordance between reduced HGS and SGA in malnutrition diagnosis was weak (κ = 0.192), and accuracy was not satisfactory (area under the receiver operating characteristic curve = 0.599 [95% CI, 0.551-0.648]). HGS did not change during the hospitalization. Reduced HGS increased by 1.2 times (95% CI, 1.03-1.40) the odds for prolonged LOS and 9.11 times (95% CI, 1.13-73.60) the risk of death. Reduced HGS did not present satisfactory accuracy to identify malnutrition, and HGS did not change during the first 14 days of hospitalization, but was associated with prolonged LOS and in-hospital death.

Changes in Grip Strength and Associations with Grip Strength in Breast Cancer Survivors Treated with Adjuvant Chemotherapy

Purpose: The aim of this study was to identify the change in hand grip strength (HGS) for consecutive 6 months in breast cancer survi vors (BCS) undergoing postoperative adjuvant chemotherapy (adjCTX) and to determine the factors relevant to HGS after chemotherapy completion Methods: This study was a retrospective observational cohort study. BCS (N=38) who underwent breast cancer surgery and subsequent adjCTX were enrolled. The HGS of both sides was measured before adjCTX and 3 weeks, 2 months and 6 months after adjCTX. And we also collected body composition, anthropometric measurements, social demographics and clinical data. Then we analyzed the changes in HGS over time, and correlation of collected data with HGS at 6 months. Results: A significant increase in HGS of the unaffected side was observed within the first 3 weeks of adjCTX and maintained up to 6 months. In correlation analysis, HGS of both sides was positively correlated with the ipsilateral HGS at 3 weeks, and contralateral HGS at 6 months. And skeletal muscle mass was also positively correlated with the HGS of the unaffected side. In addition, subjects treated with targeted therapy had lower HGS of the unaffected side. However, HGS of the affected side was significantly lower in subjects with breast reconstruction and treated without radiotherapy. Conclusions: To maintain the early recovery of HGS, active and continuous exercise intervention for strengthening might be necessary.

Normalized grip strength is a sensitive outcome measure through all stages of Duchenne muscular dystrophy.

The main aim was to explore the changes in hand-grip strength in patients with Duchenne muscular dystrophy (DMD) aged 5-29years. Secondary aims were to test the effect of mutation, ambulatory status and glucocorticoid use on grip strength and its changes over time and to compute the number of subjects needed for a clinical trial to stabilize grip strength. The analysis was performed on data collected during five international natural history studies on a cohort of DMD patients. Two hundred and two patients with genetically proven DMD were pooled from five different natural history studies. Excepting 13 patients with only one visit, the mean duration of follow-up was 2.2 ± 1.6years. A total of 977 measurement points were collected. Grip strength was measured on the dominant side with a high precision dynamometer. The analysis was performed using absolute values and normalized values expressed in percentage of predicted values for age. For absolute values, grip strength typically increased in ambulatory boys and decreased in non-ambulatory patients. However, when normalized, grip strength was already reduced at age 5years and thereafter continued to fall away from normal values. The weaker the patients, the less strength they are prone to lose over again. Grip strength constitutes a sensitive and continuous outcome measure that can be used across all stages of DMD. Its measurement is easy to standardized, can be used in ambulatory and non-ambulatory patients and does not present any floor or ceiling effect. It is thus attractive as an outcome measure in therapeutic trials.

Handgrip Strength Seems Not to Be Affected by COPD Disease Progression: A Longitudinal Cohort Study

Skeletal muscle dysfunction, functional exercise capacity impairment and reduced physical activity are characteristic features in patients with chronic obstructive pulmonary disease (COPD). Assessments addressing muscle strength of the upper limb, such as measurement of handgrip strength (HGS), are rarely performed and reported. We aimed to analyze the course of HGS and possible predictors of changes in HGS over time in COPD. Yearly assessments of various disease markers were performed for a follow-up of up to seven years in a cohort of COPD patients to assess the longitudinal disease process. Data of 194 patients with at least one follow-up measurement were analyzed. HGS decreased significantly by B = −0.86 (95% CI −1.09/−0.62, p < 0.001) over time. The multivariate mixed effects model showed an independent association between greater annual declines in HGS and lower numbers of steps per day by B = 0.11 (95% CI 0.03/0.18, p = 0.006) and an enhanced change in COPD Assessment Test scores by B = −0.01 (95% CI −0.01/−0.00, p = 0.034). No evidence for an independent association between annual decline in HGS and FEV1% pred. by B = −0.01 (95% CI −0.03/0.01, p = 0.297) was shown. Patients who died during follow-up did not exhibit greater declines in HGS compared to survivors (p = 0.884). Although HGS significantly decreased over time, no pathophysiological link with COPD disease progression could be demonstrated. Previous cross-sectional associations between HGS and mortality could not be confirmed in this longitudinal setting. Our data suggests that repeated monitoring of HGS in clinical settings seems not to be helpful to predict COPD specific disease progression.

Dietary selenium intakes and their association with muscle strength and function in ≥ 85 year old adults: the Newcastle 85 + Study

AbstractSelenium is an essential micronutrient with biochemical and cellular effects through activities of 25 selenocysteine-containing selenoproteins. Selenoproteins are anti-inflammatory and have antioxidant properties. Severe selenium deficiency causes muscle weakness and atrophy in humans however the effects of moderate selenium deficiency are unclear. The aims of this study are twofold: 1) to determine dietary selenium intakes and contributing food sources in very old adults and; 2) to determine whether dietary selenium intakes are associated with 5-year trajectories of muscle function: hand-grip strength (HGS) and Timed-Up-and-Go (TUG).Cross-sectional (baseline) and prospective (1.5, 3 and 5-year follow-up) analyses of 845 participants aged 85 years from the Newcastle 85 + study were assessed for HGS and TUG performance using standardized protocols (Antoneta et al. 2016). Baseline dietary intakes were assessed using 24-hour multiple pass recall methods on two separate days (Mendonça et al. 2016). The top selenium food contributors (~90%) and the adequacy of intakes were determined i.e. those with intakes &lt; LRNI, between the LRNI and RNI and &gt; RNI. Linear mixed models explored the associations between selenium intake categories and time on the prospective, 5-year change in HGS and TUG in all participants, males and females.Median intakes of selenium were 39, 48 and 35μg for all participants, males and females, respectively. Selenium intakes were below the LRNI in 51% of participants (median 27μg) whilst 15% had intakes ≥ the RNI (median 85μg). Only 13.3% of females and 16.9 % of males met the RNI. The top selenium contributors were cereals (46%), meat (22%), fish (10%), milk (6%), eggs (4%) and potatoes (3%) making up 91% of selenium intakes. Those with the lowest intakes had 2.72 kg lower HGS and 2.36s slower TUG compared to those with higher intakes (P &lt; 0.005). There was no association between selenium intake in HGS or TUG, but time had a significant effect on the rate of change over 5-years in both parameters (P &lt; 0.001).Overall these results show that poor dietary selenium intakes are common in very old adults and that cereal and cereal products are major sources of selenium in this population. Whilst low selenium intakes are associated with worse HGS and TUG performance in the cross-sectional analysis, no significant associations were observed in the prospective analyses.

An Investigation of Short-Term Longitudinal Associations Between Handgrip Strength and Cardiovascular Disease Biomarkers Among Middle-Aged to Older Adults: A Project FRONTIER Study.

The purpose of this study was to examine short-term longitudinal relationships between handgrip strength (HGS) and cardiovascular disease (CVD) biomarkers in middle-aged to older adults living in rural areas (N = 138). The association between HGS and CVD biomarkers was examined at baseline, with HGS as a predictor of the annual change in biomarkers, and in a parallel fashion between the annual change in HGS and CVD biomarkers over an average of 2.8 follow-up years. The results showed HGS to cross-sectionally associate with waist circumference and diastolic blood pressure at baseline, but HGS at baseline was not found to predict the annual change in any biomarker. The annual increase in HGS was significantly associated with favorable changes in high-density lipoprotein cholesterol, triglycerides, and systolic/diastolic blood pressures; yet, these associations varied by the baseline levels of biomarkers. The present findings suggest that improved muscle strength with aging is related to favorable changes in CVD biomarkers.

NOVEL METABOLOMICS MARKERS PREDICT 18-MONTH DECLINE IN HAND GRIP STRENGTH IN COMMUNITY-DWELLING OLDER ADULTS

Sarcopenia that accompanies aging necessitates early detection tools, ideally before the presentation of clinically evident symptoms. The acylcarnitines (ACs) are a class of metabolites generated by cellular fuel metabolism and their predictive utility in declining muscle strength in community-dwelling older adults is unknown. We aim to examine whether baseline acylcarnitines levels can predict changes in hand grip strength over 18 months in 121 community-dwelling older adults. We measured ACs by targeted plasma metabolomics profiling. We then performed a biologically-relevant classification of these markers. Hand grip strength was measured using a Smedley spring-type dynamometer. Multivariate linear regressions were performed to examine if: 1) there was an association between ACs and hand grip strength at baseline and 2) baseline ACs could significantly predict changes in hand grip strength over an 18-month period. At baseline, AC levels were not significantly associated with hand grip strength. We found an inverse association between baseline short-chain carboxyl and dihydroxl acylcarnitines (AC-DC/-OH) levels and 18-month changes in hand grip strength (p=0.047, β=-0.548, 95% CI=-1.088 to -0.008). Notably, a specific AC-DC/-OH species, C4-DC/C6-OH, accounts for the majority of the variance. The mean difference between Malay and Chinese ethnicity is 2.28kg (p=0.042, β=2.275, 95% CI=0.084 to 4.466). These findings suggest an association between metabolic markers and deterioration in hand grip strength. These results suggest that perturbations in fuel metabolism are detectable way before the emergence of clinically evident sarcopenia and frailty. The use of AC-DC/-OH panel as antecedent biomarkers may enable clinicians to risk stratify patients in the future.

Association of baseline hand grip strength and annual change in hand grip strength with mortality among older people

BackgroundClinicians have increasing access to longitudinal data on hand grip strength (HGS), often measured for frailty or sarcopenia assessment, of their older clients. Evidence on the association of change in HGS with mortality is mixed. We investigated whether baseline hand grip strength (HGS) and annual change in HGS are associated with mortality among older Singaporeans. MethodsData from a national longitudinal survey (3 waves: 2009, 2011 and 2015) of older people (≥60 years) in Singapore was utilized. All-cause mortality, until end-December 2015, was assessed primarily from administrative databases. Two datasets, with 4446 (Dataset 1: baseline HGS with mortality) and 2673 (Dataset 2: annual change in HGS with mortality) participants, with maximum follow-up time of 7 and 4.6 years respectively, were derived from the survey data. Associations of interest were assessed using Cox proportional hazard models. Results835 (18.8%) and 317 (11.9%) participants died during follow-up, with mean survival times of 3.6 and 2.6 years, in Dataset 1 and 2 respectively. The likelihood of mortality was lower by 4% (Hazard Ratio [95% Confidence Interval]: 0.96 [0.94-0.97]) for each unit (kilogram) increase in baseline HGS, and by 13% (0.87 [0.82-0.93]) for each kg increase in HGS over 1-year. ConclusionsHigher (alternatively, lower) baseline HGS and an increase (alternatively, decrease) in HGS over 1-year were associated with lower (alternatively, higher) likelihood of all-cause mortality among community-dwelling older people. There is clinical value, for assessing the risk of mortality, of both the cross-sectional and longitudinal measurement of HGS among older people.

Improving physical performance through independent, home-based exercise program prior to cancer-related surgery.

54 Background: Surgery in older adults is a physiologically stressful event associated with reduced functional capacity and decreased quality of life. Poor preoperative performance is linked to risk of postoperative complications and prolonged functional recovery. The goal of this study is to determine the efficacy of an independent, home-based exercise program in improving physical performance prior to cancer-related surgery. Methods: Retrospective study of 217 consecutive patients referred for comprehensive prehabilitation including physical medicine and rehabilitation physician and physical therapy visits prior to intended oncologic surgery. Physical performance was assessed at consultation (baseline) and at the preoperative follow up visit in physical therapy. Physical performance measures included Six-Minute Walk test (6MWT), Five Times Sit to Stand (5xSTS), hand grip strength (HGS), gait speed (GS), and Timed Up and Go (TUG). Results: Median (IQR) age was 71 (64,77). The most common primary cancer diagnoses were gastrointestinal (43%), genitourinary (15%), breast (9%), and sarcoma (7%). 144 of the 217 (66%) underwent surgery and of these, 75 (52%) completed preoperative functional measures during their physical therapy follow-up. For the entire cohort of 217 patients, baseline median (IQR) measures included: 6MWT distance was 357 (193.3, 420) meters, 5xSTS was 12 (9.1, 16.3) seconds, right HGS was 43.3 (30.0, 58.3) pounds, GS was 1.4 (1, 1.7) meters per second, and TUG was 8.6 (7.3, 12.2) seconds. There were similar baseline physical function results in the cohort who completed preoperative measures. During the preoperative period (from baseline to pre-surgery visit), there was significant improvement in the 6MWT ( P=0.003), 5xSTS ( P=0.000), and TUG ( P=0.027). There was no significant change in HGS or GS. Conclusions: At baseline, most patients had major functional impairment, especially decreased submaximal exercise capacity. With the independent, home-based exercise prehabilitation program, patients had significant improvement in physical performance. Prehabilitation should be further investigated in these patients.

Thyroid Function as a Predictor of Handgrip Strength Among Middle-Aged and Older Euthyroid Adults: The TCLSIH Cohort Study

ObjectivesThyroid hormones (THs) play a critical role in skeletal muscle function, such as protein synthesis and energy metabolism, suggesting that thyroid function may be involved in the decline of muscle strength. Studies regarding the long-term effects of THs on muscle strength are limited. Therefore, this large-scale longitudinal study aimed to explore how TH levels were associated with handgrip strength (HGS) among middle-aged and older euthyroid adults. DesignLongitudinal population-based cohort study (approximately 4-year follow-up period, median: 3.0 years). SettingThe Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study, Tianjin, China. ParticipantsA total of 2152 participants were enrolled, and annual measures were conducted in this longitudinal study. MeasuresChemiluminescence immunoassay was used to measure free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH). HGS was measured using a handheld digital dynamometer. Multiple linear regression analysis was used to evaluate the association between THs, FT3/FT4 ratio, TSH levels, and annual change in HGS and weight-adjusted HGS. ResultsAfter adjusting for multiple confounding factors, significant associations between FT3 levels, FT3/FT4 ratio, and annual change in HGS [standard regression coefficient (SRC) = 0.073, P < .01, and and SRC = 0.059, P = .01, respectively] were observed. However, no significant difference was observed between FT4, TSH, and annual change in HGS (SRC = 0.021, P = .34; and SRC = −0.017, P = .44, respectively). Similar associations between FT3, FT4, FT3/FT4 ratio, TSH, and weight-adjusted HGS were observed. Conclusions and implicationsThis longitudinal study is the first to demonstrate that high-normal FT3 levels and higher FT3/FT4 ratios significantly predict annual change in HGS and weight-adjusted HGS and that FT4 and TSH levels are not associated with HGS among middle-aged and older euthyroid subjects. The findings suggest that new therapeutic approaches aimed at FT3 levels and FT3/FT4 ratios may be proposed to maintain muscle strength.

Effects Of Bingocize® On Quality Of Life, Fall Risk, And Health Knowledge In Community-Dwelling Older Adults

Quality of life (QOL) is an important aspects of overall well-being in older adults. QOL is associated with functional, physical, and psychological health; all of which can be improved with increased physical activity. A high fall risk is associated with low physical function and QOL. One in four older adults experiences a fall each year, making it necessary to focus public health interventions towards decreasing fall risk and improving QOL in older adults. Bingocize® is a health promotion program designed to promote health, health knowledge, physical activity, and social engagement among older adults. PURPOSE: The purpose of this study was to determine the effects of the new version of Bingocize® on QOL and fall risk in community-dwelling older adults (N=36; mean age 73.63 ± 6.97). METHODS: Participants were clustered and randomly assigned to (a) experimental (n=19; participating in Bingocize® program, which included the bingo game, exercise, and health education) or (b) control (n=17; only played bingo). Each group completed a 12-week intervention that consisted of two 45-60 minute sessions per week. Pre and post data assessments included the TUG, 30-second chair stand, 4-staged balance, handgrip strength, WHOQOL-BREF, PANAS, and a health knowledge quiz. A mixed design analysis of variance (ANOVA) was used to compare intervention effects. Associations were significant at p≤0.05. RESULTS: There were no significant interactions for any of the variables, with the exception of positive affect (PA) (F (1,34) = 5.66, p = 0.02, power = 0.64) and handgrip strength (F (1,34) = 8.31, p = 0.007, power = 0.80). There was also a significant main effect for time for health knowledge. Post hoc analysis using independent samples t-tests were conducted on PA (t (33) = 2.39, p = 0.023, two-tailed) and handgrip strength (t (34) = 2.85, p = 0.007, two-tailed). CONCLUSION: Participating in the Bingocize® health promotion program can produce a meaningful and detectable change in handgrip strength and PA in community-dwelling older adults.

Longitudinal Associations Between Handgrip Strength and Cardiovascular Biomarkers Among Rural Adults: A Project FRONTIER

The decrease in muscular strength is one of the key symptoms of sarcopenia in older adults. A growing body of literature shows inverse associations of maximal isometric handgrip strength, a simple and non-invasive measure of skeletal muscle strength, with risk for cardiovascular disease (CVD)-related morbidity and mortality. However, the evidence is equivocal and there is little research examining the relationship of the concurrent longitudinal change in handgrip strength and CVD biomarkers. PURPOSE: This study examined longitudinal relationships between maximal handgrip strength and CVD biomarkers in older adults living in rural areas. METHODS: Data for this study came from Project FRONTIER (N=138; 59±12y, average 2.8 follow-up years), an ongoing epidemiological study monitoring the health of adults in rural northwest Texas, USA. Handgrip strength normalized to body mass index and CVD biomarkers including triglycerides, fasting blood glucose, high-density lipoprotein cholesterol (HDL-C), waist circumference (WC), and blood pressure (BP) were obtained. The association between strength and CVD biomarkers was examined at baseline, with strength as a predictor of the annual change in biomarkers, and in a parallel fashion between the annual change in strength and CVD biomarkers. RESULTS: After adjusting for demographic information, results for the total sample showed strength to associate with WC (b= -13.6, P<.001) and diastolic BP (b=6.1, P=.025) at baseline. Strength was not found to predict the annual change in any biomarker. Rather, the annual change in strength was positively associated with the change in HDL-C (b=12.7, P=.003). Interestingly, when participants were stratified into low and higher CVD risk groups, low risk adults who did not lose strength had greater annual increases in HDL-C than low risk adults that lost strength (2.3 vs. -1.4 mg/dl/year, P<.001). Adults with higher CVD risk who did not lose strength had greater annual decreases in triglycerides (P=.054) and BP (P’s≤0.05) than higher risk adults that lost strength. CONCLUSIONS: Collectively, the present findings suggest that maintenance of muscle strength with aging is related to positive changes in CVD risk factors.

Exercise during Chemotherapy Improves Physical Function: Findings from EnACT: Exercise in All Chemotherapy

Current research shows that exercise during chemotherapy is safe, feasible, and effective at improving physical function and managing symptom severity and interference in a number of different cancer types. Despite the positive findings of exercise during chemotherapy, referral for exercise during treatment has not yet become standard of care. Additionally, there is a lack of information on the effectiveness of an institute-wide exercise program for patients receiving chemotherapy. PURPOSE: To evaluate changes in objectively-measured physical function in patients receiving chemotherapy after receiving a personalized exercise prescription. METHODS: One hundred sixty eight subjects (65M, 103F; 59.32 ± 11.83 years) actively receiving chemotherapy enrolled in an out-patient exercise intervention. Participants were given home-based exercises that included resistance, aerobic, flexibility, and balance exercises. Exercise equipment included resistance bands and adjustable dumbbells. Physical function (PF), was measured using the 30-second chair stand (30CST), Timed-Up-and-Go (TUG), Hand-Grip Strength (HGS), and the 4-Stage Balance test (BAL). Data collection was performed prior to beginning the exercise program and following completion of their chemotherapy regimen (non-metastatic patients) or 6 months after starting EnACT (metastatic patients). RESULTS: Eighty two subjects completed physical function testing. A Paired-Samples T-test analysis showed a significant increase in the 30CST (MD= .74, SE= .34, p= .03) and a significant decrease in TUG (MD= -0.42, SE= .19, p= .03). There were no significant changes in HGS for either right or left hand. While the BAL also showed no significant changes after the exercise intervention, the Instep balance test showed a trend towards significant increases in performance time (MD= 0.31, SE= .17, p= .06). CONCLUSION: These preliminary results indicate that integrating a personalized exercise prescription into standard of care is efficacious in improving physical function despite the rigorous burden of receiving chemotherapy. Improving the physical function of patients during chemotherapy may prevent future treatment-related decrements in functional capacity and the need for rehabilitative measures.

Impact of protein supplementation on lean muscle mass in adult survivors of childhood cancer engaged in resistance training.

10027 Background: Muscle weakness, low lean muscle mass and poor physical performance are prevalent among adult survivors of childhood cancer. We evaluated the effects of resistance training with and without protein supplementation on lean muscle mass, and muscle strength among childhood cancer survivors. Methods: This double-blind placebo-controlled trial enrolled survivors aged ≥18 to &lt; 45 years. Participants were randomized to resistance training with daily protein supplement (21g protein/day, 90kcal) (RT+S) or resistance training with placebo (sucrose, 90kcal) (RT+P). Both groups received educational materials, access to a local fitness center and a tailored resistance training program with tapered supervision. Lean muscle mass and muscle strength were assessed at baseline and 24 weeks, using dual x-ray absorptiometry and dynamometer testing respectively. Mean changes were compared within and between groups. Results: Of 93 participants randomized, 57 completed the 24-week intervention (24 in RT+S, 33 in RT+P). The mean age was 33.1 (SD 7.0), 67% were white and 47% female. The RT+S group had a significant increase in lean body mass (1.05 kg [SD 2.34], p = 0.04), while the RT+P group did not (0.13 kg [SD 2.19], p = 0.74). Mean change in handgrip strength also improved in the RT+S group (1.98 [SD 4.30], p = 0.03); change approached significance in the RT+P group (1.49 [SD 4.60], p = 0.07). All survivors significantly improved their strength over time (Table) as measured by one max repetition test at baseline and follow-up. Conclusions: Preliminary findings indicate that a supervised resistance training program among adult survivors of childhood cancer that includes protein supplementation is feasible and may increase total lean body mass and muscle strength. Clinical trial information: NCT02501460. [Table: see text]

Reference data on hand grip and lower limb strength using the Nintendo Wii balance board: a cross-sectional study of 354 subjects from 20 to 99\u2009years of age

BackgroundAccurate assessment of isometric hand grip strength (HGS) and isometric lower limb strength (LS) are often limited to specialized clinics due to high costs and need for specialized equipment and personnel. A mobile and user-friendly device would facilitate a wider use of these measures in the clinical setting. The Nintendo Wii Balance Board (WBB) is a novel and pragmatic tool that has been validated for measuring muscle strength and other clinically relevant physiological variables. However, reference data for HGS and LS are lacking. The purpose of the current study is to establish reference data for HGS and LS in individuals ≥20 years of age using the WBB method, and to characterize the effects of age in these measurements.MethodHealthy participants were recruited at various locations and their HGS and LS were tested by six assessors using the WBB. Reference data were analysed and presented in age-groups, while the age-related change in HGS and LS was tested and characterized with linear regression models.ResultsThree hundred and fifty-four participants between 20 and 99 years of age were tested. Data are presented separately according to gender and the following age categories: 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80+, and presented in absolute values as well as percentiles. The main findings were; (1) Significantly higher HGS and LS among males compared to females and for the dominant limb compared to the non-dominant limb, (2) a significant decline in strength with increasing age, and (3) the rate of decline increased significantly (i.e. it was non-linear) with age for HGS, but not for LS.ConclusionThis study reported reference data with percentiles for a novel method for assessing HGS and LS. Data were consistent with previously known effects of age and gender on HGS and LS. The presented data may supplement future trials using the WBB in research or in the clinical setting.

Muscle Fitness Changes During Childhood Associates With Improvements in Cardiometabolic Risk Factors: A Prospective Study.

The role of muscle fitness in controlling cardiometabolic risk factors during childhood is incompletely understood. A prospective observational design including 6- to 11-year-old children (n = 512) was used to study associations between 1.5-year changes in handgrip strength, standing vertical jump displacement, the short shuttle run, and a composite of these with changes in composite and single cardiometabolic risk markers. The authors modeled sequential mixed linear regressions controlling for changes in cardiorespiratory fitness, waist circumference, and other putative confounding variables. Statistically significant associations, standardized beta (95% confidence intervals), were observed between changes in composite muscle fitness -0.19 (-0.30 to -0.07), muscular strength -0.15 (-0.25 to -0.06), and agility 0.14 (0.04 to 0.23), but not muscular power -0.06 (-0.14 to 0.03) with changes in the composite risk score. In sex-stratified analysis, associations were robust in girls, but not in boys. Control for changes in cardiorespiratory fitness and waist circumference greatly attenuated associations. Changes in muscle fitness were strongly associated with changes in waist circumference in both girls -0.21 (-0.37 to -0.05) and boys -0.23 (-0.35 to -0.11) after controlling for cardiorespiratory fitness. Our data support a unique role of muscle fitness in the promotion of metabolic health and prevention of excess adipose tissue accumulation in children.