Handgrip Strength In Patients Research Articles

Reference values for hand grip strength in the South Korean population.

ObjectiveTo establish reference values for hand grip strength (HGS) in a healthy Korean population and to identify the dependent anthropometric variables that affect HGS.MethodsBased on the sixth Korea National Health and Nutrition Examination Survey from 2014 to 2015, we analyzed the HGS data of 7,969 South Koreans. Individuals with specific chronic diseases and who reported poor subjective health status were excluded to ensure a healthy population sample. Means with standard deviations (SDs) and 95% confidence intervals were calculated for each 5-year interval starting from 10 years of age. To determine the relationship between HGS and anthropometric variables, we performed correlation analyses between HGS and height, weight, and body mass index (BMI). Additionally, based on these findings, the cut-off value for low HGS was presented by deriving -2SD values of healthy young adults as recommended by the European Working Group on Sarcopenia in Older People.ResultsThe mean age and BMI of men and women were 38.3 and 38.2 years and 23.8 and 22.4 kg/m2, respectively. Mean HGS of the dominant hand in men and women was 39.5 and 24.2 kg, respectively. The peak in HGS was at 35–39 years of age, after which HGS decreased in both sexes. HGS was significantly correlated with height, weight, and BMI. The cut-off values for weak HGS were < 28.9 and < 16.8 kg in men and women, respectively.ConclusionThese results provide useful reference values to assess HGS in patients who undergo hand surgery or who have various diseases that affect HGS. Moreover, a cut-off value for low HGS may help in defining sarcopenia among the Korean population.

Assessment of Handgrip Strength in Patients with Rheumatoid Arthritis and Fibromyalgia-Do They Differ? -An Observational Study

Background: Rheumatoid arthritis (RA) and Fibromyalgia (FM) are chronic illnesses with pain as the common component. Hand grip function is limited in both RA and FM patients, the assessment of which might help in important decision making. Methods and findings: We analyzed the hand grip strength in RA and FM patients with simple inexpensive hand dynamometer and compared it with age and sex matched healthy controls. Our study had 16 RA and 14 FM patients. The mean hand grip force in dominant right hand was 87.8 ± 22.7 kilograms in fibromyalgia while in RA it was 60.3 ± 21.0 kilograms. Non-dominant hand grip was 72.5 ± 25.7 kilograms in fibromyalgia while in RA it was 52.2 ± 29.3 kilograms. On comparison of the hand grip strength between RA and FM patients, we found that RA patients had a significantly lower dominant and non -dominant hand grip strength than FM patients (p=0.002 and p=0.055 respectively). When compared with age and sex matched healthy controls both dominant and non-dominant hand grip was significantly lower in RA group (p<0.001) while non-dominant hand grip strength in FM was significantly lower than controls (p<0.001). Conclusion: Rheumatoid arthritis patients have poor handgrip than Fibromyalgia and both have poor hand grip than age matched controls.

Performance evaluation of phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study

Background and aimsThe phase angle (PA), derived from bioelectrical impedance analysis (BIA), has been interpreted as a cell membrane integrity indicator, while handgrip strength (HGS) has been used as a prognostic indicator in certain clinical situations, such as in cardiac, oncologic patients with renal disease, hemodialysis patients, HIV-positive patients, and liver disease patients. In addition to prognostic scores, body changes due to surgical procedures indicate the importance of measuring muscle function and cell integrity. This study aimed to evaluate the behaviour of PA and HGS in patients undergoing cardiac surgery and associate these factors with clinical outcomes and prognosis. MethodsThis was a prospective cohort study of 50 consecutively recruited patients (aged ≥18 years) undergoing cardiac surgery. Measures PA and HGS were at three set points: preoperative, at hospital discharge and three months postoperative. The following data were collected: time of cardiopulmonary bypass (CPB), ischemia, mechanical ventilation (MV), Intensive Care Unit (ICU) length of stay (LOS) and hospital LOS after surgery; the EuroSCORE was also calculated. ResultsA decrease in PA was observed between the preoperative and the two postoperative stages (p<0.001). There was a reduction in HGS between the preoperative and hospital discharge assessments (p<0.001) and a recovery three months postoperative (p<0.001). The MV and EuroSCORE were inversely associated with PA and HGS in all three assessments. The PA was correlated with EuroSCORE in the first assessment (p=0.007) and in the second and third assessments (p<0.001), as well as with MV in all three assessments (p<0.001). The HGS was correlated with EuroSCORE and MV in the first and second assessments (p<0.001) and in the third assessment (p=0.010 and p=0.018, respectively). ConclusionPA and HGS appear to be related to MV time, ICU LOS and hospital LOS after surgery in patients undergoing cardiac surgery.

HAND GRIP STRENGTH IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

RespirologyVolume 22, Issue S3 p. 104-104 APSR Poster Abstracts HAND GRIP STRENGTH IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE First published: 23 November 2017 https://doi.org/10.1111/resp.13207_50Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 104-104 RelatedInformation

Hand grip strength in patients with chronic obstructive pulmonary disease.

PurposeHand grip strength (HGS) is a simple way of predicting the risk of cardiovascular disease and all-cause mortality in the general population. However, the practical significance of grip strength in patients with COPD is uncertain. The aim of this study was to compare HGS between subjects with and without COPD and to evaluate its clinical relevance in patients with COPD by using a national survey.MethodsData were collected from the Korean National Health and Nutrition Examination Survey. The study included 421 adults with COPD and 2,542 controls who completed questionnaires, spirometry, and a HGS test. HGS was compared between subjects with and without COPD, and the association between grip strength, lung function, and quality of life (QoL) was evaluated.ResultsThe mean HGS was 33.3±9.1 kg in the COPD group and 29.9±9.5 kg in the non-COPD group; adjusted HGS was 30.9±0.33 kg and 30.9±0.11 kg, respectively (P=0.99). HGS was not related to forced vital capacity (β=0.04, P=0.70) or forced expiratory volume in 1 second (β=0.11, P=0.24) in multivariable analysis. HGS was independently associated with the EQ-5D index, but the relationship was stronger in the COPD group (β=0.30, P<0.001) than in the non-COPD group (β=0.21, P<0.001). The results were similar for each component of the EQ-5D, including mobility (β=−0.25, P<0.001), daily activity (β=−0.19, P=0.01), pain/discomfort (β=−0.32, P<0.001), and anxiety/depression (β=−0.16, P=0.01).ConclusionHGS was not different between subjects with and without COPD, but was associated with QoL – including mobility, daily activity, pain/discomfort, and anxiety/depression – in patients with COPD. The HGS test could be used as a marker of QoL in patients with COPD and could assist risk stratification in clinical practice.

Determinants and nutritional assessment value of hand grip strength in patients hospitalized with cancer.

Hand grip strength (HGS) has emerged as a predictor of the nutritional status. However, many factors may modify the malnutrition-HGS association. This study explored the nutritional assessment value and determinants of HGS in patients hospitalized with cancer. In this multicenter, retrospective, observational study (11,314 patients), the Receiver operator characteristic curve was used to observe HGS and nutritional status sensitivity/specificity. Sex; age; height; weight; mid-upper arm circumference (MAMC); Patient-Generated Subjective Global Assessment (PG-SGA) score; Karnofsky score; physical function (PF) domain; cognitive function (CF) domain; global health and quality of life (QL) domain of EORTC QLQ-C30 (a quality of life instrument designed by the European Organization for Research and Treatment of Cancer); and albumin, prealbumin, and hemoglobin levels were included in a Stepwise analysis model to identify the factors influencing HGS. HGS showed a very low diagnostic value and accuracy for identifying severe malnourishment (area under the curve, 0.615-0.640; p<0.01). HGS positively correlated with sex; height; weight; MAMC; Karnofsky score; QL, PF, and CF domains; and hemoglobin and prealbumin levels (Beta= 0.02-0.42, p<=0.05), and negatively with age (Beta=-0.19, p<0.01). However, the PG-SGA score was excluded because of its very limited contribution to HGS variability. HGS is a mutifactorial index. The use of HGS cutoff values to identify malnutrition is markedly challenging. Thus, HGS may be of limited use as a predictor of nutritional status.

Cachexia Stage, Patient-Generated Subjective Global Assessment, Phase Angle, and Handgrip Strength in Patients with Gastrointestinal Cancer

ABSTRACTThe aim of this study was to correlate patients with gastrointestinal cancer, classified according to different stages of cancer cachexia (SCC) as proposed by Fearon, with nutritional assessment tools such as PG-SGA, phase angle (PA), and handgrip strength. One hundred one patients with a mean age of 61.8 ± 12.8 yr, with 58.4% being men were included. 32.6% were malnourished according to the body mass index (BMI). A severe or moderate malnutrition had been diagnosed in 63.3% when assessed using the PG-SGA, 60.4% had decreased handgrip strength, and 57.4% had lower grades of PA. Among the patients in the study, 26% did not have cachexia, 11% had precachexia, 56% cachexia, and 8% refractory cachexia. The PG-SGA, PA, and handgrip strength were associated with cachexia (P ≤ 0.001). An increased risk of death was found in patients with cachexia [RR: 9.1; confidence interval (CI) 95%: 0.1–90.2, P = 0.039], refractory cachexia (RR: 69.4, CI 95%: 4.5–1073.8, P = 0.002), and increased serum C-reactive protein (CRP) levels (P < 0.001). In conclusion, most of the patients with digestive system cancer had cachexia or refractory cachexia in the first nutritional assessment. Nutritional risk, as determined by PG-SGA, was correlated with PA and handgrip strength. High CRP levels, cachexia, and refractory cachexia were prognostic factors for cancer patients.

Characteristics of somatic build and physical activity and evaluation of hand grip strength in patients with type 1 diabetes

Abstract Introduction: In order to avoid hypoglycaemia, individuals diagnosed with type 1 diabetes usually limit their physical activity, which might lead to changes in somatic build and in the level of muscle strength. The aim of the study was to define somatic build, hand grip strength and physical activity in patients diagnosed with type 1 diabetes. Materials and methods: The study included 24 patients with type 1 diabetes and 24 healthy individuals. Body build was assessed on the basis of 20 somatic features and indices. Somatic types were assessed using the Sheldon’s method modified by Heath-Carter. Hand grip strength was measured with hand grip dynamometer, while physical activity was evaluated by means of a questionnaire survey. Results: The results obtained from female subjects showed insignificant intergroup differences concerning the measured features. Endomorphy was a predominant component among female somatotypes. Compared to the healthy controls, males with type 1 diabetes exhibited lower values of arm circumference (tensed), thigh circumference, ankle width and mesomorphy as well as hand grip strength (p&lt;0.05). The diabetic patients preferred cycling while healthy people opted for combat sports. Conclusions: Differences in somatic build, hand grip strength and physical activity between healthy individuals and patients diagnosed with type 1 diabetes were greater in the case of men than women. Compared to healthy individuals, diabetic men exhibited lower values of somatic features that are typical of mesomorphy and muscle strength. Both women and men diagnosed with type 1 diabetes preferred low-intensity and aerobic physical activity.

THU-380 - Handgrip Strength in Patients with Chronic Liver Disease Correlates with Invasive Assessment of Muscular Function and Survival

THU-380 - Handgrip Strength in Patients with Chronic Liver Disease Correlates with Invasive Assessment of Muscular Function and Survival

Abstract 14063: Hand Grip Strength Significantly Predicts Cardiovascular Event Risk in Patients With Type 2 Diabetes

Introduction: Muscle fitness is an established indicator of overall health. The power of muscle strength to predict cardiovascular endpoints in patients with type 2 diabetes mellitus (T2DM) is unclear and is addressed in the present study. Methods: We studied a high-risk cohort of 209 patients with T2DM who underwent coronary angiography for the evaluation of stable coronary artery disease (CAD). Forearm muscle dynamometry was performed to determine hand grip strength in the dominant arm the day before angiography. Significant CAD was diagnosed in the presence of coronary stenoses with lumen narrowing ≥50%. T2DM was diagnosed according to the ADA criteria. Prospectively, we recorded vascular events over 5.5±2.2 years. Results: Grip strength, measured in kilograms, at baseline did not differ significantly between patients with significant CAD and those who did not have significant CAD (34±12 vs. 31±12 kg; p=0.140). Prospectively, hand grip strength significantly predicted the incidence of major cardiovascular events (n=65) after adjustment for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol and HDL cholesterol (standardized adjusted HR 0.72 [0.52-0.99]; p=0.042). This result was not attenuated after further adjustment for the angiographically determined baseline CAD state (HR 0.72 [0.53-0.99]; p=0.046). Conclusions: We conclude that hand grip strength in patients with T2DM is inversely associated with vascular events independently both from well established cardiovascular risk factors and from the angiographically determined baseline CAD state.

Assesment of Hand grip Strength in Patients with Pelvic Organ Prolapse

Assesment of Hand grip Strength in Patients with Pelvic Organ Prolapse

Impact of hemodialysis session on handgrip strength.

Handgrip strength (HGS) is a simple and reliable method with a good predictive clinical value for assessing muscle function of patients undergoing hemodialysis (HD). However, there is no consensus regarding the appropriate moment for performing the HGS measurement since the performance of the HGS can be influenced by fluid, electrolyte and blood pressure changes that affect patients on HD. To investigate the impact of the dialysis session on the HGS in patients undergoing HD. This is a cross-sectional study with 156 patients [57.7% male, median age of 56.5 (42-67) years old, 28.8% diabetes, mean BMI of 24.75 ± 4.5 kg/m2 and HD vintage of 38 (19.25 to 72.75) months]. Measures of HGS were performed with a dynamometer during the initial minutes of the HD session and at the end of the session. The values obtained were compared with a national standard reference. Clinical, demographic and laboratory data were collected from medical records. A significant reduction of HGS was observed after the HD session (28.6 ± 11.4 kg to 27.7 ± 11.7 kg; p < 0.01). The prevalence of patients with HGS below the 30th percentile increased from 44.9% to 55.1% (p < 0.01). The decrease in blood pressure during dialysis was the only factor associated with the reduction of HGS. These findings show that the HD procedure affects negatively the HGS.

Vascular Function and Handgrip Strength in Rheumatoid Arthritis Patients

Objective. To examine the relationship of handgrip strength with forearm blood flow (BF) and vascular resistance (VR) in rheumatoid arthritis (RA) patients. Methods. Forearm BF at rest (RBF) and after upper arm occlusion (RHBF), and handgrip strength were examined in 78 individuals (RA = 42 and controls (CT) = 36). Subsequently, VR at rest (RVR) and after occlusion (RHVR) were calculated. Results. The patients' RBF (P = 0.02) and RHBF (P = 0.0001) were less, whereas RVR (P = 0.002) and RHVR (P = 0.0001) were greater as compared to the CTs. Similarly, handgrip strength was lower in the RAs (P = 0.0001). Finally, handgrip strength was directly associated with RBF (r = 0.43; P = 0.0001), and RHBF (r = 0.5; P = 0.0001), and inversely related to RVR (r = −0.3; P = 0.009) and RHVR (r = −0.3; P = 0.007). Conclusion. The present study uniquely identifies an association between regional measures of forearm blood flow and handgrip strength in patients and healthy control. In addition, this study confirms the presence of vascular and muscle dysfunction in patients with rheumatoid arthritis, as evidenced by lower forearm blood flow indices, at rest and following occlusion, and lower handgrip strength as compared to healthy individuals.

Effect of one week of yoga on function and severity in rheumatoid arthritis

BackgroundPrevious studies have shown that yoga practice improved the hand grip strength in patients with rheumatoid arthritis (RA).FindingsSixty-four participants with RA (group average age ± S.D., 46.5 ± 9.6 years; 47 females) were assessed at the beginning and end of a one week yoga program. The Stanford Health Assessment Questionnaire (HAQ), hand grip strength, rheumatoid factor, and C-reactive protein levels were assessed on the first and last day and compared using a t-test for paired data. All participants showed reduced disability scores of the HAQ and rheumatoid factor levels, with an increase in bilateral hand grip strength in male participants alone.ConclusionsThis single group study indicated that a brief intensive yoga program was beneficial in RA, with decreased disability, better functionality and changes in the rheumatoid factor levels suggesting improvement.

Assessment of the influence of Saunders traction and transcutaneous electrical nerve stimulation on hand grip force in patients with neck pain.

Spinal pain syndromes are among the most frequent causes of ill health. Long-lasting sustained overload results in a critical decrease in the distance between neighbouring vertebrae and radiation of pain. The aim of this study was to assess the effect of cervical traction and the TENS method on the strength of painless grip and maximum strength of the arm flexors. The study included 45 patients with overload-induced cervical pain, ranging in age from 21 to 66 years. The patients underwent a therapy based on the Saunders traction device and the TENS method. The traction force was regulated so that the patient would feel noticeable but painless traction. The TENS procedure was performed using the conventional method. The patients were divided into three groups. The Saunders traction device was used in the first group, transcutaneous electrical nerve stimulation and traction were applied in the second group, while the patients in the third group were received TENS only. Each patient underwent 10 treatment sessions with intervals between sessions not exceeding three days. The results showed the greatest improvement in the strength of painless hand grip. Maximum strength increased only on the left side in the group which received only the traction treatment. The use of the Saunders cervical traction device produced an increase in painless hand grip strength in patients with cervical spine pain. Both treatments had a limited effect on maximum hand grip strength.

Efeitos sistêmicos da hipoxemia noturna em pacientes com doença pulmonar obstrutiva crônica sem síndrome da apnéia obstrutiva do sono

To study the effects of nocturnal hypoxemia in patients with chronic obstructive pulmonary disease without obstructive sleep apnea syndrome. We studied 21 patients-10 desaturators and 11 nondesaturators-submitted to arterial blood gas analysis, polysomnography, spirometry, cardiopulmonary exercise testing (cycle ergometer), and hand-grip dynamometry, as well as measurements of maximal inspiratory pressure, maximal expiratory pressure, and C-reactive protein (CRP) levels. Patients with arterial oxygen tension > 60 mmHg were included; those with an apnea-hypopnea index > 5 events/hour of sleep were excluded. Maximal oxygen uptake, maximal power, systolic blood pressure, diastolic blood pressure (DBP), and maximal heart rate were measured during exercise in order to detect hemodynamic alterations. Patients presenting CRP levels above 3 mg/L were considered CRP-positive. Minimal peripheral oxygen saturation during sleep was significantly higher among nondesaturators (p = 0.03). More desaturators presented CRP > 3 mg/L (p < 0.05). No differences were observed in terms of any variables, However, mean peripheral oxygen saturation during sleep correlated with DBP and maximal inspiratory pressure (p < 0.001 and p = 0.001, respectively). Although nocturnal hypoxemia does not reduce exercise capacity or hand-grip strength in patients with mild/moderate COPD, its effect on maximal exercise DBP seems to depend on the degree of hypoxemia. In addition, there is a positive relationship between maximal inspiratory pressure and mean peripheral oxygen saturation during sleep, as well as evidence of pronounced inflammatory activation in patients with nocturnal hypoxemia.

Acute action of aminophylline in patients with amyotrophic lateral sclerosis

This study investigated whether aminophylline has an acute effect on the muscle performance of patients with amyotrophic lateral sclerosis (ALS). The study was a randomized, double-blind, crossover against placebo. Twenty-five patients (48.5 +/- 14.1 years) with ALS were evaluated by means of forced vital capacity (FVC), maximal mouth inspiratory and expiratory pressures (P(Imax)/P(Emax)) and endurance, maximum voluntary ventilation (MVV) and handgrip strength (HS); variables were measured before and after the patients received an intravenous infusion of aminophylline or placebo. MVV (P<0.02) and HS of the right and left hands (P=0.05) increased after aminophylline infusion. There was a positive correlation between FVC and P(Imax) (r=0.80; P<0.05); between MVV and P(Imax) post-aminophylline, respectively (r=0.77; P<0.05). Serum aminophylline levels ranged from 5.3 to 10.5 microg/mL (mean 7.30). The acute administration of aminophylline improves the endurance of respiratory muscles and increases handgrip strength in patients with ALS.

A Randomized, Parallel-Group, Open-Label Trial of Recombinant Human Erythropoietin vs Preoperative Autologous Donation in Primary Total Joint Arthroplasty: Effect on Postoperative Vigor and Handgrip Strength

This randomized trial assessed the effect of recombinant human erythropoietin (EPO) vs preoperative autologous donation (PAD) on postoperative vigor and handgrip strength in patients undergoing primary total joint arthroplasty. Adults with baseline hemoglobin level of 11 to 14 g/dL received EPO (600 IU/kg once weekly for 4 doses, n = 130) or PAD (n = 121) before primary, unilateral hip or knee arthroplasty. Mean changes in vigor score and handgrip strength from baseline were not significantly different between treatment groups. Multivariate analyses found a significant treatment effect favoring EPO over PAD for vigor, but not for handgrip strength. Patients in the EPO group had higher hemoglobin levels and required fewer transfusions. Both treatments were well tolerated. Additional study is needed to elucidate the influence of blood management strategies on postoperative vigor.

Handgrip strength, pulmonary function tests, and pulmonary muscle strength in fibromyalgia syndrome: is there any relationship?

It has been reported that patients with fibromyalgia syndrome (FMS) have lower maximal respiratory pressures than healthy subjects, indicating reduced pulmonary muscle strength. It has also been reported that patients with FMS have reduced grip strength. In this study, we aimed to examine the possible relationship between handgrip strength as a determinant of peripheral muscle strength and pulmonary muscle strength in patients with FMS by comparing them with healthy controls. Forty-one consecutive women with FMS (diagnosed according to the American College of Rheumatology 1990 criteria) were compared with 40 age- and body mass index-matched healthy female controls. Pulmonary function tests were assessed by spirometry. Maximal pulmonary pressures were evaluated using an oral pressure meter. A dyspnea score was obtained. Pain was scored according to visual analogue scale and chest pain was classified (0-9) in fibromyalgia patients. Chest expansion was also measured in the two groups. Tender points were also evaluated in FMS patients. Grip strength (Jamar handheld dynamometer) was also measured in the two groups. The difference in pulmonary function tests was not statistically significant between groups. Maximal respiratory pressures (maximum inspiratory pressure and maximum expiratory pressure) and endurance (maximum ventilatory volume) were significantly lower in patients with FMS than in controls. There was also a statistically significant difference between groups regarding grip strength. There was also significant correlation between maximal inspiratory pressure and maximal expiratory pressure values and handgrip strength in patients with FMS. These data indicate that handgrip strength may be a determinant of pulmonary muscle strength in fibromyalgia patients.

Effect of Regular Use of High-dose Nebulized β2-Agonists on Resting Energy Expenditure, Weight, and Handgrip Strength in Patients With Chronic Airflow Limitation

A proportion of patients with chronic airflow limitation (CAL) have a raised resting energy expenditure (REE). The mechanism underlying this is not known. The question of whether the increased REE seen in some patients with CAL is due to beta2-agonist therapy has arisen, and the aim of this study was to examine REE, body composition, and peripheral muscle strength in patients before and after the use of regular high-dose beta2-agonists administered by nebulizer. Prospective observational study. Respiratory outpatient clinic. Twenty outpatients with CAL being considered for a home nebulizer prescription. REE was measured by indirect calorimetry. Fat-free mass and handgrip strength were measured. Quality of life was assessed by the St. George's Hospital Respiratory Questionnaire. All subjects were assessed independently of this study for provision of a home nebulizer using a standard protocol. Based on the assessment, either standard-dose salbutamol therapy was continued or a nebulizer was provided with a prescription for high-dose salbutamol (5 mg qd). A mean of 8.1 months later (range, 3 to 16 months), 16 patients were restudied. Eight patients had been taking regular high-dose nebulized salbutamol, and eight had continued taking standard-dose salbutamol by metered dose inhaler. There was no difference in baseline measures between the group who were later prescribed high-dose salbutamol and the group who were not. There were no changes in REE, anthropometric measures, or handgrip strength over time in either of the groups. The long-term use of high-dose nebulized beta2-agonists in patients with chronic airflow limitation has no effect on baseline REE, handgrip strength, weight, or body composition.