Population-based reference values of handgrip strength and functional tests of muscle strength and balance in men aged 70–80 years

Abstract

With aging, the incidence of falls and fractures increases. There has during the last decades been secular changes in demographics so that the proportion of elderly increases in society. Hence, there is an increasing need for clinicians to be able to make a solid appraisal of the elderly patient's functional capacity, as to identify individuals with an increased risk to fall. If high risk individuals could be targeted fall preventive strategies might be implemented in specific risk cohorts. This would require reference values for muscle strength tests and functional tests, in order to defined high risk individuals performing inferior. From the MrOS Sweden cohort, 999 subjects aged 70–80 years were evaluated. Muscle strength and functional performance was tested by timed-stands test, 6-m and 20-cm narrow walk tests and Jamar handgrip strength test. Normative data is presented. With increasing age, there was a 10–18% successively decline in performance throughout the entire age span. This study provides reference values for handgrip strength and functional muscle tests in 70–80 years old men. The decline in the test values with increasing age, infer the use of age-specific normative data when using these tests both in clinical and research settings.

Introduction

Hip fractures constitute a health problem associated with aging (Chang et al., 2004). Often the risk to sustain a fragility fracture is selectively related to the level of bone mineral density, a trait known to diminish with aging and strongly associated with fracture risk (Cummings et al., 1995). But, muscle strength, balance and several functional capacities are also traits that deteriorate with aging and traits that all lead to an increased tendency to fall. As most hip fractures are preceded by a fall (Tinetti et al., 1988, Grisso et al., 1991, Hayes et al., 1993, Greenspan et al., 1994, Kannus et al., 2005), it is therefore of great importance to catch individuals in these ages prone to fall. In the clinical setting there is a need of tests of physical performance in order to predict the risk of falling, especially in patients with low bone mineral density. Most falls occur when a patient is rising from a sitting position or when walking (Lord et al., 2000) Therefore, hypothetically timed-stands test and gait tests seem feasible to use. In addition, the tests are easy to use in a clinical situation. The test was design as a 10-repetition test by Csuka and McCarty (1985), but was later used as a 5-repetition test as suggested by Guralnik et al. (1995). Handgrip strength is another test often used in similar clinical situations, mostly measured by a hydraulic dynamometer This is a valid and reliable tool measuring peak force in healthy subjects (Harkonen et al., 1993), in studies reported to be a good marker for physical health and therefore also a possible tool to predict fall (Proctor et al., 2006, Sasaki et al., 2007, Ribom et al., 2009). But, if the clinician is to make judgements about the normality of a patient's physical performance, age and gender specific reference values are required for comparison. The aim of this study was therefore to establish normal reference values for handgrip strength, timed-stands test, 6-m walking test, and 20-cm narrow walk in 70–80 year old men, the age ranges with an exponentially increase in the risk to sustain fall and fragility fractures.