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Hand grip strength is strongly associated with lower limb strength but only weakly with postural control in community-dwelling older adults
Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation. Norrbotten County Council.ORCID iD: 0000-0002-5948-6880
Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.ORCID iD: 0000-0002-2510-7571
Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.ORCID iD: 0000-0003-3619-2297
Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.ORCID iD: 0000-0002-9813-2719
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(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:ltu:diva-75669OAI: oai:DiVA.org:ltu-75669DiVA, id: diva2:1345119
Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-08-23
In thesis
1. Hand grip strength and postural control among individuals with and without Chronic Obstructive Pulmonary Disease: Epidemiological and motion laboratory studies
Open this publication in new window or tab >>Hand grip strength and postural control among individuals with and without Chronic Obstructive Pulmonary Disease: Epidemiological and motion laboratory studies
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Handgreppstyrka och postural kontroll hos personer med och utan kroniskt obstruktiv lungsjukdom : Epidemiologiska och rörelselaborativa studier
Abstract [en]

Background

Chronic obstructive pulmonary disease (COPD) is estimated to affect approximately 8%–10% of all adults. The disease is considered to be a heterogenic syndrome with systemic effects, in which comorbidities including cardiovascular diseases, muscle dysfunction and fatigue are common. The majority of all individuals with COPD have mild to moderate disease (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2), and only a third are identified by health care, and this under-diagnosis contributes to a lack of knowledge of COPD in the population. COPD is related to skeletal muscle dysfunction, where muscle weakness, frequently assessed with hand grip strength (HGS), is one of the components. Evidence of postural control limitations among individuals with severe or very severe COPD has been emerging during the last decade. These limitations are partly related to muscle weakness, however, research of the other underlying systems of postural control is scarce, and an increased knowledge is of importance for the prevention of falls.

Aim

The main objective of the thesis was to increase the population-based knowledge about muscle strength, assessed as hand grip strength, and also postural control among individuals with and without COPD. Another objective was to investigate the value of hand grip strength measurements in relation to lower limb muscle strength and postural control among community-dwelling older adults.

Methods

Paper I and II are based on the population-based Obstructive Lung disease in Northern Sweden (OLIN) COPD study. All individuals with obstructive lung function impairment (n=993) and an age- and sex-matched group without (n=993) (COPD and non-COPD) were identified after re-examination of population based cohorts during 2002-04. They (n=1,986) have been invited to recurrent examinations including structured interviews and spirometry. Paper I (n=1011) and II (n=831) include data from examinations during 2009-2010 and 2014, respectively, where measurements of HGS (Paper I & II) as well as assessment of fatigue and physical activity (Paper II) were included. Paper III and IV are based on the population-based Balancing Human and Robot (BAHRT) study. Randomly selected individuals over 70 years of age were invited to participate in a study of postural control aspects, in their homes and at the 2 Human Health and Performance Lab- Movement Science, at Luleå University of Technology. The examinations included a structured interview as well as measurements of postural control and sensory and motor systems including HGS, lower limb strength, proprioception, pressure sensitivity, visual acuity, vestibular function and reaction time. Participants in Paper III consisted of communitydwelling individuals over 70 years of age (n=45). Paper IV consisted of individuals with COPD recruited from both the OLIN COPD study as well as the BAHRT-study (n=22), as well as a control group without airway obstruction from the BAHRT-study (n=34).

Results

In Paper I, there was no differences in mean HGS between the groups with and without COPD. However, HGS was related to disease severity; HGS was lower among those with severe to very severe COPD (GOLD 3-4) compared to nonCOPD, and HGS was associated with forced expiratory volume during 1 second % of predicted value (FEV1 % predicted) in regression models. Five years later, in Paper II, mean HGS was lower in COPD compared to non-COPD. Further, individuals with COPD and clinically relevant fatigue had lower HGS than those without clinically relevant fatigue, significantly so among men and close to among women. There was no clear association between HGS and level of physical activity. In Paper III, there was a strong and valid model showing association between HGS and lower limb strength, where all tested muscle groups were significantly correlated to hand grip strength. The regression model with HGS and postural control was significant, however, the model was weak. In Paper IV, individuals with COPD had worse postural control than those without COPD, significantly so regarding mediolateral amplitude in quiet stance with eyes open on soft/unstable surface, as well as anteroposterior limits of stability. In the COPD group, mediolateral amplitude was related to eye sight and the burden of tobacco smoking assessed as pack-years. Further, muscle strength associated with anteroposterior amplitude in the limits of stability test.

Conclusions

In the population-based OLIN COPD study in 2009-2010, mean HGS was significantly lower among individuals with severe to very severe COPD (GOLD 3-4) than those without COPD. Five years later, mean HGS was lower among all individuals with COPD (GOLD 1-4) compared to those without COPD, which may indicate altered aging process in COPD. HGS was associated to fatigue among individuals with COPD, while there were no associations between HGS and physical activity. HGS is a valid tool for the estimation of lower limb muscle strength among community-dwelling older adults, however, HGS is not 3 appropriate to use as an estimation of postural control. Postural control was impaired among individuals with COPD and different postural control assessments had different demands on the sensory and motor systems. The burden of tobacco smoking and visual acuity might be important for quiet stance trials with visual input, while muscle strength might be important for the more dynamic limits of stability test. Further research regarding the longitudinal aspects of muscle weakness and postural control among individuals with COPD is needed to gain knowledge for appropriate preventive or rehabilitative interventions.

Abstract [sv]

Bakgrund

Kroniskt Obstruktiv Lungsjukdom (KOL) drabbar uppskattningsvis 8%-10% av alla vuxna. KOL är ett heterogent syndrom med systemiska effekter och komorbiditeter, som kardiovaskulära sjukdomar, muskeldysfunktion och fatigue, är vanliga. Majoriteten av alla individer med KOL har en lindrig till medelsvår sjukdom (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2), men underdiagnostiken är betydande, endast cirka en tredjedel av alla är identifierade via sjukvården. Denna underdiagnostik bidrar till kunskapsluckor om sjukdomen KOL bland personer i befolkningen. KOL är relaterat till muskelsvaghet, vilket vanligtvis har undersökts genom mätningar av handgreppstyrka (HGS). Senaste årtionden har nedsatt postural kontroll hos personer med KOL har varit i fokus. Dessa nedsättningar är delvis relaterade till muskelsvaghet, det saknas emellertid studier av de andra underliggande systemen för postural kontroll, och en ökad kunskap är av värde för fallprevention för denna population.

Syfte

Huvudsyftet med denna avhandling var att öka kunskapen om muskelstyrka, mätt med handgreppstyrka, samt postural kontroll hos individer med och utan KOL i befolkningen. Ett ytterligare syfte var att undersöka handgreppstyrka i relation till benstyrka och postural kontroll hos äldre personer.

Metod

Studie I och II är baserade på den populationsbaserade Obstruktiv Lungsjukdom I Norrbotten (OLIN)-studiernas KOL-studie. Samtliga individer med luftvägsobstruktion (n= 993) identifierades tillsammans med en lika stor åldersoch könsmatchad referensgrupp (KOL respektive icke-KOL) efter kliniska undersökningar av populationsbaserade kohorter 2002-04. De (n=1986) har, alltsedan 2005, blivit inbjudna till återkommande kliniska undersökningar med strukturerad intervju och spirometri. Studie I (n=1011) och II (n=831) inkluderar data från undersökningarna 2009-2010 respektive 2014. HGS mättes vid båda tillfällena, medan fatigue och fysisk aktivitet mättes vid det senare (Studie II). Studie III och IV är baserade på Balancing Human and Robot (BAHRT)-studien. Ett slumpmässigt urval av individer över 70 års ålder har inbjudits till en studie av postural kontroll, där det ingår undersökningar vid såväl hembesök som i rörelselaboratorium, Human Health and Performance Lab – Movement Science, på Luleå Tekniska Universitet. Undersökningarna inkluderade en strukturerad intervju och mätningar av postural kontroll, samt 5 sensoriska- och motoriska system som: HGS, benstyrka, proprioception, tryckkänslighet, synskärpa, vestibular funktion och reaktionstid. Deltagare i studie III bestod av individer över 70 års ålder med självständigt boende (n=45). Studie IV bestod av individer med KOL som rekryterats från OLIN:s KOL-studie samt en referensgrupp utan luftvägsobstruktion från BAHRT-studien (n=34).

Resultat

I Studie I var det ingen skillnad i HGS mellan individer med och utan KOL. Däremot var HGS relaterat till svårighetsgrad av KOL; personer med svår och mycket svår KOL (GOLD 3-4) hade nedsatt HGS än dem utan KOL, och lägre greppstyrka var associerat med forcerad expiratorisk volym under 1 sekund, % av förväntat värde (FEV1% av förväntat). Fem år senare i Studie II hade individer med KOL (GOLD 1-4) lägre HGS än dem utan KOL. Bland individer med KOL hade de med klinisk relevant fatigue lägre HGS jämfört med dem utan klinisk relevant fatigue, dessa skillnader var statistiskt signifikanta bland män och nådde nära signifikans bland kvinnor. Det fanns däremot inte något tydligt samband mellan HGS och fysisk aktivitet hos personer med och utan KOL. I Studie III framkom en stark och valid regressionsmodell som påvisade associationer mellan HGS och benmuskelstyrka, där alla testade muskelgrupper var signifikant korrelerade till HGS. Modellen med HGS och postural kontroll var visserligen signifikant, men den var mycket svag. I Studie IV hade individer med KOL sämre postural kontroll jämfört med individer utan KOL: signifikant gällande mediolateral amplitud i stillastående test med öppna ögon på mjukt/instabilt underlag, samt anteroposterior amplitud i test av stabilitetsgränser. Hos personer med KOL var mediolateral amplitud i stillastående relaterad till synförmåga och tobaksexponering angivet som pack-år. Vidare var muskelstyrka associerat med anteroposterior amplitud i det mer dynamiska testet av stabilitetsgränser.

Konklusion

Vid populationsbaserade undersökningar under 2009-2010 var HGS lägre hos individer med svår till mycket svår KOL (GOLD 3-4) jämfört med dem utan KOL. Fem år senare var HGS lägre i gruppen med KOL jämfört med dem utan KOL, vilket kan indikera förändringar i åldersprocessen vid KOL. HGS var associerat med fatigue, men inte fysisk aktivitet, hos individer med KOL. HGS är ett användbart instrument för att uppskatta benmuskelstyrka hos äldre individer, men HGS är inte lämpligt att använda som en uppskattning av postural kontroll. Postural kontroll var nedsatt hos personer med KOL och olika tester av postural kontroll ställde olika krav på de sensoriska- och motoriska systemen. Under stillastående test där individerna hade öppna ögon var den totala 6 tobaksexponeringen och synskärpa viktigast. I det mer dynamiska testet av stabilitetsgränser var emellertid muskelstyrka viktigt. Det behövs fortsatta studier av de longitudinella aspekterna av muskelsvaghet och postural kontroll hos personer med KOL, för ökad kunskap gällande lämpliga preventiva åtgärder eller rehabiliteringsinterventioner.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2019
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:ltu:diva-75508 (URN)978-91-7790-423-6 (ISBN)978-91-7790-424-3 (ISBN)
Public defence
2019-10-18, E632, Luleå University of Technology, Luleå, 09:00 (Swedish)
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Supervisors
Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-10-17Bibliographically approved

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Strandkvist, ViktorPauelsen, MaschaLarsson, AgnetaNyberg, LarsVikman, IreneGustafsson, ThomasRöijezon, Ulrik

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