Are we maximizing the utility of handgrip strength assessments for evaluating muscle function?
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Are we maximizing the utility of handgrip strength assessments for evaluating muscle function? Ryan McGrath1 Received: 9 July 2020 / Accepted: 19 August 2020 © Springer Nature Switzerland AG 2020
Introduction Poor muscle function represents the onset of the disabling cascade that leads to age-related disease and disability [1]. Handgrip dynamometers are used to measure handgrip strength (HGS) in clinical and research settings. Maximal HGS is a convenient assessment of strength capacity and reliable measure of muscle function [1]. Low HGS is robustly associated with a variety of health conditions [1], and is also used in decision algorithms for determining morbidities such as sarcopenia. Thus, HGS is recommended for routine geriatric health assessments, because it is a clinically-relevant screening tool that has procedural ease [1]. Controversy exists, however, for using HGS as a proxy assessment of overall strength capacity. Criticism surrounding HGS generally fits the premise that HGS is a measure of upper extremity strength, and the strength of the upper extremities should not be generalizable to the whole body. Measures of muscle function that occur on the lower extremities, such as knee extension power, also have strong prognostic value. For example, leg extension power is highly related to physical performance, is a better predictor of mortality relative to muscle strength, and declines earlier and faster than muscle mass and strength [1]. Therefore, advocacy exists for using measures of muscle function from the lower extremities. Yet, measuring knee extension power requires complex and expensive equipment [1]. Moreover, knee extension power is already highly related to HGS, less feasible to measure, and lacks any well-established standardized protocols [1]. Thus, while conducting knee extension power tests may provide additional insights into muscle function, the information gained by collecting knee extension power may not outweigh the feasibility lost. * Ryan McGrath [email protected] 1
Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
Another controversy surrounding HGS is that the health conditions associated with low HGS are broad [2]. For example, low HGS has been shown to be associated with several health conditions during aging such as chronic cardiometabolic morbidities, cognitive impairment, functional disability, poor mobility, frailty, and early all-cause mortality [2]. Given that low HGS is associated with such wideranging health conditions, healthcare providers that utilize HGS for assessing muscle function may experience challenges explaining what exactly low HGS is a risk factor for to their patients [2]. Therefore, the usefulness of HGS to specify prognosis for age-related disease and disability is limited. While the prognostic utility and feasibility of HGS is robust, measures of HGS are not without shortcomings. Opportunities could exist for advancing HGS protocols guidelines and improving the operationalization o
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