 |
|
Midlife Hand Grip Strength as a Predictor of Old Age Disability
Taina Rantanen, PhD;
Jack M. Guralnik, MD, PhD;
Dan Foley, MSc;
Kamal Masaki, MD;
Suzanne Leveille, PhD;
J. David Curb, MD;
Lon White, MD
JAMA. 1999;281:558-560.
ABSTRACT
| |
Context Poor muscle strength, functional limitations, and disability often coexist, but whether muscle strength during midlife predicts old age functional ability is not known.
Objective To determine whether hand grip strength measured during midlife predicts old age functional limitations and disability in initially healthy men.
Design and Setting A 25-year prospective cohort study, the Honolulu Heart Program, which began in 1965 among Japanese-American men living on Oahu, Hawaii.
Participants A total of 6089 45- to 68-year-old men who were healthy at baseline and whose maximal hand grip strength was measured from 1965 through 1970. Altogether, 2259 men died over the follow-up period and 3218 survivors participated in the disability assessment in 1991 through 1993.
Main Outcome Measures Functional limitations including slow customary walking speed ( 0.4 m/s) and inability to rise from a seated position without using the arms, and multiple self-reported upper extremity, mobility, and self-care disability outcomes.
Results After adjustment for multiple potential confounders, risk of functional limitations and disability 25 years later increased as baseline hand grip strength, divided into tertiles, declined. The odds ratio (OR) of walking speed of 0.4 m/s or slower was 2.87 (95% confidence interval [CI], 1.76-4.67) in those in the lowest third and 1.79 (95% CI, 1.14-2.81) in the middle third of grip strength vs those in the highest third. The risk of self-care disability was more than 2 times greater in the lowest vs the highest grip strength tertile. Adding chronic conditions identified at follow-up to the models predicting disability reduced the ORs related to grip strength only minimally.
Conclusions Among healthy 45- to 68-year-old men, hand grip strength was highly predictive of functional limitations and disability 25 years later. Good muscle strength in midlife may protect people from old age disability by providing a greater safety margin above the threshold of disability.
INTRODUCTION
In old age, decreased muscle strength predisposes people to functional limitations and disability.1-3 Cross-sectionally, muscle strength is significantly, but not linearly, associated with functional limitations such as walking speed.4-7 A minimum level of strength is needed to perform tasks. Conversely, when strength is well above the minimum required level, a reserve capacity exists.4-5,7 Reserve capacity serves as a safety margin that helps prevent functional limitations from developing, eg, following inactivity and deconditioning associated with surgery or an acute illness.
The purpose of this research was to study midlife muscle strength as a predictor of late life functional limitations and disability among initially healthy men with an average age of 54.0 years (range, 45-68 years) at baseline. The average follow-up time was 25.3 years.
METHODS
Subjects in these analyses are from the Honolulu Heart Program and the Honolulu-Asia Aging Study.8 From 1965 through 1968, 8006 men aged 45 to 68 years participated in exam 1. Exam 2 took place 3 years later (1968 through 1970), with 7498 men participating. Exam 4 data were collected from 1991 through 1993 when participants were 71 to 93 years old.
The current analyses were limited to those participants who were healthy at baseline. Persons who had missing data on disease status (n = 37); who had diabetes, gout, arthritis, stroke, heart attack, angina pectoris, or other heart disease at exam 1 or exam 2 (n = 1454); who dropped out or died between exams 1 and 2 (n = 406); or who reported at exam 4 that difficulty in upper extremity, mobility, or self-care tasks had been present for 25 years or more (n = 20) were excluded. All together, 6089 men qualified for the study cohort.
Hand grip strength was measured using a dynamometer (Smedley Hand Dynamometer, Stoelting Co, Wood Dale, Ill) at exams 1 and 2 with midlife strength determined as the average of the best results in these 2 exams.9
Measures of functional limitations at exam 4 included customary walking speed of 0.4 m/s or slower10 and inability to rise from a chair. Participants were asked to walk a distance of 3.05 m (10 ft) at their usual pace and time was measured using a stopwatch. Ability to rise from a chair was measured by asking the subject to stand up without using his arms and observing the performance. Disability was ascertained by asking the participants the following question: "Because of health or physical problems, do you have any difficulty . . . ?" Upper extremity disability items were doing heavy household work (washing the car, raking leaves, mowing the lawn, or cleaning up the garage) and lifting something as heavy as 4.5 kg (10 lb). Mobility disability items were walking 0.8 km ( mile) and walking up 1 flight of stairs. Self-care disability items were dressing, eating, bathing, and toileting.
At exam 4, the presence of chronic conditions was ascertained with ongoing surveillance using hospital records (stroke, coronary heart disease)11 or laboratory test results (coronary heart disease, diabetes, hypertension),12 or on the basis of participants' self-reports (chronic obstructive pulmonary disease, angina, arthritis).
Death ascertainment was based on perusal of newspaper obituaries and listings of death certificates filed with the Hawaii State Department of Health and through a computer linkage to the National Death Index.
Participants were divided into 3 groups based on the baseline hand grip strength tertiles. The relative risks of mortality prior to follow-up tests and functional limitations and disability at follow-up for the hand grip strength groups were estimated using multiple logistic regression models. The models were adjusted for baseline age, socioeconomic status, body weight and height, physical activity and smoking, and chronic conditions ascertained at exam 4.
RESULTS
At baseline, the average age was 54.0 years (SD, 5.5). The average hand grip strength was 39.2 kg (SD, 6.0), and the cutoff points for grip strength tertiles were 37.0 and 42.0 kg. The mean height was 160.3 cm (SD, 5.7), the mean weight was 63.2 kg (SD, 8.7), and mean body mass index was 23.7 kg/m2 (SD, 3.1).
Among the 6089 men who qualified for the study, 2259 (37%) died before exam 4. Of the 3830 survivors, 3218 (84.0%) participated in the follow-up tests. Baseline grip strength did not predict participation among the survivors.
Of these 3218 initially healthy men, 72 (2.2%) became unable to rise from a chair without using their arms, and 201 (6.2%) had a walking speed of 0.4 m/s or slower at follow-up. The numbers with self-reported disability were difficulty walking 0.8 kg ( mile) (n = 598 [18.6%]); walking up a flight of stairs (n = 451 [14.1%]);lifting 4.5 kg (10 lb) (n = 247 [7.7%]); doing heavy household work (n = 586 [18.2%]); dressing (n = 169 [5.3%]); bathing (n = 165 [5.2%]); eating (n = 72 [2.2%]); and toileting (n = 110 [3.4%]). There was a clear gradient of increasing risk for all functional limitations and disability outcomes according to weaker baseline hand grip strength tertiles (Figure 1). This gradient persisted after adjustment for multiple baseline confounders (Table 1). Finally, after adjusting for chronic conditions ascertained at exam 4, the risks of functional limitations and disability in the lowest and middle baseline grip strength tertiles decreased moderately after these adjustments, but remained statistically significant in most cases (Table 1).
|
|
|
|
Figure. Functional Limitations 25 Years After Assessing Grip Strength
Proportion of subjects with functional limitations and disability according to baseline (1965-1970) grip strength tertiles in 3218 initially healthy 45- to 68-year-old men at exam 4 from 1991-1993.
|
|
|
|
|
|
|
Table. Odds Ratios (ORs) and 95% Confidence Intervals (95% CIs) From Multiple Logistic Regression for Old Age Functional Limitation and Disability in the Lowest and Middle Midlife Grip Strength Tertiles Among 3218 Survivors, With Highest Third as the Reference Group
|
|
|
COMMENT
Our study provides strong evidence that hand grip strength predicts functional limitations and disability 25 years later in an initially healthy cohort of 45- to 68-year-old men. Those in the lowest grip strength tertile had the greatest risk and those in the middle tertile had intermediate risk compared with those in the highest tertile. Muscle strength is found to track over the life span: those who had higher grip strength during midlife remained stronger than others in old age.9 People with greater muscle strength during midlife are at a lower risk of becoming disabled because of their greater reserve of strength regardless of chronic conditions that may develop.
Hand grip strength has been found to correlate with strength of other muscle groups and is thus a good indicator of overall strength.13 Consequently, grip strength measurements could be used for early screening of populations to identify those at higher risk of physical disability related to low muscle strength. In these persons, exercise interventions aimed at improving strength in all muscle groups could potentially lower the risk of subsequent physical disability. Muscle strength can be increased substantially by physical exercise at all ages.14-16
There are also other potential explanations for our results. Grip strength may be a marker of physical activity, which itself preserves function and prevents disability.17 Low grip strength may indicate subclinical disease, which later develops into clinical disease and disability. Finally, good grip strength may mark some general intrinsic midlife vitality or motivation that tracks into good functional ability in old age.
The Japanese-American men studied here are not representative of all older people. However, it is unlikely that major racial or sex differences in the strength-disability relationship would be found, as the biomechanical principles of human movement are universal. Also, data were not available at baseline to allow for the exclusion of all participants with functional limitations and disability. However, activities of daily living disability is rare among middle-aged men: the prevalence is 0.9% among 45- to 54-year-old men and 1.8% among 55- to 64-year-old men18 and disability is usually related to a disease.19 After people with documented chronic conditions at baseline were excluded, it is likely that the baseline cohort contained very few disabled individuals.
Overall, there are very few long-term prospective studies on risk factors for disability and mortality in old age. Cigarette smoking, deviations from normal weight, and a low level of physical activity have been shown to be long-term predictors of self-reported disability and mortality in studies with 17 to 27 years of follow-up.20-22 This is the first study to show that muscle strength is a powerful predictor of physical disability as long as 25 years later. This study suggests that hand grip strength could be used for early screening of people at increased risk of physical disability in old age.
AUTHOR INFORMATION
Corresponding Author and Reprints: Taina Rantanen, PhD, Department of Health Sciences, University of Jyväskylä, PO Box 35, SF-40351 Jyväskylä, Finland (e-mail: Taina{at}maila.jyu.fi).
Author Affiliations: Epidemiology, Demography and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Md (Drs Rantanen, Guralnik, Leveille, and Mr Foley); Honolulu Heart Program, Honolulu-Asia Aging Study, Kuakini Medical Center, Honolulu, Hawaii (Drs Masaki, Curb, and White); and the University of Hawaii School of Medicine, Honolulu (Dr Curb). Dr Rantanen is now with the Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
REFERENCES
| |
1. Nagi SZ. An epidemiology of disability among older adults in the United States. Milbank Q. 1976;54:439-467.
2. Verbrugge LM, Jette AM. The disablement process. Soc Sci Med. 1994;38:1-14.
FULL TEXT
|
ISI
| PUBMED
3. Sakari-Rantala R, Era P, Rantanen T, Heikkinen E. Associations of sensory-motor functions with poor mobility in 75- and 80-year-old people. Scand J Rehabil Med. 1998;30:121-127.
FULL TEXT
|
ISI
| PUBMED
4. Buchner DM, Larson EL, Wagner EH, et al. Evidence for non-linear relationship between leg strength and gait speed. Age Ageing. 1996;24:386-391.
5. Ferrucci L, Guralnik JM, Buchner D, et al. Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities. J Gerontol A Biol Sci Med Sci. 1997;52:M275-M285.
6. Rantanen T, Era P, Heikkinen E. Maximal isometric knee extension strength and stair-mounting ability in 75- and 80-year-old men and women. Scand J Rehabil Med. 1996;28:89-93.
ISI
| PUBMED
7. Rantanen T, Guralnik JM, Izmirlian G, et al. The association of muscle strength with maximal walking speed in disabled older women. Am J Phys Med Rehabil. 1998;77:299-305.
FULL TEXT
|
ISI
| PUBMED
8. White L, Petrovitch H, Ross GW, et al. Prevalence of dementia in older Japanese-American men in Hawaii. JAMA. 1996;276:955-960.
ABSTRACT
9. Rantanen T, Masaki K, Foley D, et al. Grip strength changes over 27 years in Japanese-American men. J Appl Physiol. 1998;85:2047-2053.
FREE FULL TEXT
10. Tinetti ME, Inouye SK, Gill TM, Doucete JT. Shared risk factors for falls, incontinence, and functional dependence. JAMA. 1995;273:1348-1353.
ABSTRACT
11. Launer LJ, Masaki K, Petrovitch H, et al. The association between midlife blood pressure levels and late-life cognitive function. JAMA. 1995;274:1846-1851.
ABSTRACT
12. Rodriguez BL, Curb JD, Burchfiel CM, et al. Impaired glucose tolerance, diabetes, and cardiovascular disease risk factor profiles in the elderly. Diabetes Care. 1996;19:587-590.
ABSTRACT
13. Rantanen T, Era P, Kauppinen M, Heikkinen E. Maximal isometric muscle strength and socio-economic status, health and physical activity in 75-year-old persons. J Aging Phys Activity. 1994;2:206-220.
14. Frontera WR, Meredith CN, O'Reilly KP, Knuttgen HG, Evans WJ. Strength conditioning in older men. J Appl Physiol. 1988;64:1038-1044.
FREE FULL TEXT
15. Fiatarone MA, O'Neill EF, Doyle Ryan N, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330:1769-1775.
FREE FULL TEXT
16. Sipilä S, Multanen J, Kallinen M, Era P, Suominen H. Effects of strength and endurance training on isometric muscle strength and walking speed in elderly women. Acta Physiol Scand. 1996;156:457-464.
FULL TEXT
|
ISI
| PUBMED
17. LaCroix AZ, Guralnik JM, Berkman LF, et al. Maintaining mobility in late life, II. Am J Epidemiol. 1993;137:858-869.
FREE FULL TEXT
18. Laplante M, Carlson D. Disability in the United States: Prevalence and Causes, 1992. Washington, DC: US Dept of Education, National Institute on Disability and Rehabilitation Research; 1992. Disability Statistics Report (7).
19. Ettinger WJ, Fried LP, Harris T, et al. Self-reported causes of physical disability in older people. J Am Geriatr Soc. 1994;42:1035-1044.
ISI
| PUBMED
20. Pinsky JL, Leaverton PE, Stokes J. Predictors of good function: the Framingham Study. J Chronic Dis. 1987;40(suppl 1):159S-167S, 181S-182S.
21. Guralnik JM, Kaplan GA. Predictors of healthy aging. Am J Public Health. 1989;79:703-708.
FREE FULL TEXT
22. Lissner L, Bengtsson C, Björkelund C, Wedel H. Physical activity levels and changes in relation to longevity. Am J Epidemiol. 1996;143:54-62.
FREE FULL TEXT
RELATED ARTICLE
February 10, 1999
JAMA. 1999;281(6):581-582.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Low Plasma Carotenoids and Skeletal Muscle Strength Decline Over 6 Years
Lauretani et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2008;63:376-383.
ABSTRACT
| FULL TEXT
Physical Performance Characteristics of Assisted Living Residents and Risk for Adverse Health Outcomes
Giuliani et al.
Gerontologist 2008;48:203-212.
ABSTRACT
| FULL TEXT
Depression and Physical Function: Results From the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study)
Russo et al.
J Geriatr Psychiatry Neurol 2007;20:131-137.
ABSTRACT
HDL-cholesterol and physical performance: results from the ageing and longevity study in the sirente geographic area (ilSIRENTE Study)
Landi et al.
Age Ageing 2007;36:514-520.
ABSTRACT
| FULL TEXT
Association of low plasma selenium concentrations with poor muscle strength in older community-dwelling adults: the InCHIANTI Study
Lauretani et al.
Am. J. Clin. Nutr. 2007;86:347-352.
ABSTRACT
| FULL TEXT
High Body Mass Index and Physical Impairments as Predictors of Walking Limitation 22 Years Later in Adult Finns
Stenholm et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2007;62:859-865.
ABSTRACT
| FULL TEXT
Oxidative protein damage is associated with poor grip strength among older women living in the community
Howard et al.
J. Appl. Physiol. 2007;103:17-20.
ABSTRACT
| FULL TEXT
Age-related changes in multifinger synergies in accurate moment of force production tasks
Olafsdottir et al.
J. Appl. Physiol. 2007;102:1490-1501.
ABSTRACT
| FULL TEXT
Occupational and other risk factors for hand-grip strength: the Honolulu-Asia Aging Study
Charles et al.
Occup. Environ. Med. 2006;63:820-827.
ABSTRACT
| FULL TEXT
The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study.
Goodpaster et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2006;61:1059-1064.
ABSTRACT
| FULL TEXT
Body mass index, free insulin-like growth factor I, and physical function among older adults: results from the ilSIRENTE study
Onder et al.
Am. J. Physiol. Endocrinol. Metab. 2006;291:E829-E834.
ABSTRACT
| FULL TEXT
Allometric Analysis of Physical Performance Measures in Older Adults
Pua
ptjournal 2006;86:1263-1270.
ABSTRACT
| FULL TEXT
Magnesium and muscle performance in older persons: the InCHIANTI study.
Dominguez et al.
Am. J. Clin. Nutr. 2006;84:419-426.
ABSTRACT
| FULL TEXT
The effect of high physical load at work on physical function at old age.
Burdorf
Occup. Environ. Med. 2006;63:437-437.
FULL TEXT
Lifetime occupation and physical function: a prospective cohort study on persons aged 80 years and older living in a community.
Russo et al.
Occup. Environ. Med. 2006;63:438-442.
ABSTRACT
| FULL TEXT
Childhood socioeconomic status predicts physical functioning a half century later.
Guralnik et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2006;61:694-701.
ABSTRACT
| FULL TEXT
Developmental origins of midlife grip strength: findings from a birth cohort study.
Kuh et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2006;61:702-706.
ABSTRACT
| FULL TEXT
Handgrip strength among nonagenarians and centenarians in three European regions.
Jeune et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2006;61:707-712.
ABSTRACT
| FULL TEXT
Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study
Sayer et al.
Age Ageing 2006;35:409-415.
ABSTRACT
| FULL TEXT
Decreased Muscle Strength and Quality in Older Adults With Type 2 Diabetes: The Health, Aging, and Body Composition Study
Park et al.
Diabetes 2006;55:1813-1818.
ABSTRACT
| FULL TEXT
Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study
Cesari et al.
Am. J. Clin. Nutr. 2006;83:1142-1148.
ABSTRACT
| FULL TEXT
Does admission grip strength predict length of stay in hospitalised older patients?
Kerr et al.
Age Ageing 2006;35:82-84.
FULL TEXT
Strength, But Not Muscle Mass, Is Associated With Mortality in the Health, Aging and Body Composition Study Cohort
Newman et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2006;61:72-77.
ABSTRACT
| FULL TEXT
Endogenous Hormones, Muscle Strength, and Risk of Fall-Related Fractures in Older Women
Sipila et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2006;61:92-96.
ABSTRACT
| FULL TEXT
Muscle strength, pain, and disease activity explain individual subdimensions of the Health Assessment Questionnaire disability index, especially in women with rheumatoid arthritis
Hakkinen et al.
Ann Rheum Dis 2006;65:30-34.
ABSTRACT
| FULL TEXT
Effects of moderate-velocity strength training on peak muscle power and movement velocity: do women respond differently than men?
Delmonico et al.
J. Appl. Physiol. 2005;99:1712-1718.
ABSTRACT
| FULL TEXT
Insulin Resistance and Muscle Strength in Older Persons
Abbatecola et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:1278-1282.
ABSTRACT
| FULL TEXT
Upper and Lower Limb Muscle Power Relationships in Mobility-Limited Older Adults
Herman et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:476-480.
ABSTRACT
| FULL TEXT
Grip Strength, Postural Control, and Functional Leg Power in a Representative Cohort of British Men and Women: Associations With Physical Activity, Health Status, and Socioeconomic Conditions
Kuh et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:224-231.
ABSTRACT
| FULL TEXT
Factors Associated With Recovery of Independence Among Newly Disabled Older Persons
Hardy and Gill
Arch Intern Med 2005;165:106-112.
ABSTRACT
| FULL TEXT
Bone Mineral Density, Soft Tissue Body Composition, Strength, and Functioning After Hip Fracture
Wehren et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2005;60:80-84.
ABSTRACT
| FULL TEXT
A 32-Year Prospective Study of Change in Body Weight and Incident Dementia: The Honolulu-Asia Aging Study
Stewart et al.
Arch Neurol 2005;62:55-60.
ABSTRACT
| FULL TEXT
Leisure time physical activity and strenuousness of work as predictors of physical functioning: a 28 year follow up of a cohort of industrial employees
Leino-Arjas et al.
Occup. Environ. Med. 2004;61:1032-1038.
ABSTRACT
| FULL TEXT
The Catalase -262C/T Promoter Polymorphism and Aging Phenotypes
Christiansen et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2004;59:B886-B887.
ABSTRACT
| FULL TEXT
Does Sarcopenia Originate in Early Life? Findings From the Hertfordshire Cohort Study
Sayer et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2004;59:M930-M934.
ABSTRACT
| FULL TEXT
Age-related changes in finger coordination in static prehension tasks
Shim et al.
J. Appl. Physiol. 2004;97:213-224.
ABSTRACT
| FULL TEXT
Inflammatory Markers and Physical Performance in Older Persons: The InCHIANTI Study
Cesari et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2004;59:M242-M248.
ABSTRACT
| FULL TEXT
Hemoglobin Levels and Skeletal Muscle: Results From the InCHIANTI Study
Cesari et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2004;59:M249-M254.
ABSTRACT
| FULL TEXT
Skeletal Muscle Cutpoints Associated with Elevated Physical Disability Risk in Older Men and Women
Janssen et al.
Am J Epidemiol 2004;159:413-421.
ABSTRACT
| FULL TEXT
Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia
Lauretani et al.
J. Appl. Physiol. 2003;95:1851-1860.
ABSTRACT
| FULL TEXT
Sarcopenia: Effects on Body Composition and Function
Roubenoff
J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:M1012-1017.
ABSTRACT
| FULL TEXT
Habitual Walking and Its Correlation to Better Physical Function: Implications for Prevention of Physical Disability in Older Persons
Wong et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:M555-560.
ABSTRACT
| FULL TEXT
Effects of age and gender on finger coordination in MVC and submaximal force-matching tasks
Shinohara et al.
J. Appl. Physiol. 2003;94:259-270.
ABSTRACT
| FULL TEXT
Birth Weight, Childhood Size, and Muscle Strength in Adult Life: Evidence from a Birth Cohort Study
Kuh et al.
Am J Epidemiol 2002;156:627-633.
ABSTRACT
| FULL TEXT
Skeletal Muscle Strength as a Predictor of All-Cause Mortality in Healthy Men
Metter et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2002;57:B359-365.
ABSTRACT
| FULL TEXT
Physical Impairment and Disability: Relationship to Performance of Activities of Daily Living in Community-Dwelling Older Men
Brach and VanSwearingen
ptjournal 2002;82:752-761.
ABSTRACT
| FULL TEXT
Relationship of Interleukin-6 and Tumor Necrosis Factor-{alpha} With Muscle Mass and Muscle Strength in Elderly Men and Women: The Health ABC Study
Visser et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2002;57:M326-332.
ABSTRACT
| FULL TEXT
Etiology and modification of gait instability in older adults: a randomized controlled trial of exercise
Hausdorff et al.
J. Appl. Physiol. 2001;90:2117-2129.
ABSTRACT
| FULL TEXT
Stability and change in genetic and environmental influences on hand-grip strength in older male twins
Carmelli and Reed
J. Appl. Physiol. 2000;89:1879-1883.
ABSTRACT
| FULL TEXT
Predicting Function
Werner et al.
ptjournal 2000;80:1015-1015.
FULL TEXT
Change in Muscle Mass and Muscle Strength After a Hip Fracture: Relationship to Mobility Recovery
Visser et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2000;55:434M-440.
ABSTRACT
| FULL TEXT
Muscle Strength and Body Mass Index as Long-Term Predictors of Mortality in Initially Healthy Men
Rantanen et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2000;55:168M-173.
ABSTRACT
| FULL TEXT
|
