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Muscle strength, disability and mortality
Abstract
The aims of this review are to address (1) the role of muscle strength in the disablement process and (2) muscle strength as a predictor of length of life using data from prospective studies. Functional limitations, such as slow walking speed, predispose older people to disabilities. How much strength is needed for daily motor tasks such as walking varies according to other impairments present. For example, when postural balance is good, only minimum amount of strength is needed for walking. However, in the presence of balance impairment, having good level of strength may help to compensate for the deficit. Having strength well above the required level indicates reserve capacity. It was studied using data from the Honolulu Heart Program launched in 1965 among 8006 men initially aged 45–68 years, whether reserve of strength would be protective of development of future disability. All men with documented diseases at baseline were excluded from the analyses. Those men who were in the lowest third of the distribution of grip strength at baseline were at two to three times greater risk of developing disabilities assessed 25 years later compared to the highest third. It is possible that before they reach the disability level, those with greater reserve of strength may afford to lose more strength, for example following bed rest and inactivity associated with an illness. Midlife grip strength was also found to predict long‐term total mortality: those with poorer strength at baseline were more likely to die over the follow‐up period of 30 years. The association between muscle strength and disability is largely explained by biomechanical mechanisms. However, the mechanism explaining the association between muscle strength and mortality risk still remains to be explored.
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“A number of studies have shown that lower grip strength in men and women is associated with an increased risk of disability, morbidity and mortality in later life [1-6], as well as with impaired quality of life particularly in older people [7-10].”
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Sylliaas, H., Idland, G., Sandvik, L., Forsén, L., & Bergland, A. (2009) · European Journal of Epidemiology · doi:10.1007/s10654-009-9348-5 · Cited by 73
“Mortality increases after fractures and especially after hip fractures [14–16].”
BackgroundRubio‐Arias, J. Á., Rodríguez‐Fernández, R., Andreu‐Caravaca, L., Martínez-Aranda, L. M., Martínez-Rodriguez, A., & Ramos‐Campo, D. J. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8122156 · Cited by 75
“This decrease in muscle mass due to aging also generates a decrease in muscle strength and, therefore, a physical disability generating a functional limitation (activities of the daily life) as well as a decrease in the life quality [9,10] with an associated increase in the risk of mortality [11,12].”
BackgroundHandgrip strength, ageing and mortality in rural Africa
Koopman, J. J. E., van Bodegom, D., van Heemst, D., & Westendorp, R. G. J. (2014) · Age and Ageing · doi:10.1093/ageing/afu165 · Cited by 70
Xanthos, P. D., Gordon, B. A., & Kingsley, M. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.12.076 · Cited by 70
Khalafi, M., Akbari, A., Symonds, M. E., Pourvaghar, M. J., Rosenkranz, S. K., & Tabari, E. (2023) · Cytokine · doi:10.1016/j.cyto.2023.156303 · Cited by 69
Dietary Diversity and Healthy Aging: A Prospective Study
Zhang, J., & Zhao, A. (2021) · Nutrients · doi:10.3390/nu13061787 · Cited by 71
“First, the aging process is characterized by a loss of muscle mass and strength [37], increasing the risks of functional impairment [38], disability [39], and frailty [40].”
BackgroundChen, P., Lin, M.-H., Peng, L., Liu, C., Chang, C.-W., Lin, Y.-T., & Chen, L. (2012) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2012.02.002 · Cited by 69
ActiFE Ulm Study Group, Denkinger, M. D., Franke, S., Rapp, K., Weinmayr, G., Duran‐Tauleria, E., Nikolaus, T., & Peter, R. (2010) · BMC Geriatrics · doi:10.1186/1471-2318-10-50 · Cited by 67
“It has been shown to be highly and independently predictive of functional limitations and disability [42].”
BackgroundDuchowny, K. A., Clarke, P. J., & Peterson, M. D. (2017) · The journal of nutrition health & aging · doi:10.1007/s12603-017-0951-y · Cited by 71
“Consistent with existing work (12, 13, 15, 22), the results of this study indicate that older adults with clinical muscle weakness, as identified by sex/race specific”
Sharples, A. P., Polydorou, I., Hughes, D. C., Owens, D. J., Hughes, T. M., & Stewart, C. E. (2015) · Biogerontology · doi:10.1007/s10522-015-9604-x · Cited by 64
“These factors are associated with increased risk of disability, morbidity and mortality later in life (Gale et al. 2007; Laukkanen et al. 1995; Rantanen 2003; Rantanen et al. 1999, 2002).”
BackgroundHemodynamic Responses to Resistance Exercise in Patients with Coronary Artery Disease
Gjøvaag, T. F., Mirtaheri, P., SIMON, K., Berdal, G., TUCHEL, I., WESTLIE, T., Bruusgaard, K. A., Nilsson, B. B., & Hisdal, J. (2015) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000811 · Cited by 64
“Relating to this, decreased muscle strength is an independent predictor of all-cause mortality (29), and it is”
BackgroundSilva, M. R., Alberton, C. L., Portella, E. G., Nunes, G. N., Martin, D. G., & Pinto, S. S. (2018) · Experimental Gerontology · doi:10.1016/j.exger.2018.02.018 · Cited by 62
“Additionally, strong evidences indicate that low muscle strength is associated to mortality risk (Metter et al., 2002; Rantanen, 2003), on that account becoming an important outcome to be investigated.”
Carlsson, M., Littbrand, H., Gustafson, Y., Lundin‐Olsson, L., Lindelöf, N., Rosendahl, E., & Håglin, L. (2011) · The journal of nutrition health & aging · doi:10.1007/s12603-011-0017-5 · Cited by 61
Beaudart, C., Edwards, M. H., Moss, C. L., Reginster, J., Moon, R. J., Parsons, C. M., Demoulin, C., Rizzoli, R., Biver, E., Dennison, E. M., et al. (2016) · Age and Ageing · doi:10.1093/ageing/afw192 · Cited by 60
Factors underlying tiredness in older adults
Avlund, K., Rantanen, T., & Schroll, M. (2007) · Aging Clinical and Experimental Research · doi:10.1007/bf03325206 · Cited by 58
Self-citationPredicting the walking speed of pedestrians on stairs
Fujiyama, T., & Tyler, N. (2010) · Transportation Planning and Technology · doi:10.1080/03081061003643770 · Cited by 61
“In physiological research on the strength of lower limbs and walking speeds, the strength of legs has been found to be associated with functional limitations, such as walking speed (Rantanen 2003).”
BackgroundStrobl, R., Müller, M., Emeny, R. T., Peters, A., & Grill, E. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-137 · Cited by 57
“This is likely to be associated with decreasing muscle strength, decreased radius of activity and reduced cardiopulmonary fitness [44-47].”
BackgroundPrasitsiriphon, O., & Pothisiri, W. (2018) · Clinical Medicine Insights Cardiology · doi:10.1177/1179546818771894 · Cited by 55
Paturi, S., Gutta, A. K., Katta, A., Kakarla, S. K., Arvapalli, R. K., Gadde, M. K., Nalabotu, S. K., Rice, K. M., Wu, M., & Blough, E. (2010) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2010.01.008 · Cited by 54
“Age-related atrophy or sarcopenia is thought to be a consequence of normal aging and it is characterized by decreased muscle strength, reduced performance and a diminished capacity to undergo hypertrophy following an increase in muscle loading (Chale-Rush et al., 2009; Lauretani et al., 2003; Rantanen, 2003; Wu et al.…”
InfluentialInterval and Strength Training in CAD Patients
Helgerud, J., Karlsen, T., Kim, W. Y., Høydal, K. L., Støylen, A., Pedersen, H., Brix, L., Ringgaard, S., Kværness, J., & Hoff, J. (2010) · International Journal of Sports Medicine · doi:10.1055/s-0030-1267180 · Cited by 54
Voice and Handgrip Strength Predict Reproductive Success in a Group of Indigenous African Females
Atkinson, J., Pipitone, R. N., Sorokowska, A., Sorokowski, P., Mberira, M. L., Bartels, A., & Gallup, G. G. (2012) · PLoS ONE · doi:10.1371/journal.pone.0041811 · Cited by 54
“Higher HGS is associated with reduced elderly mortality and disability [50–56], and low HGS in adults is highly predictive of later-life mortality and disability levels [49,56–60].”
BackgroundCan Aerobic Training Improve Muscle Strength and Power in Older Men?
Lovell, D. I., Cuneo, R. C., & Gass, G. C. (2010) · Journal of Aging and Physical Activity · doi:10.1123/japa.18.1.14 · Cited by 52
“The capacity of older individuals to maintain muscle strength and power is an essential factor in maintaining independence (Rantanen, 2003).”
BackgroundJones, K., Baker, K., Speight, R. A., Thompson, N. P., & Tew, G. A. (2020) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16002 · Cited by 52
“The median (IQR) number of exercise sessions completed by each participant was 50 (36-59) of a possible 78 (10/12 [8-12] supervised, 39/66 [24-48] unsupervised).”
BackgroundThe association between sarcopenia and functional disability in older adults
Zhou, H., Ding, X., & Luo, M. (2024) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2023.100016 · Cited by 56
“Higher muscle strength could provide individuals with a protective reserve against the development of ADLs and IADLs disability [29], and a previous study reported that the prevalence of ADLs and IADLs disability increases with muscle strength shown to decrease [30].”
The avoidance model in knee and hip osteoarthritis: a systematic review of the evidence
Holla, J., Sanchez‐Ramirez, D. C., van der Leeden, M., Ket, J. C. F., Roorda, L. D., Lems, W. F., Steultjens, M. P. M., & Dekker, J. (2014) · Journal of Behavioral Medicine · doi:10.1007/s10865-014-9571-8 · Cited by 52
“Subsequently, muscle weakness may directly lead to activity limitations because muscle strength is needed for all activities of daily living (Rantanen, 2003); and muscle weakness may indirectly lead to activity limitations via”
BackgroundSarcopenia as a public health problem
Bruyère, O., Beaudart, C., Locquet, M., Buckinx, F., Pétermans, J., & Reginster, J.-Y. (2016) · European Geriatric Medicine · doi:10.1016/j.eurger.2015.12.002 · Cited by 54
“[17,18].”
Effects of aging on behavior and leg kinematics during locomotion in two species of cockroach
Ridgel, A. L., Ritzmann, R. E., & Schaefer, P. L. (2003) · Journal of Experimental Biology · doi:10.1242/jeb.00714 · Cited by 50
“Reduction in motor activity in aged animals could be the result of deterioration in the musculature (Anderson, 2003; Rantanen, 2003), sensory neurons (Bergman and Ulfhake, 1998; Ulfhake et al., 2002) and/or motor neurons (Parkes et al., 1999).”
BackgroundMartín, M. A. C., Silleras, B. D. M., Malafarina, V., López-Mongil, R., Niño-Martín, V., López-Trigo, J. A., & Redondo-del-Río, M. P. (2015) · Maturitas · doi:10.1016/j.maturitas.2015.04.018 · Cited by 49
Martin, H., Syddall, H. E., Dennison, E. M., Cooper, C. C., & Sayer, A. A. (2008) · Age and Ageing · doi:10.1093/ageing/afn148 · Cited by 47
Makizako, H., Tsutsumimoto, K., Doi, T., Hotta, R., Nakakubo, S., Liu-Ambrose, T. Y. L., & Shimada, H. (2015) · Trials · doi:10.1186/s13063-015-1032-3 · Cited by 49
“Handgrip strength and walking speed are simple, easy to implement in community settings, and strong predictors of health outcomes [40].”
Abe, T., Kawakami, Y., 近藤, 正., & Fukunaga, T. (2011) · Clinical Physiology and Functional Imaging · doi:10.1111/j.1475-097x.2011.01021.x · Cited by 47
“Age-related loss of skeletal muscle mass (SMM), which is defined as sarcopenia, leads to an increased risk of several diseases and mortality as well as reduced physical function and may eventually result in the loss of functional independence (Rantanen, 2003; Sowers et al., 2005).”
BackgroundClinically Relevant Physical Benefits of Exercise Interventions in Breast Cancer Survivors
Kirkham, A. A., Bland, K. A., Sayyari, S., Campbell, K. L., & Davis, M. K. (2016) · Current Oncology Reports · doi:10.1007/s11912-015-0496-3 · Cited by 45
Changes in Physical Activity and Body Composition in Postmenopausal Women over Time
Sims, S. T., Kubo, J. T., Desai, M., Bea, J. W., Beasley, J. M., Manson, J. E., Allison, M., Seguin‐Fowler, R. A., Chen, Z., Michael, Y. L., et al. (2013) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31828af8bd · Cited by 44
“First, the prevention of sarcopenia may attenuate risk of falls, loss of independence, and loss of physical function (8,9,12,14, 16,26,33).”
BackgroundSensory and Motor Peripheral Nerve Function and Incident Mobility Disability
Ward, R. E., Boudreau, R. M., Caserotti, P., Harris, T. B., Živković, S., Goodpaster, B. H., Satterfield, S., Kritchevsky, S. B., Schwartz, A. V., Vinik, A. I., et al. (2014) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13152 · Cited by 44
Martín, M. A. C., Silleras, B. D. M., Malafarina, V., López-Mongil, R., Niño-Martín, V., López-Trigo, J. A., & Redondo-del-Río, M. P. (2015) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2015.07.007 · Cited by 44
Pinto-Ramos, J., Moreira, T. S., Costa, F., Tavares, H., Cabral, J., Santos, C., Barroso, J., & Sousa‐Pinto, B. (2022) · PLoS ONE · doi:10.1371/journal.pone.0268254 · Cited by 51
Physical Fitness in Young Adults Born Preterm
Tikanmäki, M., Tammelin, T., Sipola‐Leppänen, M., Kaseva, N., Matinolli, H., Miettola, S., Eriksson, J. G., Järvelin, M., Vääräsmäki, M., & Kajantie, E. (2015) · PEDIATRICS · doi:10.1542/peds.2015-1289 · Cited by 43
“This question is 100 important because both cardiorespiratory and muscular fitness are independent predictors of 101 cardiometabolic and musculoskeletal health(13-15) and lower late-life mortality.(16,17) 102”
Background
Metadata
- Authors
- Rantanen, T.
- Affiliations
- University of Jyväskylä (FI)
- Corresponding author
- Rantanen, T.
- ORCID
- Rantanen, T.
- Venue
- Scandinavian Journal of Medicine & Science in Sports
- Publisher
- Wiley
- Published
- 2003-01-14
- Volume
- 13
- Issue
- 1
- Pages
- 3-8
- ISSN
- 0905-7188 (ISSN-L)
- 1600-0838
- OpenAlex
- W2005358707
- Cited by
- 317
- References
- 41
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 11 · 2023: 11 · 2022: 11 · 2021: 16 · 2020: 12 · 2019: 17 · 2018: 16 · 2017: 17 · 2016: 15 · 2015: 24 · 2014: 18 · 2013: 25 · 2012: 14
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Medicine and Science in Sports (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- muscle strength, grip strength, disability, mortality, functional limitations, older adults, walking speed, postural stability, reserve capacity, Honolulu Heart Program, biomechanical mechanisms
- MeSH terms
- Activities of Daily Living, Aging, Disability Evaluation, Humans, Mortality, Risk Factors, Muscle, Skeletal
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