Cited by 317Nutrition and Health in AgingFrailty in Older AdultsAging, Health, and Disability

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Muscle strength, disability and mortality

Rantanen, T.·2003·Scandinavian Journal of Medicine & Science in Sports

DOI 10.1034/j.1600-0838.2003.00298.x

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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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“It is also known that lower handgrip strength could be related to a higher subsequent risk of poor health [5-8].”
Background
Association of Muscle Weakness With Post-Fracture Mortality in Older Men and Women: A 25-Year Prospective Study
Pham, H. M., Nguyen, S. C., Ho-Le, T. P., Eisman, J. A., & Nguyen, T. V. (2016) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.3037 · Cited by 23
“7) Weight at baseline (kg) 68 (13) 67 (13) 78 (12) 80 (13) FNBMD at baseline (g/cm(2)) 0.”
Background
Hand grip strength is associated with cardiopulmonary function in Chinese adults: Results from a cross-sectional study
Zhu, R., Li, W., Xia, L., Yang, X., Zhang, B., Liu, F., Ma, J., Hu, Z., Li, Y., Li, D., et al. (2019) · Journal of Exercise Science & Fitness · doi:10.1016/j.jesf.2019.12.001 · Cited by 23
Effects of a 12-month multi-component exercise program on the body composition of postmenopausal women
Aragão, F. R., Abrantes, C. G., Gabriel, R., Sousa, M. F., Castelo‐Branco, C., & Moreira, H. (2013) · Climacteric · doi:10.3109/13697137.2013.819328 · Cited by 23
Longitudinal Relationships of Circulating Reproductive Hormone With Functional Disability, Muscle Mass, and Strength in Community-Dwelling Older Men: The Concord Health and Ageing in Men Project
Hsu, B., Cumming, R. G., Naganathan, V., Blyth, F., Couteur, D. G. L., Seibel, M. J., Waite, L. M., & Handelsman, D. J. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-1124 · Cited by 22
Novel Use of the Nintendo Wii Board for Measuring Isometric Lower Limb Strength: A Reproducible and Valid Method in Older Adults
Jørgensen, M. G., Andersen, S., Ryg, J., & Masud, T. (2015) · PLoS ONE · doi:10.1371/journal.pone.0138660 · Cited by 24
“Reduced muscle strength at midlife increases the risk of disability by two to three fold 25 years later[2].”
Background
Can self-report instruments of shoulder function capture functional differences in older adults with and without a rotator cuff tear?
Vidt, M. E., Santago, A. C., Hegedus, E. J., Marsh, A. P., Tuohy, C. J., Poehling, G. G., Freehill, M. T., Miller, M. E., & Saul, K. R. (2015) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2015.06.009 · Cited by 21
“Others have suggested that when strength falls below a minimum threshold, disability may occur (Rantanen, 2003).”
Background
Atherosclerosis and physical functioning in older men, a longitudinal study
den Ouden, M. E. M., Schuurmans, M. J., Arts, E. M. A., Grobbee, D. E., Bots, M. L., van den Beld, A. W., Lamberts, S. W. J., & van der Schouw, Y. T. (2012) · The journal of nutrition health & aging · doi:10.1007/s12603-012-0424-2 · Cited by 20
“muscle strength and lower extremity function) is a predictor of future functional limitations and disability in older people (15, 16).”
Associations of Body Composition and Physical Activity with Balance and Walking Ability in the Elderly
Hassinen, M., Komulainen, P., Lakka, T. A., Väisänen, S., & Rauramaa, R. (2005) · Journal of Physical Activity and Health · doi:10.1123/jpah.2.3.298 · Cited by 20
“9 Among those with impaired balance, good muscle strength decreases the risk of future walking limitations.(10) The epidemic of sedentary lifestyle, overweight, and obesity is increasing the risk of chronic diseases and disability with aging in developed countries.”
Background
Grip strength and healthy aging
Kozakai, R. (2017) · The Journal of Physical Fitness and Sports Medicine · doi:10.7600/jpfsm.6.145 · Cited by 20
Associations of instrumental activities of daily living and handgrip strength with oral self‐care among home‐dwelling elderly 75+
Komulainen, K., Ylöstalo, P., Syrjälä, A.-M. H., Ruoppi, P., Knuuttila, M. L. E., Sulkava, R. O., & Hartikainen, S. A. (2012) · Gerodontology · doi:10.1111/j.1741-2358.2010.00427.x · Cited by 20
Impairment of IGF-I expression and anabolic signaling following ischemia/reperfusion in skeletal muscle of old mice
Hammers, D. W., Matheny, R. W., Sell, C., Adamo, M. L., Walters, J., Estep, J. S., & Farrar, R. P. (2010) · Experimental Gerontology · doi:10.1016/j.exger.2010.11.002 · Cited by 21
“…The substantial loss of muscle mass and function that result from TK use are a concern among the high proportion of elderly individuals who undergo orthopedic surgery, as muscle mass and strength are negatively associated with disability and mortality rates (See Rantanen, 2003 for review).”
A Review of Lifetime Risk Factors for Mortality
Kuh, D. J., Hardy, R., Hotopf, M. H., Lawlor, D. A., Maughan, B., Westendorp, R., Cooper, R., Black, S., & Mishra, G. D. (2009) · British Actuarial Journal · doi:10.1017/s135732170000550x · Cited by 19
“…of physical function are now seen as summary markers of ageing and low levels have also been shown to be associated with other adverse outcomes such as specific diseases, disability, and hospitalisation (Guralnik et al., 1994; Rantanen, 2003; Silventoinen et al., 2009; Cooper et al., in press).”
Background
The validity of ultrasound-derived equation models to predict whole-body muscle mass: A systematic review
den Broeck, J. V., Buzzatti, L., Jager‐Wittenaar, H., Perkisas, S., & Scafoglieri, A. (2021) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2021.08.012 · Cited by 20
Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation
Viberg, B., Ryg, J., Overgaard, S., Lauritsen, J. L., & Ovesen, O. C. (2013) · Acta Orthopaedica · doi:10.3109/17453674.2013.875360 · Cited by 18
Circulating Tumor Necrosis Factor Alpha May Modulate the Short-Term Detraining Induced Muscle Mass Loss Following Prolonged Resistance Training
McMahon, G. E., Morse, C. I., Winwood, K. L., Burden, A., & Onambélé-Pearson, G. L. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00527 · Cited by 18
“Reduced levels of skeletal muscle mass and strength are associated with many chronic diseases and increased mortality in humans (Rantanen, 2003; Oterdoom et al., 2009; Kalyani et al., 2014; Bowen et al., 2015), understanding the fundamental adaptation of skeletal muscle is therefore, key to…”
Background
Association between tooth loss and handgrip strength in a general adult population
Zhou, Z., Gu, Y., Zhang, Q., Liu, L., Wu, H., Meng, G., Bao, X., Zhang, S., Sun, S., Wang, X., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0236010 · Cited by 18
Association between systemic inflammation and activities of daily living disability among Chinese elderly individuals: the mediating role of handgrip strength
Qin, K., Lin, L., Lu, C., Chen, W., & Guo, V. Y. (2021) · Aging Clinical and Experimental Research · doi:10.1007/s40520-021-02003-w · Cited by 18
Fitness consultations in routine care of patients with type 2 diabetes in general practice: an 18-month non-randomised intervention study
Lohmann, H., Siersma, V., & Olivarius, N. D. F. (2010) · BMC Family Practice · doi:10.1186/1471-2296-11-83 · Cited by 18
“Increases in cardio-respiratory fitness, muscle strength and level of physical activity are associated with decreased mortality and protect against age-related disabilities [1-7].”
Background
Water-Based Training Programs Improve Functional Capacity, Cognitive and Hemodynamic Outcomes? The ACTIVE Randomized Clinical Trial
Häfele, M. S., Alberton, C. L., Häfele, V., Schaun, G. Z., Nunes, G. N., Calonego, C., Castro, T. F., Andrade, L. S., & Pinto, S. S. (2022) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2021.1935433 · Cited by 17
“The 30-s chair-stand test is an easy tool to evaluate lower limbs muscular strength and better results are strongly associated with lower mortality risk (Pate et al., 1995; Rantanen, 2003).”
Method
Long-term clinical outcomes in critically ill patients with sepsis and pre-existing low muscle mass: a retrospective cohort study
Darden, N., Sharma, S., Wu, X., Mancini, B., Karamchandani, K., & Bonavia, A. S. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02274-y · Cited by 18
“The frequent coexistence of sarcopenia and sepsis in older patients has created a need to understand how these conditions interact to influence patient outcomes [3–5].”
Background
The Association Between Sarcopenia and Prealbumin Levels Among Elderly Chinese Inpatients
Chen, Q., Hao, Q., Ding, Y., & Dong, B. (2018) · The journal of nutrition health & aging · doi:10.1007/s12603-018-1130-5 · Cited by 19
Relative strength as a determinant of mobility in elders 67–84 years of age. A NuAge study: Nutrition as a determinant of successful aging
Choquette, S., B̀ouchard, D. R., Doyon, C. Y., Sénéchal, M., Brochu, M., & Dionne, I. J. (2009) · The journal of nutrition health & aging · doi:10.1007/s12603-009-0132-8 · Cited by 17
The Role of Obesity, Body Composition, and Nutrition in COVID-19 Pandemia: A Narrative Review
Rossi, A. P., Muollo, V., Valle, Z. D., Urbani, S., Pellegrini, M., Ghoch, M. E., & Mazzali, G. (2022) · Nutrients · doi:10.3390/nu14173493 · Cited by 18
Vascular status and physical functioning: the association between vascular status and physical functioning in middle-aged and elderly men: a cross-sectional study
Arts, I. E. M. A., Schuurmans, M. J., Grobbee, D. E., & van der Schouw, Y. T. (2010) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e3283348ec0 · Cited by 17
Could Questions on Activities of Daily Living Estimate Grip Strength of Older Adults Living Independently in the Community?
Simard, J., Chalifoux, M., Fortin, V., Archambault, M. J., St-Cerny-Gosselin, A., & Desrosiers, J. (2012) · Journal of Aging Research · doi:10.1155/2012/427109 · Cited by 17
“It is an easily measurable variable [3, 4] and a good indicator of frailty and future disability [5–7].”
Background
Age-related variation in mobility independence among wheelchair users with spinal cord injury: A cross-sectional study
Hinrichs, T., Lay, V., Arnet, U., Hoogland, I. E., Koch, H. G., Rantanen, T., Reinhardt, J. D., & Brinkhof, M. W. G. (2015) · Journal of Spinal Cord Medicine · doi:10.1179/2045772315y.0000000008 · Cited by 17
Self-citation
“With Every Step, We Grow Stronger”: The Cardiometabolic Benefits of an Indigenous-Led and Community-Based Healthy Lifestyle Intervention
Lai, H., Miles, R. M., Bredin, S. S. D., Kaufman, K., Chua, C. Z. Y., Hare, J., Norman, M. E., Rhodes, R. E., OH, P. I., & Warburton, D. E. R. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8040422 · Cited by 23
“In particular, musculoskeletal programs should focus on improving and/or maintaining grip strength, since grip strength is positively correlated to performance in activities of daily living [58] and inversely related to premature mortality and developing chronic disability [59,60].”
Background
Bio-impedance analysis for appendicular skeletal muscle mass assessment in (pre-) frail elderly people
van Baar, H., Hulshof, P. J. M., Tieland, M., & de Groot, C. P. G. M. (2015) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2015.05.002 · Cited by 15
“It increases the risk for adverse outcomes such as the onset of disability [2,3],morbidity, and institutionalization [2,4,5].”
Background
Reliability of point-of-care ultrasound for measuring quadriceps femoris muscle thickness
Pinto-Ramos, J., Santos, C., Costa, F., Tavares, H., Cabral, J., Moreira, T. S., BRITO, R., Barroso, J., & Sousa‐Pinto, B. (2022) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.22.07432-9 · Cited by 16
“Previous mRankin, median (P25-P75) 0 (0-1) Current mRankin, median (P25-P75) 3 (2-4) Medical research council sum score, median (P25-P75) 46 (43-47.”
Background
Reductions in Motor Unit Firing are Associated with Clinically Meaningful Leg Extensor Weakness in Older Adults
Wages, N. P., Mousa, M. H., Clark, L. A., Tavoian, D., Arnold, W. D., Elbasiouny, S. M., & Clark, B. C. (2023) · Calcified Tissue International · doi:10.1007/s00223-023-01123-x · Cited by 16
Age-related site-specific muscle loss in the thigh and zigzag walking performance in older men and women
Abe, T., Loenneke, J. P., Thiebaud, R. S., Ogawa, M., & Mitsukawa, N. (2014) · Acta Physiologica Hungarica · doi:10.1556/aphysiol.101.2014.006 · Cited by 16
Prevention and Treatment of Frailty in the Postmenopausal Woman
Shore, W. S., & deLateur, B. J. (2007) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2007.04.004 · Cited by 16
“As part of the Women’s Health and Aging Study, Rantanen and colleagues [ 41 ,42] found that absolute grip strength was a powerful predictor of cause-specific and total mortality.”
Background
Sarcopenia Indicators as Predictors of Functional Decline and Need for Care among Older People
Bjorkman, M. P., Jyväkorpi, S. K., Strandberg, T. E., Pitkälä, K. H., & Tilvis, R. S. (2019) · The journal of nutrition health & aging · doi:10.1007/s12603-019-1280-0 · Cited by 18
Ultrasound imaging for age-related differences of lower extremity muscle architecture
Kim, M. K., Ko, Y. J., Lee, H. J., Ha, H. G., & Lee, W. H. (2015) · Physical therapy rehabilitation science · doi:10.14474/ptrs.2015.4.1.38 · Cited by 15
“Age-related loss of skeletal muscle mass among the elderly and very elderly results in an increased risk of several diseases and mortality as well as reduced physical functioning and the eventual loss of functional independence [1,2].”
Background
Low- and High-Volume Water-Based Resistance Training Induces Similar Strength and Functional Capacity Improvements in Older Women: A Randomized Study
Reichert, T. L., Delevatti, R. S., Prado, A. K. G., Bagatini, N. C., Simmer, N. M., Meinerz, A. P., Barroso, B. M., Costa, R. R., Kanitz, A. C., & Kruel, L. F. M. (2018) · Journal of Physical Activity and Health · doi:10.1123/jpah.2017-0286 · Cited by 15
Leg press and chest press strength normative values by half-decades in older persons
Parrino, R. L., Strand, K. L., Hockman, A. C., & Signorile, J. F. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111401 · Cited by 14
Fitness, Strength and Body Composition during Weight Loss in Women with Clinically Severe Obesity: A Randomised Clinical Trial
Miller, C. T., Fraser, S. F., Selig, S., Rice, T., Grima, M. T., van den Hoek, D., Sari, C. I., Lambert, G. W., & Dixon, J. B. (2020) · Obesity Facts · doi:10.1159/000506643 · Cited by 14
Gene transcripts associated with muscle strength: a CHARGE meta-analysis of 7,781 persons
Pilling, L. C., Joehanes, R., Kacprowski, T., Peters, M. J., Jansen, R., Karasik, D., Kiel, D. P., Harries, L. W., Teumer, A., Powell, J. E., et al. (2016) · Physiological Genomics · doi:10.1152/physiolgenomics.00054.2015 · Cited by 14
“MUSCLE STRENGTH CORRELATES with health and physical function, and poor muscle strength in midlife is a strong, independent predictor of health status decline and mortality over 25 yr (40).”
Background
Effects of Mobility Training on Gait and Balance
Ramsey, V. K., Blasch, B. B., & Kita, A. (2003) · Journal of Visual Impairment & Blindness · doi:10.1177/0145482x0309701107 · Cited by 14
“Additional tests included the Falls Efficacy Scale (Tinetti, Richman, & Powell, 1990), a Likert-scale survey used to measure subjects' confidence in balance during mobility-oriented and other daily tasks, and grip-strength measures for the left and right hands, which are correlated with the risk factor for falls and o…”
Method
Association of Aging-Related Endophenotypes With Mortality in 2 Cohort Studies: the Long Life Family Study and the Health, Aging and Body Composition Study
Singh, J., Schupf, N., Boudreau, R. M., Matteini, A. M., Prasad, T., Newman, A. B., Liu, Y., Christensen, K., & Kammerer, C. M. (2015) · American Journal of Epidemiology · doi:10.1093/aje/kwv143 · Cited by 13
APPENDICULAR LEAN SOFT TISSUE: DEVELOPMENT AND CROSS-VALIDATION OF PREDICTIVE MODELS FOR OLDER MEN AND WOMEN
Gomes, I., Gobbo, L. A., Silva, A. M., Júnior, I. F. F., Duarte, Y. A. O., Marucci, M. D. F. N., dos Santos, V. R., & Lebrão, M. L. (2013) · The Journal of Frailty & Aging · doi:10.14283/jfa.2013.10 · Cited by 13
Peak torque, rate of torque development and average torque of isometric ankle and elbow contractions show excellent test–retest reliability
Simpson, D., Ehrensberger, M., Nulty, C. D., Regan‐Moriarty, J., Broderick, P. B., Blake, C. M., & Monaghan, K. (2018) · Hong Kong Physiotherapy Journal · doi:10.1142/s1013702519500069 · Cited by 16
“Joint torque produced by muscle strength contributes to normal movement and athletic performance, assists in joint stability and posture control during activities of daily living and plays a vital role in the maintenance of functional independence during the aging process.(2,3) The measurement of maximal muscular stre…”
Background
The Associations between Pain Sensitivity and Knee Muscle Strength in Healthy Volunteers: A Cross-Sectional Study
Henriksen, M., Klokker, L., Bartholdy, C. R., Graven‐Nielsen, T., & Bliddal, H. (2013) · Pain Research and Treatment · doi:10.1155/2013/787054 · Cited by 13
“Adequate muscle function is crucial to maintain an independent life style, and reduced knee muscle strength is further associated with elevated risks of disability and mortality [5].”
Background
Muscle Strength as a Predictor of Gait Variability after Two Years in Community-Living Older Adults
Bogen, B. E., Moe‐Nilssen, R., Aaslund, M. K., & Ranhoff, A. H. (2020) · The Journal of Frailty & Aging · doi:10.14283/jfa.2019.24 · Cited by 13
“Muscle strength may therefore primarily be an indication of general health, fitness and a physically active lifestyle (20), and gait variability may be lower in fit and healthy people (21).”
Mobility performance among healthy older adults eligible for long-term care in Japan: a prospective observational study
Otsuka, H., Kobayashi, H. H., Suzuki, K., Hayashi, Y., Ikeda, J., Kushimoto, M., Omoto, W., Hara, M., Abe, M., Kato, K., et al. (2019) · Aging Clinical and Experimental Research · doi:10.1007/s40520-019-01404-2 · Cited by 13
Muscular strength and diameter as determinants of aerobic power and aerobic power response to exercise training in CAD patients
Thomaes, T., Thomis, M. A., Onkelinx, S., Goetschalckx, K., Fagard, R., Cornelissen, V., & Vanhees, L. (2012) · Acta cardiologica. Supplementum · doi:10.1080/ac.67.4.2170680 · Cited by 13

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
DOI: 10.1034/j.1600-0838.2003.00298.x
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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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Muscle strength, disability and mortality

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