Impaired grip strength in children with congenital heart disease

ObjectivesGrip strength is known to be reduced in adults with congenital heart disease (CHD). This study compared grip strength in paediatric patients with CHD with healthy controls and determined a possible association between grip strength and health-related physical fitness (HRPF).MethodsGrip strength and HRPF were assessed in 569 children (12.4 years, 95% CI 12.16 to 12.72; 238 girls) with various CHD and compared with 2551 healthy controls (11.4 years, 95% CI 11.3 to 11.5; 1424 girls). Grip strength was determined as the maximum value of three repetitions with each hand. HRPF was tested by five motor tasks (FITNESSGRAM) and converted into an SD score (z-score).ResultsAfter adjusting for age, sex and weight, children with CHD showed significantly lower grip strength compared with healthy controls (CHD: 20.8 kg, 95% CI 20.4 to 21.2; controls: 24.5 kg, 95% CI 24.3 to 24.8). CHD subgroup analysis also revealed significantly lower grip strength than the controls, with the lowest values in patients with total cavopulmonary connection (19.1, 95% CI 18.0 to 20.2). Children with complex CHD showed the lowest values with 19.19.8 kg (95% CI 19.2 to 20.4), those with moderate 20.7 kg (95% CI 19.9 to 21.4) and those with simple 22.5 kg (95% CI 21.6 to 23.3), respectively. HRPF was also lower (z-score: −0.46, 95% CI −0.49 to –0.35) compared with healthy controls and poorly associated with grip strength (r=0.21).ConclusionsGrip strength is already reduced in children with CHD and poorly associated with HRPF. This suggests that grip strength and HRPF are different domains and have to be assessed separately.

Lower Grip Strength and Insufficient Physical Activity Can Increase Depressive Symptoms Among Middle-Aged and Older European Adults

Objectives: The present study aimed to explore the interaction between grip strength and physical activity on depression, and investigate the association of physical activity with the change in depression by different grip strength groups among middle-aged and older European adults.Methods: A total of 13936 participants aged 50 years or older from the Survey of Health, Ageing and Retirement in Europe 2007-2017 were included in this study. Group-based trajectory modeling was used to identify the low, middle and high group of grip strength by gender. Generalized estimated equations were fitted to analyze the interaction effect.Results: Significant interactions between grip strength group and physical inactivity were found (O interaction=16.70, p<0.001). Significant interactions between physical inactivity and time on depression were identified in low (b interaction=22.15, p<0.001) and moderate (j interaction=22.85, p<0.001) grip strength, but a similar result was not found in high grip strength (e interaction=3.20, p=0.526). Participants in the physical inactivity group had higher depression scores in the low and moderate grip strength group.Conclusions: Grip strength and physical inactivity have interaction with depression. Lower grip strength and insufficient physical activity could increase depressive symptoms. People with lower grip strength and physical inactivity should pay special attention to the prevention of depression.

Assessment of Musculoskeletal Pain, Fatigue and Grip Strength in Hospitalized Patients with COVID-19

IMPORTANCE Coronavirus disease 2019 (COVID-19) is an emerging disease that was declared as a pandemic by WHO. Although there are many retrospective studies to present clinical aspects of the COVID-19, still the involvement of the musculoskeletal system has not been deeply investigated.OBJECTIVE To classify the symptoms of musculoskeletal system in COVID-19 patients, to evaluate myalgia, arthralgia and physical/mental fatigue, to assess handgrip muscle strength, and to examine the relationship of these parameters with the severity and laboratory values of the disease. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was performed at the IUC-Cerrahpaşa Pandemic Clinic. Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study. Data were recorded from May 15,2020, to June 30, 2020.MAIN OUTCOMES AND MEASURES Demographic data, comorbidities, musculoskeletal symptoms, laboratory findings and CT scans were recorded. To determine the disease severity 2007 idsa/ats guidelines for community acquired pneumonia was used. Myalgia severity was calculated by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer.RESULTS 103 patients (68.7%) were nonsevere and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue (133 [85.3%]), followed by myalgia (102 [68.0%]), arthralgia (65 [43.3%]) and back pain (33 [22.0%]). Arthralgia, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, showed significant correlation with disease severity. There was severe myalgia according to NRS regardless of disease severity. The physical fatigue severity score was significantly higher in severe cases, whereas no relationship was found with mental fatigue score. Female patients with severe infection had lower grip strength with a mean value of 18.26 kg (P= .010) in dominant hand, whereas no relationship was found between disease severity and grip strength in male patients, but the mean values in both genders and in decades appears below the specified normative values. Lactate dehydrogenase (LDH) level and lymphocyte count were significantly correlated with lower grip strength. LDH, C-reactive protein (CRP) and D-dimer levels were above the normal range in patients with myalgia, arthralgia and fatigue. CONCLUSIONS AND RELEVANCE Musculoskeletal symptoms are quite common aside from other multi-systemic symptoms in patients with COVID-19. Arthralgia, which is related to the disease severity, should be considered apart from myalgia. COVID-19 patients have severe ischemic myalgia regardless of the disease activity. Although there is a muscle weakness in all patients, the loss of muscle function is related with the disease activity especially in women. Muscular involvement in coronavirus disease is a triangle of myalgia, physical fatigue, and functional impairment.

Grip Strength in Adults and Children with Cystinosis

Background: Chronic kidney disease (CKD) is associated with impaired muscle strength. Cystinosis patients have increased risk for impaired muscle strength due to early development of CKD and cystinosis-induced myopathy. This study assesses muscle strength in cystinosis patients and investigates risk factors of decreased muscle strength. Methods: Adult and pediatric patients were recruited from Cystinosis Research Network conferences and a large pediatric nephrology clinic between 2017 and 2019. Patients and caregivers completed questionnaires on demographic characteristics, disease course, daily physical activity, and neuro-muscular symptoms. Grip strength was assessed using a dynameter and calculated z-scores for age and sex were assessed for associations with patient characteristics. Results: We included 76 patients with a mean grip strength z-score of -2.1 (SD 1.1), which was lower than seen in CKD patients without cystinosis. Male sex and delayed cysteamine initiation were independently associated with impaired grip strength. Among adults, a low level of physical activity was associated with lower grip strength z-score, but no association was found in children. A third of the patients reported neuro-muscular symptoms, with swallowing issues associated with lower grip strength. There was no significant correlation between eGFR and grip strength z-score. Conclusion: Cystinosis patients have impaired muscle strength compared to healthy controls and CKD patients. This impairment is greater in male patients and in patients with late initiation of cysteamine therapy, and is associated with lower physical activity. Further studies investigating the effect of different types of physical activities, optimizing cysteamine therapy and other interventions are needed.

Grip strength among Indigenous and non-Indigenous Australian adults: a longitudinal study of the effects of birth size and current size

ObjectivesIndigenous Australians are born smaller than non-Indigenous Australians and are at an increased risk of early onset of frailty. This study aimed to identify the relationship between birth size, current size and grip strength, as an early marker of frailty, in Indigenous and non-Indigenous young adults.DesignCross sectional data from two longitudinal studies: Aboriginal birth cohort (Indigenous) and top end cohort (non-Indigenous).SettingParticipants reside in over 40 urban and remote communities across the Northern Territory, Australia.ParticipantsYoung adults with median age 25 years (IQR 24–26); 427 participants (55% women), 267 (63%) were remote Indigenous, 55 (13%) urban Indigenous and 105 (25%) urban non-Indigenous.Outcome measuresReliable birth data were available. Anthropometric data (height, weight, lean mass) and grip strength were directly collected using standardised methods. Current residence was classified as urban or remote.ResultsThe rate of low birthweight (LBW) in the non-Indigenous cohort (9%) was significantly lower than the Indigenous cohort (16%) (−7%, 95% CI −14 to 0, p=0.03). Indigenous participants had lower grip strength than non-Indigenous (women, −2.08, 95% CI −3.61 to –0.55, p=0.008 and men, −6.2, 95% CI −9.84 to –2.46, p=0.001). Birth weight (BW) was associated with grip strength after adjusting for demographic factors for both women (β=1.29, 95% CI 0.41 to 2.16, p=0.004) and men (β=3.95, 95% CI 2.38 to 5.51, p<0.001). When current size (lean mass and body mass index [BMI]) was introduced to the model BW was no longer a significant factor. Lean mass was a positive indicator for grip strength, and BMI a negative indicator.ConclusionsAs expected women had significantly lower grip strength than men. Current size, in particular lean mass, was the strongest predictor of adult grip strength in this cohort. BW may have an indirect effect on later grip strength via moderation of lean mass development, especially through adolescence and young adulthood.

Body Composition, Strength, and Dietary Intake of Patients with Hip or Knee Osteoarthritis

Purpose: To describe body composition (fat mass (FM) and fat-free mass (FFM)), strength, and nutritional characteristics of patients with hip or knee osteoarthritis undergoing total joint arthroplasty. Methods: In this prospective pilot study, osteoarthritic patients underwent body composition assessment using bioelectrical impedance analysis, grip strength measurement, and completed a 24-h dietary recall during their pre-operative assessment. Results: Fifty-five patients were included (∼66% females, age 43–89 years). Mean ± SD body mass index (BMI) was 32.79 ± 6.48 kg/m2 and 62% were obese. Compared with hip osteoarthritis patients, knee osteoarthritis patients had a higher BMI (P = 0.018) and males with knee osteoarthritis had a lower grip strength (P = 0.028). There was a wide range in FM and FFM values across the BMI spectrum. Patients with a higher FM index (FMI, FM/height in m2) had higher levels of pain (P = 0.036) and females with higher FMI had a lower grip strength (P = 0.048). Dietary under-reporting was common and many patients did not meet recommendations for protein, vitamins C and E, or omega-3 fatty acids. Those who consumed less protein than the recommended dietary allowance were older (P = 0.018). Conclusions: A wide variability of body composition and dietary intake was observed which may impact strength and ultimately affect physical function. As such, patients with osteoarthritis may benefit from targeted nutrition and physical activity interventions before and after surgery.