Midlife Hand Grip Strength as a Predictor of Old Age Disability

Rantanen, Taina PhD
Guralnik, Jack M. MD, PhD
Foley, Dan MSc
Masaki, Kamal MD
Leveille, Suzanne PhD
Curb, J. David MD
White, Lon MD

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 Jyvaskyla, Jyvaskyla, Finland.

JAMA: The Journal of the American Medical Association 281(6):p 558-560, February 10, 1999.

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 ( < or= to 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.

JAMA.1999;281:558-560