Original Study
Muscle Strength Rather Than Muscle Mass Is Associated With Standing Balance in Elderly Outpatients

https://doi.org/10.1016/j.jamda.2013.02.001Get rights and content

Abstract

Objectives

Assessment of the association of muscle characteristics with standing balance is of special interest, as muscles are a target for potential intervention (ie, by strength training).

Design

Cross-sectional study.

Setting

Geriatric outpatient clinic.

Participants

The study included 197 community-dwelling elderly outpatients (78 men, 119 women; mean age 82 years).

Measurements

Muscle characteristics included handgrip and knee extension strength, appendicular lean mass divided by height squared (ALM/height2), and lean mass as percentage of body mass. Two aspects of standing balance were assessed: the ability to maintain balance, and the quality of balance measured by Center of Pressure (CoP) movement during 10 seconds of side-by-side, semitandem, and tandem stance, with both eyes open and eyes closed. Logistic and linear regression models were adjusted for age, and additionally for height, body mass, cognitive function, and multimorbidity.

Results

Handgrip and knee extension strength, adjusted for age, were positively related to the ability to maintain balance with eyes open in side-by-side (P = .011; P = .043), semitandem (P = .005; P = .021), and tandem stance (P = .012; P = .014), and with eyes closed in side-by-side (P = .004; P = .004) and semitandem stance (not significant; P = .046). Additional adjustments affected the results only slightly. ALM/height2 and lean mass percentage were not associated with the ability to maintain standing balance, except for an association between ALM/height2 and tandem stance with eyes open (P = .033) that disappeared after additional adjustments. Muscle characteristics were not associated with CoP movement.

Conclusion

Muscle strength rather than muscle mass was positively associated with the ability to maintain standing balance in elderly outpatients. Assessment of CoP movement was not of additional value.

Section snippets

Setting

This cross-sectional study included 207 community-dwelling elderly who were referred to a geriatric outpatient clinic in a middle-sized teaching hospital (Bronovo Hospital, The Hague, Netherlands) for a comprehensive geriatric assessment (CGA) between March 2011 and January 2012. CGA was performed during a 2-hour visit including questionnaires and physical and cognitive measurements. All tests were performed by trained nurses or medical staff. Medical charts were retrospectively evaluated. The

Elderly Outpatient Characteristics

The characteristics of elderly outpatients are presented in Table 1. Mean age was 81.9 years. 64.5 Percent of the elderly outpatients had at least one fall incident in the 12 months prior to the visit to the outpatient clinic.

Ability to maintain standing balance

The percentage of elderly outpatients able to maintain balance in different standing conditions is shown in Figure 1. In more difficult standing conditions, fewer elderly outpatients were able to maintain standing balance. In the standing positions with eyes open, 183

Discussion

Muscle strength is positively associated with the ability to maintain standing balance in community-dwelling elderly referred to a geriatric outpatient clinic. Muscle mass did not associate with the ability to maintain standing balance in most balance conditions, although a positive association was found between ALM/height2 and tandem stance with eyes open. Muscle strength and muscle mass were not associated with quality of balance as measured with CoP movement. This is the first study that

Conclusion

Muscle strength rather than muscle mass is associated with the ability to maintain standing balance in community-dwelling elderly referred to a geriatric outpatient clinic. This indicates the additional value of assessment of muscle strength in clinical practice. Improvement of muscle strength is a target for potential intervention for impaired standing balance in this population of elderly outpatients with multimorbidity.

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    A.Y.B., J.H.P., and D.L. contributed equally to this article.

    This study was supported by the seventh framework program MYOAGE (HEALTH-2007-2.4.5-10), 050-060-810 Netherlands Consortium for Healthy Aging, and by the Dutch Technology Foundation STW, which is part of the Netherlands Organisation for Scientific Research, and partly funded by the Ministry of Economic Affairs, Agriculture, and Innovation. No conflicts of interest.

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