To determine the sex-specific associations of handgrip strength (HGS) and asymmetry with incident multimorbidity and examine whether these relationships differ by sex.
Prospective cohort study.
Setting and Participants
Secondary analyses of data from the English Longitudinal Study of Ageing (ELSA, waves 2-8). The analytic sample included 3977 participants (51.4% female) aged ≥50 years who had data for HGS on both hands and were living without multimorbidity at baseline.
HGS was assessed with a handheld dynamometer. Individuals in the lowest tertile of sex-specific age-adjusted HGS were defined as having low HGS. The largest HGS readings from the nondominant and dominant hand were used to calculate HGS ratio [nondominant HGS (kg)/dominant HGS (kg)]. Those with HGS ratio <0.90 or >1.10 had any HGS asymmetry. Further, those with HGS ratio <0.90 had dominant HGS asymmetry, whereas those with HGS ratio >1.10 had nondominant HGS asymmetry. Multimorbidity was defined as the coexistence of ≥2 chronic diseases. Cox proportional hazards regression models were conducted for analyses.
Low HGS was associated with multimorbidity among older men [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.03-1.40] and women (HR 1.19, 95% CI 1.03-1.38). No significant effect modification by sex was observed (P-interaction = .71). HGS asymmetry increased the risk of multimorbidity in women only (HR 1.23, 95% CI 1.07-1.41). The relationship between HGS asymmetry and multimorbidity risk differed by sex (P-interaction = .01). Similarly, both dominant HGS asymmetry (HR 1.21, 95% CI 1.05-1.40) and nondominant HGS asymmetry (HR 1.32, 95% CI 1.03-1.68) were related to incident multimorbidity in women only. There was a significant interaction between dominant HGS asymmetry and sex (P-interaction = .02).
Conclusions and Implications
Examining HGS asymmetry in HGS test protocols can provide novel insights for the predictive power of HGS in the accumulation of diseases, particularly in women.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Multimorbidity: A priority for global health research.(Available at:)Published 2018. Updated 2019. Accessed March 12, 2021)
- Aging with multimorbidity: A systematic review of the literature.Ageing Res Rev. 2011; 10: 430-439
- Multimorbidity and quality of life: A closer look.Health Qual Life Outcomes. 2007; 5: 52
- Multimorbidity in older adults.Epidemiol Rev. 2013; 35: 75-83
- Multimorbidity and mortality in older adults: A systematic review and meta-analysis.Arch Gerontol Geriatr. 2016; 67: 130-138
- Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study.Lancet. 2012; 380: 37-43
- Muscle strength: Clinical and prognostic value of hand-grip dynamometry.Curr Opin Clin Nutr Metab Care. 2015; 18: 465-470
- The frailty syndrome: Definition and natural history.Clin Geriatr Med. 2011; 27: 1-15
- Inflammation and frailty in the elderly: A systematic review and meta-analysis.Ageing Res Rev. 2016; 31: 1-8
- Muscles and their myokines.J Exp Biol. 2010; 214: 337-346
- Muscle as a secretory organ.Compr Physiol. 2013; 3: 1337-1362
- Association of grip strength with risk of all-cause mortality, cardiovascular diseases, and cancer in community-dwelling populations: A meta-analysis of prospective cohort studies.J Am Med Dir Assoc. 2017; 18: 551.e517-551.e535
- Association of handgrip strength with chronic diseases and multimorbidity: a cross-sectional study.Age (Dordr). 2013; 35: 929-941
- Strength and multimorbidity among community-dwelling elderly from southern Brazil.Nutrition. 2020; 71: 110636
- Handgrip strength, chronic physical conditions and physical multimorbidity in middle-aged and older adults in six low- and middle income countries.Eur J Intern Med. 2019; 61: 96-102
- What is the impact of physical activity and physical function on the development of multimorbidity in older adults over time? A population-based cohort study.J Gerontol A Biol Sci Med Sci. 2018; 73: 1538-1544
- Handgrip strength is inversely and independently associated with multimorbidity among older women: Results from the KORA-Age study.Eur J Intern Med. 2016; 31: 35-40
- The loss of skeletal muscle strength, mass, and quality in older adults: The Health, Aging and Body Composition Study.J Gerontol A Biol Sci Med Sci. 2006; 61: 1059-1064
- A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach.Age Ageing. 2011; 40: 423-429
- Get a grip: Individual variations in grip strength are a marker of brain health.Neurobiol Aging. 2018; 71: 189-222
- Laterality. J Bodyw Mov Ther. 2011; 15: 231-234
- Handgrip strength asymmetry and weakness together are associated with functional disability in aging Americans.J Gerontol A Biol Sci Med Sci. 2021; 76: 291-296
- Handgrip strength asymmetry and weakness are associated with lower cognitive function: A panel study.J Am Geriatr Soc. 2020; 68: 2051-2058
- Handgrip strength asymmetry and weakness may accelerate time to mortality in aging Americans.J Am Med Dir Assoc. 2020; 21: 2003-2007.e2001
- Age and gender differences in the prevalence and patterns of multimorbidity in the older population.BMC Geriatr. 2014; 14: 75
- Cohort profile: The English Longitudinal Study of Ageing.Int J Epidemiol. 2013; 42: 1640-1648
- Handgrip strength, inflammatory markers, and mortality.Scand J Med Sci Sports. 2019; 29: 1190-1196
- The role of muscle loss in the age-related decline of grip strength: cross-sectional and longitudinal perspectives.J Gerontol. 1990; 45: M82-M88
- Dynapenic-obesity and physical function in older adults.J Gerontol A Biol Sci Med Sci. 2010; 65: 71-77
- Dynapenic obesity and lower extremity function in elderly adults.J Am Med Dir Assoc. 2015; 16: 31-36
- A comparison of dominant and non-dominant hand strengths.J Hand Surg Br. 1999; 24: 421-425
- Long terms trends of multimorbidity and association with physical activity in older English population.Int J Behav Nutr Phys Act. 2016; 13: 8
- Predicting incident multimorbidity.Ann Fam Med. 2018; 16: 322-329
- Cognition mediates the relationship between sensory function and gait speed in older adults: Evidence from the English Longitudinal Study of Ageing.J Alzheimers Dis. 2019; 70: 1153-1161
- Systemic low-grade inflammation and subsequent depressive symptoms: Is there a mediating role of physical activity?.Brain Behav Immun. 2019; 80: 688-696
- Development and validation of a 10-year mortality prediction model: Meta-analysis of individual participant data from five cohorts of older adults in developed and developing countries.J Gerontol A Biol Sci Med Sci. 2017; 72: 410-416
- Multimorbidity patterns, all-cause mortality and healthy aging in older English adults: Results from the English Longitudinal Study of Aging.Geriatr Gerontol Int. 2020; 20: 1126-1132
- Muscle size, neuromuscular activation, and rapid force characteristics in elderly men and women: Effects of unilateral long-term disuse due to hip-osteoarthritis.J Appl Physiol (1985). 2007; 102: 942-948
- Rate of muscle contraction is associated with cognition in women, not in men.J Gerontol A Biol Sci Med Sci. 2019; 74: 714-719
- Gender differences in the association between grip strength and mortality in older adults: Results from the KORA-age study.BMC Geriatr. 2016; 16: 201
- Does attrition during follow-up of a population cohort study inevitably lead to biased estimates of health status?.PLoS One. 2013; 8: e83948
- A systematic review of prevalence studies on multimorbidity: Toward a more uniform methodology.Ann Fam Med. 2012; 10: 142-151
- Grip strength and hand dominance: challenging the 10% rule.Am J Occup Ther. 1989; 43: 444-447
Published online: August 10, 2021
The authors declare no conflicts of interest.
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.