Assessment of maximal handgrip strength: how many attempts are needed?

Abstract

BackgroundHandgrip strength (HGS) is used to identify individuals with low muscle strength (dynapenia). The influence of the number of attempts on maximal HGS is not yet known and may differ depending on age and health status. This study aimed to assess how many attempts of HGS are required to obtain maximal HGS.MethodsThree cohorts (939 individuals) differing in age and health status were included. HGS was assessed three times and explored as continuous and dichotomous variable. Paired t‐test, intraclass correlation coefficients (ICC) and Bland–Altman analysis were used to test reproducibility of HGS. The number of individuals with misclassified dynapenia at attempts 1 and 2 with respect to attempt 3 were assessed.ResultsResults showed the same pattern in all three cohorts. Maximal HGS at attempts 1 and 2 was higher than at attempt 3 on population level (P < 0.001 for all three cohorts). ICC values between all attempts were above 0.8, indicating moderate to high reproducibility. Bland–Altman analysis showed that 41.0 to 58.9% of individuals had the highest HGS at attempt 2 and 12.4 to 37.2% at attempt 3. The percentage of individuals with a maximal HGS above the gender‐specific cut‐off value at attempt 3 compared with attempts 1 and 2 ranged from 0 to 50.0%, with a higher percentage of misclassification in middle‐aged and older populations.ConclusionsMaximal HGS is dependent on the number of attempts, independent of age and health status. To assess maximal HGS, at least three attempts are needed if HGS is considered to be a continuous variable. If HGS is considered as a discrete variable to assess dynapenia, two attempts are sufficient to assess dynapenia in younger populations. Misclassification should be taken into account in middle‐aged and older populations.

Muscle wasting and sarcopenia in heart failure: a brief overview of the current literature

“…37,38 Anorexia, on the other hand, plays also a major role in the pathogenesis of wasting in both sarcopenia and cachexia. 53 Interestingly, the results showed the same pattern in all three cohorts with the maximal handgrip strength at Attempts 1 and 2 being higher than Attempt 3. Intervention studies have mostly focused on n-3 fatty acids; however, the clinical evidence to support a benefit of such nutritional interventions is still insufficient.…”

“…Reihnierse and colleagues studied three cohorts including a total of 939 individuals and assessed the handgrip strength three times. 53 Interestingly, the results showed the same pattern in all three cohorts with the maximal handgrip strength at Attempts 1 and 2 being higher than Attempt 3.…”

Handgrip weakness, low fat‐free mass, and overall survival in non‐small cell lung cancer treated with curative‐intent radiotherapy

“…This is based on literature suggesting that performing three attempts lowers the risk of misclassification bias (weak vs. not weak) in middle-aged and older adults. 11 The highest value for both sides was registered. Patients with handgrip weakness (i.e.…”

Handgrip Strength and Its Associated Factors among Community-dwelling Elderly in Sri Lanka: A Cross-sectional Study

“…Furthermore, maintaining muscle strength is very important to reduce functional limitations of older people [1]. Handgrip strength (HGS) is frequently measured as a proxy for muscle strength [2]. It is a simple, noninvasive, reliable, and low-cost screening technique which does not require trained personnel [3].…”