Muscle mass, strength, and physical performance predicting activities of daily living: a meta‐analysis

Abstract

Background Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are essential for independent living and are predictors of morbidity and mortality in older populations. Older adults who are dependent in ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities. The aim of this systematic review and meta‐analysis was to determine if muscle measures are predictive of ADL and IADL in older populations. Methods A systematic search was conducted using four databases (MEDLINE, EMBASE, Cochrane, and CINAHL) from date of inception to 7 June 2018. Longitudinal cohorts were included that reported baseline muscle measures defined by muscle mass, muscle strength, and physical performance in conjunction with prospective ADL or IADL in participants aged 65 years and older at follow‐up. Meta‐analyses were conducted using a random effect model. Results Of the 7760 articles screened, 83 articles were included for the systematic review and involved a total of 108 428 (54.8% female) participants with a follow‐up duration ranging from 11 days to 25 years. Low muscle mass was positively associated with ADL dependency in 5/9 articles and 5/5 for IADL dependency. Low muscle strength was associated with ADL dependency in 22/34 articles and IADL dependency in 8/9 articles. Low physical performance was associated with ADL dependency in 37/49 articles and with IADL dependency in 9/11 articles. Forty‐five articles were pooled into the meta‐analyses, 36 reported ADL, 11 reported IADL, and 2 reported ADL and IADL as a composite outcome. Low muscle mass was associated with worsening ADL (pooled odds ratio (95% confidence interval) 3.19 (1.29–7.92)) and worsening IADL (1.28 (1.02–1.61)). Low handgrip strength was associated with both worsening ADL and IADL (1.51 (1.34–1.70); 1.59 (1.04–2.31) respectively). Low scores on the short physical performance battery and gait speed were associated with worsening ADL (3.49 (2.47–4.92); 2.33 (1.58–3.44) respectively) and IADL (3.09 (1.06–8.98); 1.93 (1.69–2.21) respectively). Low one leg balance (2.74 (1.31–5.72)), timed up and go (3.41 (1.86–6.28)), and chair stand test time (1.90 (1.63–2.21)) were associated with worsening ADL. Conclusions Muscle measures at baseline are predictors of future ADL and IADL dependence in the older adult population.

Instrumental Activities of Daily Living (iADL) Limitations in Europe: An Assessment of SHARE Data

“…Our results confirmed previous findings that older age, being female, and having less education are associated with a higher prevalence of iADLs limitations. To this end, it is not surprising that ageing, as a natural process, will be associated with disability, and therefore impact iADLs limitations’ presence and perception [ 16 , 23 ].…”

“…Therefore, significant differences observed in labour market participation have the potential to affect women disproportionately [ 24 , 25 ]. Moreover, the propensity of women with decreased muscle mass and experiencing early chronic onset events may explain observed increases in levels of PD and the increased numbers of iADLs limitations reported [ 16 , 26 , 27 ]. iADLs prevalence also affected the nature of the activities studied, which, in the older population selected, tend to be practiced most frequently by women [ 12 ].…”

“…These parameters are believed to be vitally important for active ageing. Additionally, previous studies have shown that disability in older people is influenced by living environment architectural, communication, social and other barriers and obstacles, such as ramps, handrails, elevators or appropriated signage, that promote healthy living and may actively influence the ageing process [ 8 , 13 , 14 , 15 , 16 ].…”

Relative Handgrip Strength Diminishes the Negative Effects of Excess Adiposity on Dependence in Older Adults: A Moderation Analysis

“…Our findings bring two thresholds of relative HGS as moderators of the adverse effect: <0.35, in which the adverse effect of abdominal obesity on dependence could worsen, and >0.62, in which the detrimental effect could be improved or even disappear. Because muscle strength represents a critically important and modifiable predictor of ADL [13,14,43], and an increase in body fat is inherent in aging [46], our results underscore the importance of an optimal level of relative HGS among the older adult population. Thus, this study provides support for the importance of considering both HGS and WHtR as contributors to diagnostic functional disability/dependence, and healthcare professionals should encourage participation in physical activity to improve muscular fitness in old age [47].…”

“…Handgrip strength (HGS) is the most common index of muscle strength, owing to its ease of assessment, low cost, and simplicity, and it is considered a valid "proxy" of overall muscle strength for clinical and epidemiological studies [11]. Lower HGS correlates strongly with cardiovascular disease [2] and mortality [12], and several studies [13,14] have highlighted its protective role against activities of daily living (ADL) dependence in older adults. Thus, maintaining an optimum HGS is an effective determinant factor for healthy aging [5,15].…”