Skip to content

Advertisement

BMC Geriatrics

What do you think about BMC? Take part in

Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review

BMC GeriatricsBMC series – open, inclusive and trusted201717:238

https://doi.org/10.1186/s12877-017-0625-y

Received: 8 December 2016

Accepted: 8 October 2017

Published: 16 October 2017

Abstract

Background

Hand grip strength (HGS) is used for the diagnosis of sarcopenia and frailty. Several factors have been shown to influence HGS values during measurement. Therefore, variations in the protocols used to assess HGS, as part of the diagnosis of sarcopenia and frailty, may lead to the identification of different individuals with low HGS, introducing bias. The aim of this systematic review is to gather all the relevant studies that measured HGS to diagnose sarcopenia and frailty and to identify the differences between the protocols used.

Methods

A systematic review was carried out following the recommendations of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed and Web of Science were systematically searched, until August 16, 2016. The evidence regarding HGS measurement protocols used to diagnose sarcopenia and frailty was summarised and the most recent protocols regarding the procedure were compared.

Results

From the described search 4393 articles were identified. Seventy-two studies were included in this systematic review, in which 37 referred to sarcopenia articles, 33 to frailty and two evaluated both conditions. Most studies presented limited information regarding the protocols used.

Conclusions

The majority of the studies included did not describe a complete procedure of HGS measurement. The high heterogeneity between the protocols used, in sarcopenia and frailty studies, create an enormous difficulty in drawing comparative conclusions among them.

Keywords

SarcopeniaFrailtyHandgrip strengthOlder adults

Background

Ageing is accompanied by numerous underlying physiological changes and increasing risk of certain health conditions, such as chronic diseases. These changes that constitute and influence ageing are complex [1]. Sarcopenia and frailty are two geriatric syndromes that are frequently confounded [2].

Sarcopenia was initially proposed by Irwin Rosenberg, in 1989, to define the age-related decrease of muscle mass. It derives from the Greek words ‘sarx’, that means flesh, and ‘penia’, that means loss [3]. In 2009, the International Working Group on Sarcopenia (IWGS) provided a consensus definition describing sarcopenia as the age-associated loss of skeletal muscle mass and function. It was proposed that older patients who presented decline in physical function, strength or overall health should be considered for sarcopenia diagnosis [4]. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) released a clinic definition and a consensus diagnostic criteria for age-related sarcopenia. They presented sarcopenia as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death. The diagnosis should consider the presence of low muscle mass and low muscle function (strength or performance) to define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’ [2].

Frailty is a clinically recognisable state of increased vulnerability resulting from age-associated decline in reserve and function across multiple physiologic systems [5], which is associated with adverse outcomes, such as falls, functional decline, hospitalisations and mortality [69]. Even though, there is no single generally accepted clinical definition of frailty, in the Cardiovascular Health Study (CHS) it was defined as a clinical syndrome in which three or more of the following characteristics were present: unintended weight loss, exhaustion, weakness, slow gait speed and low physical activity [10]. Fried’s frailty scale has been the most extensively tested for its validity and is the most widely used instrument in frailty research [11].

Hand grip strength (HGS) is used to diagnose both sarcopenia and frailty [2, 4, 10]. It can be quantified by measuring the amount of static force that the hand can squeeze around a dynamometer [12] and it is an indicator of overall muscle strength [13]. Age and gender are described as the strongest factors influencing HGS in healthy subjects, HGS declines with increasing age [14] and presents lower values for women [15, 16]. It has good intra- and inter-tester reliability and can be recommended the use in clinical practice [17, 18]. HGS can independently identify changes in nutritional status [19]; it responds earlier than anthropometrical measurements to nutritional deprivation and has shown to be significantly associated with sarcopenia [2] and frailty [10].

While HGS is considered a reliable measure to assess muscle strength, several factors have been shown to influence HGS values during measurement. It was reported that a different posture [20], different positions of the elbow [20] and wrist [21], the hand used to test [22] and the setting of the dynamometer [23] may affect the values of strength. It is even reinforced that certain positions can optimise the measurement and produce a maximal HGS. Therefore, variations in the protocols used to assess HGS, as part of the diagnosis of sarcopenia and frailty, may lead to the identification of different individuals with low HGS, introducing bias. This can occur even when the same cut-off points are adopted, which consequently can lead to differences in the number of individuals identified with sarcopenia and frailty.The American Society of Hand Therapists (ASHT) recommended, in 1981, that HGS should be measured with the individuals seated with their shoulders adducted, their elbows flexed 90° and their forearms in neutral position using the Jamar dynamometer [24]. This protocol has been updated with more details of the procedure in 1992 [25], and later in 2015 [26]. In 2011, a new protocol was proposed, the Southampton protocol [27], representing another step towards an improvement of the description of HGS measurement. Nevertheless, there is still a lack of consistency in the studies’ protocols to evaluate HGS used over time.

This systematic review resulted from the need to evaluate the differences between the protocols used for the HGS measurement to diagnose sarcopenia and frailty in older adults. For this reason, this revision represents a step forward towards the standardisation of the procedure. Therefore, the aim of this article is to gather all the relevant studies that measure HGS and to identify the differences between the protocols used. To this end, the proposed systematic review will answer the following questions:
  1. 1.

    Which dynamometer was used for measuring HGS?

     
  2. 2.

    Which hand was used?

     
  3. 3.

    What was the individual’s posture?

     
  4. 4.

    What was the arm position?

     
  5. 5.

    Which handle position was used?

     
  6. 6.

    How long did the HGS measurement take?

     
  7. 7.

    How long were the intervals between the measurements?

     

Methods

A systematic review was carried out following the recommendations for reporting systematic reviews and meta-analyses of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (The PRISMA Statement) [28]. PubMed and Web of Science were systematically searched until August 16, 2016, with no restriction on the year of publication. The search was limited to English, Portuguese, Spanish and French publications and to human subjects. The reference lists within the articles were scanned for any additional references missing from the databases’ search. The following search terms were used: [1] ((hand OR handgrip OR grip OR grasp) AND (force OR strength)) AND (sarcopenia OR frail elderly OR frail OR frailty). Subsequently, search results were inserted in EndNote X7 and duplicates were excluded. All the titles and abstracts were screened based on the eligibility criteria and classified as “relevant” or “not relevant”. Full texts of eligible articles were assessed and read. Those that met all criteria were included.

Eligibility criteria

Studies were included if [1] participants were aged 65 years or older within well-defined samples, with a clear description of the inclusion and exclusion criteria; [2] sarcopenia and frailty were considered as outcomes, in which HGS was used to identify this condition; [3] a description of the protocol used to measure handgrip strength was provided; [4] the outcome measures described are: type of dynamometer for the assessment of HGS, individual’s position (including shoulder, elbow, arm and handle position and posture), hand dominance, number of repetitions, acquisition and rest time, encouragement and handgrip strength values.

Randomised control trials, cohort studies, case control studies and cross-sectional studies were included, and meta-analyses or review articles, case reports, case series, meetings’ proceedings, conference summaries and duplicate records were excluded. Articles were not included if information about either the posture of the individual, or concerning the arm position (shoulder, elbow or wrist) was absent. When the complete procedure was not described but a reference was made to another article, we searched for the missing parts of the procedure. If the article did not add more details regarding the procedure, it was still excluded. In case of disagreement about the inclusion of a study, the reviewers discussed their opinions to reach consensus. The studies were divided into two subgroups: [1] articles about sarcopenia and [2] articles about frailty. Final studies selected for inclusion in each category were independently compiled in data tables. Articles which presented the same data as an earlier study were still excluded.

Results

From the described search 4393 articles were identified. After removing duplicates, a total of 2753 articles remained. From these, after screening for title and abstract 2166 articles were excluded. Five hundred and eighty-seven full-text articles were assessed for eligibility and 515 references were excluded. Seventy-two studies were found eligible and, therefore, included in this systematic review. Figure 1 presents a flow diagram of the literature search and of the selection process.
Fig. 1

Flow diagram of the literature search and selection process

The studies comprised in this systematic review were published between 2003 and 2016. Fifty-two were cross-sectional studies, 17 were cohorts, and three were clinical trials. The sample size ranged between 24 and 11,844 individuals.

From the articles included, 37 studies referred to sarcopenia, 33 to frailty and two evaluated both conditions. The EWGSOP and the CHS definitions were used in the majority of studies to diagnose sarcopenia and frailty.

Description of HGS measurement

Most studies presented limited information regarding the protocols used. As shown in both Tables 1 and 2, all 72 studies described the dynamometer used, but only five specified if it was calibrated for the study. Although, there was a wide range of equipment used, the Jamar dynamometer was the most mentioned (n = 35), followed by the Smedley dynamometer (n = 10). Sixty-six studies described the posture of the individual, in which the majority was measured in a sitting position (n = 47), and 19 were in a standing position. Three studies mentioned variations regarding the posture, depending on the ability of the individuals.
Table 1

Details and HGS protocols of the studies that diagnose sarcopenia, included in this systematic review

Study details

Author

Sample

Size

Age

Dynamometer

Repetitions

Hand

Posture

Shoulder position

Elbow position

Wrist position

Handle position

Encouragement

Acquisition time

Rest time

HGS analysis

Cut-off values

Cross-sectional study

Toulouse and Lyon, France

Abellan van Kan et al. [52]

Community-dwelling older women from the EPIDOS cohort

3025

≥75

Martin vigorimeter, Medizin Tecnik, Tuttlingen, Germany

3

Dominant

Standing upright

Adducted

180°

Adjusted to a comfortable position

Higher value

Lowest 25%

Cross-sectional study

Turkey

Akin et al. [53]

Community-dwelling older adults from KEHES Study

879

≥60

Takei TKK

5401 digital handgrip dynamometer, Takei, Niigata-City, Japan

3

Dominant

Standing upright

Adducted

90°

Higher value

Fried’s criteria*

Cross-sectional study

S. Paulo, Brazil

Alexandre Tda et al. [54]

Older urban population from the SABE Study

1149

≥60

Takei Kiki Kogyo TK 1201, Tokyo, Japan

2

Dominant

Sitting position

Resting on the table (forearms too)

Palms facing up

Adjusted to a comfortable position

1 min

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Milan, Italy

Barichella et al. [55]

Consecutive patients from a specialised tertiary care center

364

≥65

DynEx digital hand dynamometer, Akern/MD Systems, Florence, Italy

3

Dominant

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

Mean value

M: <30 kgf

W: <20 kgf

Cross-sectional study

The Netherlands

Bastiaanse et al. [56] (a)

Adults with intellectual disabilities from the HA-ID study

884

≥50

Jamar hand dynamometer, Sammons Preston Rolyan, USA

6

Both

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

2nd

1 min

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Liège, Belgium

Beaudart et al. [57] (d)

Consecutive outpatients from an osteoporotic and geriatric department of a clinic and community-dwelling older adults

250

≥65

Hydraulic and pneumatic dynamometer Saehan Corporation, MSD Europe, Bvba, Belgium

(calibrated)

6

Both

Sitting position

Forearms resting on the arms of the chair

Neutral position, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Liège, Belgium

Beaudart et al. [58] (d)

Community-dwelling older adults from the SarcoPhAge study

534

≥65

Hydraulic dynamometer Saehan Corporation, MSD Europe, Bvba, Belgium

(calibrated)

6

Both

Sitting position

Forearms resting on the arms of the chair

Neutral position, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

The Netherlands

Bijlsma et al. [59]

Young and healthy older Europeans from the Leiden Longevity Study

654

38–82

Jamar hand dynamometer, Sammons Preston Inc., Bolingbrook, IL, USA

3

Dominant

Standing upright

Abducted

180°

Adjusted to hand size

(middle phalanx rested on the inner handle)

Higher value

M: <30.3 kgf

W: <19.3 kgf

Cross-sectional study

Leiden, The Netherlands; Jyvaskyla, Finland; Tartu, Estonia; Paris, France and Manchester, United Kingdom (UK)

Bijlsma et al. [60]

Middle to older participants from the MYOAGE study

452

18–30/ 69–81

Jamar hand dynamometer, Sammons Preston, Inc., Bolingbrook, IL, USA

6

Both

Standing upright

Abducted

180°

Adjusted to hand size

Higher value

**

Cross-sectional study

Guelph, Ontario, Canada

Campbell et al. [61]

Assisted-living older adults

40

≥65

Vernier digital hand dynamometer and collected using LoggerPro software, Vernier, OR, USA; 60 Hz

6

Both

Sitting position

Adducted

90°

Dynamometer vertical

Yes

Self-selected pace

Higher value

M: <30 kgf

W: <20 kgf

Prospective cohort study

Northern Italy

Cerri et al. [62]

Consecutively admitted older inpatients of an Acute Geriatric Clinic, S. Gerardo University Hospital

103

≥65

Jamar hand dynamometer

3

Dominant

Sitting position

Adducted

90°

Forearm neutral

Between 0 and 30° extension

1 min

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Madrid and Barcelona, Spain

Cuesta et al. [63] (a)

Geriatric outpatients from the ELLI study

298

≥70

Jamar hand dynamometer

3

Dominant

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

2nd

1 min

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Midwestern United States of America (USA)

Fukuda et al. [64]

Caucasian ambulatory individuals

107

65–89

DHS-176 digital handgrip dynamometer, Detecto, Webb City, MO

3

Dominant

Standing upright

Adducted

90°

3 to 5 s

Mean value

**

Cross-sectional study

Spain

Garatachea et al. [65]

Caucasian community-dwelling older adults from two geriatric nursing homes

81

71–93

Smedley digital hand dynamometer, Sportstek,VIC, Australia

3

Non-dominant

Standing upright

Abducted

180°

Adjusted to hand size

30 to 60 s

Higher value

**

Prospective cohort study

Spain

Gonzalez-Montalvo et al. [66]

Consecutive patients hospitalised for hip fracture in a public 1300-bed university hospital

509

≥65

Jamar hydraulic dynamometer, Sammons Preston, Bolingbrook, IL, USA

3

Dominant

Sitting position

Forearms resting on the arms of the chair

Neutral, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

USA

Gray et al. [67]

Community-dwelling older adults

43

≥65

Takei Scientific Instruments digital grip strength dynamometer, Niigata City,

Japan

3

Preferred hand

Standing upright

Arms down by the side

Neutral

Interphalangeal joint

of the index finger maintained at 90°

Yes

Minimum of 3 s

1 min

Higher value

**

Cross-sectional study

Taipei, Taiwan

Han et al. [68]

Healthy volunteers from the Taiwan Fitness for Seniors Study

878

≥65

Baseline hydraulic dynamometer, Fabrication Enterprises Inc., Irvington, NY, USA

3

Dominant

Adducted

90°

Forearm neutral

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

6th district of Tehran, Iran

Hashemi et al. [69] (c)

Community-dwelling individuals from the SARIR study

300

≥55

Baseline pneumatic

squeeze bulb dynamometer, Jamar, Inc. USA: c7489–02 Rolyan

(calibrated)

6

Both

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

2nd

30 s

Mean value

Compared with normative data from Merkies et al. [70]

Cross-sectional study

Northern Bavaria, Germany

Kemmler et al. [71]

Community-dwelling German women from the FORMoSA study

1325

≥70

Jamar hand dynamometer, Sammons Preston Inc., Bollington, USA

2

Both

Standing upright

Arms down by the side

Adjusted to hand size

Higher value

W: <20 kgf

Prospective cohort study

I-Lan County, Taiwan

Lee et al. [72]

Young healthy volunteers and older adults from the I-Lan Longitudinal Ageing Study

508

20–40/ ≥65

Smedley hand dynamometer, TTM, Tokyo, Japan

3

Dominant

Standing upright

Abducted

180°

Higher value

M: <22.4 kgf

W: <14.3 kgf

Cross-sectional study

Korea

Lee et al. [73] (b)

Ambulatory women from the University Hospital Menopause Clinic

196

≥65

Jamar hand dynamometer, Sammons Preston Inc., Bolingbrook, IL, USA

3

Dominant

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Between 0 and 30° dorsiflexion

2nd

Mean value

W: <18 kgf

Cross-sectional study

Tamana, Japan

Maeda et al. [74]

Patients admitted to acute phase wards from Tamana Regional Health Medical Center

224

≥65

Smedley hand dynamometer, TTM, Tokyo, Japan

2

Dominant

Standing or sitting position, depending on their ability

Higher value

M: <26 kgf

W: <18 kgf

Cross-sectional study

Salvador, Bahia, Brazil

Martinez et al. [75]

Hospitalised elderly patients in a multi-specialty hospital

110

≥60

Saehan hydraulic dynamometer, Saehan Corporation, 973, Yangdeok-Dong, Masan 630–728, Korea

3

Sitting position

90°

1 min

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Guelph, Canada

McIntosh et al. [76]

Community-dwelling older adults

85

≥65

Vernier digital hand dynamometer and collected using LoggerPro software, Vernier, OR, USA; 60 Hz

6

Both

Standing upright

Adducted

90°

Yes

Higher value

M: <30 kgf

W: <20 kgf

Prospective cohort study

Reykjavik, Iceland

Mijnarends et al. [77]

Community-dwelling older adults from the AGES-Reykjavik Study

2309

66–93

Good Strength

software, Metitur, Finland

3

Dominant

Sitting position

Relaxed

90°, neutral

Attached by belts to a strain-gauge system, thumb up

Yes

4–5 s

30 s

M: <30 kgf

W: <20 kgf

Prospective cohort study

Seongnam, Korea

Moon et al. [78]

Community-dwelling older adults from the Korean Longitudinal Study on Health and Aging

297

≥65

Jamar hydraulic hand dynamometer, Sammons Preston,

Bolingbrook, IL, USA

2

Dominant

Sitting position

Adducted

90°

Forearm neutral

Adjusted

to a comfortable position

1 min

Mean value

M: <26 kgf

W: <16 kgf

Cross-sectional study

London, Ontario, Canada

Morat et al. [79]

Healthy and independent living older adults from the

Canadian Centre for Activity and Aging

24

≥65

Smedley hand

dynamometer, TTM, Tokyo, 100 kg

6

Both

Standing upright

90°

Forearm neutral

Neutral

 

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Goiâna, Brazil

Pagotto et al. [80] (b)

Community-dwelling older adults

132

≥60

CROWN hydraulic

dynamometer

2

Dominant

Sitting position

Adducted and neutrally rotated

90°

Extended between 0 and 30° dorsiflexion

2nd

6 s

1 min

Both values

M: <30 kgf

W: <20 kgf

and

Fried’s criteria*

Cross-sectional study

UK

Patel et al. [81] (d)

Community-dwelling older adults from the Hertfordshire Sarcopenia Study

1890

68–77

Jamar hand dynamometer

6

Both

Sitting position

Forearms resting on the arms of the chair

Neutral, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Pavia, Italy

Rondanelli et al. [82]

Older adults consecutively admitted to a physical medicine and rehabilitation division, in Santa Margherita institute

159

≥65

Jamar 5030 J1 hydraulic hand dynamometer, Sammons Preston Rolyan, Bolingbrook, IL,USA

4

Sitting position

Comfortable arm position

Yes

5 s

1 min

Mean value of the last three efforts

**

Prospective cohort study

Barcelona, Spain

Sanchez-Rodriguez et al. [83] (d)

Consecutive hospitalised

patients from a postacute care geriatric unit

100

≥70

Jamar hand dynamometer, Nottinghamshire, UK

3

Sitting position

Forearms resting on the arms of the chair

Neutral, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

Compared with normative data from Luna-Heredia et al. [16]

Retrospective cohort study

Kuopio, Eastern Finland

Sjoblom et al. [84]

Finnish postmenopausal women from the OSTPRE study

590

65–72

Pneumatic hand-held dynamometer Martin Vigorimeter, Germany

3

Sitting position

Mean value

Lowest 25%

Cross-sectional study

Porto, Portugal

Sousa et al. [85] (b)

Hospitalised adult patients from medical and surgical wards in a general and teaching hospital

608

≥18

Jamar hydraulic hand dynamometer, Sammons Preston, Bolingbrook, IL, USA

(calibrated)

3

Non-dominant

Sitting position

Adducted and neutrally rotated

90°

Between 0 and 30° dorsiflexion

2nd

1 min

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Berlin, Germany

Spira et al. [86]

Community-dwelling older adults from the BASE-II study

1405

60–80

Smedley hand dynamometer, Scandidact, Denmark

6

Both

Standing upright

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

Higher value

Fried’s criteria*

Cross-sectional study

Manchester, UK and Leuven, Belgium

Verschuere et al. [87] (d)

Men from the European Male Ageing Study

679

40–79

Jamar hand dynamometer, TEC Inc., Clifton, NJ

6

Both

Sitting position

Forearms resting on the arms of the chair

Neutral, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

Fried’s criteria*

Multicentre cohort study

Italy

Vetrano et al. [88]

Older adults admitted to acute care wards, of seven Italian hospitals, from the CRIME study

770

≥65

North Coast hydraulic hand dynamometer, North Coast Medical Inc., Morgan Hill, CA

4

Both

Sitting position or lying at 30° in bed (when unable to sit)

90° or with elbows supported

Neutral

Higher value

M: <30 kgf

W: <20 kgf

Cohort study

Ankara, Turkey

Yalcin et al. [89]

Residents in Seyranbagları Nursing Home and Rehabilitation Center

141

≥65

Takei Scientific Instruments, Niigata, Japan

2

Dominant

Abducted (30°)

180°

Palm perpendicular to the shoulder line

5 s

Mean value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Obu, Aichi, Japan

Yoshida et al. [90]

Community-dwelling older adults from Obu Study of Health Promotion for the Elderly

4811

≥65

Grip-D hand dynamometer, Takei, Niigata, Japan

1

Dominant

Standing upright

Single value

M: <28.8 kgf

W: <18.2 kgf

Cohort study

North west regions and Western suburbs of Adelaide, Australia

Yu et al. [91]

Community-dwelling individuals, from the CASA, FAMAS and NWAHS studies

1123

≥18

Lafayette Instrument Company, IN, USA (CASA and NWAHS), Smedley, Chicago, IL (FAMAS)

3

Dominant

Sitting position

Arm supported by a horizontal surface

Mean value

M: <30 kgf

W: <20 kgf

S Seconds; Min Minutes; M Men; W Women

(a) Study cited the ASHT 1981 protocol

(b) Study cited the ASHT 1992 protocol

(c) Study cited the ASHT protocol, without specifying which protocol year was used

(d) Study cited the Southampton protocol

* Fried’s criteria (Cut-off points for handgrip strength) Men: ≤29 kgf (BMI ≤ 24 kg/m2); ≤30 kgf (BMI 24.1–26 kg/m2); ≤30 kgf (BMI 26.1–28 kg/m2); ≤32 kgf (BMI > 28 kg/m2) / Women: ≤17 kgf (BMI ≤ 23 kg/m2); ≤17.3 kgf (BMI 23.1–26 kg/m2); ≤18 kgf (BMI 26.1–29 kg/m2); ≤21 kgf (BMI > 29 kg/m2)

** Not defined due to the type of analysis conducted by the study

Table 2

Details and HGS protocols of the studies that diagnose frailty, included in this systematic review

Study details

Author

Sample

Size

Age

Dynamometer

Repetitions

Hand

Posture

Shoulder position

Elbow position

Wrist position

Handle position

Encouragement

Acquisition time

Rest time

HGS analysis

Cut-off values

Multicentric prospective cohort study

Burgos, Albacete and Madrid, Spain

Abizanda et al. [92] (c)

Institutionalised older adults, in four nursing homes from the ACTIVNES study

91

≥70

Jamar hand dynamometer, Sammons Preston Rolyan, Bolingbrook, IL

3

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

2nd

Higher value

Fried’s criteria*

Cross-sectional study

Alexandria, Egypt

Abou-Raya et al. [93]

Consecutive patients with congestive heart failure

126

≥65

Jamar hand dynamometer

2

Dominant

Sitting position

Adducted

90°

Between 0 and 30° dorsiflexion and 0 and 15° ulnar deviation

2nd

Yes

M: ≤21 kgf

W: ≤14 kgf

Cross-sectional study

USA

Bandeen-Roche et al. [94]

Older adults from the 2011 baseline of the National Health and Aging Trends Study

7439

≥65

Jamar digital hand dynamometer

2

Dominant

Sitting position

Adducted

90°

Dynamometer or forearm resting on the table

2nd

Yes

Higher value

Lowest 20% within 8 sex and BMI categories

Cross-sectional study

The Netherlands

Bastiaanse et al. [56] (a)

Adults with intellectual disabilities from the HA-ID study

884

≥50

Jamar hand dynamometer, Sammons Preston Rolyan, USA

6

Both

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

2nd

1 min

Higher value

Fried’s criteria*

Cross-sectional study

Liège, Belgium

Beaudart et al. [58] (d)

Community-dwelling older adults from the SarcoPhAge study

534

≥65

Hydraulic dynamometer Saehan Corporation, MSD Europe, Bvba, Belgium

(calibrated)

6

Both

Sitting position

Forearms resting on the arms of the chair

Neutral position, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

Fried’s criteria*

Cross-sectional study

England

Buttery et al. [95]

Consecutively patients from three elderly care wards of an urban teaching hospital

44

67–91

Jamar isometric hand dynamometer, Sammons Preston, Bolingbrook, Illinois, USA

6

Both

Sitting position

Adducted and neutrally rotated

90°

Between 0 and 30° dorsiflexion and 0 and 15° ulnar deviation

2nd

Yes

Higher value

Compared with normative data from Bohannon et al. [96]

Cross-sectional study

Germany

Buttery et al. [97]

Community-dwelling older adults from the DEGS1

1843

65–79

Smedley hand dynamometer, Scandidact, Denmark, 100 kg

4

Both

Standing upright

Higher value

Fried’s criteria*

Cross-sectional study

Urban administrative section of Taipei, Taiwan

Chang et al. [98]

Community-dwelling older adults

234

≥65

Handgrip dynamometer, Fabrication Enterprises, Inc., Irvington, NY

Both

Adducted

90°

Yes

Lowest 20% at baseline

Cross-sectional study

Saint Bruno,Québec, Canada and Santa Cruz, Rio Grande do Norte, Brazil

Da Camara et al. [99]

Community-dwelling older adults

124

65–74

Jamar hand dynamometer, Jamar, Irvington, NY, USA

3

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

Adjusted to a comfortable position between the 2nd or 3th handle

1 min

Mean value

Fried’s criteria*

Cross-sectional study

Chicago, USA

Danilovich et al. [100] (b)

Convenience sample of older adults

42

≥65

Jamar hand hydraulic dynamometer

4

Both

Sitting position

Adducted and neutrally rotated

90°

Between 0 and 30° dorsiflexion

2nd

Higher value

M: <30 kgf

W: <20 kgf

Cross-sectional study

Denmark

Dato et al. [101]

Community-dwelling older adults

3719

≥70

Smedley hand dynamometer TTM

3

Dominant

Sitting position

Adducted

Higher value

**

Cross-sectional study

The Netherlands

Evenhuis et al. [102]

Individuals with borderline to profound intellectual disabilities of three care provider services from the HA-ID Study

848

≥50

Jamar hand dynamometer, 5030 J1, Sammons Preston Rolyan, Dolgeville, NY

6

Both

Sitting position

Adducted and neutrally rotated

90°

Between 0 and 30° dorsiflexion and 0 and 15° ulnar deviation

2nd

Yes

Fried’s criteria*

Prospective cohort study

USA

Fried et al. [10]

Community-dwelling older adults from the Cardiovascular Health study

5317

≥65

Jamar hand dynamometer

3

Dominant

Sitting position

90°

2nd

Yes

Mean value

Fried’s criteria*

Cross-sectional study

The Kolpino district, St. Petersburg, Russia

Gurina et al. [103]

Community-dwelling older adults from the “Crystal” Study

611

≥65

Carpal dynamometer (DK-50, Nizhni Tagil, Russian Federation)

6

Both

Standing upright

Arms hanging down at the sides

30 s

Mean value

Lowest 20%, adjusted for sex and BMI

Cross-sectional study

Vienna, Austria.

Haider et al. [104] (d)

Pre-frail and frail community-dwelling older adults

83

≥65

Jamar hydraulic hand

dynamometer, Lafayette, Louisiana

6

Both

Sitting position

Forearms resting on the arms of the chair

Neutral, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

1 min

Higher value

**

Cross-sectional and prospective cohort study

The Netherlands

Hoogendijk et al. [105]

Older adults from the Longitudinal Aging Study Amsterdam

1115

≥65

Takei TKK 5001, Takei Scientific Instruments, Tokyo, Japan

4

Both

Standing upright or sitting position when the participant was not able to stand

180°

Sum of the highest values of each hand

Fried’s criteria*

Cross-sectional study

Seoul, Korea

Kang et al. [106]

Female outpatients from the department of family medicine at Kangbuk Samsung Hospital

121

≥65

Lavisen electronic hand grip dynamometer KS 301, Lavisen Co.

Ltd., Namyangju, Korea

Right

Abducted

180°

Medial phalange of the third finger perpendicular to the handle

≤14.5 kgf

Cross-sectional study

Seoul and Gyeonggi province, Korea

Kim et al. [107]

Older adults who registered at six senior welfare centers

486

≥65

Jamar hydraulic hand dynamometer; Sammons Preston, Bolingbrook, IL, USA

2

Abducted

180°

Higher value

Lowest 20%, adjusted for sex and BMI

Cross-sectional study

Beaver Dam, Wisconsin

Klein et al. [108]

Adults and older adults from the Beaver Dam Eye Study

2962

≥53

Lafayette hand dynamometer, Model 78,010, Lafayette Instrument Company, Lafayette, Indiana

4

Both

Standing upright

Abducted

180°

Adjusted to hand size

Mean value for the dominant hand

M: ≤ 34.5 kgf

W: ≤ 18.5 kgf

Randomised controlled trial

Itabashi Ward, Tokyo, Japan

Kwon et al. [109]

Pre-frail community-dwelling older women

89

≥70

Smedley hand dynamometer, Yagami, Tokyo, Japan

2

Dominant

Standing upright

Arms hanging naturally at their sides

Higher value

W: ≤23 kgf at baseline

Cohort study

Korea

Lee et al. [110]

Community-dwelling older adults from the Living profiles of Older People Survey

11,844

≥65

Tanita, No. 6103, Japan

4

Both

Elbow by the side of the body

90°

Higher value

Lowest 20%, adjusted for sex and BMI

Prospective cohort study

Boston, Massachusetts, USA

Mohr et al. [111]

Community-dwelling men from the Massachusetts Male Aging study

646

50–86

Jamar hydraulic hand dynamometer, Sammons Preston, Bolingbrook, IL

2

Dominant

Sitting position

Arms at their sides

90°

Forearm neutral

Neutral

Adjusted to hand size

3 s

1 min

Higher value

M: ≤28 kgf (BMI ≤ 24.9 kg/m2);

≤30 kgf (BMI 25.0–27.2 kg/m2); ≤32 kgf

(BMI > 27.2 kg/m2)

Prospective cohort study

Barcelona, Spain

Mora et al. [112]

Community-dwelling women from the Mataró Ageing Study

110

≥70

Jamar hand dynamometer

3

Non-dominant

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Between 0 and 30° dorsiflexion and between 0 and 15° ulnar deviation

Yes

Mean value

Fried’s criteria*

Cross-sectional study

Belo Horizonte, Brazil

Moreira et al. [113] (b)

Community-dwelling older women with type 2 diabetes

99

65–89

Jamar hand dynamometer

3

Dominant

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Between 0 and 30° dorsiflexion

2nd

Yes

Mean value

Fried’s criteria*

Double-blind, randomised, controlled trial

Rotterdam, The Netherlands

Muller et al. [114]

Community-dwelling older men

100

≥70

Jamar hand dynamometer, Horsham, PA

3

Non-dominant

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Between 0 and 30° dorsiflexion and between 0 and 15° ulnar deviation

Yes

Mean value

**

Cross-sectional study

Dimantina, Brasil

Parentoni et al. [115] (c)

Convenience sample of older women

106

≥65

Saehan dynamometer, SH5001

(calibrated)

3

Dominant

Sitting position

Adducted and neutrally rotated

90°

Forearm neutral

Neutral

2nd

Yes

1 min

Mean value

Fried’s criteria*

Cross-sectional study

Calabria district, Italy

Passarino et al. [116]

Community-dwelling older adults

369

65–85

Smedley hand dynamometer TTM

3

Dominant

Sitting position

Adducted

Higher value

**

Cohort study

Texas, New Mexico, Colorado, Arizona and California, USA

Samper-Ternent et al. [117]

Non-institutionalised Mexican Americans from the Hispanic Established Population for the Epidemiological Study of the Elderly

1370

≥65

Jamar hydraulic hand dynamometer, Model 5030 J1, J.A. Preston Corp., Clifton, NJ

2

Dominant

Sitting position

Resting on the table

Palm facing up

Adjusted to a comfortable position

Yes

Higher value

Lowest 20%, adjusted for sex and BMI

Cohort study

United States and Denmark

Sanders et al. [118]

Community-dwelling individuals from The Long Life Family Study

4875

32–105

Jamar hydraulic hand Dynamometer, Lafayette, IN

2

Dominant

Sitting position

Mean value

Lowest 25%, adjusted for sex and BMI

Cross-sectional study

Saarland, Germany

Saum et al. [119] (d)

Community-dwelling adults from ESTHER study

3112

≥59

Jamar hand dynamometer, Lafayette Instrument Company, Lafayette, IN

3

Dominant

Sitting position

Forearm resting on the arm of the chair

Neutral, over the end of the arm of the chair, thumb facing upwards

Adjusted so that the thumb is round one side of the handle and the four fingers are around the other side

Yes

Higher value

M: <30 kgf

W: <20 kgf

and

Fried’s criteria*

Cross-sectional study

Lausanne, Switzerland

Seematter-Bagnoud et al. [120]

Community-dwelling older adults from the Lc65+ study

861

65–70

Baseline hydraulic dynamometer

3

Right

Sitting position

Adducted and neutrally rotated

90°

Between 0 and 30° dorsiflexion and 0 and 15° ulnar deviation

2nd

Yes

Higher value

Fried’s criteria*

Randomised, Double-Blind, Placebo-Controlled Trial

The Netherlands

Tieland et al. [121]

Frail older adults

62

≥65

Jamar hand dynamometer, Jackson, MI, USA

6

Both

Sitting position

90°

Fried’s criteria*

Cross-sectional study

Portugal

Vieira et al. [122] (c)

Institutionalised older adults from three urban residential homes

50

68–99

Jamar hydraulic hand dynamometer, J00105

3

Dominant

Sitting position

Adducted and in extension

90°

Forearm neutral

Extended between 0 and 30°

.

10 s

1 min

M:<30 kgf

W: <18 kgf

Cross-sectional study

Baltimore, Maryland, USA

Walston et al. [123]

Community-dwelling women from the Women’s Health and Aging Studies I and II

463

70–79

Jamar hand dynamometer, model BK-74978, Fred Sammons, Inc., Burr Ridge, IL

6

Both

Sitting position

Adducted

90°

.

Yes

Higher value of the non-dominant hand

Fried’s criteria*

Cross-sectional study

Southern Taiwan

Wu et al. [124]

Community-dwelling older adults and outpatients from a hospital-based outpatient clinic

90

≥65

Jamar hand dynamometer, Sammons Preston, Bolingbrook, IL

Dominant

Sitting position

Fried’s criteria*

S Seconds; Min Minutes; M Men; W Women

(a) Study cited the ASHT 1981 protocol

(b) Study cited the ASHT 1992 protocol

(c) Study cited the ASHT protocol, without specifying which protocol year was used

(d) Study cited the Southampton protocol

* Fried’s criteria (Cut-off points for handgrip strength) Men: ≤29 kgf (BMI ≤ 24 kg/m2); ≤30 kgf (BMI 24.1–26 kg/m2); ≤30 kgf (BMI 26.1–28 kg/m2); ≤32 kgf (BMI > 28 kg/m2) / Women: ≤17 kgf (BMI ≤ 23 kg/m2); ≤17.3 kgf (BMI 23.1–26 kg/m2); ≤18 kgf (BMI 26.1–29 kg/m2); ≤21 kgf (BMI > 29 kg/m2)

** Not defined due to the type of analysis conducted by the study

Most studies chose to measure HGS only in the dominant hand (n = 33), in four studies measurement was obtained from the non-dominant, and in 25 in both dominant and non-dominant. In one study HGS was measured using the preferred hand while the right hand was used in two other studies. In seven articles information about the chosen limb was absent. The position of the shoulder and the elbow was indicated in 46 and 62 studies, respectively, and the wrist position was described in 39 studies. The dynamometer’s handle was referred in 37 articles, while the second handle position was mentioned in 16 articles. Encouragement during the procedure was reported in 26 studies, only nine studies indicated the data acquisition time and, 19 studies specified the rest time. Most studies (n = 42) used the higher HGS value for the analysis. The ASHT protocol was mentioned in 11 studies, of which the 1981 protocol was referred twice and the 1992 protocol was cited in five studies. The others did not specify the ASHT protocol used. The Southampton protocol was alluded to in eight studies.

Discussion

The aim of this systematic review is to identify the HGS protocols used to diagnose sarcopenia and frailty. The heterogeneity in HGS protocols, the wide variability in the criteria used to identify either sarcopenia and frailty and the different inclusion and exclusion criteria in the evaluated studies is an issue in this research field. Indeed, these differences hinder comparison between the studies and hamper progress of the study of these conditions.

We observed that most studies which diagnose these conditions did not mention the protocol used in the measurement of HGS, or did not include a full description of it. Although the ASHT and Roberts et al. proposed standardised protocols, the results of the present review showed high heterogeneity of the chosen procedure. Studies concerning sarcopenia and frailty did not differ in standardised protocols used. Plus, the complete description of the procedure is lacking in most studies. In trying to overcome this problem, some authors raise an additional difficulty when they cite the previous publication of their study protocol.

The parameters regarding the HGS procedure that were presented in the Tables 1 and 2 and its influence in HGS values were evaluated in several studies. As shown below, in spite of some results being similar between the studies, others present contradictory results.

Dynamometer

The ASHT recommends a calibrated Jamar dynamometer in the second handle position for the measurement of HGS [2426]. While, the Southampton protocol suggested the handle should be adjusted so that the thumb is round one side of the handle and the four fingers are around the other side and the instrument should feel comfortable in the hand [27].

The Jamar hydraulic dynamometer presents higher intra and inter-individual reliability [17]. Despite this being referred to as the most widely used and tested dynamometer [27], this review shows a great variability in the dynamometers used, regardless of Jamar’s predominance. Present results exhibit a great number of studies which failed to describe if the instruments were properly calibrated for the measurements. A correctly calibrated dynamometer is highly reliable. Nevertheless, it should be recalibrated regularly [29].

Other dynamometers, such as Smedley dynamometer (mechanical) and Martin vigorimeter (pneumatic), measure HGS by a different mechanism [30]. Concerning the Smedley dynamometer, it has shown excellent results regarding its laboratory tested accuracy but, when applied among older adults, it did not produce comparable results to the Jamar hydraulic [31]. Low agreement between Jamar dynamometer and Takei dynamometer was observed [32]. Otherwise, the results of the comparison between the Jamar dynamometer and the Martin vigorimeter in a healthy elderly population, indicate a very high correlation between the two HGS data values [33]. When the hydraulic dynamometers, Baseline and Saehan, were tested they shown to be valid, reliable and comparable to the Jamar dynamometer [34, 35].

Hand

A summary of the studies comparing HGS in dominant and non-dominant limbs, revealed that it is reasonable to expect greater grip strength in the dominant upper extremity in right-handed individuals [36]. Yet, it is important to consider that the difference between sides varies widely among studied samples and in a significant proportion of individuals the opposite is observed [37, 38].

Posture and arm position (shoulder, elbow and wrist)

Most studies revised here, a standing or sitting position was selected. In some cases, the position was adapted to the individual’s physical function. The influence of the standing versus sitting posture in HGS values was evaluated and no significant differences were found by several studies [3941]. When comparing standing versus sitting position, Balogun et al. observed significant differences only between sitting with elbow at 90 degrees and standing with elbow at full extension [20]. These results were in agreement with one study that showed that grip strength is significantly greater when measured with the elbow in the fully extended position [42]. Additionally, even though the posture alone did not significantly influence HGS values, combined with the elbow position it could indicate the presence of an interaction between the elbow position at 180 degrees and a standing position. On the other hand, other results showed a stronger grip strength measurement in the 90 degrees elbow flexed position than in the fully extended position [41, 43].

Su et al. also evaluated different shoulder and elbow positions. They observed that when the shoulder was positioned at 180 degrees of flexion with elbow in full extension the highest mean grip strength measurement was recorded; whereas the position of 90 degrees elbow flexion with shoulder in zero degrees of flexion produced the lowest grip strength score [44]. While, De et al. did not find significant differences when shoulder joints varied between 90 and 180 degrees [41].

Regarding the wrist position, one study suggested that a minimum of 25 degrees of wrist extension was required for optimum grip strength [21]. Later, it was shown that HGS measured with wrist in a neutral position was significantly higher than that in the wrist ulnar deviation [41] and, in another study that the mean grip strength scores were higher for all the tested six positions when wrist was positioned in neutral than in extension position [45].

Handle position

Some researchers opted for HGS measurement in a standard handle position. However, in others, researchers adapted the handle to hand size or to a comfortable position for the individual. It was suggested that hand size and optimal grip span only correlated in women [46]. Other studies results have shown that the second handle position was the best position for the majority of the participants. Therefore, the authors suggested the use of a standard handle position (second setting) over multiple different positions [23, 47]. This would provide accurate results and increase the comparability of the results [47].

Repetitions

Mathiowetz et al. suggested that the mean of three trials is a more accurate measure than one trial or even the highest score of three trials [48], while the latter was the most widely adopted by the studies included in this systematic review. In contrast, it was suggested that muscle fatigability might occur with each attempt and one trial is sufficient for the measurement of grip strength [49]. In another study, it was observed that the mean values of grip strength generated for each method of grip strength testing (one trial, the mean of three trials, and the best of three trials) produced comparable results [50].

Encouragement

To our knowledge, only one research described the effects of the encouragement during HGS measurement. It showed that instruction, verbal encouragement, and visual feedback had critical effects on the handgrip strength and, therefore it should be mentioned in the articles [51]. More than half of the articles included here did not provide a full description of if and how the encouragement was made during the trials.

Analysis

As described above, most studies used the higher value for the HGS analysis, however other forms of HGS values chosen by the authors, such as the mean or the sum of the values obtained during the measurements was also observed. Hence, the diagnosis of sarcopenia and frailty between the studies is even less comparable.

Comparison of the protocols

Although the most recent ASHT protocol presents more details regarding the HGS measurement, this protocol has not been adopted by any of the studies included in this revision. Almost every aspect was described in the protocol, making the variations between the studies almost impossible, but also increasing the complexity of the measurement, and therefore the duration of the procedure. Despite the fact that the Southampton protocol referred to all the aforementioned aspects in Table 3, it did not describe in detail the joints position, which could lead to variations in HGS values between the studies.
Table 3

Recent HGS protocols proposed

 

ASHT protocol – 2015 [26]

Southampton protocol – 2011 [27]

Posture

Subject seated in a chair without arm rests, with feet fully resting on the floor, hips as far back in the chair as possible, and the hips and knees positioned at approximately 90°

Subject seated (same chair for every measurement)

Arm position

 

Forearms rested on the arms of the chair

 -Shoulder

Adducted and neutrally rotated

 -Elbow

Flexed to 90°, the forearm should be in midprone (neutral)

 -Wrist

Between 15 and 30° of extension (dorsiflexion) and 0–15° of ulnar deviation

Just over the end of the arm of the chair, in a neutral position, thumb facing upwards

Trials

Three trials

Three trials on each side, alternating sides (start with the right hand)

Dynamometer

 -Model

Jamar dynamometer

Jamar hydraulic hand dynamometer

 -Calibration

Yes

 -Handle position

2nd

Thumb is round one side of the handle and the four fingers are around the other side

Acquisition time

At least 3 s

Rest time

At least 15 s

Instructions

“This test will tell me your maximum grip strength. When I say go, grip as hard as you can until I say stop. Before each trial, I will ask you ‘Are you ready?’ and then tell you ‘Go’. Stop immediately if you experience any unusual pain or discomfort at any point during testing. Do you have any questions? Are you ready? Go!”. “Harder... harder... harder...Relax”

‘I want you to squeeze as hard as you can for as long as you can until I say stop. Squeeze, squeeze, squeeze, stop’ (when the needle stops rising)

HGS analysis

Mean of three trials

Maximal grip score from all six trials

Due to the great variability in the studies concerning sarcopenia and frailty, namely in the inclusion and exclusion criteria, and in the definition and procedures used to identify these conditions, it is difficult to evaluate the impact of each parameter of the procedure in HGS values. Therefore, to diminish the heterogeneity observed in the studies, the most recent ASHT protocol should be adopted. Variations in the procedure are strongly discouraged, however when it is impossible to fully implement this protocol, namely due to the individuals’ health conditions, any variation should be reported.

Main topics

The mixed results above discussed reinforce the need to standardise HGS measurement. The difference between the protocols can influence the HGS results and, consequently, affect the comparability between the studies. A common approach would be not only important for research purposes but also for clinical practice. For both sarcopenia and frailty, the major studies that suggested a diagnosis using HGS did not recommend a protocol for its measurement, neither referred to the protocols used to estimate the outlined cut-off points. There is a necessity to include guidelines concerning a standardised protocol in the consensus made by European and International societies. That will allow the results of the studies to be more comparable and more suitable for the application in clinical practice.

In order to describe with precision the handgrip strength protocol used, researchers should always make reference to which protocol was adopted (when applied). For a complete description of the protocol, we suggest that all the points addressed in Table 3 should be mentioned in the methods section of the articles, and therefore include the description of the posture, arm position (including shoulder, elbow and wrist positions), number of trials, characteristics of the dynamometer (brand, model, resolution, calibration and handle position), acquisition and rest time, the applied instructions and the HGS values used in the analysis. The cut-off points to identify low HGS for sarcopenia or frailty should also be stated. Additionally, deviations to the protocol must be described.

Strengths and limitations

Some strengths of this systematic review can be highlighted. Besides the original search, we additionally handsearched the references of the included articles for a broader research. Plus, for our knowledge there is no other review of literature that comprises a detailed description of the methods of HGS in observational and experimental studies about sarcopenia and frailty in older adults and that considered the most recent protocols proposed for HGS measurement.

This article also had a few limitations. Data was only searched in two databases (Pubmed and Web of Science) and the inclusion of other databases could increase the range of articles found. In addition, we identified three articles in which we could not locate the references made for the full procedure. The focus of the present revision was to gather information regarding HGS methods, hence, we have not evaluated the methodologic quality of the included studies. In our opinion, we do not consider that the limitations would substantially alter our results.

Conclusion

In conclusion, the majority of the studies included did not describe a complete procedure of HGS measurement. The high heterogeneity between the protocols used, in sarcopenia and frailty related studies, create an enormous difficulty in drawing comparative conclusions among them. Even though, there are suggested standardised procedures, present results reinforce the need to uniform the procedure not only in the studies that diagnose these conditions but also in studies which present normative data. Further studies should evaluate which factors contribute to higher HGS values. Meanwhile, we suggest the adoption of the most recent ASHT protocol. In our opinion, this is the most detailed one and, thus, it is less probable to generate differences in HGS values between the studies. Nevertheless, we embrace that the complexity of this protocol may increase the difficulty in its application, especially in clinical practice. Future studies of these issues should include a complete description of the procedure, mentioning the deviations to the protocol.

Abbreviations

ASHT: 

American Society of Hand Therapists

CHS: 

Cardiovascular Health Study

EWGSOP: 

European Working Group on Sarcopenia in Older People

HGS: 

Handgrip strength

IWGS: 

International Working Group on Sarcopenia

PRISMA: 

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Declarations

Acknowledgements

Not applicable.

Funding

Not applicable.

Availability of data and materials

The datasets analysed during the current study available from the corresponding author on reasonable request.

Authors’ contributions

RS and TA conceived of the study, and participated in its design and coordination and helped to draft the manuscript. Both authors read and approved the final version of the manuscript.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto

References

  1. WHO. World report on ageing and health. Luxembourg: World Health Organization; 2015.Google Scholar
  2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39(4):412–23.PubMedPubMed CentralView ArticleGoogle Scholar
  3. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127(5 Suppl):990s–1s.PubMedGoogle Scholar
  4. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249–56.PubMedView ArticleGoogle Scholar
  5. Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1–15.PubMedPubMed CentralView ArticleGoogle Scholar
  6. Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative observational study. J Am Geriatr Soc. 2005;53(8):1321–30.PubMedView ArticleGoogle Scholar
  7. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, et al. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007;62(7):744–51.PubMedView ArticleGoogle Scholar
  8. Cawthon PM, Marshall LM, Michael Y, Dam TT, Ensrud KE, Barrett-Connor E, et al. Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc. 2007;55(8):1216–23.PubMedView ArticleGoogle Scholar
  9. Wong CH, Weiss D, Sourial N, Karunananthan S, Quail JM, Wolfson C, et al. Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study. Aging Clin Exp Res. 2010;22(1):54–62.PubMedView ArticleGoogle Scholar
  10. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMedView ArticleGoogle Scholar
  11. Bouillon K, Kivimaki M, Hamer M, Sabia S, Fransson EI, Singh-Manoux A, et al. Measures of frailty in population-based studies: an overview. BMC Geriatr. 2013;13:64.PubMedPubMed CentralView ArticleGoogle Scholar
  12. Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. Hand grip strength: age and gender stratified normative data in a population-based study. BMC Res Notes. 2011;4:127.PubMedPubMed CentralView ArticleGoogle Scholar
  13. Rantanen T, Volpato S, Ferrucci L, Heikkinen E, Fried LP, Guralnik JM. Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. J Am Geriatr Soc. 2003;51(5):636–41.PubMedView ArticleGoogle Scholar
  14. Frederiksen H, Hjelmborg J, Mortensen J, McGue M, Vaupel JW, Christensen K. Age trajectories of grip strength: cross-sectional and longitudinal data among 8,342 Danes aged 46 to 102. Ann Epidemiol. 2006;16(7):554–62.PubMedView ArticleGoogle Scholar
  15. Budziareck MB, Pureza Duarte RR, Barbosa-Silva MC. Reference values and determinants for handgrip strength in healthy subjects. Clin Nutr. 2008;27(3):357–62.Google Scholar
  16. Luna-Heredia E, Martin-Pena G, Ruiz-Galiana J. Handgrip dynamometry in healthy adults. Clin Nutr. 2005;24(2):250–8.PubMedView ArticleGoogle Scholar
  17. Bohannon RW, Schaubert KL. Test-retest reliability of grip-strength measures obtained over a 12-week interval from community-dwelling elders. J Hand Ther. 2005;18(4):426–7.Google Scholar
  18. Peolsson A, Hedlund R, Oberg B. Intra- and inter-tester reliability and reference values for hand strength. J Rehabil Med. 2001;33(1):36–41.PubMedView ArticleGoogle Scholar
  19. Flood A, Chung A, Parker H, Kearns V, O’Sullivan TA. The use of hand grip strength as a predictor of nutrition status in hospital patients. Clin Nutr. 2014;33(1):106–14.PubMedView ArticleGoogle Scholar
  20. Balogun JA, Akomolafe CT, Amusa LO. Grip strength: effects of testing posture and elbow position. Arch Phys Med Rehabil. 1991;72(5):280–3.PubMedGoogle Scholar
  21. O'Driscoll SW, Horii E, Ness R, Cahalan TD, Richards RR, An K-N. The relationship between wrist position, grasp size, and grip strength. J Hand Surg Am. 1992;17(1):169–77.PubMedView ArticleGoogle Scholar
  22. Incel NA, Ceceli E, Durukan PB, Erdem HR, Yorgancioglu ZR. Grip strength: effect of hand dominance. Singapore Med. 2002;43(5):234–7.Google Scholar
  23. Firrell JC, Crain GM. Which setting of the dynamometer provides maximal grip strength? J Hand Surg Am. 1996;21(3):397–401.PubMedView ArticleGoogle Scholar
  24. Fess E, Moran C. Clinical assessment recommendations. 1st ed. Indianapolis: American Society of Hand Therapists; 1981.Google Scholar
  25. Fess E. Clinical assessment recommendations. Chicago: American Society of Hand Therapists; 1992.Google Scholar
  26. MacDermid J, Solomon G, Fedorczyk J, Valdes K. Clinical assessment recommendations 3rd edition: Impairment-based conditions. American Society of Hand Therapists; 2015.Google Scholar
  27. Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40(4):423–9.PubMedView ArticleGoogle Scholar
  28. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.PubMedPubMed CentralView ArticleGoogle Scholar
  29. Fess EE. A method for checking Jamar dynamometer calibration. J Hand Ther. 1987;1(1):28–32.Google Scholar
  30. Innes E. Handgrip strength testing: a review of the literature. Aust Occup Ther J. 1999;46(3):120–40.View ArticleGoogle Scholar
  31. Guerra RS, Amaral TF. Comparison of hand dynamometers in elderly people. J Nutr Health Aging. 2009;13(10):907–12.PubMedView ArticleGoogle Scholar
  32. Amaral JF, Mancini M, Novo Junior JM. Comparison of three hand dynamometers in relation to the accuracy and precision of the measurements. Rev Bras Fisioter. 2012;16(3):216–24.Google Scholar
  33. Desrosiers J, Hebert R, Bravo G, Dutil E. Comparison of the Jamar dynamometer and the Martin vigorimeter for grip strength measurements in a healthy elderly population. Scand J Rehabil Med. 1995;27(3):137–43.PubMedGoogle Scholar
  34. Mathiowetz V, Vizenor L, Melander D. Comparison of baseline instruments to the Jamar dynamometer and the B&L Engineering Pinch Gauge. OTJR. 2000;20(3):147–62.Google Scholar
  35. Reis MM, Arantes PMM. [Medida da força de preensão manual- validade e confiabilidade do dinamômetro saehan.] Fisioter Pesqui. 2011;18:176–81.Google Scholar
  36. Bohannon RW. Grip strength: a summary of studies comparing dominant and nondominant limb measurements. Percept Mot Skills. 2003;96(3 Pt 1):728–30.PubMedView ArticleGoogle Scholar
  37. Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther. 1989;43(7):444–7.PubMedView ArticleGoogle Scholar
  38. Schmidt RT, Toews JV. Grip strength as measured by the Jamar dynamometer. Arch Phys Med Rehabil. 1970;51(6):321–7.PubMedGoogle Scholar
  39. El-Sais WM, Mohammad WS. Influence of different testing postures on hand grip strength. Eur Sci J. 2014;10(36):290-301.Google Scholar
  40. Watanabe T, Owashi K, Kanauchi Y, Mura N, Takahara M, Ogino T. The short-term reliability of grip strength measurement and the effects of posture and grip span. J Hand Surg Am. 2005;30(3):603–9.PubMedView ArticleGoogle Scholar
  41. De S, Sengupta P, Maity P, Pal A, Dhara P. Effect of body posture on hand grip strength in adult Bengalee population. JESP. 2011;7(2):79–88.Google Scholar
  42. Oxford KL. Elbow positioning for maximum grip performance. J Hand Ther. 2000;13(1):33–6.PubMedView ArticleGoogle Scholar
  43. Mathiowetz V, Rennells C, Donahoe L. Effect of elbow position on grip and key pinch strength. J Hand Surg Am. 1985;10(5):694–7.PubMedView ArticleGoogle Scholar
  44. Su CY, Lin JH, Chien TH, Cheng KF, Sung YT. Grip strength in different positions of elbow and shoulder. Arch Phys Med Rehabil. 1994;75(7):812–5.Google Scholar
  45. Parvatikar V, Mukkannavar P. Comparative study of grip strength in different positions of shoulder and elbow with wrist in neutral and extension positions. JESP. 2009;5(2):67–75.Google Scholar
  46. Ruiz-Ruiz J, Mesa JLM, Gutiérrez A, Castillo MJ. Hand size influences optimal grip span in women but not in men. J Hand Surg Am. 2002;27(5):897–901.PubMedView ArticleGoogle Scholar
  47. Trampisch US, Franke J, Jedamzik N, Hinrichs T, Platen P. Optimal Jamar dynamometer handle position to assess maximal isometric hand grip strength in epidemiological studies. J Hand Surg Am. 2012;37(11):2368–73.PubMedView ArticleGoogle Scholar
  48. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984;9(2):222–6.PubMedView ArticleGoogle Scholar
  49. Abizanda P, Navarro JL, Garcia-Tomas MI, Lopez-Jimenez E, Martinez-Sanchez E, Paterna G. Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons. Arch Gerontol Geriatr. 2012;54(1):21–7.PubMedView ArticleGoogle Scholar
  50. Coldham F, Lewis J, Lee H. The reliability of one vs. three grip trials in symptomatic and asymptomatic subjects. J Hand Ther. 2006;19(3):318–26.Google Scholar
  51. Jung MC, Hallbeck MS. The effects of instruction, verbal encouragement, and visual feedback on static handgrip strength. Proc Hum Factors Ergon Soc Annu Meet. 1999;43(12):703–7.Google Scholar
  52. Abellan van Kan G, Cesari M, Gillette-Guyonnet S, Dupuy C, Nourhashemi F, Schott AM, et al. Sarcopenia and cognitive impairment in elderly women: results from the EPIDOS cohort. Age Ageing. 2013;42(2):196–202.PubMedView ArticleGoogle Scholar
  53. Akin S, Mucuk S, Ozturk A, Mazicioglu M, Gocer S, Arguvanli S, et al. Muscle function-dependent sarcopenia and cut-off values of possible predictors in community-dwelling Turkish elderly: calf circumference, midarm muscle circumference and walking speed. Eur J Clin Nut. 2015;69(10):1087–90.View ArticleGoogle Scholar
  54. Alexandre Tda S, Duarte YA, Santos JL, Wong R, Lebrao ML. Prevalence and associated factors of sarcopenia among elderly in Brazil: findings from the SABE study. J Nutr Health Aging. 2014;18(3):284–90.PubMedView ArticleGoogle Scholar
  55. Barichella M, Pinelli G, Iorio L, Cassani E, Valentino A, Pusani C, et al. Sarcopenia and Dynapenia in patients with parkinsonism. J Am Med Dir Assoc. 2016;17(7):640–6.PubMedView ArticleGoogle Scholar
  56. Bastiaanse LP, Hilgenkamp TI, Echteld MA, Evenhuis HM. Prevalence and associated factors of sarcopenia in older adults with intellectual disabilities. Res Dev Disabil. 2012;33(6):2004–12.Google Scholar
  57. Beaudart C, Reginster JY, Slomian J, Buckinx F, Dardenne N, Quabron A, et al. Estimation of sarcopenia prevalence using various assessment tools. Exp Gerontol. 2015;61:31–7.PubMedView ArticleGoogle Scholar
  58. Beaudart C, Reginster JY, Petermans J, Gillain S, Quabron A, Locquet M, et al. Quality of life and physical components linked to sarcopenia: the SarcoPhAge study. Exp Gerontol. 2015;69:103–10.PubMedView ArticleGoogle Scholar
  59. Bijlsma AY, Meskers CGM, Ling CHY, Narici M, Kurrle SE, Cameron ID, et al. Defining sarcopenia: the impact of different diagnostic criteria on the prevalence of sarcopenia in a large middle aged cohort. Age. 2013;35(3):871–81.PubMedView ArticleGoogle Scholar
  60. Bijlsma AY, Meskers MC, Molendijk M, Westendorp RG, Sipila S, Stenroth L, et al. Diagnostic measures for sarcopenia and bone mineral density. Osteoporos Int. 2013;24(10):2681–91.PubMedView ArticleGoogle Scholar
  61. Campbell TM, Vallis LA. Predicting fat-free mass index and sarcopenia in assisted-living older adults. Age. 2014;36(4):9674.Google Scholar
  62. Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A, et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: prevalence and outcomes. Clin Nutr. 2015;34(4):745–51.PubMedView ArticleGoogle Scholar
  63. Cuesta F, Formiga F, Lopez-Soto A, Masanes F, Ruiz D, Artaza I, et al. Prevalence of sarcopenia in patients attending outpatient geriatric clinics: the ELLI study. Age Ageing. 2015;44(5):807–9.PubMedView ArticleGoogle Scholar
  64. Fukuda DH, Smith-Ryan AE, Kendall KL, Moon JR, Stout JR. Simplified method of clinical phenotyping for older men and women using established field-based measures. Exp Gerontol. 2013;48(12):1479–88.PubMedView ArticleGoogle Scholar
  65. Garatachea N, Fiuza-Luces C, Torres-Luque G, Yvert T, Santiago C, Gomez-Gallego F, et al. Single and combined influence of ACE and ACTN3 genotypes on muscle phenotypes in octogenarians. Eur J Appl Physiol. 2012;112(7):2409–20.PubMedView ArticleGoogle Scholar
  66. Gonzalez-Montalvo JI, Alarcon T, Gotor P, Queipo R, Velasco R, Hoyos R, et al. Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome. Geriatr Gerontol Int. 2015.Google Scholar
  67. Gray M, Glenn JM, Binns A. Predicting sarcopenia from functional measures among community-dwelling older adults. Age. 2016;38(1):22.Google Scholar
  68. Han DS, Chang KV, Li CM, Lin YH, Kao TW, Tsai KS, et al. Skeletal muscle mass adjusted by height correlated better with muscular functions than that adjusted by body weight in defining sarcopenia. Sci Rep. 2016;6:19457.PubMedPubMed CentralView ArticleGoogle Scholar
  69. Hashemi R, Shafiee G, Motlagh AD, Pasalar P, Esmailzadeh A, Siassi F, et al. Sarcopenia and its associated factors in Iranian older individuals: results of SARIR study. Arch Gerontol Geriatr. 2016;66:18–22.PubMedView ArticleGoogle Scholar
  70. Merkies IS, Schmitz PI, Samijn JP, Meche FG, Toyka KV, van Doorn PA. Assessing grip strength in healthy individuals and patients with immune-mediated polyneuropathies. Muscle Nerve. 2000;23(9):1393–401.PubMedView ArticleGoogle Scholar
  71. Kemmler W, Teschler M, Goisser S, Bebenek M, von Stengel S, Bollheimer LC, et al. Prevalence of sarcopenia in Germany and the corresponding effect of osteoarthritis in females 70 years and older living in the community: results of the FORMoSA study. Clin Interv Aging. 2015;10:1565–73.PubMedPubMed CentralView ArticleGoogle Scholar
  72. Lee WJ, Liu LK, Peng LN, Lin MH, Chen LK. Comparisons of sarcopenia defined by IWGS and EWGSOP criteria among older people: results from the I-Lan longitudinal aging study. J Am Med Dir Assoc. 2013;14(7):528.e1–7.PubMedView ArticleGoogle Scholar
  73. Lee ES, Park HM. Prevalence of sarcopenia in healthy Korean elderly women. J Bone Miner Metab. 2015;22(4):191–5.View ArticleGoogle Scholar
  74. Maeda K, Akagi J. Sarcopenia is an independent risk factor of dysphagia in hospitalized older people. Geriatr Gerontol Int. 2015;Google Scholar
  75. Martinez BP, Batista AK, Gomes IB, Olivieri FM, Camelier FW, Camelier AA. Frequency of sarcopenia and associated factors among hospitalized elderly patients. BMC Musculoskelet Disord. 2015;16:108.PubMedPubMed CentralView ArticleGoogle Scholar
  76. McIntosh EI, Smale KB, Vallis LA. Predicting fat-free mass index and sarcopenia: a pilot study in community-dwelling older adults. Age. 2013;35(6):2423–34.PubMedPubMed CentralView ArticleGoogle Scholar
  77. Mijnarends DM, Koster A, Schols JM, Meijers JM, Halfens RJ, Gudnason V, et al. Physical activity and incidence of sarcopenia: the population-based AGES-Reykjavik study. Age Ageing. 2016;Google Scholar
  78. Moon JH, Moon JH, Kim KM, Choi SH, Lim S, Park KS, et al. Sarcopenia as a predictor of future cognitive impairment in older adults. J Nutr Health Aging. 2016;20(5):496–502.PubMedView ArticleGoogle Scholar
  79. Morat T, Gilmore KJ, Rice CL. Neuromuscular function in different stages of sarcopenia. Exp Gerontol. 2016;81:28–36.PubMedView ArticleGoogle Scholar
  80. Pagotto V, Silveira EA. Applicability and agreement of different diagnostic criteria for sarcopenia estimation in the elderly. Arch Gerontol Geriatr. 2014;59(2):288–94.PubMedView ArticleGoogle Scholar
  81. Patel HP, Syddall HE, Jameson K, Robinson S, Denison H, Roberts HC, et al. Prevalence of sarcopenia in community-dwelling older people in the UK using the European working group on sarcopenia in older people (EWGSOP) definition: findings from the Hertfordshire cohort study (HCS). Age Ageing. 2013;42(3):378–84.PubMedPubMed CentralView ArticleGoogle Scholar
  82. Rondanelli M, Guido D, Opizzi A, Faliva MA, Perna S, Grassi MA. Path model of sarcopenia on bone mass loss in elderly subjects. J Nutr Health Aging. 2014;18(1):15–21.PubMedView ArticleGoogle Scholar
  83. Sanchez-Rodriguez D, Marco E, Miralles R, Guillen-Sola A, Vazquez-Ibar O, Escalada F, et al. Does gait speed contribute to sarcopenia case-finding in a postacute rehabilitation setting? Arch Gerontol Geriatr. 2015;61(2):176–81.PubMedView ArticleGoogle Scholar
  84. Sjoblom S, Suuronen J, Rikkonen T, Honkanen R, Kroger H, Sirola J. Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia. Maturitas. 2013;75(2):175–80.PubMedView ArticleGoogle Scholar
  85. Sousa AS, Guerra RS, Fonseca I, Pichel F, Amaral TF. Sarcopenia among hospitalized patients - a cross-sectional study. Clin Nutr. 2015;34(6):1239-44.Google Scholar
  86. Spira D, Norman K, Nikolov J, Demuth I, Steinhagen-Thiessen E, Eckardt R. Prevalence and definition of sarcopenia in community dwelling older people: data from the berlin aging study II (BASE-II). Z Gerontol Geriatr. 2015.Google Scholar
  87. Verschueren S, Gielen E, O'Neill TW, Pye SR, Adams JE, Ward KA, et al. Sarcopenia and its relationship with bone mineral density in middle-aged and elderly European men. Osteoporos Int. 2013;24(1):87–98.PubMedView ArticleGoogle Scholar
  88. Vetrano DL, Landi F, Volpato S, Corsonello A, Meloni E, Bernabei R, et al. Association of sarcopenia with short- and long-term mortality in older adults admitted to acute care wards: results from the CRIME study. J Gerontol A Biol Sci Med Sci. 2014;69(9):1154–61.PubMedView ArticleGoogle Scholar
  89. Yalcin A, Aras S, Atmis V, Cengiz OK, Varli M, Cinar E, et al. Sarcopenia prevalence and factors associated with sarcopenia in older people living in a nursing home in Ankara Turkey. Geriatr Gerontol Int. 2015.Google Scholar
  90. Yoshida D, Suzuki T, Shimada H, Park H, Makizako H. T, et al. using two different algorithms to determine the prevalence of sarcopenia. Geriatr Gerontol Int. 2014;14:46–51.PubMedView ArticleGoogle Scholar
  91. Yu S, Appleton S, Adams R, Chapman I, Wittert G, Visvanathan T, et al. The impact of low muscle mass definition on the prevalence of sarcopenia in older Australians. Biomed Res Int. 2014;2014:361790.PubMedPubMed CentralGoogle Scholar
  92. Abizanda P, Lopez MD, Garcia VP, Estrella Jde D, da Silva GA, Vilardell NB, et al. Effects of an oral nutritional supplementation plus physical exercise intervention on the physical function, nutritional status, and quality of life in frail institutionalized older adults: The ACTIVNES Study. J Am Med Dir Assoc. 2015;16(5):439.e9-.e16.Google Scholar
  93. Abou-Raya S, Abou-Raya A. Osteoporosis and congestive heart failure (CHF) in the elderly patient: double disease burden. Arch Gerontol Geriatr. 2009;49(2):250–4.PubMedView ArticleGoogle Scholar
  94. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70(11):1427–34.PubMedPubMed CentralView ArticleGoogle Scholar
  95. Buttery AK, Martin FC. Knowledge, attitudes and intentions about participation in physical activity of older post-acute hospital inpatients. Physiotherapy. 2009;95(3):192–8.PubMedView ArticleGoogle Scholar
  96. Bohannon RW, Peolsson A, Massy-Westropp N, Desrosiers J, Bear-Lehman J. Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis. Physiotherapy. 2006;92(1):11–5.View ArticleGoogle Scholar
  97. Buttery AK, Busch MA, Gaertner B, Scheidt-Nave C, Fuchs J. Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey. BMC Geriatr. 2015;15.Google Scholar
  98. Chang SF, Yang RS, Lin TC, Chiu SC, Chen ML, Lee HC. The discrimination of using the short physical performance battery to screen frailty for community-dwelling elderly people. J Nurs Scholarsh. 2014;46(3):207–15.Google Scholar
  99. da Camara SM, Alvarado BE, Guralnik JM, Guerra RO, Maciel AC. Using the short physical performance battery to screen for frailty in young-old adults with distinct socioeconomic conditions. Geriatr Gerontol Int. 2013;13(2):421–8.PubMedView ArticleGoogle Scholar
  100. Danilovich MK, Corcos DM, Marquez DX, Eisenstein AR, Hughes SL. Performance measures, hours of caregiving assistance, and risk of adverse care outcomes among older adult users of Medicaid home and community-based services. SAGE Open Med. 2015;3:2050312115614588.Google Scholar
  101. Dato S, Montesanto A, Lagani V, Jeune B, Christensen K, Passarino G. Frailty phenotypes in the elderly based on cluster analysis: a longitudinal study of two Danish cohorts. Evidence for a genetic influence on frailty. Age. 2012;34(3):571–82.PubMedView ArticleGoogle Scholar
  102. Evenhuis HM, Hermans H, Hilgenkamp TIM, Bastiaanse LP, Echteld MA. Frailty and disability in older adults with intellectual disabilities: results from the healthy ageing and intellectual disability study. J Am Geriatr Soc. 2012;60(5):934–8.PubMedView ArticleGoogle Scholar
  103. Gurina NA, Frolova EV, Degryse JMA. A roadmap of aging in Russia: the prevalence of frailty in community-dwelling older adults in the St. Petersburg district - the “crystal” study. J Am Geriatr Soc. 2011;59(6):980–8.Google Scholar
  104. Haider S, Luger E, Kapan A, Titze S, Lackinger C, Schindler KE, et al. Associations between daily physical activity, handgrip strength, muscle mass, physical performance and quality of life in prefrail and frail community-dwelling older adults. Qual Life Res. 2016.Google Scholar
  105. Hoogendijk EO, Suanet B, Dent E, Deeg DJ, Aartsen MJ. Adverse effects of frailty on social functioning in older adults: results from the longitudinal aging study Amsterdam. Maturitas. 2015.Google Scholar
  106. Kang JY, Kim CH, Sung EJ, Shin HC, Shin WJ, Jung KH. The association between frailty and cognition in elderly women. Korean J Fam Med. 2016;37(3):164–70.PubMedPubMed CentralView ArticleGoogle Scholar
  107. Kim S, Park JL, Hwang HS, Kim YP. Correlation between frailty and cognitive function in non-demented community dwelling older Koreans. Korean J Fam Med. 2014;35(6):309–20.PubMedPubMed CentralView ArticleGoogle Scholar
  108. Klein BE, Klein R, Knudtson MD, Lee KE. Relationship of measures of frailty to visual function: the beaver dam eye study. Trans Am Ophthalmol Soc. 2003;101:191–9.Google Scholar
  109. Kwon J, Yoshida Y, Yoshida H, Kim H, Suzuki T, Lee Y. Effects of a combined physical training and nutrition intervention on physical performance and health-related quality of life in Prefrail older women living in the community: a randomized controlled trial. J Am Med Dir Assoc. 2015;16(3).Google Scholar
  110. Lee Y, Kim J, Han ES, Ryu M, Cho Y, Chae S. Frailty and body mass index as predictors of 3-year mortality in older adults living in the community. Gerontology. 2014;60(6):475–82.PubMedView ArticleGoogle Scholar
  111. Mohr BA, Bhasin S, Kupelian V, Araujo AB, O'Donnell AB, McKinlay JB. Testosterone, sex hormone-binding globulin, and frailty in older men. J Am Geriatr Soc. 2007;55(4):548–55.PubMedView ArticleGoogle Scholar
  112. Mora M, Granada ML, Palomera E, Serra-Prat M, Puig-Domingo M. Obestatin is associated to muscle strength, functional capacity and cognitive status in old women. Age. 2013;35(6):2515–23.Google Scholar
  113. Moreira BD. Dos Anjos DMD, Pereira DS, Sampaio RF, Pereira LSM, Dias RC, et al. the geriatric depression scale and the timed up and go test predict fear of falling in community-dwelling elderly women with type 2 diabetes mellitus: a cross-sectional study. BMC Geriatr. 2016;16.Google Scholar
  114. Muller M, van den Beld AW, van der Schouw YT, Grobbee DE, Lamberts SW. Effects of dehydroepiandrosterone and atamestane supplementation on frailty in elderly men. J Clin Endocrinol Metab. 2006;91(10):3988–91.PubMedView ArticleGoogle Scholar
  115. Parentoni AN, Lustosa LP, Santos KDd SLF, Ferreira FO, Mendonça VA. [Comparação da força muscular respiratória entre os subgrupos de fragilidade em idosas da comunidade]. Fisioter Pesqui. 2013;20(4):361–6.Google Scholar
  116. Passarino G, Montesanto A, De Rango F, Garasto S, Berardelli M, Domma F, et al. A cluster analysis to define human aging phenotypes. Biogerontology. 2007;8(3):283–90.PubMedView ArticleGoogle Scholar
  117. Samper-Ternent R, Al Snih S, Raji MA, Markides KS, Ottenbacher KJ. Relationship between frailty and cognitive decline in older Mexican Americans. J Am Geriatr Soc. 2008;56(10):1845–52.PubMedPubMed CentralView ArticleGoogle Scholar
  118. Sanders JL, Singh J, Minster RL, Walston JD, Matteini AM, Christensen K, et al. Association between mortality and heritability of the scale of aging vigor in epidemiology. J Am Geriatr Soc. 2016.Google Scholar
  119. Saum KU, Mueller H, Stegmaier C, Hauer K, Raum E, Brenner H. Development and evaluation of a modification of the fried frailty criteria using population-independent Cutpoints. J Am Geriatr Soc. 2012;60(11):2110–5.Google Scholar
  120. Seematter-Bagnoud L, Santos-Eggimann B, Rochat S, Martin E, Karmaniola A, Aminian K, et al. Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor. Aging Clin Exp Res. 2010;22(3):212–8.PubMedView ArticleGoogle Scholar
  121. Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, van de Rest O, de Groot LCPGM, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713–9.PubMedView ArticleGoogle Scholar
  122. Vieira AI, Nogueira D, de Azevedo Reis E, da Lapa Rosado M, Vania Nunes M, Castro-Caldas A. Hand tactile discrimination, social touch and frailty criteria in elderly people: a cross sectional observational study. Arch Gerontol Geriatr. 2016;66:73–81.PubMedView ArticleGoogle Scholar
  123. Walston J, Arking DE, Fallin D, Li T, Beamer B, Xue Q, et al. IL-6 gene variation is not associated with increased serum levels of IL-6, muscle, weakness, or frailty in older women. Exp Gerontol. 2005;40(4):344–52.PubMedView ArticleGoogle Scholar
  124. Wu IC, Shiesh SC, Kuo PH, Lin XZ. High oxidative stress is correlated with frailty in elderly chinese. J Am Geriatr Soc. 2009;57(9):1666–71.Google Scholar

Copyright

© The Author(s). 2017

Advertisement