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Published in: BMC Geriatrics 1/2020

Open Access 01-12-2020 | Sarcopenia | Research article

Relative contribution of muscle strength, lean mass, and lower extremity motor function in explaining between-person variance in mobility in older adults

Authors: Nathan P. Wages, Janet E. Simon, Leatha A. Clark, Shinichi Amano, David W. Russ, Todd M. Manini, Brian C. Clark

Published in: BMC Geriatrics | Issue 1/2020

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Abstract

Background

Approximately 35% of individuals > 70 years have mobility limitations. Historically, it was posited lean mass and muscle strength were major contributors to mobility limitations, but recent findings indicate lean mass and muscle strength only moderately explain mobility limitations. One likely reason is that lean mass and muscle strength do not necessarily incorporate measures globally reflective of motor function (defined as the ability to learn, or to demonstrate, the skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns). In this study we determined the relative contribution of lean mass, muscle strength, and the four square step test, as an index of lower extremity motor function, in explaining between-participant variance in mobility tasks.

Methods

In community-dwelling older adults (N = 89; 67% women; mean 74.9 ± 6.7 years), we quantified grip and leg extension strength, total and regional lean mass, and time to complete the four square step test. Mobility was assessed via 6-min walk gait speed, stair climb power, 5x-chair rise time, and time to complete a complex functional task. Multifactorial linear regression modeling was used to determine the relative contribution (via semi-partial r2) for indices of lean mass, indices of muscle strength, and the four square step test.

Results

When aggregated by sex, the four square step test explained 17–34% of the variance for all mobility tasks (p <  0.01). Muscle strength explained ~ 12% and ~ 7% of the variance in 6-min walk gait speed and 5x-chair rise time, respectively (p <  0.02). Lean mass explained 32% and ~ 4% of the variance in stair climb power and complex functional task time, respectively (p <  0.02). When disaggregated by sex, lean mass was a stronger predictor of mobility in men.

Conclusion

The four square step test is uniquely associated with multiple measures of mobility in older adults, suggesting lower extremity motor function is an important factor for mobility performance.

Trial registration

NCT02505529–2015/07/22.
Appendix
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Literature
2.
go back to reference Cummings S, Studenski S, Ferrucci L. A diagnosis of dismobility--giving mobility clinical visibility: a mobility working group recommendation. JAMA. 2014;311(20):2061–2.PubMedPubMedCentralCrossRef Cummings S, Studenski S, Ferrucci L. A diagnosis of dismobility--giving mobility clinical visibility: a mobility working group recommendation. JAMA. 2014;311(20):2061–2.PubMedPubMedCentralCrossRef
3.
go back to reference Gill T, Allore H, Hardy S, Guo Z. The dynamic nature of mobility disability in older persons. J Am Geriatr Soc. 2006;54(2):248–54.PubMedCrossRef Gill T, Allore H, Hardy S, Guo Z. The dynamic nature of mobility disability in older persons. J Am Geriatr Soc. 2006;54(2):248–54.PubMedCrossRef
4.
go back to reference Newman A, Simonsick E, Naydeck B, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;295(17):2018–26.PubMedCrossRef Newman A, Simonsick E, Naydeck B, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;295(17):2018–26.PubMedCrossRef
5.
go back to reference Simonsick E, Newman A, Visser M, et al. Mobility limitation in self-described well-functioning older adults: importance of endurance walk testing. J Gerontol a biol Sci med. Sci. 2008;63(8):841–7. Simonsick E, Newman A, Visser M, et al. Mobility limitation in self-described well-functioning older adults: importance of endurance walk testing. J Gerontol a biol Sci med. Sci. 2008;63(8):841–7.
6.
go back to reference Cawthon P, Fox K, Gandra S, et al. Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc. 2009;57(8):1411–9.PubMedPubMedCentralCrossRef Cawthon P, Fox K, Gandra S, et al. Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc. 2009;57(8):1411–9.PubMedPubMedCentralCrossRef
7.
go back to reference Vermeulen J, Neyens J, van Rossum E. Spreeuwenberg, M, de Witte L. Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review BMC Geriatrics. 2011;11:33.PubMed Vermeulen J, Neyens J, van Rossum E. Spreeuwenberg, M, de Witte L. Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review BMC Geriatrics. 2011;11:33.PubMed
8.
go back to reference Hardy S, Kang Y, Studenski S, Degenholtz H. Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs. J Gen Intern Med. 2011;26(2):130–5.PubMedCrossRef Hardy S, Kang Y, Studenski S, Degenholtz H. Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs. J Gen Intern Med. 2011;26(2):130–5.PubMedCrossRef
9.
go back to reference Shumway-Cook A, Ciol M, Yorkston K, Hoffman J, Chan L. Mobility limitations in the Medicare population: prevalence and sociodemographic and clinical correlates. J Am Geriatr Soc. 2005;53(7):1217–21.PubMedCrossRef Shumway-Cook A, Ciol M, Yorkston K, Hoffman J, Chan L. Mobility limitations in the Medicare population: prevalence and sociodemographic and clinical correlates. J Am Geriatr Soc. 2005;53(7):1217–21.PubMedCrossRef
10.
go back to reference Musich S, Wang S, Ruiz J, Hawkins K, Wicker E. The impact of mobility limitations on health outcomes among older adults. Geriatr Nurs. 2018;39(2):162–9.PubMedCrossRef Musich S, Wang S, Ruiz J, Hawkins K, Wicker E. The impact of mobility limitations on health outcomes among older adults. Geriatr Nurs. 2018;39(2):162–9.PubMedCrossRef
11.
go back to reference Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutrition. 1997;127(5 Suppl):990S–1S.CrossRef Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutrition. 1997;127(5 Suppl):990S–1S.CrossRef
12.
go back to reference Evans W. What is sarcopenia? J. Gerontol A Biol Sci Med Sci. 1995; 50 Spec No: 5–8. Evans W. What is sarcopenia? J. Gerontol A Biol Sci Med Sci. 1995; 50 Spec No: 5–8.
13.
go back to reference Cawthon P, Travison T, Manini T, et al. Establishing the link between lean mass and grip strength cut-points with mobility disability and other health outcomes: proceedings of the sarcopenia definitions and outcomes consortium conference. J Gerontol A Biol Sci Med Sci. 209b; https://doi.org/10.1093/gerona/glz081. Cawthon P, Travison T, Manini T, et al. Establishing the link between lean mass and grip strength cut-points with mobility disability and other health outcomes: proceedings of the sarcopenia definitions and outcomes consortium conference. J Gerontol A Biol Sci Med Sci. 209b; https://​doi.​org/​10.​1093/​gerona/​glz081.
15.
go back to reference Dite W, Temple V. A clinical test of stepping and change of direction to identify multiply falling older adults. Arch Phys Med Rehabil. 2002;83:1566–71.PubMedCrossRef Dite W, Temple V. A clinical test of stepping and change of direction to identify multiply falling older adults. Arch Phys Med Rehabil. 2002;83:1566–71.PubMedCrossRef
16.
go back to reference Moore M, Barker K. The validity and reliability of the four square step test in different adult populations: a systematic review. Syst Rev. 2017;6(1):187.PubMedPubMedCentralCrossRef Moore M, Barker K. The validity and reliability of the four square step test in different adult populations: a systematic review. Syst Rev. 2017;6(1):187.PubMedPubMedCentralCrossRef
17.
go back to reference Jung H, Yamasaki M. Association of lower extremity range of motion and muscle strength with physical performance of community-dwelling older women. J Physiol Anthropol. 2016;3:30.CrossRef Jung H, Yamasaki M. Association of lower extremity range of motion and muscle strength with physical performance of community-dwelling older women. J Physiol Anthropol. 2016;3:30.CrossRef
18.
go back to reference Saito A, Wakasa M, Kimoto M, et al. Age-related changes in muscle elasticity and thickness of the lower extremities are associated with physical functions among community-dwelling older women. Geriatr Gerontol Int. 2019;19:61–5.PubMed Saito A, Wakasa M, Kimoto M, et al. Age-related changes in muscle elasticity and thickness of the lower extremities are associated with physical functions among community-dwelling older women. Geriatr Gerontol Int. 2019;19:61–5.PubMed
19.
go back to reference Guralnik J, Simonsick E, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.PubMedCrossRef Guralnik J, Simonsick E, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.PubMedCrossRef
20.
go back to reference Gómez J, Curcio C, Alvarado B, Zunzunegui M, Guralnik J. Validity and reliability of the short physical performance battery (SPPB): a pilot study on mobility in the Colombian Andes. Colomb Med (Cali). 2013;44(3):165–71.CrossRef Gómez J, Curcio C, Alvarado B, Zunzunegui M, Guralnik J. Validity and reliability of the short physical performance battery (SPPB): a pilot study on mobility in the Colombian Andes. Colomb Med (Cali). 2013;44(3):165–71.CrossRef
21.
go back to reference Corbett D, Valiani V, Knaggs J, Manini T. Evaluating walking intensity with hip-worn accelerometers in elders. Med Sci Sports Exerc. 2016;48(11):2216–21.PubMedPubMedCentralCrossRef Corbett D, Valiani V, Knaggs J, Manini T. Evaluating walking intensity with hip-worn accelerometers in elders. Med Sci Sports Exerc. 2016;48(11):2216–21.PubMedPubMedCentralCrossRef
22.
go back to reference Randolph C, Tierney M, Mohr E, Chase T. The repeatable battery for the assessment of neuropsychological status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol. 1998;20(3):310–9.PubMedCrossRef Randolph C, Tierney M, Mohr E, Chase T. The repeatable battery for the assessment of neuropsychological status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol. 1998;20(3):310–9.PubMedCrossRef
23.
go back to reference Charlson M, Pompei P, Ales K, MacKenzie C. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRef Charlson M, Pompei P, Ales K, MacKenzie C. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRef
24.
go back to reference Tavoian D, Ampomah K, Amano S, Law T, Clark B. Changes in DXA-derived lean mass and MRI-derived cross-sectional area of the thigh are modestly associated. Sci Rep. 2019;9(1):10028.PubMedPubMedCentralCrossRef Tavoian D, Ampomah K, Amano S, Law T, Clark B. Changes in DXA-derived lean mass and MRI-derived cross-sectional area of the thigh are modestly associated. Sci Rep. 2019;9(1):10028.PubMedPubMedCentralCrossRef
25.
go back to reference Hangartner T, Warner S, Braillon P, Jankowski L, Shepard J. The official positions of the international society for clinical densitometry: acquisition of dual-energy X-ray absorptiometry body composition and considerations regarding analysis and repeatability of measures. J Clin Densitom. 2013;16(4):520–36.PubMedCrossRef Hangartner T, Warner S, Braillon P, Jankowski L, Shepard J. The official positions of the international society for clinical densitometry: acquisition of dual-energy X-ray absorptiometry body composition and considerations regarding analysis and repeatability of measures. J Clin Densitom. 2013;16(4):520–36.PubMedCrossRef
26.
go back to reference Manini T, Visser M, Won-Park S, et al. Knee extension strength cutpoints for maintaining mobility. J Am Geriatr Soc. 2007;55(3):451–7.PubMedCrossRef Manini T, Visser M, Won-Park S, et al. Knee extension strength cutpoints for maintaining mobility. J Am Geriatr Soc. 2007;55(3):451–7.PubMedCrossRef
27.
go back to reference Villafañe J, Valdes K, Vanti C, Pillastrini P, Borboni A. Reliability of handgrip strength test in elderly subjects with unilateral thumb carpometacarpal osteoarthritis. Hand (N Y). 215; 10(2): 205–209. Villafañe J, Valdes K, Vanti C, Pillastrini P, Borboni A. Reliability of handgrip strength test in elderly subjects with unilateral thumb carpometacarpal osteoarthritis. Hand (N Y). 215; 10(2): 205–209.
28.
go back to reference O’brien R. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673–90.CrossRef O’brien R. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673–90.CrossRef
29.
go back to reference Zientek L, Thompson B. Commonality analysis: partitioning variance to facilitate better understanding of data. JEI. 2006;28:299–307. Zientek L, Thompson B. Commonality analysis: partitioning variance to facilitate better understanding of data. JEI. 2006;28:299–307.
30.
go back to reference Schwarz G. Estimating the dimension of a model. Ann Stat. 1978;6(2):461–4.CrossRef Schwarz G. Estimating the dimension of a model. Ann Stat. 1978;6(2):461–4.CrossRef
31.
32.
go back to reference Schafer J. Analysis of incomplete multivariate data. New York: Chapman and Hall; 1997.CrossRef Schafer J. Analysis of incomplete multivariate data. New York: Chapman and Hall; 1997.CrossRef
33.
go back to reference Little R, Rubin B. Statistical analysis with missing data 2nd edition. New York: Wiley; 2002. p. 4–22.CrossRef Little R, Rubin B. Statistical analysis with missing data 2nd edition. New York: Wiley; 2002. p. 4–22.CrossRef
34.
go back to reference Faul F, Erdfelder E, Buchner A, Land A-G. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.CrossRefPubMed Faul F, Erdfelder E, Buchner A, Land A-G. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.CrossRefPubMed
35.
go back to reference Janssen I, Heymsfield S, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002; (50)5: 889–896. Janssen I, Heymsfield S, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002; (50)5: 889–896.
36.
go back to reference Visser M, Goodpaster B, Kritchevsky S, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol Series A. 2005;60(3):324–33.CrossRef Visser M, Goodpaster B, Kritchevsky S, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol Series A. 2005;60(3):324–33.CrossRef
37.
go back to reference Reid K, Naumova E, Carabello R, Philips E, Fielding R. Lower extremity muscle mass predicts functional performance in mobility-limited elders. J Nutr Health Aging. 2008;12(7):493–8.PubMedPubMedCentralCrossRef Reid K, Naumova E, Carabello R, Philips E, Fielding R. Lower extremity muscle mass predicts functional performance in mobility-limited elders. J Nutr Health Aging. 2008;12(7):493–8.PubMedPubMedCentralCrossRef
38.
go back to reference Curcio F, Basile C, Liguori I, Della-Morte D, Gargiulo G. Tinetti mobility test is related to muscle mass ad strength in non-institutionalized elderly people. Age (Dordr). 2016; 38: 525–533. Curcio F, Basile C, Liguori I, Della-Morte D, Gargiulo G. Tinetti mobility test is related to muscle mass ad strength in non-institutionalized elderly people. Age (Dordr). 2016; 38: 525–533.
39.
go back to reference Schaap L, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2013;35:51–65.PubMedCrossRef Schaap L, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2013;35:51–65.PubMedCrossRef
40.
go back to reference Cawthon P, Orwoll E, Peters K, et al. Strong relation between muscle mass determined by D3-creatine dilution, physical performance and incidence of falls and mobility limitations in a prospective cohort of older men. J Gerontol A Biol Sci Med Sci. 2019a;74(6):844–52.PubMedCrossRef Cawthon P, Orwoll E, Peters K, et al. Strong relation between muscle mass determined by D3-creatine dilution, physical performance and incidence of falls and mobility limitations in a prospective cohort of older men. J Gerontol A Biol Sci Med Sci. 2019a;74(6):844–52.PubMedCrossRef
41.
go back to reference Stoessl A, Lehericy S, Strafella A. Imaging insights into basal ganglia function, Parkinson’s disease, and dystonia. Lancet. 2014;384(9942):532–44.PubMedPubMedCentralCrossRef Stoessl A, Lehericy S, Strafella A. Imaging insights into basal ganglia function, Parkinson’s disease, and dystonia. Lancet. 2014;384(9942):532–44.PubMedPubMedCentralCrossRef
42.
go back to reference Mogenson G, Jones D, Yim C. From motivation to action: functional interface between the limbic system and the motor system. Prog Neurobiol. 1980;14(2–3):69–97.PubMedCrossRef Mogenson G, Jones D, Yim C. From motivation to action: functional interface between the limbic system and the motor system. Prog Neurobiol. 1980;14(2–3):69–97.PubMedCrossRef
43.
go back to reference Lord S, Fitzpatrick R. Choice stepping reaction time: a composite measure of falls risk in older people. J Gerontol A Biol Sci Med Sci. 2001;56(10):M627–32.PubMedCrossRef Lord S, Fitzpatrick R. Choice stepping reaction time: a composite measure of falls risk in older people. J Gerontol A Biol Sci Med Sci. 2001;56(10):M627–32.PubMedCrossRef
44.
go back to reference Pijnappels M, Delbaere K, Sturnieks D, Lord S. The association between choice stepping reaction time and falls in older adults—a path analysis model. Age Aging. 2010;39(1):99–104.CrossRef Pijnappels M, Delbaere K, Sturnieks D, Lord S. The association between choice stepping reaction time and falls in older adults—a path analysis model. Age Aging. 2010;39(1):99–104.CrossRef
46.
go back to reference Wagner J, Norris R, Van Dillen L, Thomas F, Naismith R. Four square step test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness. Int J Rehabil Res. 2013;36(3):253–9.PubMedCrossRef Wagner J, Norris R, Van Dillen L, Thomas F, Naismith R. Four square step test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness. Int J Rehabil Res. 2013;36(3):253–9.PubMedCrossRef
47.
go back to reference Pool D, Valentine J, Bear N, Donnelly C, Elliott C, Stannage K. The orthotic and therapeutic effects following daily community applied functional electrical stimulation in children with unilateral spastic cerebral palsy: a randomized controlled trial. BMC Pediatr. 2015;15:154.PubMedPubMedCentralCrossRef Pool D, Valentine J, Bear N, Donnelly C, Elliott C, Stannage K. The orthotic and therapeutic effects following daily community applied functional electrical stimulation in children with unilateral spastic cerebral palsy: a randomized controlled trial. BMC Pediatr. 2015;15:154.PubMedPubMedCentralCrossRef
48.
go back to reference Clark B, Tavoian D, Goodpaster B, Cawthon P, Hensen R, Manini T. Comment on “pitfalls in the measurement of muscle mass: a need for a reference standard” by Buckinx et al. J Cachexia Sarcopenia Muscle. 2018;9(7):1269–71.PubMedCrossRef Clark B, Tavoian D, Goodpaster B, Cawthon P, Hensen R, Manini T. Comment on “pitfalls in the measurement of muscle mass: a need for a reference standard” by Buckinx et al. J Cachexia Sarcopenia Muscle. 2018;9(7):1269–71.PubMedCrossRef
49.
go back to reference Evans W, Hellerstein M, Orwoll E, Cummings S, Cawthon P. D3 -creatine dilution and the importance of accuracy in the assessment of skeletal muscle mass. J Cachexia Sarcopenia Muscle. 2019;10(1):14–21.PubMedPubMedCentralCrossRef Evans W, Hellerstein M, Orwoll E, Cummings S, Cawthon P. D3 -creatine dilution and the importance of accuracy in the assessment of skeletal muscle mass. J Cachexia Sarcopenia Muscle. 2019;10(1):14–21.PubMedPubMedCentralCrossRef
50.
go back to reference Wang W, Wang Z, Faith M, Kotler D, Shih R, Heysmfield S. Regional skeletal muscle measurement: evaluation of new dual-energy X-ray absorptiometry model. J Appl Physiol. 1999;87(3):1163–71.PubMedCrossRef Wang W, Wang Z, Faith M, Kotler D, Shih R, Heysmfield S. Regional skeletal muscle measurement: evaluation of new dual-energy X-ray absorptiometry model. J Appl Physiol. 1999;87(3):1163–71.PubMedCrossRef
51.
go back to reference Hanson R, Williamson D, Finnegan T, et al. Estimation of thigh cross-sectional area by dual-energy X-ray absorptiometry in frail elderly patients. Am J Clin Nutr. 2007;86:952–8.CrossRef Hanson R, Williamson D, Finnegan T, et al. Estimation of thigh cross-sectional area by dual-energy X-ray absorptiometry in frail elderly patients. Am J Clin Nutr. 2007;86:952–8.CrossRef
52.
go back to reference Freda P, Shen W, Reyes-Vidal C, et al. Skeletal muscle mass in acromegaly assessed by magnetic resonance imaging and dual-photon x-ray absorptiometry. J Clin Endocrinol Metab. 2009;94(8):2880–6.PubMedPubMedCentralCrossRef Freda P, Shen W, Reyes-Vidal C, et al. Skeletal muscle mass in acromegaly assessed by magnetic resonance imaging and dual-photon x-ray absorptiometry. J Clin Endocrinol Metab. 2009;94(8):2880–6.PubMedPubMedCentralCrossRef
Metadata
Title
Relative contribution of muscle strength, lean mass, and lower extremity motor function in explaining between-person variance in mobility in older adults
Authors
Nathan P. Wages
Janet E. Simon
Leatha A. Clark
Shinichi Amano
David W. Russ
Todd M. Manini
Brian C. Clark
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Sarcopenia
Published in
BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-01656-y

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